The North East of India: drugs and HIV: trails of tears and hope in a hidden jewellery

Assam, Meghalaya, Nagaland, Manipur and Mizoram, spellbound names of five of the eight states in the north east of India squeezed between Bangladesh, Myanmar, Bhutan, China and Nepal, showcase the natural beauty of India's far-flung east. World-known Assam tea is produced here bringing to mind the images of lush green hills and paddy fields, where in a peaceful scenery women pick tea leaves and farm families' plant, weed and harvest rice.

But there are other, little known realities to that. In early September, a joint New Delhi-based UN team traveled to the North East of India, where the United Nations has engaged with the National Aids Control Organization (NACO) in an HIV and AIDS prevention and care programme. Adult HIV and AIDS prevalence rates in Manipur and Nagaland are 1.57 and 1.2 per cent respectively and well above the national average of 0.34 per cent according to the Department of AIDS Control, Ministry of Health and Family Welfare, Government of India. In comparison to other Indian states, the North East is less populated, but still there are some 100,000 people, who live with HIV and AIDS in the eight north eastern states.

For the so-called high risk groups, numbers are alarming: in Manipur 19.8 per cent of injecting drug users are HIV positive as well as 10.4 per cent of men having sex with men. In Nagaland, 16.4 percent of female sex workers are living with HIV and AIDS, all numbers well above national average. Although HIV prevalence has been decreasing since 2002 at national level, this has not translated into a similar decrease in the north east. Whereas interventions for injecting drug users have shown impact, prevalence rates remain high above the national average of 6.9 per cent, meaning that much more needs to be done.

During our joint mission composed by staff from Joint United Nations Programme on HIV and AIDS (UNAIDS), United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP) and the United Nations Office on Drugs and Crime (UNODC), we heard the voices of drug users, both male and female, who now receive support through the United Nations to cope with their lives as drug users. They have opened their hearts to give their testimony about how they got into drugs and how they now deal with it: there is the former heroin user who still wonders how a friend could get him hooked up to heroin after only three days, although he was promised lunch in exchange for work. He is now a client of the first oral substitution treatment centre run by the Voluntary Health Association of Meghalaya. The Association has attended to some 150 clients, who since 2006 have received Buprenorphine to treat their heroin addiction. Although many of the clients now talk openly about their repeated relapses and the frustration that goes with it, they all assure us that only the treatment with Buprenorphine has helped them to lead a normal life, meaning a productive life with employment and trustful family relations and a life safe from HIV and hepatitis. They are relieved not to have to worry anymore about how to get drugs. But not only that, ultimately, they also want to get free of Buprenorphine, an aim that is feasible according to the association doctor who provides medical and psychosocial assistance to the recovering drug users.

There are also stories of women, female drug users, whose voices are seldom heard. Drug use is globally perceived as a man's issue with roughly nine out of ten drug users being male. One woman tells us about how she lost her parents at an early age. To get some sleep and peace of mind she resorted to drugs, heroin and pharmaceuticals because - as she put it - she was getting a very good trip. First she took Spasmoproxyvon, a painkiller in form of tablets, but then also injected it. The side-effects were terrible and the woman knew it. Still, she and other women say, it is harder for them to be a drug user when they want to make a change, to speak about it and seek and find treatment. The medical doctor at the Meghalaya Manbha foundation, who attends to the women, says it needs to be a family health centre not a drop-in centre to make them feel more at ease. Steps that help to make a difference can be so small and easy to take.

One of our thoughts of our first mission is definitely that we all need to do more so that the voices of these men and women in the North East are heard stronger and more often by policy-makers in the capital, by the joint UN programme and other cooperating agencies to help design and implement large-scale programmes for those who are vulnerable to and need treatment of drug use and HIV.

The work of the United Nations in India in support of NACO and the State Aids Control Society (SACS) in the North East, is possible thanks to the contribution by AusAID, DFID and SIDA.

Written by Cristina Albertin, UNODC Representative for South Asia on her visit to the North East of India