North East India: A ray of hope for female injecting drug users and female sex partners of male injecting drug users

22 year old Chawngmawii from Mizoram state, North East India left home when she was sixteen. Coming from a broken family with a history of abuse, she started living with her friends or in the streets when she got hooked on to injecting drugs like spasmoproxyvon. She got into sex work to support her drug habit and in 2008 was diagnosed as HIV positive.  With the help of some NGOs, she started visiting the drop in centres (DICs) which are set up under the Targeted Intervention projects in the state, supported by the National AIDS Control Programme. However, it did not met her immediate needs as the services provided were very male centric.

Chawngmawii's tale is synonymous with that of many other women like her in North East India. Several states in the region are facing an HIV epidemic - driven by both injecting drug use and high risk sexual behaviour. Despite the availability of free services for injecting drug users (IDUs), through both non-governmental organizations and government hospitals for the past decade, it has been observed that a significant proportion of female IDUs, are unable to access treatment and care services for drug driven HIV/AIDS. This is mainly because the services are not gender responsive and the specific needs of female IDUs are not met. The lack of trained female service providers often deters female IDUs from accessing services, since they feel uncomfortable speaking openly about their problems with men. Another impediment is that the existing interventions are separate for female sex workers and IDUs.  Female IDUs, a significant proportion of whom also engage in sex work, find it difficult to access services from two different places. Also, in general, female IDUs find it difficult to visit the existing drop - in centres (DICs) since they are primarily occupied by men.

In India, UNODC works with the Government of India to improve the quality and coverage of services for drug treatment in connection with the prevention of HIV/AIDS among IDUs in the country. Under a joint UN programme in the North East, UNODC works in the four states of Manipur, Nagaland, Mizoram and Meghalaya, with particular focus on establishing female service delivery models for HIV prevention among female IDUs and female sex partners of IDUs. Under this initiative, female - specific interventions have been rolled out at four sites in the region viz. Aizawl (Mizoram), Dimapur (Nagaland), Imphal (Manipur) and Shillong (Meghalaya).

Most of the staff involved in this initiative, including a project manager, a counsellor, two outreach workers, a doctor, a nurse and six peer educators, are women, thus making it comfortable for the female IDUs and partners of IDUs to avail services. A seperate female specific DIC has been set up for these clients at each of the sites, thus making it comfortable for the clients to access services. Besides existing harm reduction strategies such as needle/syringe and condom programming, counselling and management of sexually transmitted infections (STIs) and abscesses, the project also addresses gender specific requirements like female sexual health services for pre - post natal care, parenting support, gender based violence services, support for income generation and a referral system to facilitate access to services such as integrated counselling and testing, anti-retroviral therapy (ART), treatment for sexually transmitted infections (STIs) and drug treatment services including Opioid Substitution Therapy (OST). (OST is as a widely accepted harm reduction and treatment strategy for opioid dependent individuals. It involves the administration of an opioid medication like buprenorphine to an opioid dependent drug user under medical supervision, along with psychosocial support, which helps the client in weaning off from injecting drugs.)

Chawngmawii enrolled herself as a client at the female DIC in Aizwal, Mizoram, and has been visiting the DIC every day since October 2010. "I go and rest, have a bath and fill my belly in the DIC for the day, something which I could never do in the other DICs as there were too many male clients," says Chawngmawii. "Since the others who come to the DIC are also women, I don't have to be extra careful when I sleep or change. It is a safe haven and I really feel at home". With a female doctor at the DIC, Chawngmawii even gets herself checked for aliments like headache, fever and allergies and receives free medication.

One of the strengths of the project has been the involvement of female HIV positive persons and recovering female drug users as peer educators. So far, six female peer educators have been trained at each site as core trainers, to impart information on drug driven HIV/AIDS and services available at the DIC to their peers through outreach activities. As the peer educators themselves are recovering drug users, HIV positive persons with a history of drugs or partners of IDUs, they are able to build strong bonds with the clients at the DICs, as they easily relate to them though their own experiences. This has helped the initiative to reach out a greater number of female IDUs, who are often a hidden population, with relative ease. The initiative has also been able to address to the needs of the female sex partners of IDUs, which have often been overlooked. They receive information on drugs and HIV/AIDS, STIs, gynecological problems, and even income generation skills so that they can earn for their families.

The most striking outcome of the initiative has been its  easy acceptance amongst the female IDUs and female partners of male IDUs. Within a short span of six months, the initiative has been able to demonstrate encouraging results. This is similar to UNODC's experience in other countries such as  Bangladesh and Nepal in South Asia, where UNODC has carried out  similar initiatives for female IDUs. It will be essential to implement such programmes for a longer period of time, so that female IDUs and the female sex partners of male IDUs can access the treatment and care services entitled to them without any inhibition, or fears of stigma and discrimination.

"Ever since I have enrolled myself at the DIC, I can see the change in my behavior in understanding and accepting my status as a HIV+ person. No condom no sex, is what I tell my clients. As for my injecting behavior, I use clean needles and syringes which are available at the DIC free of cost, but the staff at the DIC is very particular that I exchange the used syringe for a new one. The love and support given by the NGO has given me ray of hope and I think that some day I will be able to lead a life which is free from drugs."

This intervention by UNODC has been possible thanks to support from AusAID for the Joint UN HIV/AIDS project in  the four North Eastern states of India. The lead partners for this initiative are the State AIDS Control Societies (SACS) of the four states. The intervention is based on the gaps identified by the North East Regional Office (NERO) of NACO (National AIDS  Control Organisation), the SACS and NACO. Besides the SACS, the project is also collaborating with agencies such as the police and other law enforcement authorities, the health department and the social welfare departments in the respective states.