World AIDS Day: Northeast India stands on the brink of HIV crisis- Denial, a major problem!


December 1, 2017

Living with HIV is not a joke, especially if the society around the patient is one that looks upon them in utter disgust instead of being supportive and helping them combat it with strength by providing them emotional support. In Northeast India, there are thousands (only as per statistics not inclusive of unreported cases) who live with HIV. The National AIDS Control Organisation (NACO) recently reported that out of the 21.17 lakh people living with HIV/AIDS in the country, around 63,000 are in the Northeast India. The table is topped by Manipur, which has shown the highest estimated adult HIV prevalence of 1.15%, followed by Mizoram (0.80%) and Nagaland (0.78%).

There has been emergence of new cases in areas like Jaintia Hills in Meghalaya and South and North Tripura in the HIV map. Northeast is concentrated among one of the most vulnerable populations at high risk for HIV. The concentrated epidemics are driven by unprotected sex between sex workers and their clients and by injecting drug use with contaminated injecting equipment. Several of the most at risk groups have high and still rising HIV prevalence rates.

However, although overall prevalence remains low, even relatively minor increases in HIV infection rates in a country of more than one billion people translate into large numbers of people becoming infected. Lets us look at some reasons why HIV has turned into a menace for Northeast India-

#1 Injecting Drug Use (IDU)

Injecting drugs with contaminated injecting equipment is the main risk factor for HIV infection in the north‐east (especially in the states of Manipur, Mizoram and Nagaland. Products injected include legal pharmaceuticals (e.g. buprenorphine, pentazocine and diazepam), in addition to heroin. Current interventions targeting IDU tend to be inconsistent, and too small and infrequent to yield demonstrable results. Comprehensive harm reduction programs, including clean needle and syringe exchange and opioid substitution therapy (OST) need to be extended and expanded as a matter of urgency in those parts of India with serious drug injecting‐related HIV epidemics. The recent data from HSS 2010 shows that  In Northeast Manipur and Mizoram have reported more than 10% HIV prevalence among IDUs.

The easy availability of drugs has reached to a point where the drug users enjoy the perks of home deliveries. Studies have pointed out that the National Highway 44 running through the state has become the main trafficking route of drugs. While police are keeping a tap on drug peddlers, the supply of drugs however, cannot be stopped owing to the state's close proximity to major opium cultivating areas- Golden Triangle countries (Myanmar-Laos-Thailand).

#2 Migration and Mobility

Migration for work takes people away from the social environment of their families and community. This can lead to an increased likelihood to engage in risky behavior. Concerted efforts are needed to address the vulnerabilities of the large migrant population. Furthermore, a high proportion of female sex workers in India are mobile. The mobility of sex workers is likely a major factor contributing to HIV transmission by connecting high‐risk sexual networks.

#3 Low Status of Women

Infection rates have been on the increase among women and their infants in some states as the epidemic spreads through bridging population groups. As in many other countries, unequal power relations and the low status of women, as expressed by limited access to human, financial, and economic assets, weakens the ability of women to protect themselves and negotiate safer sex both within and outside of marriage, thereby increasing their vulnerability.

#4 Unsafe Sex and Low Condom Use

In India, sexual transmission is responsible for 87.4 percent of reported HIV cases and HIV prevalence is high among sex workers (both male and female) and their clients. A large proportion of women with HIV appears to have acquired the virus from their regular partner who was infected during paid sex.  Overall HIV prevention efforts targeted at sex workers are increasing in India. However, the context of sex work is complex and enforcement of outdated laws often act as a barrier against effective HIV prevention and treatment efforts. Although recent data suggest an increase in condom use, in many places condom use is still limited, especially where commercial encounters take place in 'risky' locations with low police tolerance for this activity.

#5 Men Who Have Sex with Men (MSM)

Relatively little is known about the role of sex between men in India's HIV epidemic, but the few studies that have examined this subject have found that a significant proportion of men in India do have sex with other men. As per recent data After Chattisgarh, Nagaland (13.58%) have the highest HIV prevalence among MSM. Poor knowledge of HIV has been found in groups of MSM. The extent and effectiveness of India's efforts to increase safe sex practices between MSM (and their other sex partners) will play a significant role in determining the scale and development of India's HIV epidemic.

Apart from the obvious reasons, there are a section of people who live in denial of HIV. HIV denialism can be a closed group and at most times, there is often nothing that can be done about this. It is mostly a form of coping mechanism for some people undergoing the crisis. Proper psychological support is unusual, especially in scenario presented by Northeast India where, in most cases, even visiting a counsellor is considered a stigma, a sign of mental illness and such other stereotypical judgements. If they are lucky, patients will be told about antiretroviral therapy, and about the possibility of extending their life expectancy to near-normal levels. Or they might not. Just as likely, they will come away with the impression they have contracted the modern-day plague, with no more than just a couple of years left to live.

Under circumstances like these, the crucial role of people like NETSU (Northeast Technical Support Unit) member from Meghalaya Barry Kharmalki can be highly deemed as constructive and influential. Barry recovered from drug addiction after years of intensive pain, both physical and mental. However, his hope to start a new life and a family was short lived as just at a time when everything seemed to be going out quite well, he was tested HIV positive. Shattered hopes and broken dreams, Barry was prepared to end his life but as life would have it, he dedicated himself in trying to help the other victims of drug addiction and HIV to live a normal life. Since then, there's no turning back for Barry be it day or night, he is on the job, spreading awareness, rescuing drug addicts, and giving hope to the hopeless.

HIV detection is surely not an end for it may just be the beginning of a life as proven by Barry Kharmalki who not only brought back his life back on track but is now helping others do the same. Hence do not live in denial, come out into the open and seek solutions to the problems that's killing you inside as what does not kill you will surely make you stronger! Stand up and fight against HIV/AIDS

READ BARRY'S INSPIRING STORY HERE: A social outcast turns 'Saviour' for thousands of lost souls in Meghalaya!

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