Prescription drugs like the opiate pethidine that killed Michael Jackson have replaced cannabis and heroin as the drugs of choice among young people in India. The reasons are fairly obvious. Prescription drugs are licit and easily available.
Like Nukshinaro Ao from Tuensang in Nagaland, most teenagers start with cannabis before moving on to opiates and prescription drugs. Ao, now 30, started smoking cannabis when she was 18. By 23, she had moved to injecting prescription drugs. “I’ve always been scared of needles and injections, but when the sweats, cramps and pain of withdrawal started, no other fears existed,” said Ao, who stopped drug use three years ago after she tested positive for HIV, the virus that causes AIDS.
Sharing needles is driving new infection in the north-eastern states. Drug injectors account for 1.7 per cent of India’s HIV infections, up from 0.9 per cent two years ago. With Punjab and western Uttar Pradesh emerging as the new epicentres of injecting drugs, these numbers are expected to rise further.
“Testing positive for HIV did not come as a surprise. I was expecting it as many of my friends had AIDS,” said Ao at the 18th International AIDS Conference held in Vienna to focus attention on injecting drug use, which accounts for approximately one in three new HIV cases outside of sub-Saharan Africa.
In Eastern Europe and Central Asia, HIV prevalence can be as high as 70 per cent among people who inject drugs, says the UNAIDS 2009 report on the Global AIDS Epidemic.
The rise in infections has prompted public health experts to ask governments to a) decriminalise drug users and b) lift bans on drugs such as methadone and buprenorphine, which are used for substitution maintenance therapy at de-addiction centres.
Michel Sidibe, director general, UNAIDS said, “Drug addicts are reluctant to register at de-addiction centres for fear of harassment by the police. “Drug injectors are patients, not criminals. Scientific evidence has to be incorporated into illicit drug policies that are pushing injectors from prevention and care services infections.”
The fight against AIDS has shown remarkable progress in the past few years. Despite increase in the population, new infections have dropped 17 per cent from 2001 to 2008.
In India, adult HIV prevalence has dropped from 0.45 per cent in 2002 to 0.29 per cent in 2008, to its lowest ever number of 2.27 million. All states except Andhra Pradesh are reporting less than one per cent infection — down from five states in 2002.
To sustain progress and scale up prevention and treatment, donor countries need to pledge US$ 20 billion over three years to the Global Fund in September.
Michel Kazatchkine, executive director, Global Fund said, “Increased funds must be matched with an efficient use of resources by integrating HIV programmes with healthcare delivery, as is happening in Ethiopia, where AIDS and tuberculosis drugs are given along with bednets for malaria, routine vaccinations and ante-natal and hygiene advice”. India has got US$ 1 billion in grants from the Global Fund since 2002 fight the three diseases.
“We need to take best practices, lower personnel and drug costs to increase the number of people being treated and stop mother-to-child infections. An HIV-free generation is possible, we cannot slow the momentum now,” said Kazatchkine.
While the world is focusing on using innovations in science, diagnostics and understanding the virus, India has chosen to stick to the tried and tested methods of controlling HIV.
K Chandramouli, secretary and director general, National AIDS Control Organisation (NACO) said, “Our focus in on scaling up of existing prevention methods, such as preventing mother-to-child transmission and ensuring blood safety, focusing on prevention efforts on the communities where transmission is the highest, such as migrants, men who have sex with men, injecting drug users and sex workers.”
Unprotected sex (87.1 per cent heterosexual and 1.5 per cent homosexual) remains the biggest route of infection in India.
Ao said, “India has decriminilised homosexuality. Now it should do the same for drug injectors. I realise addiction is stupid, but when you’re young, you make mistakes.” She asks, “Don’t you think we should get a chance to get de-addicted and live free of drugs and infections such as HIV?”