Changing a Habit of Addiction in the Land of the Gods

Severe punishments doled out to drug offenders in Uttarakhand have motivated users to shift from heroin and brown sugar to injecting pharmaceutical cocktails. (Photo by G. Charanjit Sharma for India HIV/AIDS Alliance)

Severe punishments doled out to drug offenders in Uttarakhand have motivated users to shift from heroin and brown sugar to injecting pharmaceutical cocktails. (Photo by G. Charanjit Sharma for India HIV/AIDS Alliance)

Uttarakhand’s natural beauty has captivated tourists and residents alike for centuries. Wildlife and nature enthusiasts, pilgrims, and even those wanting an escape from city life have turned to the serenity of Uttarakhand’s lush green mountains, fresh air, and the sacred Ganges river that runs through this North Indian state, often called ‘the Land of the Gods.’

Beyond its scenic beauty, Uttarakhand is also well-known for the cannabis that naturally grows all over the state. Cannabis has traditionally been associated with the holy men of this region but recently has seen an increase in consumption by the local population and tourists. Over the years, however, drug consumption has shifted towards heroin and brown sugar. Severe punishments given to drug offenders by the government for using these substance have motivated users to shift to injecting pharmaceutical cocktails, sold not by pharmacies but by local residents who bring them from outside the state.

New options for drug use have also led to an increase in number of people who inject drugs (PWID) and growing numbers who are infected with HIV, Hepatitis C and TB from sharing of syringes. Prolonged drug use impacts individual productivity. Most PWID are unable to keep steady jobs; they have limited financial resources, little family support or no meaningful access to drug treatment facilities. Social stigma and exclusion are constant features of daily life for PWID in Uttarakhand. Marginalized, they are routinely treated with disrespect and denied access to services they need, including healthcare.

Mindful of the current state of drug use in Uttarakhand, Alliance India’s Hridaya programme is working with seven organisations to offer harm reduction services in four districts, including the holy town of Haridwar and the state capital of Dehradun. Aiming to cover all PWID in these areas over the next two years, the programme will focus on the unmet needs of this vulnerable populations and complement activities in the state under India’s National AIDS Control Programme.

In addition to providing PWID with Hepatitis C education and overdose management, Hridaya will also encourage Hepatitis C testing, work with families of PWID to strengthen community mobilization, establish legal support and crisis response teams, and offer counselling on sexual and reproductive health, along with service referrals. To improve implementation and impact, the programme will also conduct drug pattern assessments to understand the dynamics of drug use in the state to respond more effectively to the needs of PWID.

In January 2013, the Hridaya team trained 30 newly recruited staff in Uttarakhand, including project officers, outreach workers, peer educators and peer counsellors from six CBOs. In these sessions, special effort has also been made to increase capacity overall and specifically train women in these roles to respond more effectively to the needs of female PWID. Similar staff trainings were held in Hridaya’s two other focus states, Haryana and Bihar.

Hridaya’s three-day training on harm reduction uses an intensive participatory workshop model featuring various techniques such as interactive presentations, group discussions, demonstrations, and feedback. Topics covered include: an overview of Hridaya; drug basics; drug-related harms; principles of harm reduction; outreach and peer education; Targeted Intervention (TI) prevention interventions under the national programme; needle and syringe exchange; operational aspects of interventions such as demand calculation, waste management and disposal; post-exposure prophylaxis for needle stick injury; sexually-transmitted infections; safer sex; drop-in-centres; service referrals; and networking.

As a guiding principle, Hridaya affirms the essential humanity and worth of PWID. This core value informs both the programme’s goals and its implementation. Building rapport with PWID and gaining their trust are essential steps in harm reduction programming, and Hridaya’s approach is designed to support the expansion of service offerings and demonstrate the importance of harm reduction as a key strategy to address HIV in PWID communities in India.

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The author of this blog, Francis Joseph, is Programme Officer for Alliance India’s Drug Use & Harm Reduction programmes and is based in New Delhi. 

Spanning five countries (India, China, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 injecting drug users (IDUs), their partners and children. The programme protects and promotes the rights of these groups by fostering an enabling environment for HIV and harm reduction programming in these five countries. CAHR is supported by the Ministry of Foreign Affairs, Government of Netherlands. 

CAHR in India is called ‘Hridaya’ and is implemented by India HIV/AIDS Alliance in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This programme helps build the capacity of service providers, makes harm reduction programmes more gender-responsive, improves access to services and advocates for the rights of PWIDs. In addition to providing services, Hridaya has a strong capacity building component to support advocacy, knowledge management and improved services for PWIDs.

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