November 1st is International Drug Users Day. Initiated in 1995 by the Dutch drug user organization, Landelijk Steunpunt Druggebruikers (LSD), the day aims to raise awareness and increase action to address the needs of people who use drugs.
In India, networks of people who inject drugs (PWID) and people living with HIV (PLHIV) mark the day by advocating with stakeholders for action to create an enabling environment for PWID and expand access to a full range of harm reduction services.
The PWID response in India has primarily used a health services-based approach. Though mitigating aspects of PWID vulnerability, this approach fails to address the central role that rights protections play in ensuring the overall wellbeing of PWID nor does it deal with related issues like stigma, discrimination, harassment, violence, alienation and destitution. There can be no doubt that India needs a comprehensive, rights-based harm reduction approach.
PWID need to be afforded choices to seek addiction treatment but also to avail services that best suit their needs. Alliance India programme teams frequently meet PWID during field visits who rue the high costs of addiction treatment in India. While there are more than a hundred de-addiction centres in district hospitals and medical colleges across the country, most are not functional. In any case, few PWID are keen to be treated in government facilities due to fear of criminal sanctions.
There are an additional 400 centres run under the aegis of Ministry of Social Justice and Empowerment that are operated by non-profit organisations but charge PWID for services. Not only are they heavy on the pocket, most function with little or no real regulation. A recent article in the Mumbai Mirror highlighted the case of a de-addiction centre in Alibaug, Maharashtra, but this is just one of many examples of exploitation of PWID seeking services they need.
India is also lagging behind on oral substitution therapy (OST) for PWID, an essential tool for managing addiction and mitigating the risk of HIV infection from injecting. According to a recent report by India’s Department of AIDS Control (DAC), although more than 143,000 PWID were reached through Targeted Interventions for HIV prevention in 2012, only 11,500 were covered by OST. The figure is not even close to the national target to put 20% on OST.
To the public at large, drug use remains a “menace”. There is little understanding of the issues, and scant political will to make the changes needed. The biggest barriers to a rights-based approach remain the laws that criminalise the use of narcotic substances except for medical purposes. Some argue that criminalisation is directly responsible for the stigma and discrimination faced by PWID every day. Until India rationalizes its policies toward drug use and improves services, PWID here will continue to face grim prospects.
The author of this post, Simon W. Beddoe, is Advocacy Officer: Drug Use & Harm Reduction at Alliance India.
With funding from European Union, the Asia Action on Harm Reduction programme supports advocacy to increase access by people who inject drugs (PWID) to comprehensive harm reduction services and reduce stigma, discrimination and abuse towards this vulnerable population. In India, the three-year programme will initially engage with PWID and local partners in Bihar, Haryana, Uttarakhand, Delhi and Manipur.
Spanning five countries (India, China, Indonesia, Kenya, and Malaysia), Community Action on Harm Reduction (CAHR) expands harm reduction services to more than 180,000 people who inject drugs (PWID), 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.
In India, CAHR 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.