Protecting Rights to Ensure Health: International Drug Users Day 2013

India is lagging behind in efforts to reach people who inject drugs with oral substitution therapy. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

India is lagging behind in efforts to reach people who inject drugs with oral substitution therapy. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

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.

Advertisements

Fighting for the Right to Health for Women Living with HIV: A Success in Gujarat

Image for Daxa Blog

Stigma and discrimination often prevent women living with HIV from accessing the essential health care services. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

It was 5am. Anita (name changed) was about to give birth. The labour pain was leaving her numb. Her family rushed her to the nearby government hospital, but the doctors refused to attend her. She kept fighting the pain. The morning of hope soon turned into an evening of despair. Anita had a stillbirth. Her only fault: she is HIV positive.

Sadly, Anita’s case in Palanpur city of Banaskantha district of Gujarat is not unique. Women living with HIV (WLHIV) face discrimination everywhere: they are ostracized by their families, ridiculed and abused by society, and refused healthcare by providers.

Following the incident, a number of protests were held by Banaskantha Network of Positive People (BanasNP+) but all in vain. Seeing no action at local level, Gujarat State Network of Positive People (GSNP+) picked up the case. Along with BanasNP+, GSNP+ submitted a detailed report to the health commissioner of the state and Gujarat State AIDS Control Society (GSACS).

Fortunately, the health commissioner was proactive. He immediately took up the case and sent a team to Palanpur for further investigation. A circular was also issued to all the hospitals citing a high court ruling that states that people living with HIV (PLHIV) should not be denied care and treatment because of their positive status.

In the meantime, GSNP+ documented various cases of such stigma and discrimination against WLHIV by healthcare providers across Gujarat. GSNP+ then organised a state-level advocacy meeting with GSACS and presented these documented cases. Following this, GSACS decided to conduct priority visits to the districts along with GSNP+. A meeting was called by GSACS in Palanpur that brought together the resident medical officer (RMO), gynaecologists, ART medical officer, paediatric doctors, and staff from the District AIDS Prevention and Control Unit (DAPCU). The discussion clarified the roles and responsibilities of each medical department and highlighted the particular role of gynaecologists. The meeting sought commitment from healthcare providers that WLHIV shall not be discriminated against and will get the same treatment as other patients.

The impact of this advocacy meeting was visible within a few weeks. One WLHIV who had earlier been asked to go to Ahmedabad for delivery by the hospital was now given proper care. She delivered healthy twins.

In Palanpur, these efforts have paid off and shown how partnership and coordination with the concerned government departments can work positively, creating a win-win situation. Yet stigma and discrimination remain among the primary barriers to achieving universal access to HIV treatment, care, and prevention. As HIV treatment programmes become increasingly available, access to these lifesaving services depends on the degree to which all health facilities welcome PLHIV and respect our rights.

__________________________

The author of this post, Daxa Patel, is head Gujarat State Network of Positive People (GSNP+). One of India’s most prominent HIV activists, Daxa collaborates with India HIV/AIDS Alliance on our Koshish and Vihaan Programmes.

With funding from the European Union, our Koshish programme strengthens civil society organizations and networks that work with PLHIV and other marginalized groups, such as men who have sex with men, transgenders, sex workers and people who inject drugs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This programme is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres will support PLHIV, including those from underserved and marginalized populations who have had difficulty in accessing treatment including women, children and high-risk groups in 31 states and territories.