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.

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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.

Too Little, Too Late is Not Enough: International Overdose Awareness Day 2013

The right medical help at the right time can help avert overdose-related deaths. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

The right medical help at the right time can help avert overdose-related deaths. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

In the past few years, a number of famous celebrities including Michael Jackson have died due to fatal drug overdose. The media is quick to target the lifestyles of these stars, paying little heed to the grieving families and fans. Some of these deaths have left us surprised, while others we saw coming.

For people who inject drugs (PWID), a fatal drug overdose is an occupational hazard. In India, overdose deaths are particularly common among street-based drug users in bigger cities. Often, these deaths are not reported or even recorded for fear of legal consequences. Like most countries, Indian law criminalises illicit drug use. When someone overdoses, they seek medical help as the last resort, not wanting to deal with the possibility that the police might be called to the hospital.

Anyone who has witnessed an overdose will tell you about frustration and helplessness. The extent of the problem in India is unknown, as there is little reliable data on the annual number of drug overdose deaths. Estimations by NGOs working in the field indicate that in areas with high levels of injecting drug use, hundreds of people die from overdose each year. These cases are mainly due to mixing drugs or use of drugs of poor or unknown quality. Those of us who use drugs or know people who do always need to be aware of the underlying dangers of using drugs in combination. People who have been trying to quit or have been abstinent for a while — such as after a treatment programme or incarceration— are more prone to overdose than those who regularly use drugs.

Preventing overdose-related deaths can require just a few simple steps. A Naloxone injection in time can save a person’s life. What is needed is to ensure that Naloxone — a drug included in India’s National List of Essential Medicines — is readily available at all public healthcare facilities. Unfortunately this is not yet the case. In a number of recent cases, the emergency ward has had no Naloxone available. Relatives or friends of the overdosing PWID have had to rush to procure Naloxone from nearby pharmacies, where they are charged 10- to 20-times the actual price by staff who exploit the urgency of the situation.

Naloxone is an integral and necessary part of effective programming for PWID, but it still needs to be fully integrated into India’s national programme. Alliance India has incorporated overdose prevention and management into the harm reduction services provided to PWID under our Hridaya programme. Our Asia Action programme complements these efforts by supporting advocacy for expanded access to Naloxone and other interventions to reduce overdose-related deaths.

International Overdose Awareness Day is an opportunity to raise awareness about drug overdose, reduce stigma, and advocate for expanded access to overdose-related services. Join Alliance India in solidarity with friends from all over the world as we remember those who have died and recommit to our efforts to end the epidemic of overdose-related deaths.

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The author of this post, Simon W. Beddoe, is Advocacy Officer: Drug Use & Harm Reduction at Alliance India.

With funding from European Commission, 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.

World Hepatitis Day 2013: Making Hepatitis C a Priority

Sixteen million people inject drugs worldwide. Three million live with HIV, and two-thirds of them live with Hepatitis C. (Photo by Francis Joseph for India HIV/AIDS Alliance)

Sixteen million people inject drugs worldwide. Three million live with HIV, and two-thirds of them live with Hepatitis C. (Photo by Francis Joseph for India HIV/AIDS Alliance)

A dear friend of mine was struggling as a single mother, working two jobs and balancing drug use. To make things simpler, she quit the jobs and started working from home. Unfortunately, her drug use turned out to be more problematic than anticipated. Her situation was further complicated when she was diagnosed as positive for Hepatitis C, a viral disease that leads to the inflammation of the liver and related complications.

With no medical insurance, she faced a financial challenge to cover the six-month long treatment. At first, she got contributions from family and friends and then a loan, and lastly she sold her jewellery. She recovered only to be hit with the virus again. This time her condition deteriorated so quickly that she was not able to make it through a second round of treatment. Only half of those who are treated actually recover. My friend’s is just one of the many stories of people struggling with Hepatitis C.

Hepatitis C represents a huge public health problem in India and globally. According to the World Health Organization about 150 million people are chronically infected with the Hepatitis C virus, and more than 350,000 people die every year from Hepatitis C-related liver diseases. The Hepatitis C virus is more infectious than HIV. An estimated 10–12 million people in India are infected with Hepatitis C, including 50 percent of people who inject drugs (PWID) nationally and 90 percent of PWID in the northeast. Left untreated, Hepatitis C can lead to liver cirrhosis, liver cancer or liver failure.

Hepatitis C is especially of concern for those co-infected with HIV, as several studies have shown that HIV-Hepatitis C co-infection leads to increased rates of disease progression. PWID are especially vulnerable to infection by both HIV and Hepatitis C; co-infection rates are as high as 93% among PWID in Manipur. However, unlike first- and now second-line HIV treatment, which is available to people living with HIV who need it in India, Hepatitis C treatment is not available in government hospitals largely due to its high cost, and health programmes for PWID typically do not screen patients for Hepatitis C due to the unavailability of treatment. Consequently, this results in high morbidity and mortality among PWID.

To address this concern, our Government of the Netherlands-supported Hridaya programme disseminates information on Hepatitis C prevention through outreach and counselling sessions at drop-in centers (DICs) in 36 sites in four states: Bihar, Jammu, Haryana and Uttarakhand. The programme also identifies clients and refers them for testing. Those found to be Hepatitis C-positive are further educated on self-care and positive prevention. The programme’s outreach team works with spouses and families of PWID, explaining Hepatitis C risk and prevention in the context of injecting drug use.

To address the growing problem of HIV-Hepatitis C co-infection among women who inject drugs, our Elton John AIDS Foundation-funded Chanura Kol project has initiated Hepatitis C interventions. Women enrolled in the project are educated about transmission risks, prevention strategies, and the importance of testing.

With both programmes, Alliance India is working to ensure that Hepatitis C prevention education and treatment literacy become a priority for PWID and a core part of this country’s efforts to improve the lives and health of PWID.

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The author of this post, Simon W. Beddoe, is Advocacy Officer: Drug Use & Harm Reduction.

With funding from European Commission, the Asia Action on Harm Reduction programme supports advocacy to increase access by people who inject drugs (PWID) in India to comprehensive harm reduction services and reduce stigma, discrimination and abuse towards this vulnerable population. The three-year programme in the beginning will primarily engage with PWID and local partners in Bihar, Haryana, Uttarakhand, Delhi and Manipur and  gradually extend its reach across India.