Realising ART Adherence among People Who Inject Drugs in India

Hridaya educates PWID living with HIV about positive prevention, emphasizing the importance of adhering to ART treatment regimens. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Hridaya educates PWID living with HIV about positive prevention, emphasizing the importance of adhering to ART treatment regimens. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Adherence to antiretroviral therapy (ART) is strongly correlated with HIV viral suppression, reduced rates of resistance, an increase in survival, and improved quality of life. Yet there are numerous cases in India of people living with HIV who exist in co-morbid conditions: dependent on substances but dropping their ART regime due to societal stigma and discrimination or to a lack of understanding about the need to adhere to treatment.

Lamyanba (name changed) from Imphal has been injecting drugs since 1989. When he tested positive for HIV recently, he had a dangerously low CD4 count of 19 and was immediately put on ART. He responded favourably to treatment, and his CD4 count increased to 600 in a span of six months. When his health improved, he decided to stop the treatment without consulting a doctor or service provider. Lamyanba’s decision is unfortunately too common.

Recognizing that people who inject drugs (PWID) living with HIV frequently drop out from ART treatment, the Hridaya programme is undertaking active monitoring to address this problem. A tracking tool has been developed to monitor a client’s routine diagnostics. The tool indicates the dates for ART follow-ups, and an outreach worker contacts clients to remind them of their follow-up appointments. Outreach workers also keep a check on client CD4 counts.

Supported by Government of Netherlands, Hridaya works in the states of Bihar, Haryana, Uttarakhand, Jammu and Manipur to strengthen harm reduction interventions at state and district levels. Aiming to cover all PWID in these states, the programme focuses on the unmet harm reduction needs of vulnerable drug-using populations and complements HIV prevention activities in each state under India’s National AIDS Control Programme.

Hridaya routinely educates PWID living with HIV about positive prevention focusing on the value of adhering to ART treatment. The programme team works with clients to identify barriers to accessing ART treatment and advises on the need for strict adherence to the treatment regime. In Imphal, Hridaya aims to keep 95 percent of clients on treatment and minimize loss-to-follow-up. With this support, Lamyanba is back on ART, leading a healthy positive life.

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The author of this blog, Roshan Ningthoujam, is programme manager for Hridaya at Social Awareness Service Organisation (SASO) in Manipur, India.

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.

“11 for ICAAP 11”: A Selection of Alliance India Posters at ICAAP (November 17-22, 2013, Bangkok, Thailand)

Alliance India is presenting a total of 31 posters at the 11th International Congress on AIDS in Asia and the Pacific (ICAAP 11) in Bangkok, Thailand, 17-22 November 2013. To mark the 11th ICAAP, below are a selection of 11 of our posters displayed in Bangkok that detail our work supporting community-based programming for people living with HIV (PLHIV), men who have sex with men (MSM), transgenders, hijras, sex workers and people who inject drugs (PWID), all key priorities to addressing India’s complex epidemic.

Paving the Pathway: PLHIV community consultations enhance national care and support programme in India

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Factors Influencing SRH Service Uptake by PLHIV: Findings from the Koshish baseline study in India  

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An Emergent Crisis: Addressing the Hepatitis C Epidemic in People Who Inject Drugs (PWID) in India

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By the Community, For the Community: Involving PWID in Assessment of Drug-using Patterns Assessments

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Identifying Access Barriers for Transgenders Seeking Gender Transition Services in India

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Community-led Advocacy to Address SRH Needs of PLHIV: Experience from the Koshish programme in India

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Service without a Smile: Pehchan study of the friendliness of HIV services to sexual minorities in India

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Positive Rights and Sexual Health: A review of SRH laws and policies for PLHIV in India

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Tracking Organisational Development of Sexual Minority CBOs in India Using Pehchan’s ‘CBO CyclePoster_Page_10

Power in Our Hands: Increasing involvement by sexual minorities in HIV programme oversight in India 

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Promoting Entrepreneurship among Sex Workers to Reduce HIV Vulnerability in Andhra Pradesh

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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.

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.

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.

From Addiction to Action

Photo: Francis Joseph ( in middle) during a meeting of Alliance India members. Francis is the Programme Officer for Hridaya, an HIV and harm reduction programme supported by the Community Action on Harm Reduction (CAHR), Netherlands and implemented by Alliance India. Photographer: G Charanjit Sharma

Francis Joseph (center) with Alliance India colleagues. [Photo by G. Charanjit Sharma]

Francis Joseph is Programme Officer for Hridaya, our HIV and harm reduction programme in India supported through the five-country Community Action on Harm Reduction (CAHR) programme with funding from the Government of the Netherlands. Hridaya works in partnership with SASO, Sharan, a number of community-based harm reduction organisations, and the Indian Drug User Forum (IDUF), a national network of people who use drugs.‎

In this interview, Francis discusses the National AIDS Control Organisation’s approach to prevent HIV among people who inject drugs (PWID) and the work that Hridaya does to provide an additional package of services to this community, their spouses, children and families. Francis offers us a glimpse into the personal and programmatic consequences of social and self-stigma against people who inject drugs, and opens up about his personal connection to the PWID community which inspires his work every day.

Q: Why is a programme like Hridaya important especially in a country like India?

Francis Joseph (FJ): The National AIDS Control Organisation has adopted harm reduction strategy under the National AIDS Control Programme Phase three (NACP III) to prevent HIV amongst people who inject drugs (PWID), and has scaled up services through targeted interventions implemented by NGOs. The primary objective under the NACP III was to halt and reverse the spread of the HIV epidemic by 2012 and to cover 80% of the overall population of PWIDs through targeted interventions. By reaching out to a significant proportion of the estimated injecting drug users (IDU) population, the NACP III laid the foundation for an effective and evidence-based comprehensive response to halt and reverse the HIV epidemic among IDUs.

While considerable progress was made under NACP III with respect to the scale-up of interventions for IDUs as well as quality assurance in the country there were areas that were identified as emerging areas of concern. Some of these services include sexual and reproductive health services for spouses/sexual partners of male PWID, inadequate regulated drug treatment services and active engagement of PWID within the programme. The country lacks leaders from this community and especially lacks networks of drug users.

Any successful harm reduction approach requires greater involvement of PWID. Hridaya aims to empower drug users, identify individuals and build them as leaders from this community so that they are informed, educated and can voice for their basic human rights. Hridaya’s overall aim is to empower the drug using community in each of its focus states so that they can strengthen the harm reduction approach at the state and district level, and develop a local resource pool for capacity building initiatives.

Q: There are so many preconceived notions about IDUs. How does this affect their ability to seek treatment? Can you talk a bit about stigma?

FJ: Generally, people perceive drug users as criminals, social outcasts, and a threat to society. This makes it difficult for people who want to reach out to them to even contact them, or to build rapport and trust with them, and this is incredibly important since these factors further fuel the HIV epidemic in the country.

PWIDs are generally assumed to be HIV positive and are, hence, refused treatment when care and treatment is required. There have been many instances of PWID being denied treatment at public health care facilities, getting arrested and being treated with police brutality, and experiencing community hostility.

All of this leads to a complete lack of access to treatment and other essential services. The shabbily dressed appearance and unhygienic conditions of a number of PWIDs leads to them being denied access to any service. This has led to a sense of mistrust and has fuelled stigma and discrimination.

There was an incident in Delhi where a PWID burst his femoral vein due to injecting and was rushed to a nearby hospital. He was bleeding profusely and needed immediate critical care. The doctor on duty refused to help this man before an HIV test had been done on him. All through this, the man continued to be in incredible pain and was near death, but no one would help him.

Q: What motivates you about your job? Are there people you’ve met who inspire you to continue working in this area?

FJ: I come from the same community of PWID and have also experienced the pain of rejection, isolation, denial from family, friends, relatives and society at large. I know exactly what it feels like being socially rejected and ostracized, denied for many social entitlements and disowned by my family. I have lived a life full of negativity and have seen the inside of treatment centres and incarceration.

There are millions of people like me and very few have been fortunate enough to have come out of their dependence. I feel that I have a special calling that has motivated me to do something for my community. I began my new life of sobriety from the very basics, taking one day at a time, and I painstakingly built it up to where I am now. Today, I’m at a level where my voice is heard and I can speak up for the needs of the people who share a common background with me.

Q: What do you wish more people in general society understood about harm reduction and IDUs?

FJ: There are three approaches to any drug treatment programme: Drug demand reduction, drug supply reduction and harm reduction. The first two approaches see the solutions to this problem as generating awareness in reducing the desire to use drugs and prevent and delay the onset of drugs use to disrupt the supply of drugs through the implementation of draconian laws. Both these approaches focus on abstinence, which has constantly proven to result in a very poor outcome.

We at Hridaya follow the harm reduction approach, which-as the name suggests–aims to reduce the harm associated with injecting drugs use, such as HIV and Hepatitis C, and not eliminate the drug use per se. General society perceives that the only option to treat drug users is for them to follow the route of abstinence, which is practically impossible since there may be a certain segment of people who would never be able to give up drugs completely. Hence, the harm reduction approach advocates for drug users to stay safe and healthy regardless of whether they are still doing drugs or of the conditions that they live in.

Q: Are there any resources that you would recommend for people who want to learn more about harm reduction in relation to injection drug use?

FJ: I urge people to read more about this topic. To break the stigma against IDUs, we need more informed people. For those who are interested in learning more, there are some very good resources available on www.unodc.org/India/harmreduction,   www.nacoonline.org/publications/harmreduction and www.aivl.org

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The subject of this post, 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 project 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.

It Takes Two: The role of sensitizing partners in the fight against drug-use driven HIV

Hridaya’s outreach workers meet frequently with people who inject drugs to ensure that they are provided with essential harm reduction services and their families are offered the support and services they require.

The excruciating pain Sameera (name changed) experienced in her abdomen came out of the blue. Unable to afford the doctor’s fee to treat the ailment, she resorted to home remedies. She finally told her husband, Raymond (name changed), when her condition worsened, but she knew he wouldn’t be of much help. Sameera had recently realized, after three years into their marriage, that Raymond was dependent on drugs and had been injecting drugs for a number of years.

She learned that Raymond had started with brown sugar (an opium derivative), but had later switched to injecting pharmaceutical combinations. That explained why he never stuck to any job, and had, at times, even resorted to petty crimes. To make ends meet, Sameera had started to do odd jobs, such as washing dishes or doing household chores. She tried dissuading her husband from taking drugs, but his habit was a hard one to break. Feelings of desolation, anguish and stress increased the discord between the couple and, now, with her paralyzing pain, Sameera felt even more helpless and hopeless.

What Sameera didn’t know was that Raymond had been approached by a local NGO that provided free needles, syringes, condoms, and advice on safer injecting practices and safe sex to injecting drug users like himself. The NGO was implementing the Hridaya Project, which aims to strengthen the HIV response amongst people who inject drugs (PWID) in three states in India including Sameera and Raymond’s home state of Uttarakhand. The programme builds the capacity of service providers and makes harm reduction programmes more gender-responsive. Hridaya also serves to improve access to health services, and advocates for the rights of injecting drug users.

A female outreach worker from the Hridaya Project had kept in touch with Raymond. Fortunately, it didn’t take long for Raymond to trust her since he recognised that the outreach worker was trained and possessed essential skills and knowledge about his condition. She also seemed sensitive towards his drug use and for his concern for Sameera’s health. Raymond learned that the Hridaya Project had an exclusive service component for the spouses or partners of drug users, which provides outreach services to them, empowers them through peer support groups, and increases their access to sexual and reproductive health and legal rights.

Though a bit hesitant at first, Raymond invited the outreach worker to his home where she talked to Sameera about issues related to her husband’s addiction. She also addressed Sameera’s sexual and reproductive health concerns, which included her recent abdominal pain, and informed Sameera about how to avail of medical treatment from the nearest district hospital. To help Sameera overcome her inhibitions about seeing a doctor, the outreach worker accompanied Sameera on each of her visits to the doctor regarding her gynecological concerns.

Sameera was very grateful to the outreach worker and the Hridaya Project for helping her get treated and empowering her with more knowledge.  She is now aware of her sexual and reproductive health needs, knows how to protect herself from HIV, and is also much more informed about harm reduction and her husband’s health needs. Drug use is a compelling psychological disorder and it is with love, care and compassion that Sameera can help Raymond get out of it, a fact that she now understands. With her newfound knowledge and support, Sameera is optimistic that her relationship with Raymond and their life together will continue to change for the better.

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The author of this post, Francis Joseph, is Programme Officer for the Drug Use & Harm Reduction programmes of  India HIV/AIDS Alliance, New Delhi.

Spanning five countries (China, India, 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. 

In India, CAHR is called Hridaya and is implemented by Alliance India in partnership with SASO, Sharan, and a number of community-based harm reduction organisations and networks. This project 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.