In a state with the highest concentration of HIV/AIDS in India, a majority of them injecting drug users (IDUs), interventions have focused on IDUs but have neglected their spouses, sexual partners and children, points out Chitra Ahanthem
Ever since the first reported cases of HIV in India in Tamil Nadu and Maharashtra in the late-'80s, the virus has spread across India, especially in the north-east. According to the latest epidemiological report of HIV/AIDS in Manipur, brought out by the Manipur State AIDS Control Society (September 1986 to April 2003), 15,166 out of a total of 95,734 blood samples screened were HIV-positive. In a state which has an area of 22,327 sq km and a population of around 2.3 million (2001 census), this is the highest concentration of HIV/AIDS infection in India.
The first HIV cases were reported from a study of random blood samples of injecting drug users (IDUs) in 1989-90. At present, 56.81% of the total population of HIV-positive people in Manipur are IDUs, though the figure was as high as 80% at one point. The geographical proximity of Manipur to Burma (Myanmar) and consequently the Golden Triangle drug trail, has made it a major transit route for drug smuggling, with drugs easily available. However, the transmission route of HIV/AIDS in the state is no longer confined to injecting drug users: it has spread further to the female sexual partners of IDUs and their children. This is not surprising as women are particularly vulnerable to HIV infection and other sexually transmitted infections/diseases because of biological and socio-cultural factors including economic, educational and legal discrimination and unequal gender relations.
Going by the MACS report, there are only 2,297 women who are HIV-positive: a mere 2.39% of the total HIV-positive population. But these figures do not reflect the ground reality. Women more often than not fail to avail of the inadequate health services available because of gender inequity, lack of knowledge and negotiating power within the family and lack of financial independence. When it comes to HIV/AIDS, which is often associated with one's morality, the fear of stigma and discrimination keeps women away from health-related services made available by government and non-government agencies.
Government/non-government agencies and organisations have been implementing intervention programmes (counselling, condom promotion, medical check-ups, needle and syringe exchange programmes) among vulnerable groups like IDUs, Men having Sex with Men (MSM), sex workers, truck drivers etc. They also organise prevention/awareness programmes for youth, community leaders, teachers, security enforcement personnel etc. Those infected by HIV/AIDS are given medicines for the various infections that come with HIV, and home-based care is available for bedridden people living with HIV/AIDS.
On the other hand, most of the existing interventions in Manipur have focused on IDUs, with inadequate focus on services for women who are infected/affected/afflicted with HIV/AIDS. Because the majority of the HIV-infected population in Manipur were/are IDUs most people looked at that 'high risk' group alone, forgetting that the injecting drug users also have affected partners in the form of their spouses and/or sexual partners.
During the early-'90s, the belief that people who are drug users would mend their ways if they were married made parents marry off their wards at a very young age. Most of the men have now died, leaving behind acutely vulnerable wives and children. The women are pushed out of their marital homes because of property disputes while their own families do not want them back on account of their young age and widowed status.
Also, there is a need to acknowledge that women's vulnerability to HIV/AIDS increases in the face of armed conflict. The state of Manipur, like most other states in the north-eastern region of India, has diverse ethnic populations at odds with each other, often leading to clashes. The existence of various armed groups resorting to guerilla warfare against the various central and state security forces who are deployed in huge numbers to maintain peace and order have only contributed to the complexity of the situation.
Most service providers facilitate Self Help Groups (SHGs) for widows of IDUs. SHGs comprising 25-30 members are often the only support system women have. The members share needs and issues, network with related agencies, hold training and income-generation programmes for embroidery, knitting, block printing, tailoring, making preservatives etc.
Significantly, most existing programmes are either funded by foreign agencies or by the Manipur State AIDS Control Society which releases funding from the National AIDS Control Organisation (NACO). There have been many instances where programmes have been suspended for some time or abandoned altogether for lack of funds, which does not bode well for people who are living with HIV/AIDS. In the long run, funding agencies will move on to other areas of development work. This means there is an urgent need for community funding and local sustenance for HIV/AIDS interventions. But this is easier said than done, considering the ignorance and misconceptions that remain attached to HIV/AIDS.
(Chitra Ahanthem is a Manipur-based researcher and journalist)
InfoChange News & Features, August 2003