Targeting drug users with humane approach

Even as the overall incidence of HIV prevalence continues to decline in India, the rates of infection are high among people who inject drugs, underlining the need for a multi-pronged approach including behavioural interventions and harm reduction programmes.

“According to a report by UNAIDS, HIV prevalence among people who inject drugs is estimated to be 28 times higher than the rest of the adult population. The cause for this high incidence is the unsafe practice of needle sharing among drug users.

Rates of co-infections of HIV and hepatitis B and C are also high among injecting drug users, further complicating health matters for them,” says Dr Kumar Bendadi, MD, Ben’s Sex and HIV Clinic, Hyderabad.

“Historically, India’s north eastern states had high prevalence of HIV among drug users. According to NACO, the number of injecting drug users in India was estimated at about 1.77 lakh of which around 29 per cent were believed to be from the North-East.

However, in recent years, prevalence of HIV among drug users has found to have increased in other parts of the country including cities like Mumbai. All this while, rates of sexual transmission of HIV have continued to decline, thanks to increasing awareness about safe sex practices.

This tells us that our campaigns which have succeeded for other high risk groups have not had similar impact on drug users,” says Dr Bendadi.
“We need to take into account what we did right in the case of sex workers and MSM populations and what is lacking in our efforts for reducing transmissions among drug users.

WHO recommends harm reduction interventions for injecting drug users in the form of distribution of safe syringes and needles. However, people who inject drugs often fail to have access to these services because they fear abuse and punitive actions. This is another factor responsible for limited success in reaching out to them,” says the doctor.

Multi-prolonged approach
The National AIDS Programme follows focused and targeted interventions among high risk groups to help them access to preventive mechanisms and treatments. It needs to now focus on a multi-pronged approach that includes behavioural counselling, de-addiction programmes as well as Harm Reduction Interventions.

“This must also include raising awareness about the availability of newer medicines such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP),” informs Dr Bendadi.