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Early substance abuse prevention is key: experts

Early substance abuse prevention is key: experts
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First Published: Tue, Jan 06 2009. 10 00 PM IST

 Needling point: (above) Intravenous drug users at Nigambodh Ghat; (right) Vinod Acharya became HIV-positive while injecting drugs. Ramesh Pathania / Mint
Needling point: (above) Intravenous drug users at Nigambodh Ghat; (right) Vinod Acharya became HIV-positive while injecting drugs. Ramesh Pathania / Mint
Updated: Tue, Jan 06 2009. 10 00 PM IST
New Delhi: Vinod Acharya was a regular at liquor shops as a young man living in the Garhwal mountains in Uttarakhand when he got addicted to smack, a variant of heroin.
Needling point: (above) Intravenous drug users at Nigambodh Ghat; (right) Vinod Acharya became HIV-positive while injecting drugs. Ramesh Pathania / Mint
Easy access to drugs lured him to Delhi in 1990, where he took to picking pockets to sustain his habit. He soon shifted to injecting drugs, and although he had studied till class IX, he did not know sharing needles was dangerous.
In 2003, he tested HIV-positive.
Now at 40, he works with a non-profit organization that helps rehabilitate people addicted to injectible drugs, and earns Rs5,500 a month. Also diagnosed with Hepatitis C, a virus spread by blood transfusion or sharing needles with infected people, Acharya is on anti-retroviral treatment, a cocktail of drugs that reduces HIV’s ability to damage the immune system. “How I wish I had taken up the job of washing utensils in a restaurant. Instead, I took the easy way out and stole to sustain my drug habit. I went to jail a number of times and there, too, I smuggled drugs in and didn’t realize at what point I moved from oral to injecting,” Acharya said. “Now it’s too late.”
This is just one story among many who are into substance abuse through injections.
Rajiv Shaw, regional manager (north India) at Sharan, the organization Acharya works with, warned that many such people, particularly street children abusing solvents, are left out of government programmes and are likely to emerge as the next big generation of people who are at high risk of contracting HIV/AIDS. “There is no serious clampdown on heroin pushers or stationery shops selling solvents,” Shaw said.
The third phase of the government’s National AIDS Control Programme (NACP) that runs through March 2012 has placed people who are injecting drugs in the high-risk category along with sex workers, homosexuals and transgenders. It aims to step up targeted intervention projects in these three categories from the existing 1,183 (of which 17% were for those abusing drugs through injections) to 2,100, with an outlay of Rs2,288 crore. According to 2007 data released by the National AIDS Control Organisation? (Naco), 7.2%?of the 2.3 million Indians infected with HIV have contracted the disease through use of injectible drugs.
However, it completely ignores those who are at a stage when they are abusing drugs, but have not yet started injecting them. And, this is where danger lurks, as substance abuse typically ends with injectibles, putting people at a high risk of getting HIV/AIDS.
“There is need for dialogue between the government and different stakeholders on gateway drugs for those graduating from tobacco to the next drug (opium, cough syrup, heroin, injectibles and so on),” said Shaw.
This is a left-out aspect of the state’s HIV/AIDS agenda because it is not covered by the ministry of health and family welfare—that administers NACP—but the ministry of social justice and empowerment, which is typically cash-starved and has inadequate interventions?on?the ground, he added.
Dushyant Meher, an activist volunteer at non-profit Salaam Balak Trust who has worked on a project on street children on drugs and HIV/AIDS, agreed. “The overlap between ministries comes in the way of implementation and taking ownership,” Meher said.
Experts such as Bidisha Pillai, officer in charge of preventing drugs and HIV in India at the United Nations Office on Drugs and Crime (UNODC), agreed that prevention of substance abuse must start early among the young to stop the progression to injectible drug use. She said the social justice ministry and UNODC have a primary prevention programme, which includes school-based intervention, mass media campaign and youth volunteer programme in the North-East. However, “there is need to continue and strengthen these programmes”, Pillai said.
But is this enough?
No, say those working with street children, a particularly vulnerable group.
Salaam Balak’s Meher said the trust has been struggling to find a suitable government programme to help children kick drug habits since at least 60% of those who approach the non-profit are on drugs.
“The perception that since you are not injecting, you are not a drug user and, therefore, not at high risk of HIV, has to change,” said Zulfiqar Khan, founder of Theatre Age Group, a non-governmental organization that works with shoeshine boys and ragpickers in Chandigarh.
Sharan runs two centres at Nigambodh Ghat in Delhi that are supported by Delhi State AIDS Control Society and Naco, where at least 1,500 injectible drug users walk in daily.
Shaw said the major problem in dealing with them is to ensure a continuity in treatment, which can often be prolonged. All Sharan can do for those who are tested HIV-positive is to refer them to government hospitals and care homes. Had there been interventions before a person reaches the stage of injecting drugs, many people such as Acharya could have been saved.
“Our health minister is passionate about people quitting smoking, but that is only one chunk of tobacco use,” said Ashok Row Kavi, noted gay rights activist who works at the UN Programme on HIV/AIDS.
“IDUs (injection drug users) are criminal elements in the eyes of law and unless structural changes are made through legislation, they will continue to be exploited and harassed, and real concerns related to safe and healthy living will not be taken up,” he added.
In the meanwhile, as dusk deepens at Delhi’s Gole Market, a bunch of kids not yet into their teens huddle together—sniffing glue, drinking cough syrup and injecting drugs. They are too young to know better, and by the time anybody takes action, they would just be an additional statistic on India’s HIV/AIDS horizon.
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First Published: Tue, Jan 06 2009. 10 00 PM IST