The impact of HIV in the state of Manipur

By Rajesh Khongbantabam *

Manipur has one of the highest HIV prevalence rates in India and with just 2% of the country's population; it has nearly 8% of India's HIV cases.

According to the Epidemiological Report published by the National AIDS Control Organisation (NACO), Manipur is ranked third behind Maharastra and Tamil Nadu on the list of states with the highest HIV prevalence.

But if we calculate the seroprevalence rate in the state per one million people, prevalence rates in Manipur are at least six times higher than those of Maharashtra and 20 times higher than that of Tamil Nadu.

The HIV seroprevalence rate among injection drug users (IDUs) in Manipur increased from zero to 50% from 1990 to 1991. Preliminary reports conducted by sentinel surveillance indicate that the seroprevalence rate among IDUs in Manipur increased from 59.9% in 1994 to 80.70% in 1997.

While the reports also show declining seroprevalence rates from 1998 onwards, with 72.78% in 1998, 66.02% in 2000 and 56.27% in 2007 the seroprevalence rate among IDUs in Manipur remains one of the highest in the world.

The HIV prevalence rate among pregnant women has also increased with 0.8% of pregnant women testing positive for the disease in 1994, 1.32% in 1997, 2.70% in 1999 and 2.04% in 2001. The trend has not stabilized and the numbers continue to grow.

A generation of young widows, whose husbands have died from AIDS-related illnesses and a large numbers of orphans, are emerging. Reports also indicate that the HIV seroprevalence rate among attendees of sexually transmitted infection (STI) clinics increased sharply from 4.8% in 1994 to 13% in 2003 and 7.2% in 2004.

Injection Drug Users

Since NACO started its epidemiological analysis in September 1989, Manipur has seen increases in the number of youths injecting drugs and in HIV infections among IDUs.

Of the 5.7 million people estimated to be living with HIV in India, figures from Manipur State AIDS Control Society show that about 26,000 HIV-positive people live in the state. The UNAIDS estimates that at least 40,000 people in Manipur are living with the disease.

At this juncture, the scenario looks very grim as significant sections of the workforce have been lost, which has had an impact on the already poor socioeconomic conditions in Manipur. There is also much concern over the costs of treating so many HIV-positive people.

The increasing need for care and treatment is especially problematic in a state like Manipur that is already struggling to meet the basic health-care needs of its people. HIV continues to overwhelm the health system in many areas and the epidemic has started to impact on nearly every dimension of social and economic life.

Despite the many steps being taken to curb the disease, HIV will eventually have a significant impact on the state economy due to a loss of productivity and procurement of medicines.

Many people believe that it is a waste of time and resources to invest in the treatment of IDUs but the fact is that investing in the treatment of drug dependency also helps decrease, crime, the every dollar spent on treatment, seven dollars are returned in cost saving.

It is important to realize that the HIV epidemic and the consumption of illicit drugs generate very high costs, in terms of damage to public health, social well-being and economic growth. The costs to the economy are particularly high because the people most affected by the diseases are also those who are in the most economically active age group. The economic toll of the HIV epidemic is likely to hit resource-poor Manipur hard.

Sex Workers

A survey conducted among sex workers in 2005 revealed that more than half of the respondents were fully aware of the fact that they needed to take precautionary measures to protect themselves from HIV.

But many also said they allowed their clients to decide whether or not to use a condom. Due to a fear of harassment from pressure groups and security personnel the sex workers also said they often perform their services in a hurried manner and many were at risk of contracting sexually transmitted infections.

Sex workers are also sometimes raped or assaulted by their clients, leading to the tearing of their genitals, bleeding, psychological trauma and an increased risk of infection. According to statistics released by the Manipur State AIDS Control Society, 27% of sex workers tested in 2007 were found to be living with HIV.

Men who have sex with men (MSM)

Men who have sex with men are considered to be a high risk group when it comes to HIV transmission. One of the factors behind this is the denial, stigma and discrimination experienced by MSM, making them more reluctant to identify themselves and less likely to seek out programmes designed specifically for them.

These issues need to be addressed if the goals of public health policy are to be achieved. Qualitative and quantitative researches on these issues are urgently needed.