What kind of polical leadership do we require for making our future generations free from HIV/AIDS ?

Dr. Khomdon Singh Lisam *

Do we want our future generations to be free from HIV/AIDS? Do we want our future generations to be free from drugs? If the answer is yes, what do we need to do now? The time for action is today. Tomorrow, it may be too late. Do not think, AIDS will not touch your family in the near future. Because young people want to experiment new things, explore what is unknown. In the process, many young people tend to experiment sex and drug use before marriage at least once in their life time either out of curiosity , pleasure , peer pressure or just to forget what they do not want to remember. AIDS does not discriminate between rich and poor, educated and illiterate, high or low, male or female, hill and valley, Meitei or Naga or Muslim or Kuki. AIDS tends to kill in families. I myself have seen many families where three out of four or two out of three in the family are having HIV/AIDS - not only in many parts of valley but also in many interior areas of Ukhrul, Tamenglong , Churachandpur, Chandel and Senapati. I am not exaggerating. I am only putting the facts before you for you to ponder.

Changing scenario of HIV/AIDS in Manipur:
We are facing an unprecedented human catastrophe because of HIV/AIDS. AIDS has inflicted immense human suffering in every district and every subdivision of Manipur in hills and valley. More than 27,900 HIV positives have been reported as of October, 2007, of which 7106 were women and 1362 were children below 10 years of age. Women constitute about 25% of the total positives. The HIV/AIDS scenario in Manipur is changing over time. The HIV seroprevalence rate among the IDUs has shown a decline from 80.7% during 1997 to 19.8% during 2006. Every day, every hour, there are new infections. The HIV epidemic is now no longer confined to injecting drugs users but it has spread to their spouses and their children and also to the commercial sex workers and MSMs. It has spread from people with high risk behaviors to the general population through sexual transmission. It has spread from males to females and from urban areas to the rural areas. All the districts and subdivisions are affected. The Imphal East and West districts constitute about 56% of the all HIV positive cases, Thoubal district constitute 9%, Churachandpur 7%, Ukhrul 6%, Bishnupur 5%. The HIV seroprevalence rate among the pregnant women is 1.4 but in Ukhrul district, it is more than 4%, which is the highest in India. The beautiful town of Ukhrul , Siroy and Kamjong are worst affected. The HIV seroprevalence rate among the CSWs is 11.6%, among the MSMs 12.4%. The young people between 15-25 years constitute 45% of the total HIV positive cases. AIDS is becoming the No. 1 killer of young people in Manipur. The future of our young people and the future of our society is at stake because of HIV/AIDS.

Earlier experience of political leaders in Manipur:

1. AIDS was included in the election manifesto of 2002 because of intensive advocacy campaigns on the eve of election in 2001. But nothing was done to translate the election manifesto into action during 2002-2006
2. In the all political parties conference held on 23rd November, 2006 at Kangla, almost all the representatives from political parties have pledged to include HIV/AIDS in the election manifesto of 2007 and that was done.
3. The State Legislators Forum was formed on 30th June, 2007 with the Hon'ble Speaker as the chairman. The Legislators Forum has made a 15 point declaration. Our legislators are now sensitized.
4. The Legislators Forum has organized an impressive World AIDS Day, 2007 on 1st December, 2007. They have organized one day convention on HIV/AIDS for Panchayats and ZillaParisad at Porompat, Imphal and organized a series of one day HIV/AIDS awareness campaigns in the constituencies of the MLAs since November, 2007 till date.
5. Some political leaders have organized IEC campaigns in their own constituencies in a limited way out of their own initiatives.

What are our political issues in the context of HIV/AIDS.
Manipur is facing a number of problems. Whatever problem happening in any part of the world, it is also happening in Manipur - political instability , corruption, unemployment , poverty, female illiteracy , insurgency , terrorism, ethnic conflict, low status of women in society , civil war, human rights violations of any kind, extortion, kidnapping , rape, women trafficking , drug trafficking , drug abuse , national highway blockade , bands etc. We are facing the question of life and death almost every day. Our political leaders have no time to think about HIV/AIDS. Many a time, they do not want to remember HIV/AIDS -because it is also considered a taboo.

But AIDS is real and it is happening here right at our doorsteps. It is a question of life and death for our young people. Our political workers are dying, our political workers are getting infected, our religious leaders are dying, our legislators are dying of HIV/AIDS, our police officers and government employees, agricultural workers are dying, our young people, our women and our children are dying of HIV/AIDS. AIDS has destroyed the families and family relationships. AIDS has impoverished the families. AIDS has produced innumerable widows and orphans. AIDS has completely devastated villages after villages in some of the countries in Subsaharan Africa. What is the guarantee that these catastrophes will not happen to Manipur within 15-20 years time. It has already started showing the tip of the iceberg.

We therefore need to examine what are the political issues to ensure the highest level of political commitment in the fight against HIV/AIDS.

1. Legislators are law makers and policy makers. The support and participation of legislators in the fight against HIV/AIDS is therefore of paramount importance.
2. We need to overcome the legal barriers for effective implementation of the AIDS Control Programme. We need to legalize needle syringe exchange programme, drug substitution programme, condom promotion etc. We need to legalize the provision of health and medical care to the CSWs and MSMs. We need to overcome the discrimination and stigmatization of people living with HIV/AIDS.
3. As law makers, they can consider bringing out a new law for effective implementation of the AIDS Control Programme in Manipur.
4. As Policy Makers, they can consider revising the Manipur State AIDS Policy-1996 to incorporate new and emerging issues providing ART treatment including 2nd line ART or protease inhibitors, research support, female condoms , vaginal microbicides and vaccine trial. Policies need to be implemented. They should monitor proper and effective implementation of the state policies.
5. We need to amend or revise the Manipur State AIDS Policy adopted on 3rd October, 2006 to incorporate the women and children's issues, the widows and orphans issues, vocational training and income generating activities for rehabilitated commercial sex workers and injecting drug users, medical treatment and food and nutrition of people living with HIV/AIDS.
6. We need to provide a strong leadership to the programme. Leaders make the difference. HIV/AIDS should not be implemented as routine Government programme. It needs to be implemented passionately as a result oriented programme.
7. We need to intensify our IEC efforts to reach the poorest of the poor section of the society particularly women who are working in the forest and paddy fields with no education, no income, no means of earning and no employment . Smallpox vaccine took 120 years to eradicate smallpox. Even if the AIDS vaccine is available today, we still need to intensify our IEC efforts. More than 98.6% of our general population is not yet infected.
8. We need to equip our young generations with the basic knowledge and skills of protecting themselves from HIV/AIDS. Protecting our young generations from HIV/AIDS should be the high priority agenda of our political parties.
9. We need to expand and strengthen the targeted intervention projects for the people with high risk behaviours such as IDUs, CSWs and MSMs to achieve at least 90% saturation. We should achieve 90% condom use , reduce STD prevalence below 1%, reduce needle sharing below 1% , reduce needle borrowing rate below 5%., increase needle cleaning rate above 90%. But we are now far away from achieving these standards of targets.
10. We need to expand and strengthen the facilities for treatment of sexually transmitted diseases to cover every district and every community health centre.
11. We need to provide blood banking services in every district so that no woman dies due to want of blood and nobody get untested blood transfusion in the name of emergency.
12. We need to include sex education and reproductive health in the school curriculum for students from Class-VI to XII.
13. We need to involve all the government departments, private corporations and agencies in the fight against HIV/AIDS so as to enable them to implement the AIDS Control programme with their own budget under their own supervision. This is called “mainstreaming and this is the one point agenda of the National Council on AIDS chaired by the Prime Minister.
14. We need to do something to translate the Manipur State AIDS Policy into action. The State Government has repeatedly announced that HIV/AIDS is Top priority in Manipur. But no budget is earmarked for HIV/AIDS Control programme in the state. Many forward states like Maharastra, Tamil Nadu, Kerala, and Karnataka have contributed substantial budget from their state budget to supplement the central funding from NACO. When the first HIV positive case was reported to then Chief Minister of Manipur in the last week of February, 1990, the then Chief Minister announced that the State Government will immediately release Rs. 1.00 crore for HIV/AIDS Control programme in the state. The news was highly publicized in many newspapers. But the money is yet to be released till date. The State Government should provide fund for staffing and strengthening of our blood banks and STD Clinics in the hill districts.
15. Our legislators are very active and they want to carry out many HIV/AIDS activities in their own constituencies. The Manipur Legislative Assembly and the State Government may consider revising the present guidelines for utilization of the Local Area Development Fund meant for MPs , MLAs so as to enable our legislators to utilize at least 5% of the Local Area Development Fund to carry out HIV/AIDS activities like IEC campaigns , voluntary blood donation campaigns , strengthening district level blood banks in hill districts, strengthening STD Clinics in hill districts etc.
16. As political leaders, they need to mobilize all cross section of the people to make the AIDS Control programme a people's mass movement. We are yet to mobilize the churches in the hill districts and the Meira Paibees in the valley who are very powerful force for change in Manipur.
17. As political leaders, they need to participate and supervise proper and effective implementation of the AIDS Control programme in their own constituencies. They need to insert HIV/AIDS prevention messages in their day to day speech or talk to the people.
18. As political leaders, they can mobilize the religious leaders particularly the church leaders and Muslim leaders in the fight against AIDS.

We know leaders are needed because we know that HIV is more than a virus, more than an epidemic. It is a social and political challenge that must be faced head-on. Political leaders are distinguished by their action, innovation and vision. They can set their personal example and mobilize the people and masses towards a specific cause. The words coming out from the mouth of political leaders can incite the community into action. Political leaders have dynamism, energy, stamina, tenacities, foresight and perseverance in the face of obstacles and challenges

Nelson Mandela said "I hope that as time goes on, we realize that it is important for us to talk openly about people who die of AIDS," “HIV/AIDS knows no boundaries, History will judge us harshly if we fail to do so right now.' George W. Bush, President of America said on April 29, 2003 - “There are only two possible responses to suffering on this scale. We can turn our eyes away in resignation and despair, or we can take decisive, historic action to turn the tide against this disease and give the hope of life to millions who need our help now. The United States of America chooses the path of action and the path of hope."

President Bush's bold and aggressive attack on global HIV/AIDS has made it clear - political leadership is essential to battling HIV/AIDS. Early and effective action by high-level political leaders can contain and even roll back epidemics, as evidenced in Uganda, Thailand, and Senegal. Where leaders have been silent, inactive, or worse -- combative, or propagating incorrect or stigmatizing messages -- HIV continues to spread despite the best efforts of communities and contributors. Leadership is an essential enabler for HIV/AIDS efforts, spurring action and magnifying its effects.

Parliamentarians, Legislators and political leaders wield enormous power, authority, and legitimacy. They can combat stigma, denial, and misinformation through forthright discussion of the nature of the disease and thus lead the people to change their behavior. They can influence cultural patterns that contribute to the spread of disease, including gender inequity. By demonstrating that all sectors of society must contribute to the battle against AIDS and applying appropriate levels of human and financial resources to prevention, control, and treatment activities, they are powerful mobilizers of new partners, action, and resources. It is political leadership that ensures a multisectoral response, proven crucial to combating HIV/AIDS effectively.

Considering these issues, I would like to appeal to all political leaders in Manipur irrespective of their party affiliations to initiate the following actions without further loss of time :-

1. To bring out a draft bill for discussion in the state Legislative Assembly so that it can be passed into an Act. Legislators as law makers may like to enact a legislation to overcome the legal barriers, overcoming discrimination of people living with HIV/AIDS, making harm reduction a legally valid programme etc.
2. To initiate for revision of the Manipur State AIDS Policy-1996 incorporating the recent developments like the issues of women and children, widows and orphans, ART treatment, food and nutrition, providing vocational training and income generating schemes for widows and people at risk.
3. To ensure proper and effective implementation of the Manipur State AIDS Policy and monitor the progress of implementation of the AIDS Control programme at state and district levels in Manipur. It should be free from extortion and intimidation.
4. To amend or revise the Manipur State AIDS Policy-1996 to ensure mainstreaming of HIV/AIDS and make it a regular programme of the departments of education, youth affairs and sports , social welfare , women and child development , rural development , Panchayats , Zilla Parisads , police and drug enforcement agencies, Jail Authorities etc.
5. To convince the State Government to contribute a certain amount of money from the state budget every year, which will strengthen the blood banks in the hill districts, STD Clinics in the hill districts, help and in the care and support of people with HIV/AIDS.
6. To amend the guidelines for utilization of the Local Area Development Fund so as to enable ach and every legislator If the politicians, as public leaders can lead the people in building up a people's mass movement against HIV/AIDS, we can definitely achieve a HIV-free, Drug free and AIDS free society in Manipur in the near future.

***Comments and suggestions to this article may be sent to: aidsconsortiumindia[AT]yahoo[DOT]co[DOT]in

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* Dr. Khomdon Singh Lisam has the following credentials: MBBS, M.H.A(AIIMS), HSMC(IHF/London), M.A(HMPP/UK), CCEA( Chula/Bangkok), PDCE( UCLA/USA) He is also the Chairman and Executive Director AIDS Consortium. He can be contacted at aidsconsortiumindia(at)yahoo(dot)co(dot)in.
This article was webcasted on February 29, 2008.

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