HIV/AIDS in Manipur is 15 years over now. Many phases have passed. From widespread prevalence of HIV among the Injecting Drug Users during the mid-90’s to emergence of young widows and consequently orphans due to AIDS now has been the scenario of this pandemic in the state.

At par with the increasing statistics of infections and deaths, Manipur state has also responded quickly and in time with regard to HIV/AIDS prevention and control efforts.

From shouting preventive slogans through various media to the free provision of ART drugs to patients, we have come a long way in fighting the HIV/AIDS menace in this small and highly vulnerable state. But the problem still persists. New trends have appeared, new challenges have come up and new solutions are called for.

Projections – still alarming.

It seems that the Manipur society as a whole has not understood the problem of HIV/AIDS in the State. Many a layman refuses to accept the statistics and projections made on HIV/AIDS. Many more are not aware of how many children are living without father or mother in the State, how many children are bearing the virus nowadays.

It is said, out of about 24,000 total reported HIV positives in Manipur, 5% are children, 25% are women. The infections among the general population may be estimated as 13 out of every 1000 population.

The annual estimated pregnancies in the state is around 48,000 including more than 600 HIV positives who are going to deliver around 200 positive children per year.

If mother to child prevention services are not rendered at all, we will see around 200 HIV infected children each year. Although the Nevirapine treatment is given at PPTCT /ICTC centres, it reaches only a fraction of the total institutional deliveries. Many children are born at home, particularly in remote and hill areas.

Most women lack knowledge on HIV/AIDS, and even more about the Nevirapine prophylaxis. The services therefore are almost nil to a vast majority of pregnant mothers. So educating the women, empowering them, developing health seeking behaviour etc. are the top priority areas in preventing the further HIV transmission to newborn babies.

In the beginning, only the Injecting Drug Users were focused.

Nowadays, the prevalence rate among MSM (Men having sex with men) is increasing day by day. The sexual behaviours of this group of people are dangerous as far as the HIV spread is concerned. Last years surveillance data indicated 15.6 per cent HIV infection among the MSM in Manipur.

This is also a neglected area where we need to focus. The MSM need to be given social recognition and their creativity is to be counted as a treasure of the society. They need to be empowered and educated so as to be able to defend themselves from HIV infections and STDs.

The social recognition of the homosexuals and their creative excellence in various fields need to be the main agenda in formulating specific HIV/AIDS programmes and projects for them. The third gender people like MSM need empowerment, education and recognition so that they meet the mental and physical harassments of sexually active young people, security personnel etc. Their talents may also be utilized to make them involved in AIDS control programmes.

Disclosure - stories of victimized victims

Very recently, we are beginning to see another neglected side of the story. The ordeals of the affected and infected people have begun to appear in local dailies almost daily.

In the past, we heard of HIV infected women being discriminated and stigmatized by the families of in-laws, deprived of property rights, inheritance rights etc. They were refused to share social gatherings by the locals due to the stigma attached to them. Now, in my opinion, the tragedy has changed.

HIV positive women fighting for life, fighting for their children, fighting for rights and fighting against all odds are many times sexually abused and tortured by people who are considered as saviours to them. When they approach for help, they are welcome and helped only to abuse them and to lure for sexual offers.

It really is a shame. The stories appeared during the last one week have exposed the nature of some people who are sitting in the wrong chairs doing wrong actions only to bring down the society to the stone age.

Only a week ahead of the World AIDS Day, the Sangai Express published a stories of such a HIV infected woman victim who approached for justice to a lawyer and had to sacrifice the chastity of a woman to the justice-provider for her only child.

In another story appeared two days later in the same paper, another HIV infected woman seeking ART drugs for life was reportedly lured by a person working in HIV/AIDS field. She even lamented about the behaviour and attitudes of some people manning ART centres. In fact, ART centres may be considered as a temple as people are coming to it with the hope of regaining their lives.

There are many more untold stories, which are kept concealed for fear of social stigma and discrimination. Now the question arises – what is the most immediate need for an HIV infected/ affected woman ? Is it emotional healing, economic rehabilitation, medical care, ART drugs or is it legal awareness or self protection against opportunist service providers. This is another side of the AIDS scenario in Manipur.

Moral education, religious mindset and life skills for young people

In traditional societies, religion had been a successful tool for mass control. Unity, peace, harmony, happiness and good life are common aspects of all religions. Apart from religion, meditation is also a useful practice for control of mind and differentiation between the good and the bad or the useful and the harmful.

In our experience, most people are afraid of God. So, God can be a solution for social evils. Children should be taught the values of life, what God allows and what God does not allow. They will automatically follow the things God allows them to do. In this way, the many social problems can be solved.

Children and young people should be given adequate moral education at the family level, school level and the community level. Life skills that are necessary for a successful social life are to be taught to the children in their formative period so that they can face the emergent feelings and experiences in life.

HIV/AIDS control and prevention programmes should be integrated with the moral education for young people so that there is long term solution for a disease free next generation. Teaching the children ‘what ought to do and what ought not to do’ is a must.

The entertainment and real life situations should be kept separate in the minds of our youths. We have to explore various means to face the media invasion of the present information technology age.

The young people should be educated with accurate and full information about sex and sexuality so that they can decide for themselves - what is moral and what is immoral. A frank and explicit discussion on sexual health education without hesitation and embarrassment is required to meet the emerging challenges in the society.

A responsible moral behaviour should be promoted among the youths. They should be empowered to say no to sex and no to drugs. It needs a life skill. During the adolescence period, there are many misconceptions in their minds regarding sexual matters. These are to be clarified with sex education.

They are to be convinced that ‘love and affection’ can be without sex. Love without sex promotes healthy communication between lovers, reduces risk of HIV/AIDS/STDs and premature pregnancy. Moreover, there is trust and respect for each other. All these lessons are to be made part of moral education. There is strong need for changing the traditional social perception, notion and attitude towards sex.

Short term preventive measures like condom promotion and needle syringe exchange have to be complemented with long term social healing programmes like moral education for the children. They are the pillars of the nation. Losing moral characters, obstinate brought-up in families, long divide between generations, media onslaught etc. are the current ailments in our society, which needs a different healing process.

Next to parents, teachers in schools have a big responsibility for a good and safe behaviour of the children. Pupils naturally respect the teachers, keep faith in them and listen to them carefully – that also daily. Schools are more effective than other mass media in spreading AIDS awareness and behaviour change.

Because, mass media give message but there is no follow-up and effective feedback from listeners. The teachers however can follow-up their pupils daily, they can observe the changing behaviour among the pupils regularly. Thus, focusing the schools as an important social healing tool will only save the next generation from HIV/AIDS.

Services needing social support

Today, medical science is well-developed enough to give longer lives to those living with HIV/AIDS. In the beginning, it is thought people with HIV are useless and people with AIDS will die soon. Now those sayings are far from truth as there are plenty of anti-retroviral drugs to control the progress of losing body’s immunity. AIDS has become a manageable disease just like the Diabetes, High Blood Pressure and Arthritis.

Anti-retroviral drugs in the form of combination therapy acts as immune booster plus decelerator of replication of the Human Immune Deficiency Virus inside the infected human body. These AIDS controlling drugs are available free of cost at selected government health set-ups under the HIV/AIDS control programme.

All pregnant mothers need to check for their HIV status, disclose to concerned agencies and individuals, to avail the life-long treatment free of cost or they will put themselves and their children to the jaws of death. Silence will endanger them. If disclosed, doors remain wide open to give meaningful lives to affected and infected individuals.

The provision of services in regard to prevention, care and treatment cannot go alone. It has to be supported with empowerment, education, sustainable approach and social understanding. Women should not remain silent – they have to understand they only know their problem and they are the only advocates of their problem.

Stigmas and dogmas attached to HIV/AIDS are reasons for infected or affected people remaining silent over their HIV status. Concealing the status out of shyness and fear helps in silent spread of the virus among the general population. Majority of to-be-married couples hesitate to undergo pre-marital HIV test in spite of repeated appeals from all circles.

This indecision among the young brides and grooms will only result in their leading an uncertain future married life. Many innocent young women become widows, many newborn children are orphaned. The society at large owes responsibility for this social disaster.

Now that anti-retroviral treatments are rolled out successfully does not mean that the HIV/AIDS problem will wither away. It will persist until and unless our people are able to follow a positive behaviour in terms of safe relationships, active awareness generation, gender equality and a strong political and individual commitment in combating the disease.

World AIDS Day – relevance

This year's World AIDS Day is important because 25 years have passed since the appearance of HIV in the world. As many as 65 million people have been affected by this virus till date. Twenty five million people globally have died of AIDS and about 40 million people are now estimated to be living with the virus.

Fifteen million children have lost either of the two parents due to AIDS. Young people who are the pillars of a nation, young women who are mothers of the society and young children who are the potentials of the next generation are becoming victims of the cruelty of HIV/AIDS epidemic around the world.

During the last two and a half decade, many developments in the field of HIV/AIDS have taken place, many commitments have been made at various levels to contain the epidemic.

Billions of rupees have been spent in fighting the epidemic. Many mistakes might have been committed, many corrections might have been made. It is yet to ascertain the accountability of the promises made, the works taken up and the money spent on it. It is time to see, how sincere the warriors are, how much accountability is there in them and what will be the future course of action.

The theme for this year's observance has thus been brought out to check the accountability of the promises made and also the actions taken up in the war against AIDS. In Manipur too, time has come to assess the performance and quality of services rendered for an AIDS free Manipur for the last 15 years.