Two Great Forces in the response towards AIDS epidemic

By Seram Neken *

Countdown for another World AIDS Day begins. In commemoration of the Day, I take the opportunity to unroll the role of two great forces that have really slowed down the pace of the epidemic in Manipur. People with HIV & AIDS and the Legislators have responded with great vigour in the fight against this disease. However, we should not remain complacent at the moment as we have to go miles and miles before achieving an AIDS free society in Manipur.
–Writes: Seram Neken

Epidemic scenario in Manipur:

Routine screening for HIV (Human Immune Deficiency Virus) started in Manipur from 1986 and the first case of HIV infection was reported in February 1990 from the blood samples of October 1989 among the Injecting Drug Users (IDU). The first case of HIV infection among children in Manipur was reported in January 1994 while the first case of pediatric AIDS was reported in February 1995. After two decades of the emergence of AIDS in Manipur, the cumulative number of reported HIV positives in the state by January 2011 is 38,016 including 10,109 females. The number of reported AIDS cases is 4724 and deaths 658.

The above figure reflects only those cases which are reported. Many people are carrying the virus ignorantly, without testing their blood and without reporting to agencies concerned due to one or the other reason. As per the sentinel surveillance reports 2008, the rate of HIV prevalence among women attending antenatal clinics stands at 0.5 percent.

This figure was as high as 2.7 percent in 1999, 2.4 percent in 2002 and 1.4 percent in 2006. However, due to the various awareness and intervention programmes taken up by the government and non-government agencies with support of the civil society, the rate of prevalence among such women who represent the general population came down steadily.

HIV prevalence rate among the Injecting Drug Users has also come down from 72.78 percent in 1998 to 28.65 percent in 2008, as a result of the IDU intervention projects implemented by the NGOs. 17.21 percent HIV prevalence among the Men Having Sex with Men (MSM) and 10.87 percent prevalence among Female Sex Workers are officially reported by the end of 2008.

Chronology of events:

With the detection of first HIV infection case in India in 1986, subsequent constitution of the high-powered National AIDS Committee and launch of the National AIDS Control programme in 1987, Manipur State AIDS Committee under the chairmanship of the Chief Minister was formed. The State AIDS Cell was established in the Health Directorate, Government of Manipur under the supervision of one Medical Officer designated as State AIDS Officer.

The HIV sentinel surveillance started in Manipur from 1994 as an annual event. In 1995, teachers' training on HIV and AIDS was, for the first time, introduced by the State AIDS Cell. Media workshops and Legislators conferences were also organised during 1995 as part of advocacy programme on the disease. The Manipur State AIDS Policy was adopted on 3rd October 1996. It was the first policy statement on HIV and AIDS in the whole of India.

The policy includes effective provisions on harm reduction strategy for prevention of HIV infection among the high risk groups and confidential HIV antibody testing. The Manipur State AIDS Control Society was formed and registered on 28th March 1998 to replace the erstwhile State AIDS Cell under the Medical Directorate of Manipur Government and to implement HIV prevention and control programmes under National AIDS Control Organisation.

The Rapid Intervention and care Project (RIAC) was launched on 7th November 1998. By 1999, intervention projects for prevention of HIV transmission among the high risk groups like Female Sex Workers, MSMs, Migrant Workers and Truckers began its implementation in collaboration with NGOs. The community Care Centres started providing care and support to AIDS patients from 1999.

On 4th June 2001, the Prevention of Mother to Child HIV Transmission (PMTCT) programme was launched in the state. The same programme was subsequently launched at all district hospitals of the state. From 2001 onwards, Hepatitis C testing started at the blood banks and the CD4 count machine was installed at Microbiology department of RIMS in 2002. In 2004, the rolling out of ART treatment was done to avail free treatment of PLWHAs.

Involvement of PLWHAs:

In line with the implementation of GIPA (Greater Involvement of People Living with HIV/AIDS) principles established at the Paris AIDS Summit in December 1994, Manipur Network of Positive People (MNP+) was established on the 7th September 1997 by only five injecting drug users. It is the only network formed and run by the people living with HIV & AIDS in the state of Manipur with the goal of working towards reducing stigma and discrimination and initiation of Networks among PLWHA in the state of Manipur.

A full fledged state level network closely working with 19 state level networks of the country, the MNP+ initiated the formation of 9 district level networks spanning over the state including a support group in Sugnu (a catchments area). It has got its registered District Level Networks in all districts of the state.

"Nothing About Us - Without us" being its slogan, the MNP+ has now more than 1500 members from different districts. Imphal West, Imphal East, Ukhrul, Bishnupur, Chandel, Churachandpur and Senapati districts have got their own Networks of Positive People under the MNP+.

The present activities of the MNP+ include: Running of Drop-in Centres to provide services to PLHAs, care and support under Lifeaid project funded by Catholic Relief Service, Oral Drug Substitution with support from Emanuel Hospital Association and DFID, children welfare programmes under CHAHA Project in partnership with SASO, and education support programme extending support to children affected by the pandemic.

Involvement of Legislators:

Prior to the general elections of 2002, the All Manipur Working Journalists' Union organised a two-day workshop for politicians on HIV and AIDS on 9 and 10 January 2002 at Manipur Press Club Imphal under the sponsorship of Manipur State AIDS Control Society. As a follow-up action of the workshop, the political parties of the state included the AIDS prevention agenda in their election manifestoes.

With the support of UNAIDS and in line with the Parliamentary Forum on AIDS, the State Legislative Forum on AIDS was established on 30th June 2007 with the signing of the 15-point Imphal Declaration. Besides the funding from UNAIDS, the 60 MLAs of Manipur contribute rupees one lakh each for organizing Advocacy and Awareness activity in their constituencies. Moreover, the Manipur State Panchayat Forum on HIV/AIDS was also formed on the 16th Jan, 2008 with 14 members.

Since inception, the MLFA has organised a number of political conventions in various assembly constituencies of the state. During the organisation of conventions, some MLAs of the concerned assembly constituencies announced their individual commitments in the response to the AIDS epidemic. For instance, MLA of Sagolband Assembly Constituency Dr. Loken Singh announced to contribute Rs. 50,000/- for the HIV/AIDS programmes in his constituency.

Late E. Kunjeswore, the then MLA of Yaiskul Assembly Constituency said that he would pursue the government to allot Rupees one crore for HIV/AIDS prevention and control programme in Manipur. He also committed to spend 2% of his Local Area Development Fund for HIV and AIDS issues in his area. Radhabinod Koijam of Thangmeiband Assembly Constituency and Senior Opposition leader committed to support those infected and affected by HIV/AIDS in his constituency.

O. Joy Singh, Opposition Leader and MLA Langthabal Assembly Constituency announced that he would provide financial aide to PLHAs in his constituency. MLA Lilong Assembly Constituency Md. Hellaludin Khan promised to provide Rs. 5,000/- annually to the families affected by HIV/AIDS in his constituency. The involvement and commitment of the powerful politicians in this issue have been appreciated in the nook and corner of the state.

Challenges ahead

In spite of tireless efforts to combat the disease, there are still reports of new infections and deaths in the nook and corner of Manipur state. We have conquered many, but we have still a long way to go. Areas that need urgent attention on this regard are: Hepatitis-C (HCV) co-infection with HIV, non-availability of ART 2nd line regiment, economic rehabilitation of affected women and children, prevention of cross border transmission and improvement of service delivery in border areas.

Manipur has a long porous border of 357 KM with other states and countries. Moreover, HIV prevalence in neighboring Myanmar is considerably high and prevention activities are poor. The border trade which started since 1988 through Moreh has an indirect impact on HIV situation in Manipur. Therefore, coverage of HIV intervention in border towns/ villages needs to be widened and services improved.

The issues of women and children infected and affected by HIV need to be addressed especially and urgently. Most of the infected / affected young widows in Manipur have less opportunity for income generation and social support. There is need for nutritional and educational support to children orphaned by AIDS. The Hepatitis co-infection is a major concern to most HIV positive people.

The costly medicine and complicated treatment options make it difficult for many HIV positive people to lead a longer and healthier life. And Last but not the least is the Manipur State AIDS Policy which needs to be re-adopted with due improvements to suit the changing scenario of the epidemic.