Injecting drug use and HIV in northeast India: negotiating a public health response in a complex environment

Abstract

The northeast Indian states of Manipur and Nagaland are characterized by longstanding and sometimes violent civil insurgence, tribalism and religious conservatism. A number of conflicts are being played out in these two states between insurgent groups and the Indian military, rival insurgent groups and different tribal groups. This has a profound effect on the daily lives of individuals and communities, and development within the region. The problem of injecting drug use is substantial, with approximately 2% of the population injecting drugs, both heroin and pharmaceutical agents. Consequently, Manipur and Nagaland are the two highest HIV-prevalence states in India. Acknowledgement of injecting drug use and HIV as issues worthy of attention and the development of an effective response to them have been complicated by deeply felt social conservatism. The emergence of an effective public health response for HIV prevention in this complex setting will be described and discussed.

Keywords:

• HIV/AIDS
• injecting drug use
• harm reduction
• sex workers
• public health
• northeast
• social change

Notes

1. Chandrasekaran et al., ‘Containing HIV/AIDS in India’.

2. Jacob, ‘AIDS, Security and Conflict Initiative’.

3. Ministry of Development, ‘North Eastern Region Vision 2020’.

4. Singh, Nagaland.

5. Government of Manipur, http://www.manipur.nic.in.

6. Census of India 2001, http://censusindia.gov.in.

7. Government of Nagaland, http://www.nagaland.nic.in.

8. Census of India 2001, http://censusindia.gov.in.

9. Ministry of Development, North Eastern Region Vision 2020.

10. Baruah, Durable Disorder.

11. Census of India 2001, http://censusindia.gov.in

12. Baruah, Durable Disorder.

13. Ibid.

14. MSF, Top 10 Most Underreported Humanitarian Stories.

15. Baruah, Durable Disorder and Jacob, ‘AIDS, Security and Conflict Initiative’.

16. DiNatale, ‘Project ORCHID’.

17. Deutschmann et al., Evaluation of Project SHALOM.

18. Von Furer Haimendorf, Return to the Naked Nagas.

19. Beyrer et al., ‘Overland Trafficking Routes and HIV-1 Spread’ and UNODC, Drug Use in the Northeastern States.

20. Reid and Costigan, Revisiting ‘The Hidden Epidemic’.

21. Chandrasekaran et al., ‘Containing HIV/AIDS in India’; Singh and Sharma, Rapid Situation Assessment of Drug Use; and UNODC, Women and Drug Use.

22. Kermode et al., ‘My First Time’ and Kermode et al., ‘Killing Time with Enjoyment’.

23. NACO, National Baseline.

24. NACO, Notes of HIV.

25. Eicher et al., ‘A Certain Fate’ and Sharma et al., ‘Five Years of Needle Syringe Exchange’.

26. NACO, Notes of HIV.

27. Ibid.

28. UNODC, Drug Use in the Northeastern States.

29. Ball, ‘HIV, Injecting Drug Use and Harm Reduction’.

30. Deutschmann et al., Evaluation of Project SHALOM.

31. Ibid.

32. Sharma et al., ‘Five Years of Needle Syringe Exchange’.

33. Kumar et al., ‘Opioid Substitution Treatment’.

34. NACO, Notes of HIV.