Statistical Complacency about HIV/AIDS in Manipur

Seram Neken *

"There is no dearth of problems in Sana Leibak Manipur. From law and order menace, communal flare-ups, extortion and terrorism to unavailability of text-books for students; from economic drain, price-rise, inadequate roads, power and water supply to drug abuse, alcoholism and HIV/AIDS; each and every issue ever found around the globe is here in Manipur.

Amid the myriad of troubles facing the state, HIV and AIDS issues can hardly draw the required attention of both the government and citizens. In the present situation, issues like fake encounters, extortions, human right violations, communal tensions, territorial integrity, price-rise, fuel scarcity etc. seem to be more immediate and serious than HIV and AIDS.

People at large have apparently ignored the potential disaster to be brought about by the unchecked AIDS menace in this region. In fact, every attempt to development and prosperity will vanish in futility, if its people are not prevented against HIV infection in time. It is time those working in the field continuously reminded the general population with preventive commandments, care options and treatment regimens concerning this disease. Otherwise, complacency on the matter will become dangerous in the near future."

AIDS (Acquired Immune-Deficiency Syndrome) has so far killed thousands of young men and women in the nook and corner of Manipur during the last two decades. Many young housewives in their twenties and thirties have become widows. Children in large numbers have been orphaned, for no fault of theirs. Ignorance and carelessness are responsible for the rampant spread of HIV among the general population. Earlier, AIDS was believed to be the disease for a select group of people indulging in high risk behaviour such as the sex workers and the injecting drug users. Today, the HIV virus has spread from high risk groups to the general population through unprotected sex. We have witnessed a generalised epidemic in the state.

Routine screening for HIV started in the state from 1986 and the first case of HIV infection was reported from among the Injecting Drug Users (IDU) in 1990. In 1994, the HIV prevalence rate among the Injecting Drug Users was 55.7 % and the figure rose to as high as 76.9 % in 1997. The rate steadily came down from 56.27 % in 2001 to 17.9% in 2007. It stands at 28.65% as per the sentinel surveillance conducted in 2008. The stabilisation and reduction of HIV prevalence among this risk group has been possible due to the successful implementation of Rapid Intervention and Care project (RIAC) under the National AIDS Control Organisation since 1996.

Among the risk groups, female sex workers also contribute considerably towards the HIV epidemic in the state. During surveillance in 2003 and 2004, HIV prevalence among them stood at 12.4%. In 2008, this has slightly decreased to 10.87%. Many NGOs are working hard under the NACO for prevention and control of HIV infection among them. Another risk group of people under intervention is the MSM (Men Having Sex with Men). Prevalence among them was 29.2% in 2003 and it has now come down to 17.21%.

The most worrying part of the story is penetration of the virus among the women attending ante-natal clinics (Pregnant mothers). High rate of HIV prevalence among them indicates onslaught of generalised epidemic. In 2002, out of every thousand pregnant mothers attending ante-natal clinics, 24 were HIV infected. Manipur was categorised as high prevalence state in India, as the prevalence rate among this category surpassed 1%.

However, the rate came down to 1.3% in 2007 and it is only 0.5% in 2008. As per official statistics available, HIV and AIDS epidemic in the state has been stabilised and the agencies concerned have been successful in their mission. However, we shall not remain satisfied and complacent with such figures as it is not sure whether the statistics truly reflect the reality.

Nowadays, the moral behaviour of our youths is turning from bad to worse, amidst the sudden onslaught of various new media, alien cultures, changing lifestyles, widening generation gaps and so on. Indulgence in Pre-marital and extra-marital sexual activities has increased considerably. Commercial sexual activities have increased in the city areas with the increase of number of flesh traders.

In majority of young men and women, sex has apparently become inevitable in their love relations. There are reports of even the married women indulging in unwanted relations with others, facilitated by the misuse of mobile telephony. Young boys and girls, married men and women and even children find a new liberty to explore extra and multiple relations, which were seldom seen before the coming of mobile phones in Manipur. In such an unhealthy and dangerous trend, none can surely believe that HIV and AIDS menace has been controlled in this state.

Two people need to be addressed on priority – the innumerable number of uninfected adolescent youths and thousands of HIV infected people. Consistent preventive communication for the increasing numbers of adolescent boys and girls is the only effective vaccine available for HIV prevention among the general population. We need to inform and educate the youths through suitable media to enable them to get protection from HIV and AIDS. There shall not be dearth of messages and motivating education.

In Manipur, communication activities for HIV prevention are apparently poor for the time being, as the youths in nook and corner are not continuously fed with preventive messages. The communication activities are mainly concentrated in the heart of the state. Reach of messages is as important as access to the messages by the target people. Communication aspect needs to be widened and improved.

For the thousands of people living with HIV, we need to create an enabling environment by motivating and encouraging them to lead positive lives. Health care services and treatments have to be made easily accessible to them. By October last year, total number of PLHAs getting ART treatment at nine ART centres of the state was 6,833 including 509 children. Among them, 2616 were females and 31 were transgender people. The people living with HIV and AIDS are reportedly also facing serious problems regarding the treatment regimens.

If a PLHA who is on 1st line ART is getting resistance to all the 1st regimens, then he needs to change his/her ART treatment regimens to either Alternative 1st line ART regimens or 2nd line ART regimens. To access 2nd line and Alternative 1st line ART, the PLHAs need to adhere to some complicated procedures or guidelines. Because of the complicated procedures, around 20-25 PLHAs have expired since the initiation of 2nd line ART programme in India. However, the Supreme Court has now given a verdict to make available the 2nd line ART or Alternative 1st line ART to all needy PLHAs irrespective of all these terms of references, following a PIL by various organisations. In Manipur too, there are hundreds of PLHAs requiring 2nd line ART treatment and still the number rises day by day. The AIDS control programme needs to focus on these needs of PLHAs.

Early detection of children with HIV is a problem in Manipur as there is no PCR (Polymerase Chain Reaction) machine in the state. Under the PPTCT programme, testing is done with ELISA or Rapid test, which is not accurate for children at early stages. If we want accuracy of results in children, we have to spend a large sum of money at private clinics. Because of non-availability of this type of facilities in the government run hospitals, most children born under PPTCT programme are not completely safe and may die immaturely before their first birthday.

People living with HIV are living a quality of life because of free ART programme. However, PLHAs who are co-infected with Hepatitis-C are dying of liver complications. The reason behind this problem is that most of the PLHAs who are co-infected with Hep-C are not able to afford the cost of treatment and the laboratory investigations. The national programme needs to consider certain help options for the respective PLHAs.

The National AIDS Control Programme Phase III launched in July 2007 with the goal of Halting and Reversing the Epidemic ends in mid-2012. The fourth edition which is on the preparation stage at present needs to be planned with more involvement of civil society organizations and positive networks. More provisions are required to be laid for women and children, and their rehabilitation. It is not encouraging to base the programme formulation solely on available statistical data.

We need to do deep on ground reality and speculate potential dangers due to impending social changes. Better statistics do not always mean that the epidemic has been successfully controlled. This may also be due to lack of programme reach and surveillance activities. We shall not be complacent in having decreased statistical data. Many things remain to be executed to save the future generation.

(This article is filed under RK Maipaksana Journalist Fellowship)

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* Seram Neken wrote this article for Hueiyen Lanpao (English Edition)
This article was posted on May 24, 2011.

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