Lukewarm Response to AIDS in Manipur

Seram Neken *

30th International AIDS Candlelight Memorial at JN Dance Academy Hall on May 19 2013 :: Pix - Deepak Oinam

A mysterious disease swept the gay population in San Francisco in the United States in the early 1980s. Amid confusion and misconception about the disease, many young people had died unaware. In 1983, four young men – Bobby Campbell, Bobby Reynolds, Dan Turner and Mark Feldman, knowing they would die within a year, decided to fight against the disease by putting a banner reading "Fighting for our lives". Thus the International AIDS Candlelight Memorial observance began 30 years ago.

Manipur also joins the rest of the globe in observing the Memorial Day on Sunday, 18th May to honour those who have died of AIDS and to mobilize the society for a collective fight against the disease. 'Let's keep the light on HIV' is the theme for this year's observance, which takes place on the third Sunday of May every year.

Manipur's unique response towards the epidemic was the involvement of people living with the virus in fighting the disease. Manipur Network of Positive People (MNP+), the only network formed and run by people living with HIV and AIDS, was established way back on 7 September 1997 by only five persons (Injecting Drug Users) at Yaiskul Hiruhanba Leikai in Imphal.

'Nothing about us, without us' being its slogan, MNP+ has the objective was to reduce stigma and discrimination, to initiate capacity building, care and support for PLWHA, and to sensitise the community on AIDS awareness.

At present, the MNP+ having more than 1500 members has formed its networks in all districts except Tamenglong to provide services of counseling, treatment, care and support to PLHIVs. Burning challenges before the PLHIVs in Manipur are their lack of capacity, the Hepatitis C Co-infection, dearth of 2nd Line ART facilities, increasing number of infection among women and children.

According to Ng. Ratan, Programme Manager, VIHAAN Project (Sub-Recipient GFATM-IV & RCC-2), the implementation of national AIDS control programme in Manipur is not satisfactory, as the implementing agencies services seem to sideline the quality of services.

As per findings of his agency, as many as 1045 PLHIVs who had been tested positive at ICTCs (Integrated Counselling & Testing Centres) lost linkage to five ART centres (JNIMS, RIMS, Thoubal, CC Pur and Ukhrul ART Centres) for follow up services till March 2014. After investigation, 750 of them were found to have incomplete addresses, while 27 expired after taking ART and 9 expired before administering ART. 234 were found to have either stopped treatment or migrated to other places. He further said the VIHAAN project brought back 25 PLHIVs to avail of ART treatment.

Ng. Ratan who is also a senior member of MNP+, charged the ICTCs, ART Centres and the government agencies for such lapses causing poor linkage between ICTC and ART centres. ICTCs (Integrated Counselling & Testing Centre) are supposed to establish proper linkages with other services like ART Centre, STI Clinic, DOTS centres, Government or private hospitals, Targetted Intervention projects, ICDS/social welfare schemes, District AIDS prevention and control units.

Ratan lamented over the inaction of Manipur state AIDS Control Society in updating its monthly epidemiological data and annual sentinel surveillance reports on time. The data presented on the website of Manipur State AIDS Control Society does not reflect the present trend of HIV epidemic of Manipur, as the available data is only for January 2011. The report on ART treatment displayed in the same website is for October 2010, he asserted.

On being asked about the revision of the Manipur State AIDS Policy, he said that the process of Revision of the Manipur State AIDS Policy, which was adopted in October 1996, has been taking a long time. The state government seems to sideline the urgency of responding to the epidemic in Manipur, he added.

According to the Epidemiological Analysis reports published by Manipur AIDS Control Society through its website, the state has around 38,000 (including 10,000 females) HIV positives by the first month of 2011. According to Sentinel Surveillance Report for 2008, HIV prevalence rate among Injecting Drug Users is 28.65%, while it is 0.5% among Pregnant women. Among the MSM (Men Having Sex With Men) and the FSW (Female Sex Workers), the rate of prevalence stands as 17.21% and 10.87% by 2008.

As per the ART reports of September 2013 available with VIHAAN project, a total of 10,481 PLHIVs including 4,362 adult females are getting ART treatment at the various ART centres of Manipur. Among them, 368 are male children and 348 are female children, while 54 belong to the transgender community.

Informing that as many as 110 PLHIVs are on 2nd Line ART now, Ng. Ratan opined that the State AIDS Clinical Expert Panel which is to give approval for jumping to 2nd Line ART regime has become a hurdle to the needy PLHIVs. A number of PLHIVs are in need of the same, but due to technical procedures involving approval of the Panel, they cannot get the treatment in time, he added.

With the beginning of routine screening for HIV in Manipur in 1986, the first case of HIV infection in the state was reported in February 1990 from the blood samples collected from certain IDUs in October 1989. Thereafter, AIDS gradually became the most alarming epidemic in Manipur with a number of both reported and unreported infections and deaths in the nook and corner. A number of young women were widowed and fairly good number of children orphaned for no fault of theirs. The first case of HIV infection among children was reported in January 1994, while pediatric AIDS detected in February 1995.

The state government and the civil society rapidly responded the catastrophe with a number of strategies including adoption of State AIDS Policy in October 1996. Rapid Intervention and Care (RIAC) project solely for prevention of HIV spread among IDUs was launched in November 1998, and this was followed by intervention programmes among other high risk groups of population. Prevention of Parent to Child HIV transmission project was initiated in the state in June 2001, and a CD4 count machine, for the first time, was installed in 2002. Provision of ART free treatment to needy PLHIVs started in 2004.

Meanwhile, HIV and AIDS issues in Manipur appear to have been toned down in recent years, as the awareness generation efforts are becoming minimized day by day. In spite of the decreasing statistics on HIV prevalence, it is a fact that many young people are still vulnerable to HIV infection nowadays. A large number of youths are carrying the virus either knowingly or unaware. Many people are dying in the nook and corner of Manipur. Besides poor awareness generation, services like care, support, treatment and rehabilitation are yet to be complacent. On this occasion, let us renew the efforts in making an HIV-free Manipur.