HIV and Drug Abuse in India

The Acquired Immune Deficiency Syndrome is caused by a virus called HIV (Human Immune Deficiency Virus). It is a condition in which the built in defense system of the body breaks down completely. AIDS was recognized for the first time in the USA in 1981. In India it was identified in after 5 years in May 1986. In October 1985 the health authorities of the Government of India realizing the threat and spread of HIV and AIDS through the Indian Council of Medical Research organized the screening of high risk groups with the aim of finding out whether HIV infection has reached India. Among the states, Manipur stands first followed by Maharashtra and thirdly Tamil Nadu. HIV is currently spreading in the world at the rate of one new infection every fifty seconds. The HIV/AIDS is not confined to any one class, community, religion, age-group, sex or profession, though according to the Indian Health Organization women and children are believed to be more prone to AIDS. The HIV infection is spread over all religions and all groups.

HIV is an infectious disease but is not easily transmitted through the environment such as air, water, food etc. Therefore it is non-communicable disease. However the main causes or the modes through which the virus enters the body are:

1. Sexual intercourse with an infected person.
2. The second mode is through the transfusion of HIV infected blood or the blood products or through infected blood in needles, syringes and other such instruments.
3. The third way is the transmission from an infected mother to her newborn.

A study conducted by the Directorate of Health Services, Manipur in 1991 pointed out that in the analysis of 6,680 specimens of HIV the highest risk factor (93.9%) in spreading HIV was found to be intravenous drug addicts followed by blood donors (2.93%) and homosexuals (2.61%). Prostitutes infect their clients and in turn also get infected by them. According to one estimate the level of HIV infection escalated from 1% to 30% among the sex-workers in Mumbai in just three years from 1989-1991. Drug addicts who take drugs by injection carry the possibility of spreading the HIV infection through shared infected needles. In Manipur where 40 to 50%of intravenous drug-users are HIV positive many of them are sent to jail in some cases even by their own parents.

Blood donors too transmit the HIV infection. There are estimated to be 2000 blood banks in our country which supply about 20 lakhs bottles of blood every year. Half of these blood banks are government banks and the remaining half is unlicensed.

It is difficult to visualize the devastating effects of the pandemic in our lifetime and beyond. What initially appeared to be an illness confined to few homosexuals has affected millions of men, women and children worldwide. AIDS is not a just a health problem rather it is a societal problem with important social, cultural and economic dimensions. It threatens the basic social institutions at the individual, family and community levels. Its economic consequences are equally serious as it could claim up to half of the national expenditure for health if the needs of AIDS patients were to be met fully. Families of HIV patients too suffer economically, psychologically and socially.

Programs that provide information, condoms and HIV testing to persons in high-risk groups are crucial to preventing the further spread of the disease. In its official policies and statements, the Indian government has recognized the importance of reaching out to women in prostitution and men who have sex with men as a central element of its HIV/AIDS response. The national AIDS program led by AIDS control society of India, funded largely through a $200 million World Bank loan, invests in programs that target persons in high-risk groups. Bill and Melinda Gates Foundation pledged international funding amounting to $ 200 million for combating the disease. Still the potential costs of fighting the disease are staggering. However the facilities available for the care of AIDS patients are woefully inadequate.

Effective strategies have to be designed and developed which can help the patients in overcoming fear and hysteria. Counseling families, neighborhoods and members of social-support networks is also an important need because eventually they have to bear a major responsibility for the sick and the survivors. The trained medical staff can impart information about AIDS to the patients and to their relatives. Since persons suffering from STDs are also a significant risk factor it is important to give high priority to the programmes for the prevention and control of STDs.

The blood or blood products should be tested for HIV before transfusion. The HIV tests should be made free and confidential for persons who indulge in high-risk activities. The medical staff should ensure the use of disposable syringes and other operation equipment. The condoms should be freely distributed and its use should be encouraged among the sex-workers who are the most vulnerable group. The drug-users should be persuaded away from using intravenous drug abuse. The voluntary organizations should help spread knowledge on AIDS to different vulnerable groups through innovative and community-based approaches.

HIV/AIDS and Women

Women are facing devastating impact of HIV/AIDS in world over. In India women are already economically, culturally and socially disadvantaged lacking access to treatment, financial support and education. They are outside the structures of power and decision making. They lack the opportunity of participating equally within the community and are subjected to punitive laws, norms and practices exercising control over their bodies and sexual relations. They are perceived as the main transmitters of Sexually Transmitted Infections (STIs) referred generally as women diseases. The traditional beliefs about sex, blood and other type of disease transmission, these perceptions have become fertile ground for the stigmatization of women within the context of HIV/AIDS.

How does HIV/AIDS affect women?

The transmission of HIV infection in women is through the same routes as men. A small number of women become infected through artificial insemination from an infected person. Lesbians do get HIV/AIDS by using drugs, sharing needles and sharing sex toys with an infected partner without washing. Infected women transmit the infection to their unborn babies during pregnancy, birth and breast -feeding.

Misconceptions:

• Withdrawal during intercourse.
• Douching
• Birth control pills and diaphragm does not protect from being infected with HIV/AIDS.

HIV/AIDS and Pregnancy

An important biological difference between men and women that leads to additional social and cultural consequences with regard to HIV/AIDS is that women with HIV can transmit the virus to their babies before, during and after birth. This type of transmission is called vertical transmission. Only a minority of children gets infected during early pregnancy. Most infected infants acquire their infection during delivery when the infant exposed to large amount of infected maternal blood and secretions. Transmission of HIV/AIDS through breastfeeding poses a substantial additional risk of infection.

Reasons why women do not seek treatment include

• Low self esteem and abusive relationship.
• Fear of being recognized and ostracized from the community.
• Distrust in health care system.
• Partner's failure to disclose status.
• Women are restricted by household responsibilities and lack of mobility.
• There is restricted access to prescribed treatment due to poverty.
• Women oriented health services do not include STD related services.
• Services that only focus on STD treatment carry a greater stigma than integrated services.

Empowering Women

Women have the right to say 'NO' to unsafe sex and to share needle and syringes.

• Insisting the male partner to use condom always for sex.
• To have sex with one partner who they know is not infected with HIV/AIDS and who is not engaging in high risk behaviour.
• To have regular sexual health care checkups to prevent STDs.
• To use sterile needle and syringe each time to inject.
• Finding a way to talk to the partner about HIV/AIDS prevention helps to feel good about the relationship.

Women need counseling on reproductive health issues, family planning and safe infant feeding. There is a need for active networking for comprehensive healthcare and social support for positive women and their family. Pregnant women and infants should be tested who are in high-risk category. There should be rapid assessment for anti-retro viral therapy. Other supportive treatments should be given side-by-side for their rehabilitation.

Drug Abuse in India

June 26 is celebrated as International Day against Drug Abuse and Illicit Trafficking every year. It is an exercise undertaken by the world community to sensitize the people in general and the youth in particular, to the menace of drugs. The picture is grim if the world statistics on the drugs scenario is taken into account. With a turnover of around $500 billions, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other. Drug addiction causes immense human distress and the illegal production and distribution of drugs have spawned crime and violence worldwide. Today, there is no part of the world that is free from the curse of drug trafficking and drug addiction. Millions of drug addicts, all over the world, are leading miserable lives, between life and death. 

India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts are increasing day by day. According to a UN report, One million heroin addicts are registered in India, and unofficially there are as many as five million. What started off as casual use among a minuscule population of high-income group youth in the metro has permeated to all sections of society. Inhalation of heroin alone has given way to intravenous drug use, that too in combination with other sedatives and painkillers. This has increased the intensity of the effect, hastened the process of addiction and complicated the process of recovery. Cannabis, heroin, and Indian-produced pharmaceutical drugs are the most frequently abused drugs in India. Cannabis products, often called charas, bhang, or ganja, are abused throughout the country because it has attained some amount of religious sanctity because of its association with some Hindu deities. The International Narcotics Control Board in its 2002 report released in Vienna pointed out that in India persons addicted to opiates are shifting their drug of choice from opium to heroin. The pharmaceutical products containing narcotic drugs are also increasingly being abused. The intravenous injections of analgesics like dextropropoxphene etc are also reported from many states, as it is easily available at 1/10th the cost of heroin. The codeine-based cough syrups continue to be diverted from the domestic market for abuse 

Drug abuse is a complex phenomenon, which has various social, cultural, biological, geographical, historical and economic aspects. The disintegration of the old joint family system, absence of parental love and care in modern families where both parents are working, decline of old religious and moral values etc lead to a rise in the number of drug addicts who take drugs to escape hard realities of life. Drug use, misuse or abuse is also primarily due to the nature of the drug abused, the personality of the individual and the addict's immediate environment. The processes of industrialization, urbanization and migration have led to loosening of the traditional methods of social control rendering an individual vulnerable to the stresses and strains of modern life. The fast changing social milieu, among other factors, is mainly contributing to the proliferation of drug abuse, both of traditional and of new psychoactive substances. The introduction of synthetic drugs and intravenous drug use leading to HIV/AIDS has added a new dimension to the problem, especially in the Northeast states of the country. 

Drug abuse has led to a detrimental impact on the society. It has led to increase in the crime rate. Addicts resort to crime to pay for their drugs. Drugs remove inhibition and impair judgment egging one on to commit offences. Incidence of eve- teasing, group clashes, assault and impulsive murders increase with drug abuse. Apart from affecting the financial stability, addiction increases conflicts and causes untold emotional pain for every member of the family. With most drug users being in the productive age group of 18-35 years, the loss in terms of human potential is incalculable. The damage to the physical, psychological, moral and intellectual growth of the youth is very high. Adolescent drug abuse is one of the major areas of concern in adolescent and young people's behavior. It is estimated that, in India, by the time most boys reach the ninth grade, about 50 percent of them have tried at least one of the gateway drugs. However, there is a wide regional variation across states in term of the incidence of the substance abuse. For example, a larger proportion of teens in West Bengal and Andhra Pradesh use gateway drugs (about 60 percent in both the states) than Uttar Pradesh or Haryana (around 35 percent). Increase in incidences of HIV, hepatitis B and C and tuberculosis due to addiction adds the reservoir of infection in the community burdening the health care system further. Women in India face greater problems from drug abuse. The consequences include domestic violence and infection with HIV, as well as the financial burden. Eighty seven per cent of addicts being treated in a de-addiction center run by the Delhi police acknowledged being violent with family members. Most of the domestic violence is directed against women and occurs in the context of demands for money to buy drugs. At the national level, drug abuse is intrinsically linked with racketeering, conspiracy, corruption, illegal money transfers, terrorism and violence threatening the very stability of governments. 

India has braced itself to face the menace of drug trafficking both at the national and international levels. Several measures involving innovative changes in enforcement, legal and judicial systems have been brought into effect. The introduction of death penalty for drug-related offences has been a major deterrent. The Narcotic Drugs and Psychotropic Substances Act, 1985, were enacted with stringent provisions to curb this menace. The Act envisages a minimum term of 10 years imprisonment extendable to 20 years and fine of Rs. 1 lakh extendable up to Rs. 2 lakhs for the offenders. The Act has been further amended by making provisions for the forfeiture of properties derived from illicit drugs trafficking. Comprehensive strategy involving specific programmes to bring about an overall reduction in use of drugs has been evolved by the various government agencies and NGOs and is further supplemented by measures like education, counseling, treatment and rehabilitation programmes. India has bilateral agreements on drug trafficking with 13 countries, including Pakistan and Burma. Prior to 1999, extradition between India and the United States occurred under the auspices of a 1931 treaty signed by the United States and the United Kingdom, which was made applicable to India in 1942. However, a new extradition treaty between India and the United States entered into force in July 1999. A Mutual Legal Assistance Treaty was signed by India and the United States in October 2001. India also is signatory to the following treaties and conventions:

• 1961 U.N. Convention on Narcotic Drugs
• 1971 U.N. Convention on Psychotropic Substances
• 1988 U.N. Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances
• 2000 Transnational Crime Convention

The spread and entrenchment of drug abuse needs to be prevented, as the cost to the people, environment and economy will be colossal. The unseemly spectacle of unkempt drug abusers dotting lanes and by lanes, cinema halls and other public places should be enough to goad the authorities to act fast to remove the scourge of this social evil. Moreover, the spread of such reprehensible habits among the relatively young segment of society ought to be arrested at all cost. There is a need for the government enforcement agencies, the non-governmental philanthropic agencies, and others to collaborate and supplement each other's efforts for a solution to the problem of drug addiction through education and legal actions.

Practically every country has its own substance abuse problem to face.

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