3 ways India is making drug use safer

India is massive. It is the world’s largest democracy, with a population of 1.2 billion people of whom 2.1 million are living with HIV. This makes it the country with the third highest population of people living with HIV globally, after South Africa and Nigeria.

During the period 2000-2015, the annual estimated number of new HIV infections decreased by 66%, however this pace of decline is not fast enough to meet global HIV targets.

The HIV epidemic in India is concentrated in specific regions and populations. One such population is people who use drugs, who are considered a high-risk group for contracting HIV and are one of a few marginalised communities that receive Targeted Interventions (TI).

Here, we explore three such harm reduction interventions that focus on preventing new HIV infections among people who use drugs.

1. Working with the government to understand drug trafficking

Heroin is one of the mostly widely available drugs in India. It enters the country through two main routes. The first originates from Afghanistan (where 85% of the world’s opium is grown) and moves through Pakistan and into north-west India. The second route is from Myanmar where heroin and ATS (Amphetamine type substances) enter India through the north-eastern states such as Manipur.

Through the Hridiya programme, our partner Alliance India provides services for people who use drugs in three locations in north and north-east India:

• Uttar Pradesh, which has a population of 200 million and the highest HIV prevalence amongst high-risk groups in select states and the estimated population of people who inject drugs is 13,500
• Uttarakhand
• Delhi

Uttar Pradesh and Uttarakhand share an open border with Nepal, which doubles up as a popular transit route for drugs from India into Nepal. In response, the Hridiya project has invested in ‘TI PLUS’ – an additional Targeted Intervention that operates in this area – to provide needle and syringe programmes to approximately 120 people who inject drugs and train community-based mentors to enrole those hardest to reach. By providing ongoing support and a telephone helpline, services to prevent HIV are more community friendly and accessible.

Six years after the initial phase of this project, the State AIDS Control Programme in Manipur has expanded these harm reduction services, including community distribution of Naloxone – a life-saving drug that can reverse the effects of an opioid overdose when it is given in time.

2. Testing and treating Hepatitis C

Globally, half of the 15.6 million people who inject drugs are living with Hepatitis C – a liver infection caused by the Hepatitis C virus (HCV) – and a quarter are living with HIV. Those enrolled in the TI programme receive access to life-saving Hepatitis C testing and treatment support.

In 2018, the government of India launched the national viral Hepatitis control programme with a focus on treating Hepatitis C among people who inject drugs. Alliance India contributed to the development of the national policy and guidelines to test and treat it among people who inject drugs.

Now, Alliance India colleagues are mobilising communities of people who inject drugs to test for the virus and advocating to integrate Hepatitis C treatment within existing government clinics such as antiretroviral treatment (ART) centres.

The final initiative is to pilot opioid substitution (OST) centres in community locations, and identify other locations to distribute clean needles and syringes. This enables people to access services in informal locations, often in people’s homes, which are closer and easier to reach.

3. Providing women who use drugs with tailored services to reduce violence

In New Delhi, Alliance India lead Women Initiated New Goals for Safety (WINGS), a research project that supports women who inject drugs in Pune. They also take the lead in making sure harm reduction services are female-friendly.

In the district of Punjab for example, together with the Punjab State AIDS Control Society, there are plans to set up a drop-in centre exclusively for women who inject drugs. Here, they will receive harm reduction as well as sexual and reproductive health and rights services, and social protection support for their families in a ‘one stop shop’.

This article was co-written by Charan Sharma, Technical Advisor Harm Reduction at India HIV/AIDS Alliance.