Posted by: Singh Is King | Thursday, December 6, 2007

Carrying HIV in their veins

Ninety-five per cent of HIV positive IDUs sampled by the PSACS have been found to have educational status equal to or below class XII, highlighting the need to reach out to the uneducated. Of the 500 injecting drug users tested, only 11 were graduates; 106 illiterates, 161 class V pass outs and 222 plus two pass outs. The problem cuts across age groups, being most pronounced among the unemployed, uneducated and unskilled sections. It is in fact inversely proportional to the level of education; needle sharing, non-cleaning of syringes and lack of awareness about HIV transmission through infected needles being common among the less-educated, as per the Punjab State AIDS Control Society (PSACS) survey.

At 20, village boy Gurpreet can’t sleep unless he has had three rounds of drug intake. Starting on dope as a seven-year-old, he soon graduated to lethal levels. Now, smoking or chewing does not yield him any pleasure. He gets his kick only out of injecting morphine and sedatives, available easily. And he does so many times in the day, so much so that he has exhausted most veins of his body and has only one option left – injecting between thighs.Gurpreet and those like him are posing to Punjab health authorities a mighty challenge. Though related to the state’s old problem of drug abuse, this one is clearly much more serious. Reason: It comes with the risk of HIV, known to be transmitted through infected needles. In Punjab, as elsewhere in India, the most recent shift in drug use patterns has been the shift from smoking or chasing to “injecting drug use” (IDU); the shift brings with it a potential risk of HIV.

Major findings

* HIV along highways: IDUs close to GT road have higher HIV positivity than those away from it
* Most users 20 to 29-year-old
* HIV positivity highest among those above 44
* Urban IDUs outnumber rural in numbers and HIV prevalence rates
* Most drug users non-migrants

The problem, earlier known to affect northeastern states, is now also engulfing Punjab and Haryana, where a recent UNAIDS and the Society for Promotion of Youth and Masses (SPYM) survey found 60 per cent of 3,300 injecting drug users in 10 cities sharing needles. A crackdown on narcotics has prompted drug users into injecting painkillers, says Rajesh Kumar of the SPYM. Other commonly injected drugs in India are heroin, buprenorphine and dextropropoxyphene.

And if you thought that was the end of matter, here’s how IDU is threatening Punjab. The first community-based survey of IDUs in the state reveals an overall HIV positivity of 13.80 per cent among Punjab’s IDUs, way above India’s per cent positivity of 10.16.

Among injecting drug users in Punjab are not only old addicts like unskilled agricultural labourers and truck drivers but new entrants like hotel and service sector employees, even women. The highest HIV positivity of 33.33 per cent in Punjab has been found among IDUs from hotel industry, followed by 25 per cent among those from service sectors.

The problem cuts across age groups, being most pronounced among the unemployed, uneducated and unskilled sections. It is in fact inversely proportional to the level of education; needle sharing, non-cleaning of syringes and lack of awareness about HIV transmission through infected needles being common among the less-educated, as per the Punjab State AIDS Control Society (PSACS) survey.

Ninety-five per cent of HIV positive IDUs sampled by the PSACS have been found to have educational status equal to or below class XII, highlighting the need to reach out to the uneducated. Of the 500 injecting drug users tested, only 11 were graduates; 106 illiterates, 161 class V pass outs and 222 plus two pass outs.

“HIV transmission through IDU needs to be prevented by opening more testing and drug counseling centres and stressing substitution therapy,” say N.M. Sharma of the PSACS, which has also showed how HIV infection is moving along national highways in Punjab.

For wider surveillance, the PSACS collected blood samples of IDUs from two areas – one along the GT Road and the other from Malwa belt away from GT Road. The findings were shocking. IDU site, SWACH, Ludhiana, representing samples from Fatehgarh Sahib, Ludhiana, Jalandhar, Kapurthala and Amritsar along GT road showed HIV prevalence of 21.20 per cent in the 250 IDUs tested, placing this site at No. 5 in India in terms of IDU-HIV prevalence.

Bathinda site representing samples of IDUs from non-GT road areas of Malwa showed surprisingly lower HIV prevalence of 6.4 per cent. Though Malwa is considered the hotbed of drug abuse, the survey shows that all areas are vulnerable to HIV due to IDU. India-wide, the highest HIV prevalence of 31.6 per cent among IDU sites has been reported from Chennai, followed by Khozikode (25); Chandigarh is eight with 17.6 per cent HIV prevalence among IDUs.

The latest findings about Punjab are alarming considering in high-prevalence IDU-HIV areas like Manipur, HIV transmission from injecting (also called intravenous) drug users to their spouses has been established. One study found 45 per cent of the wives of HIV-infected IDUs to be HIV positive.

In Punjab, the problem is severe among those above 44 (mostly married), who have reported the highest HIV positivity of 22.22 per cent among IDUs classified by age, followed by 30 to 44-year-old with 17.04 per cent HIV positivity. Highest numbers of IDUs are from the 20 to 29 year group.

As per National AIDS Control Organization (NACO), IDU accounts for 2.2 per cent of HIV transmissions in India. But UNAIDS India chief Denis Broun, recently in Chandigarh, said, “Our survey shows IDU transmission figure may be higher. If their numbers are higher, which is possible, IDU would be a major HIV transmission route in future. Punjab and Haryana need to devise interventions to tackle the issue.”


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