HEALTH-INDIA: Border Town in Losing Battle with Drugs, HIV and Insurgency

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

CHURACHANDPUR, India, Mar 8 2005 (IPS) - Perhaps no place on earth deserves free anti-retroviral drugs (ARVs) more than this remote district of 240,000 people in the northeast Indian state of Manipur – just on the porous India-Burma border.

ARVs are substances used to kill or inhibit the multiplication of retroviruses such as HIV and according to voluntary organisations at least 2,000 people in Churanchandpur are known to have contracted the virus that causes AIDS. Also there are more than 5,000 known injecting drug users (IDUs) who are suspected as carriers.

Churachandpur’s tragedy is that its role as a major transit point for heroin from Burma – the world’s second largest producer after Afghanistan – has resulted in too many of its own people turning into users, hence making themselves vulnerable to contracting HIV through shared needle-use.

A walk through Churachandpur town’s dusty, narrow streets and featureless, tin-roofed buildings reveals two equally desperate confrontations going on simultaneously: one between the Indian army and insurgents seeking to liberate Manipur state and the other between voluntary agencies – woefully short of funds and resources – and the AIDS scourge.

Sadly, Manipur could also be on its way to becoming a failed state. The insurgency here thrives because of the support of heroin smugglers. The heroin traffickers in turn thrive because of support from insurgents. And officials term this as a ”narco-insurgency”.

Till a few months ago, local authorities tackled drug addicts, whether HIV positive or not, by simply locking them away to ‘dry out’ in the Churachandpur district jail. That stopped after the army requisitioned the prison, along with several other public buildings for its own use in a bid to stamp out the spiraling insurgency, which it considers a more pressing problem in this sensitive border area.

”We used to visit the inmates, often numbering more than a hundred at a time and provide counseling and care until the army occupied the jail,” Rev. Dr. C.L. Muana, a medical doctor and Presbyterian priest who leads voluntary work in predominantly Christian Churachandpur, told IPS.

More than his priestly functions, Muana is revered in Churachandpur for running Shalom, the only institution that provides worthwhile care or treatment for HIV victims.

Besides being a pilgrimage center for AIDS sufferers, Shalom is also a center for researchers and representatives of international funding agencies.

Yet, not one of the 30 people living with HIV/AIDS that benefit from Shalom’s care and services receives free ARVs. They have to get their drugs from the pharmacies, with each individual having to pay as much as 25 U.S. dollars a month for them – which often amounts to over a third of their monthly salary.

Upendra Singh, an administrator at Shalom, explained to IPS the difficulties involved in getting ARVs to those living with HIV/AIDS in Churanchandpur.

”We have to start with tests to ensure that a prospective recipient of ARV drugs, which are toxic to the liver, does not carry the hepatitis C virus. And more than 90 percent of injecting drug users carry both viruses – HIV and hepatitis C,” he said.

But even more daunting is the fact that to qualify for free ARV treatment provided by the Manipur state government, patients have to travel more than 65 kilometers along a bumpy road and subject themselves to aggressive frisking by Indian Army patrols manning roadblocks on the way to the capital Imphal.

Once in Imphal, they have to pay costly amounts for tests, including the all-important CD-4 count.

CD-4 is an immune system cell that plays a key role in orchestrating the way the immune system attacks foreign invaders. HIV infection leads to the destruction of these cells, leaving the immune system less able to fight infection.

A normal CD-4 count in a healthy, HIV negative adult is usually between 600 and 1,200 per cubic millimeter of blood. In an AIDS patient it is usually below 200.

”For us at Shalom that means accompanying patients in batches to the government hospitals in Imphal, filling in various forms and waiting in long queues for what could be days – frankly nobody is that motivated,” said Muana adding that it would help get a CD-4 machine installed in Churachandpur.

At Imphal itself, fewer than 300 patients are currently on a nationally supported programme that provides free ARVs.

But Dr. Brajachand Singh, a professor of microbiology at the state-run Regional Institute of Medical Sciences (RIMS), and a key figure who draws up the list of beneficiaries in Manipur state, said there were firm plans to scale that figure up to 1,000 patients.

A former Commonwealth Medical Fellow specialising in the diagnosis of viral ailments, Singh said buying and running CD-4 machines is costly (at a million dollars a piece at least) and they are difficult to operate in remote locations because of the fragility of the machine parts.

In any case, scaling up the number of people on ARV therapy and other programmes have, since mid-February, been placed on hold as a result of the Manipur state AIDS Control Society (MACS) coming under a crippling half-a-million-dollar extortion demand placed on it by insurgent groups.

Whether or not MACS would continue to receive support from its parent organization – the World Bank- funded, National AIDS Control Organisation (NACO) – will be decided in New Delhi, said officials who spoke to IPS on condition of anonymity.

”It is well-known that the insurgents take percentages from every institution in the state including the police department and it is not surprising that they want a cut of the World Bank money,” said a member of a voluntary agency who wanted to remain anonymous.

The war against narcotics looks even less winnable with ‘No 4’ or highly refined heroin powder openly sold in public places like the Churachandpur Cinema, in the town’s main market.

Here youths readily inject themselves with needles provided free by several voluntary agencies under ‘harm reduction’ programmes.

But there is much heated debate on the wisdom of distributing needles to reduce chances of HIV transmission through sharing contaminated ones.

M. Sarania – an officer with the central Narcotic Control Board (NCB) – argues that whatever its merits, provision of free needles ”does not motivate people to give up drugs.”

What does work against hard-to-kick drug habits are private institutions with Biblical names like ‘Gilead Balm’ and ‘Bethseda’ in Churachandpur that for a monthly fee of around 30 dollars undertake to chain down drug addicts. But these institutions now face public interest litigation by human rights activists.

According to Sarania controlling the trafficking is nearly impossible because of the porous borders between Burma and Manipur – as well as the adjoining states of Nagaland and Mizoram. Also, poor coordination among various state and central agencies makes matters worse.

All too obviously, the political will is missing. Esther Chinnu Haokip, a well-known woman’s rights activist and a native of Churachandpur is certain that drug trafficking or the insurgency will not stop as long as ”the nexus between politicians and militants continues.”

Among Manipur’s many ‘open secrets’ is the support that the lucrative heroin trade and insurgency receives from elected politicians and officialdom.

Police officers have been sacked for diverting uniforms and supplies meant for their own forces to insurgent groups while politicians, including a former deputy speaker in the Manipur assembly, have been caught red-handed with heroin consignments meant for shipment to western countries.