IV drug abuse blamed for rising HIV infection rate in parts of India

CHENNAI, INDIA–David, 37, injects heroin daily–a schedule that has never varied for the past 15 years. Despite perpetually running short on cash to buy his fix, he has never been desperate enough, he says, to share needles.

Audio slideshow: A drug addict injects despite HIV fears

“I know how HIV goes from one body to another,” David says. “I’ve seen many friends get sick and die like that.”

Still, David admits that when he finally faces the dire choice between buying a new needle or heroin, his addiction will overcome his fear of HIV.

David remains HIV negative but his dependence on heroin puts him at an enormous risk. A study released in November by UNAIDS and the World Health Organization notes that intravenous drug use is the main risk factor for HIV infection in north-east India, and now plays a growing role in major cities like Chennai, Mumbai and New Delhi.

The study shows that efforts to help drug users tend to be at best “inconsistent, too small and infrequent” to make a dent. If an urgent effort is not made to expand programs that help addicts, the study found, there is a strong possibility that intravenous drug use combined with paid sex could make the HIV epidemic in India far worse.

Needle exchange programs, which have proven to reduce the rate of infection among addicts in Europe and the United States, are almost non-existent in India. The Indian government notes that such programs are “frowned upon in India because of ethical and moral implications” of appearing to condone drug abuse.

That political attitude leaves David with few choices. He depends on his 68-year-old father’s meager pension to survive, and as his father’s health dwindles so do the days of not sharing needles.

ARV production is an Indian government responsibility

Human Rights Watch recently invited Lives in Focus to collaborate on a Web log in conjunction with the XVI International AIDS Conference in Toronto, Canada from Aug. 13-18.

One of the speakers, Anand Grover, the co-founder of the Mumbai Lawyers Collective HIV/AIDS Unit, delivered a speech on the second day of the conference titled “Human rights and Social Vulnerabilities,” in which he expressed concern about the availability of inexpensive generic drugs in five to ten years with India’s agreement to comply with the Agreement on Trade -Related Aspects of Intellectual Property Rights (TRIPS) regarding product patents.

Lives in Focus had interviewed Grover in Mumbai earlier about this subject and asked what alternatives there are to Western pharmaceutical companies imposing licenses on Indian generic drug makers and why the Indian government itself does not begin production of the drugs. Listen to his thoughts on the subject in this audio clip.

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Related Previous Posting:

Anand Grover addresses the gulf between the Indian government’s statistics and NGOs statistics on the number of people infected with the HIV virus. (Audio Interview).

Anand Grover discusses condoms and Morality (Video Interview).

Making a big decision

Dr. Troy Cunningham

Troy Cunningham did not intend to spend too much energy in his temporary job as an HIV/AIDS awareness counselor in the late 90s. He had taken one year off to study for his medical entrance exams and was told this job entailed light work and plenty of time to study. He brought his books with him, but what he saw grabbed his full attention. Back in medical school, he independently studied what he could about HIV/AIDS because there were no official courses on the disease. Now at 35, he heads the medical staff at the Freedom Foundation in Hyderabad and helps the center make its most critical decision.

Listen to Dr. Troy, as he is known, explain how he decides which child should remain in the custody of his or her extended family and which child will be admitted as an orphan to the center.

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What did marriage bring me?

Shabana

Shabana, 20, realized she was HIV+ after her husband’s health began rapidly deteriorating. A Muslim woman, she now serves as a counselor trying to educate those in her community about the dangers of HIV/AIDS and how it spreads.

Lives in Focus has profiled her in a video interview and talked to her mother about how she handled her daughter’s situation. But perhaps the most poignant glimpse into Shabana’s delicate psyche came at the end of the interview when she asked if she could pose a question.

Listen to her in Hindi.

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With English voiceovers.

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Related Previous Postings:
A mother’s love (Podcast).
Shabana’s hopes (Video Interview).
Facing the Glare (Photography).

Working in the Middle East and HIV

Nirmala Kumari worked as a domestic worker in the Middle East for nearly ten years. She earned a good salary—especially when compared to Indian standards for the same work. She wired most of her earnings to her husband every month to help care for their two sons and saved some for a ticket back to India every two years.

click image for audio slideshow

While she was thousands of miles away for those long years, her husband visited prostitutes using the very money Nirmala sent home.

Nirmala is one of hundreds of thousands of Indian men and women who work in the Gulf as menial laborers doing the jobs native Arabs refuse. The distance and airfare keep them in the Middle East for years at a time.

The long periods of separation can lead to indiscretions. The problem is compounded within extended families. A young woman diagnosed as HIV positive confided to a social worker in Hyderabad that her brother-in-law had frequently raped her while her husband worked in the Middle East. Another man described his need for companionship while his wife was away.

Nirmala, now 35, says she continued to love her husband even after she discovered his infidelity. She continued to love him as he died of AIDS. HIV positive herself, she hopes to rebuild her life. She would like to return to Dubai to earn higher wages but worries about her health once she runs out of the ARVs supplied by the Indian government. Nirmala says she would not dare seek medical treatment for the disease in the Middle East—a sure-fire way to be deported.

Click the image above to view English captions while Nirmala speaks.

Listen to her in Telugu.

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A friendship with Narasimha

Slideshow: Time spent with Narasimha

While I first met many of those profiled on Lives in Focus for the first time last year, Srinivas has been visiting them since 2001. His relationship in many ways extends beyond that of a photographer and subject.

Srinivas watched in 2002 as AIDS took the life of one sister but spared the other. On this past trip, Srinivas was sincerely moved when he saw how well the surviving sister had fared despite losing her entire family.

When I accompanied him in 2005, I was struck by how everyone considered Srinivas an old friend. In this series, Srinivas talks about his friendship with one patient:

I met Narasimha in 2002 when I was visiting Freedom Foundation AIDS Shelter for the third time. At that time he was quite ill from the effects of HIV. There were days when he just lay in bed and other times he was quite active, helping around the clinic, tending to the garden and helping bathe the really sick patients.

During my time there he kept asking me to take a full-length photo of him so that when he died his mother could put that up on the wall.

One thing that struck me about him was how positive he was about life even as he lay in bed not knowing whether he would make it to tomorrow.Since 2004 Narasimha has been on anti-retroviral medication and his health has greatly improved.

As of now, he gets his medication free from the government hospital. The situation will change as he becomes immune to the first line of treatment and has to switch to the more expensive second and hence third line of treatment.

Click on the audio slide show above to hear Srinivas discuss his friendship.

Related Previous Posting: Narasimha, a 30-year-old HIV+ auto-rickshaw driver, wonders about his future (Video Interview).

The life of a social worker in the early years of the AIDS epidemic

Ashok Rau, a co-founder and executive trustee of the Freedom Foundation, a care and support center for HIV positive people, today plays a national role in India’s fight against AIDS. He was nominated by the President of India as a member of the Technical Resource Group on Legal and Ethical Issues of HIV/AIDS and he is a member of the National AIDS committee.

This recognition, however, came after a decade of police harassment and mistrust by neighbors.

Established in 1992, the Foundation was started to provide a treatment program for alcoholics and drug-addicts, but it did not take long to notice a link between addiction and AIDS. In 1995, the Freedom Foundation opened a separate center for HIV positive people—one of the first of its kind in the country.

Ashok Rau

Finding a landlord willing to rent space to accommodate a growing number of patients was a struggle in itself–the only property the Freedom Foundation managed to rent was an abandoned chicken shed outside Bangalore. Rau and co-founder Karl Sequiera, spent months washing away the stench of chicken droppings and working as masons to build livable quarters.

The reality of the epidemic drew patients from all over India, but few doctors and social workers were willing to work at the center out of fear. Rau and Sequiera took on the work themselves, cooking and caring for patients and living among them.

As time passes, it is important to acknowledge the struggles of those involved in the early years of the battle against AIDS in India—much like the National Institutes of Health now honors the work of western researchers by gathering oral histories in which they recollect their roles in discovering the cause of the illness.

Lives in Focus here presents an audio podcast of Rau recalling his life as a social worker caring for HIV positive people at a time when few acknowledged their existence.

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A numbers game

In late January, the Chinese government, the World Health Organization and UNAIDS released a report which revised downward the estimate of the number of people living with the HIV virus in the vast country.

The revision states that 650,000 people in China are infected with the HIV virus–75,000 of whom have full-blown AIDS. An earlier study (released in 2003) had reported that about 840,000 people were HIV positive–of whom 84,000 had full-blown AIDS.

The new numbers, according to UNAIDS and WHO, are a result of China’s improved surveillance system. The Chinese Health Ministry expanded the number of sites from which it collects data from 194 in 2003 to 329 in 2005. It has also increased the population groups covered by the system, making the new estimate more accurate, according to the UNAIDS and WHO.

But with 70,000 new infections in China last year, international health organizations warned that the revised numbers leave no room for complacency.

India faces its own surveillance challenges. Political, social and economic issues complicate the process of gathering information to accurately reflect the number of HIV positive people in India.

In this audio podcast, Anand Grover, an attorney and project director for the Lawyers Collective HIV/AIDS Unit in Mumbai, India, addresses the gulf between the Indian government’s statistics and NGOs statistics on the number of people infected with the HIV virus. The Collective’s attorneys represent indigent people in court to help win them access to medicines or to protect their jobs against discrimination. The Collective is also trying to influence Indian legislation to make access to health services a government obligation.

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Related Previous Posting: Anand Grover discusses condoms and Morality (Video Interview).

A mother’s love

Slideshow: A mother’s love

Fatima, 35, worries that one day her six-year-old granddaughter will have to look upon her as a mother instead. Fortunately, the child’s own HIV+ mother—Shabana–has remained healthy on an anti-retroviral treatment. As much as Fatima praises God for keeping Shabana alive, she knows that medicines also play a vital role and she is prepared to sacrifice to keep her daughter healthy.

“We will eat whatever we find so we can still buy the medicine,” says Fatima. “God will find a way—we have at least that much faith.”

In this audio podcast, Fatima talks about how her heart pounded when she first learned of Shabana’s illness and how her faith keeps her strong. (Click the photograph above for an audio slide show or here for audio only.)

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Related Previous Posting: Shabana’s hopes (Video Interview)

Posting delay

We wanted to explain why we haven’t posted anything since Dec. 21, 2005. We are applying for a grant for the next phase of the project and that work is consuming most of our energy. The deadline is Jan. 31.

The next few items we are considering include:

1. Shabana’s mother’s thoughts and feelings about her daughter’s situation;

2. An expert speaking about the infrastructure required to get treatment to those who need it;

3. And the photographer’s reflection on his long friendship with someone surviving because of anti-retroviral drugs.

We apologize for this delay and we will begin posting as soon as the application material is postmarked.