Addressing Vulnerability of Women IDUs in Manipur Female Drop in Centre Presented by Sunil Nanda, Alliance India International HIV/AIDS Conference, Mexico, Aug 2-8, 2008

HIV & Drug Use Scenario in Manipur, response and women vulnerability Manipur with population of about 2.4 million, the highest HIV Prevalence State in India and amongst the six high prevalent states in north-east Manipur is one of the first states in India to take up harm reduction approaches for HIV prevention which has resulted in decline in IDUs prevalence from 80% (1998) to 24% (2006), one of the highest in the world The epidemic is no longer confined to the IDUs Prevalence rate among pregnant women increased from 0.8% (1994) to 1.67% (2004) with some decline to 1.3% (2006) Effective prevention interventions amongst ANCs are very much neglected Prevalence rate among STD Clinic attendees is 12.2% (2006) Hepatitis-C co-infection among drug users is as high as 60% and is declining in recent years Manipur State AIDS Control Society has been implementing NACP I and II focusing on prevention rather than care and support. Besides most of the care and support projects do not address women and children. In NACP III (2007-12) increased focus given to care, support and access to treatment Several NGOs work on prevention and harm reduction with focus on Men Alliance India’s work focus is on women IDUs and their spouses/partners Women have low societal status, marginalized, confined to homes, IDUs/drug users are hidden population and several indulge in sex work.

Alliance – SASO Programme India HIV/AIDS Alliance and SASO are implementing women focused programmes since 2004; Home and Community-Based Care and Support programme The target groups of women are linked to various services through the outreach work and community support groups at the community and at the women ‘friendly’ clinical based Drop in Centre (DIC). Men as husbands/ partners are encouraged to come to DIC for services Apart from providing harm reduction and care and support services the programme has linkages with government institutions for ART , PPTCT and social schemes like widow pension; female drug users are referred to two rehabilitation centers with exemption of treatment and rehabilitation costs. The hands on doctors training at the clinical DIC have increased the scale of skilled treatment practitioners in Manipur. Support services: condoms and syringes, medicine and diagnostics, detoxification, abscess management, IEC, telephone helpline, IGP for women, preparedness for ART.

Achievements, Lessons Learned, Next Steps Achievements: More than 90% of IDU clients of the programme (both female and male) are not sharing needle and syringes. Female IDUs are much more aware about condom use, at least 90% of them are using condoms regularly (most of these women are sex workers). More than 70% of female drug users have come for health checkups. Formal and established referral system with Govt. VCCT, PPTCT and ART centers, has increased successful referrals Lessons Learned: Often neglected women focused out reach work and women support group activities in communities and the women friendly clinical based DIC make bring greater impact in combating vulnerability and HIV/AIDS among women, their spouses/partners and children.   Next Steps: This woman focused community based model needs to be replicated so that their vulnerability and HIV/AIDS among them and their families is controlled. Website: www.aidsalliance.org/india