Punjab leads in HIV among injecting drug users in India

Sunday, 01/12/2013

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Chandigarh : In what is a dubious distinction, Punjab has attained the number one position in the incidence of HIV among injecting drug users (IDUs) in the country, a recent report by the National AIDS Control Organisation (NACO) has revealed.

Raising a major cause of concern for the border state, which is already waging a no-holds-barred war against another dreaded disease cancer, the NACO report revealed that HIV positive persons among the IDUs in Punjab are 21.02 per cent against the national average of 7.2 per cent. With this, Punjab has also left behind Manipur, which had held the much maligned spot for 26 years. In Manipur, the prevalence rate is 17 per cent. At present, there are 15,545 IDUs in Punjab

However, the number of HIV positive cases and deaths has come down drastically as compared to the previous years in Punjab.

A report compiled by the Punjab State AIDS Control Society (PSACS) showed that till October this year, as many as 2,656 new HIV positive cases were detected, of which 1,373 were registered in HIV care. While 874 HIV patients began Anti-Retro Viral Therapy, 647 were currently alive on it. Still, 178 HIV deaths were recorded in the state.

Barring 2006, this was the lowest-ever number of HIV positive cases and deaths reported in Punjab during the past eight years.

This gave the state a bit of relief as in 2012, as many as 608 HIV deaths were reported in Punjab and 4,863 HIV positive cases were detected. The number of deaths and HIV positive cases remained 578 and 5,387, respectively, in 2011; 560 and 5,433 in 2010; 417 and 5,351 in 2009; 322 and 4,954 in 2008; 238 and 4,601 in 2007; 15 and 2,110, respectively in 2006.

However, the NACO report, which was based on the national sentinel surveillance data (NSSD), a wing under the Union Ministry of Health and Family Welfare, said alongside Gujarat and Goa, the agrarian state has also recorded the highest adult HIV prevalence at 0.32 per cent.

According to the PSACS, the number of IDUs in Punjab went up from 462 in 2010 to an all-time high 5,624 in 2013 till October. In 2011, as many as 1,414 IDUs were registered while 2,818 IDUs were detected in 2012.

Showing firm commitment to tackle the problem, Principal Secretary Health and Medical Education Research Vini Mahajan said the state government has prepared a comprehensive action plan involving an expenditure of Rs 100 crore to free Punjab from HIV.

Mahajan, who is already spearheading the sustained campaign against cancer, disclosed that the main objectives of anti-HIV programme awareness among parents, teachers and youth regarding the consequences of substance abuse and injectable drug usage; prevention programmes aimed at the target population so as to reduce the prevalence of HIV; and community participation and mobilisation of civil society along with peer led intervention to tackle HIV in IDUs.

IDUs MOST VULNERABLE

With approximately 2.4 million HIV infections, India is home to the third highest number of people living with HIV/AIDS (after South Africa and Nigeria). The Indian HIV epidemic, like most Asian countries, is contained chiefly within some subgroup of population most at risk of acquiring and transmitting HIV. These high-risk groups comprise of female sex workers, high-risk men who have sex with men, trans-genders and IDUs. The latest available data from Sentinel Surveillance show an overall declining trend in the epidemic at the national level and in particular among the female sex workers. However, IDUs have emerged as the most vulnerable risk group with increasing HIV prevalence in many states. Compared to 0.31 per cent adult prevalence of HIV in general population, prevalence of HIV in IDUs is 9.2 per cent.

Peculiar problem

The Sentinel Survey estimated a 13 per cent sero-positivity in IDUs of Punjab. It also revealed that of the nine districts reporting greater than 15 per cent HIV prevalence among IDUs in the country, three districts were in Punjab. This led to the UNAIDS-2008 study based on respondent-driven sampling, which estimated the state IDU population to be 18,000 (upper limit).

The study found that the majority of IDUs in the state are male (99 per cent), belong to the age group of 18 to 35 years and many are married and sexually active. They are mostly unemployed and unskilled and hail from the low socio-economic section of society. They usually inject the accessible pharmaceutical preparations and varieties of opium-based sedatives and share their injecting equipment. Further, the sentinel surveillance estimates for 2008-09 set the alarm bell ringing that the sero-positivity among IDUs in the state has increased to 26 per cent. Amritsar was found to have the highest HIV prevalence rate of 56 per cent amongst IDUs in the country.