Harm Reduction in India

1
Harm Reduction in India
Jimmy Dorabjee Centre for Harm Reduction Macfarlan
e Burnet Institute for Medical Research Public
Health, Melbourne, Australia.
2
History of Harm Reduction in India
Buprenorphine Data on Effectiveness

• Community Based Treatment of Heroin/Buprenorphine
  Dependence in Delhi in 1993 (SHARAN)
• Community Based Treatment of Heroin Dependence in
  Delhi in 1993 (AIIMS) All India Institute of
  Medical Sciences
• Community Based Treatment of Opioid Dependence in
  Delhi slums from 1995-1998 (SHARAN)
• Mid Term evaluation of (SHARAN) program by ICMR
  1996 - endorsed buprenorphine substitution
  program
• Larger program Five city Buprenorphine
  substitution program implemented by 7 NGOs from
  1999-2002 (SHARAN)
• Community Based Treatment of Heroin Dependence-
  Nagaland in 2001 (AIIMS)
• Data from other organizations

3
SHARAN/EC funded buprenorphine intervention
1999-2002 - Dramatically increased treatment
availability and uptake
City Target IDUs Heroin
Drug free inhalers Chennai 250
2925 - 497 (300) Delhi 500 2708
5074 635 (350) Imphal 250 983
- 440 (165) Kolkata 300 2499 1534 143
(200) Mumbai 200 1086 3705 615
(300) Total 1500 10201
10313 2330 (1315) A total of
20514 opioid users accessed the program. Total
number of IDUs 10201
(Rx Availability 2000)
4
But

• Buprenorphine still currently available only in
  few treatment centers/NGOs
• Small scale
• Not available as a treatment option to the
  majority of drug users

Photo Jimmy Dorabjee
5
IDU PREVALENCE IN INDIA
IDU PREVALENCE IN INDIA
HIGH 1,100,000 Aciejas, Friedman, et al
(2006) LOW 223,121 300,000 (UNODC NACP III)
NACP III- National AIDS Control Program III
6
HIV PREVALENCE AMONG IDU ()
0.48
22.80
7.86
9.20
4.51
24.10
12.80
4.80
10.92
7.41
18.00
5.19
Source NACO 2005
7
In the past year buprenorphine substitution
scaled up
Photos Jimmy Dorabjee
8
In the past year 300 Govt. funded Abstinence
NGOs begin PLI
Photo Jimmy Dorabjee
9
Coverage achieved in 2006-07

• SPYM Significant reach to drug using populations
  through integrating harm reduction into existing
  drug demand reduction programs. Total
  contacted DUs 67,314/Referral services 43,373
• Sharan Coverage Comprehensive services through
  DICs and community based interventions in 7
  States and 2 Union territories. IDU
  coverage 20314 OST-1775/ NSP-1953/ Referral
  for drug treatment-10,113
• EHA-AIHI Opioid substitution treatment for male
  and female drug users in Manipur and Nagaland.
  Total 2537 Males 2369 - Females 168
• UNODC ROSA Total number of drug users reached
  5800
• Regular sex partners reached 3327/OST-232/ 4
  Prison interventions
• Integration of care and support for drug users
  into harm reduction programs (Int. AIDS Alliance)

Source DfID Challenge Fund Evaluation 2007
10
INTERVENTION COVERAGE in 2006-07
TI
DIC
DIC

• COVERAGE STILL LOW!
• assuming NACPIII IDU Figures (223121)
• Sharan Coverage 3728
• SACS TI (330 IDUs x 63 TIs)20,790
• EHA2537
• Other NGOs 10,000

DIC
TI
DIC
TI
DIC
TI
DIC
DIC
DIC
TI
DIC
TI
DIC
DIC
11
Challenges

• Current interventions need financial resources
• Scaling up coverage and reach
• Capacity building
• Government commitment and resources for
  substitution
• Current Targeted Intervention budget
• Rs 137 (US3)/person/month (DSACS Delhi)
• Actual need Rs 1,370 (US30)/person /month
  (Hopkins)
• 10 times the resources needed as per current
  allocations

12
Based on current mapping for national coverage

• Funding needed Per Year
• For 1,100,000 IDUs Rs. 18,084,000,000
  (401,866,666)
• For 300,000 IDUs Rs. 4,932,000,000
• (109,600,000)
• For 223,121 IDUs Rs. 3,668,109,240
• (81,513,538)

13
But all is not well
Photo Jimmy Dorabjee
14
Some treatment approaches in NE India

• Partial Haircuts, buried waist deep in the
  ground, caged, chained a punishment paradigm
  dominates

Some Institutions providing enlightened
treatment
Photo Jimmy Dorabjee
15
Public humiliation - Haircuts
Drug Users only Change when chained.
Photos RK Raju, North East India Harm Reduction
Network
16
Photo Jimmy Dorabjee
17
Itchy wood Punishment for drug users
Photo Ch. Bangkim, Imphal
18
Cages
No Chains no Gains
Photo RK Raju, North East India Harm Reduction
Network
Photo Jimmy Dorabjee
19
Acknowledgements data sources

• Luke Samson, SHARAN
• Dr M. Suresh Kumar, Institute of Epidemiology,
  Chennai, Centre for Harm Reduction.
• Gordon Mortimore, DfID-PMO - Challenge Fund
• Charan Sharma, (EHA) Emmanuel Hospitals
  Association
• Dr Rajesh Kumar, (SPYM) Society for Promotion of
  Youth and Masses
• Asst Prof Anju Dhawan, National Drug Dependence
  Treatment Centre, All India Institute for Medical
  Sciences
• Photographs. RK Raju, North East India Harm
  Reduction Network,
• Photographs. Ch. Bangkim, Social Awareness
  Service Organization
• All other photographs. Jimmy Dorabjee