Manipur today has the highest number of female injecting drug users (FIDU) in India but the number of women accessing treatment for Hepatitis C, a resultant disease, is low, according to official reports. In view of the high incidence of Hepatitis C in the wake of increasing number of injecting drug users in the state, the National Viral Hepatitis Control Programme (NVHCP) was rolled out in Manipur two years ago.
According to a study by the World Health Organisations (WHO), Hepatitis C, a liver disease caused by the Hepatitis C virus (HCV) in people who inject drugs, people who use drugs through other routes of administration (non-injecting) and “men who have sex with men” (MsM), and people living with HIV are prone to Hepatitis C infection. As such, the Government of India prioritised them as targeted group to get treated under the National Viral Hepatitis Control Programme launched in 2018. The objective of the programme is to wipe out Hepatitis C infection in the country by 2030.
The programme was also implemented in Manipur on July 28, 2019 whereby inaugurating two model treatment centres at Jawaharlal Nehru Institute of Medical Sciences (JNIMS) and Regional Institute of Medical Sciences (RIMS). The state government has initiated to open Hepatitis C treatment centres in almost all the districts of Manipur, including newly created district for easy accessibility.
The number of female injecting drug users is highest in Northeast among states in India
Despite the programme being implemented, among all the states in India, the prevalence rate of female injecting drug users is highest in Northeast states. Amongst the eight north-eastern states, Manipur recorded the highest number of FIDU, according to a survey report published by the United Nations on Drugs and Crime in 2015. The report was entitled, “Women who use drugs in North East India”.
As per data received from the state directorate of health services, during the period July 1, 2019 to April 4, 2021, as many as 919 patients in the state had initiated for treatment of Hepatitis C. Out of them, 724 had completed their treatment.
Gender gap in treatment
It has been two years since the government launched the programme, but there is a huge gender gap in treatment. According to data received from the Model Treatment Centre RIMS, the total number of patients treated during the period July 1, 2019 to April 12, 2021 is only 297. Of it, 252 are males and 45 females. In all, 58 patients are under treatment. Of which, 46 are males and only 12 are female patients.
And as per data received from the Model Treatment Centre JNIMS, 580 patients had initiated for Hepatitis C treatment. Of which, 549 are males and 31 female patients.
The figures point to the fact that many FIDU, one of the marginalised groups compounded by societal discrimination, are still yet to access the National Viral Hepatitis Control Programme.
“As a recovered woman drug user, I want every drug user to get tested and access the free Hepatitis C treatment if found positive provided by NVHCP. But for this, I would like to appeal to the state government on behalf of FIDU to conduct mass awareness and screening for Hepatitis C,” one of the patients, Tina (name changed), who was treated for Hepatitis C at the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) told the Imphal Free Press.
Growing up in a broken family led her to get addicted to drugs for almost 10 years. But it has been five years since she had completely given up on drugs and working in one of the drug rehabilitations centres with a dream of providing a successful future for her son.
“I don’t know anything about NVHCP. When one of the NGO conducted mass screening for Hepatitis C in our rehabilitation centre, I came to know that I was infected with Hepatitis C. I was completely saddened with the result and regretted being a drug user at one time. However, with the support from the NGO, I got treated at Model Treatment Centre JNIMS and now I am completely cured,” she said while informing about the benefit received from the NVHCP.
Meanwhile, state nodal officer, NVHCP, Dr RK Rosie, speaking to the Imphal Free Press, said that women usually don’t have health seeking behaviour in comparison with male. As such, lesser number of women avail the free treatment provided under the NVHCP, she said.
Rosie said that the department is giving more preference to injecting drug users or drug users and people living with HIV. Anyone approaching the model treatment centres or any patient who are associated with the Manipur State AIDS Control Society or through NGOs are provided proper treatment and support, she said.
To encourage more infected people to come for treatment, treatment centres are being opened in almost all the districts of Manipur, Rosie added.
Soubam Chanu Inaocha, secretary, Meitei Leimarol Sinai Shang, an NGO working for FIDU and Female Sex Worker (FSW), said that FIDU and FSW are among the most vulnerable group to HIV or Hepatitis C infection.
But owing to societal discrimination, stigma, social insecurity and lack of support from their own family, they are reluctant to get treated for any kind of ailment. In addition to it, they usually lack awareness about the policies and programme provided by the government.
“We had conducted screening for Hepatitis C for FIDU in 2018. Altogether, 12 FIDU were tested and out of it, two tested positive. From this figure itself, we can presume how many FIDU or FSW might have been infected with Hepatitis C,” secretary of Meitei Leimarol Sinai Shang said.
Due to the condition of poor socio-economic scenario in the state, the number of FIDU and FSW has been gradually increasing since the past many years. Along with it, the geographical proximity of availability of drugs, couple issue, changes in lifestyle from conventional to cosmopolitan are some of the reasons for the growing number of drug users in the state, she added.
The worsening situation in the wake of the new COVID-19 pandemic wave is adding to the challenges they and the community face with dealing with ever-increasing number of FIDU and FSW in the state and the prevalence of HIV positive and Hepatitis C infection among them and people living around them.
The Meitei Leimarol Sinai Shang secretary also said that conducting mass screening exclusively for female injecting drug users or female sex workers is highly needed as most of them are reluctant to come out from their preferred community for fear of being discriminated and ostracised by the society they live in.
