Monday, March 1, 2010, Chandigarh, India By Usha Rai
The Angel's Care Centre at Moreh, 110 km from Imphal, Manipur, and on
the border with Myanmar, one of the worst HIV-infected countries of
the world, has to provide medical help not just to the over 400 People
Living with HIV and AIDS (PLHA) in Moreh but to the infected of
Myanmar who cross the border desperate for medical help.
The fact that Moreh is close to the Golden Triangle (Myanmar, Laos and
Thailand) of the drug route, and within sniffing distance from India's
National Highway 39, has compounded the problem. Forty per cent of the
Manipuri families inject drugs and there are 33,403 HIV positive in
In fact, Manipur is one of the six HIV high prevalence states of the
country with 1.13 per cent of the people infected. But in Manipur, as
in the adjoining Nagaland, it is a deadly combination of alcohol and
drugs in the form of tablets that the young turn to for their 'high.'
When this fails to satisfy them, they have no qualms about injecting
heroin no 4 and other drug opiates. Since a dose of heroin costs just
Rs 20 in Moreh as against Rs 100 and more in Imphal, young people in
this small border town resort to it when angry, depressed and even
when happy and in need of celebration.
Though India is the medical destination for a range of ailments --
heart surgery to kidney transplants and corneal replacement, the
treatment of HIV-infected from across the border is almost a
clandestine operation. In a state like Manipur where adequate
facilities are not available for treatment of the local HIV-infected
population, many feel it is difficult to justify treatment of
foreigners, however poor they are, coming from a country that has not
been able to provide medical succour to its people.
Sachin, project coordinator of the Angel Care Centre, and Sumati,
secretary of the NGO Meetei Leimarol Sinnai Sang (MLSS), Imphal,
however, feel frustrated about their inability to help the very young
and very sick people from across the border. Some are 20 years or even
younger and others 40. They come with acute skin infection, TB and
other ailments. At any given time, there are 60 to 70 patients from
Myanmar and Sachin says they are HIV positive.
Many of them are farmers and daily wage labourers who buy the ART
(antiretroviral therapy) medicines from pharmacies in Myanmar. They do
not have reports on their CD-4 count or level of immunity because they
have no access to these facilities in their own country.
Without a CD-4 count report, they cannot be given ART in Moreh. So
they are treated for subsidiary ailments and sent home. Since MLSS
runs a DOTS Centre in Imphal and there is high prevalence of HIV among
the TB-infected, the people from Myanmar are able to access the TB
medicines from Manipur. They cross the border regularly for the
treatment but since they speak only Burmese, there are problems of
While hospitals in Morey and even those in Imphal are in a dilemma
about treating PLHA from across the border, Dr Priyo Kumar of JN
Hospital, Manipur, says since the country lies on India's border,
treating patients from Myanmar is quite ethical. Besides it also helps
protect Manipur's population from the infected from across the border.
With the present support from the Global Fund for AIDS, Tuberculosis
and Malaria coming to an end this March, Sachin and Sumati are worried
about the future of the Angel Care Centre which has become the
lifeline for over 200 PLHA. It has a 10-bedded community care centre
and is providing antiretroviral therapy to 55 persons from Moreh-21
men, 32 women and two children. The ART Link Centre was set up only in
November 2009. If instead of upgrading the Angel Care Centre, it has
to close down, there will be a vacuum in the care and support of PLHA.
They will have to travel 110 km to Imphal for treatment, says Sumati.
In Manipur, the combination of HIV with Hepatitis B and Hepatitis C is
playing havoc in the lives of those infected. This phenomenon has not
been seen in other parts of the country. However at the JN Hospital,
one of the top hospitals for treatment of HIV, the increased risk to
the life of an HIV-infected from Hepatitis B is given special
attention. Hopefully other hospitals and caregivers will realise the
gravity of HIV with Hepatitis and give it due importance.
There has been a small decline in injecting drug users in Manipur and
now the HIV-infected are joining the network of positive people. They
have gained confidence and some have even become peer educators.
Take the case of Hanglem Bimola, 40, a widow on ART, now working with
MLSS as a peer educator. A graduate from Bishnupur district of
Manipur, Bimola married in 1996 an injecting drug user in Imphal not
knowing his HIV status and had a baby girl the following year. When
she was pregnant again, her husband died. The child born in 1999 too
died after three months.
Then the discrimination by her in-laws began. They would not eat food
cooked by her and she had to stay in a separate room. She then went to
her parents' house and in 2001 fell ill and was diagnosed as HIV
She tried to support herself and her child by selling vegetables but
no one would buy her vegetables because of her HIV status. So she
moved to Imphal. Bimola recalls that after she bathed in a public pond
at Utlou village, people of the village held a public meeting and
disinfected the pond because they feared the water was contaminated.
Then she got in touch with the NGO MLSS and soon graduated to becoming
a peer educator. Now she works with the Bishnupur Network of Positive
People in an Access to Care and Treatment project.
In the case of Romeo S Misao, 37, he took to drugs to gain popularity
among his peers. He was only 17 then and soon got addicted to it. When
his parents found out and stopped giving him money, he started
stealing and selling off things at home — he even sold his blood — to
be able to buy heroin. In 1994 when he fell sick he was diagnosed HIV
When Misao disclosed his status, his friends began distancing
themselves from him. He took to alcohol to get over the depression.
After coming out of a rehab clinic, he learnt through some articles in
magazines that there was life beyond HIV. He then went for
psychological help. Tested for Hepatitis C/HIV, he was found positive
and put on medication. Misao has joined the Network of Positive People
at Senapati and his life has changed for the better.
Dr Priyo Kumar feels creating awareness and getting people to access
services is the biggest challenge of the state, especially in areas
that are hard to reach. The first case of HIV was seen in Manipur in
1989-90. Thereafter for a few years, many people suffered on account
of common Opportunistic Infections, which could not be detected and
some even led to death. Complications like cryptomeningitis,
penicilliosis and toxoplasma were common.
Doctors could not diagnose cryptococcal meningitis and injection
amphotericin-B was not available in Manipur. The cost of medicines was
prohibitive and some HIV-infected had to spend Rs 5,000 per 100
tablets of zidovudine (retrovir).
With the introduction of HAART (highly active antiretroviral therapy)
in 1996, HIV became like any other chronic manageable disease like
diabetes, hypertension or arthritis but treatment was still beyond the
reach of the common man. Many people ended up with incomplete regimens
complicating their health profile further. Side effects were also
But challenges continue to persist in Manipur. Of the six ART centres,
only two are providing good service. There is a dearth of sound health
professionals. In 2000, identification of HIV was still a problem
especially among wives and partners of sex workers who remained
unaware of their status. Also spread of the infection from mother to
child continued to be a serious issue and inadequate medical
infrastructure led to situations where opportunistic infections were
often undiagnosed and follow-up was inadequate.
Truth resides in every human heart, and one has to search for it there, and to be guided by truth as one sees it. But no one has a right to coerce others to act according to his own view of truth. - Mohandas Gandhi
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