The two evils on the warpath
Sandip C. Jain
It is not a coincidence that India is the second most HIV – AIDS infected country in the world and that the hill areas have been classified as a High HIV prevalent area, as reported in June 2006 issue of the Himalayan Times. Along with rising infection levels, a local Gangtok paper called NOW! wrote about the spread of drugs in the Darjeeling district, with Spasmo Proxyvon, the prescription drug given to girls to ease their period pains becoming the party drug of the youth. It is unfortunate that these two evils, HIV – AIDS and drug abuse go hand-in-hand, one social taboo alongside another. Public denial of both is equally strong and ruthless and has not changed to consider lending a helping hand inside the community. Instead, the people affected by these two evils are branded and ashamed in front of their family and friends and are left to combat their illnesses alone and without a hope in hell. No wonder there aren’t many who want to take their family members to the help clinics, for rehab and counselling, or admit that someone inside their family is HIV positive, he or she is just prone all of a sudden to constant fever, nothing more. These problems run deep into the conservative heart of society and go against the prevalent outdated traditions, making the diseases nearly impossible to approach and leave the problems lingering without a proper solution.

India and risk factors

The United Nations has estimated that India with 40% of Asia’s population has over 60% of the continent’s HIV positive cases. UNAIDS is predicting that by the end of 2006 there will be 5, 7 million people living with HIV in India. Soon the example of the most HIV – infected country in the world, might change from South Africa to India, as India already is the second most infected country on earth and even a small increase in HIV infections could translate into very large numbers of people becoming infected. UNAIDS has outlined some risk factors that puts India in danger of experiencing a rampant spread of HIV if attitudes are not changed. The most unnerving factor is that unsafe sex and low condom use is wide spread. In the whole of India, a staggering 84% of all the reported HIV cases are due to unprotected sex. Such is the stigma of shame attached to buying a packet of condoms among the young that many lives could have been saved, if the availability, the encouragement and the price of condoms would have been more appropriate. The factor of migration for work for extended periods of time has only increased rather than declined in the past years. For long periods of time people are away from their social environment provided by their families and community and this can place them outside the usual normative constraints. In such instances, being outside their own social environment might encourage them to take part in risky behaviour. Students studying away from home for many years also fall victim to the less constraint life away from families. A recent study has shown that drug addicts are shifting away from inhaling to injecting hard drugs. 41% of these drug abusers inject with used needles and syringes, which has put them and their sexual partners in the high risk group. Only a reported 3% of those who regularly re-use needles and syringes are using appropriate and effective methods such as alcohol, bleacher or boiling water to clean their syringes. And lastly, the low status of women still plagues the Indian society. Unequal power relations, described by United Nations, as the limited access to human, financial and economic assets, weaken the ability of women to protect themselves. The Government of India’s response has been to place more funds and efforts into combating the reduction of the risk factors in the last decade, but major challenges still remain. The raising of the overall effectiveness of state – level programmes, increasing safe behaviour and reducing the stigma associated with HIV positive people and drug – addicts among the population, leave a lot to desire. But there is some light at the end of the tunnel, as co-operation of different NGOs ran by socially conscious local people and international volunteers have shown a positive contribution to the fight against AIDS.

Misconceptions and hard-line education

Sexual education is not part of the curriculum of most schools in Kalimpong. Pounding some general information into the heads of hormone – charged youths is a prerequisite to assist in the changing of attitudes, as misconceptions of HIV and AIDS are common. Many people think that HIV can be transmitted through mosquitoes. This is not true, as when you are bitten by a mosquito, the mosquito does not inject blood of a previous victim, but quite happily pumps out your blood instead. HIV can be transmitted through oral sex, even though oral sex is a lower risk activity, but in receptive and insertive oral, it can be possible when there is contact between semen and the mouth membranes. Risk grows with frequency of activity. One cannot however become affected with HIV through casual contact with a HIV positive person. You cannot be infected by shaking someone’s hand, by hugging or ‘dry’ kissing. Neither is it possible through using the same toilet, drinking from the same glass or by being exposed to coughing or sneezing by an HIV positive person. Finally, HIV and AIDS is not the same thing. HIV; Human Immunodeficiency Virus and AIDS; Acquired Immune Deficiency Syndrome is the collection of symptoms, diseases and infections associated with an acquired deficiency of the immune system. While HIV is universally accepted as the underlying cause of AIDS, not all HIV positive individuals have AIDS as HIV can remain in a latent state for many years. Such misconceptions are killed by extensive awareness campaigns. In Finland the schools actively take part in eradicating misconceptions and educating the children about the dangers of drug – abuse and HIV. Nurses and doctors give lectures to students from 10-year- olds up until the youths graduate from school at the age of 19 on average. Pounding the information is crucial, even though many critics state that talking about sex and drugs only encourages the young to try these hot topics for themselves. No matter what the public opinion is concerning sexuality and drug experimenting, the children must be knowledgeable enough to know the consequences of their actions. So hitting home the message to the hormone-charged youngsters is important, and if showing graphic pictures and film-clips to scare children into refusing drugs and being careful during sex is considered brutal by some, however, it is highly necessary. Talking of sex and sexuality openly and explaining in detail, with the use of pictures, will hopefully form a lasting impression in the child’s mind. Even the police and drug counsellors take actively part in the education of children. Giving lectures on drug-abuse, by describing cases involving youngsters like those sitting in the classroom listening, has a tremendous effect. Holding my first and last sample of heroin in my hands, listening to list of horrible side-effects and the unimaginable withdraw symptoms, with a policeman reminding me of the legal consequences of abusing such drugs, made a lasting impression on me. Years later, having the unexpected opportunity to meet a poor soul addicted to heroin, I was reminded of the lessons in school and having a pretty good picture in my mind of what sort of hell this man had ended up in. The meeting of a real junky was enough to scare me never to even hold a piece of that evil in my hands again. A situation, where youngsters might be offered and tempted to try a hard drug must be prevented by bashing the barriers of ignorance and shyness, by talking about them often and long enough. In this day and age of gigantic infection figures, hard measures must be taken, or otherwise the society will have to confront a landslide of new HIV infections and pay a high price for its stupidity and shyness. The example of Finland might sound a bit too harsh, but the co-operation of nurses, doctors, counsellors, police and NGOs works as an effective protective net and a similar approach might be considered here in Kalimpong as well. NGOs have started educating the school children, but there are not enough volunteers to reach every child in every school and due to small budgets, the lessons are given to classes only once.

The situation in Kalimpong

In Kalimping since January, there have been five more new HIV positive cases. This brings the total number of people infected with HIV in the past five years to 25 lost souls. According to the Superintendent of Kalimpong Sub-Division Hospital, Dr. Suva Ratna Pradhan, only in one of the cases, did a boy contract HIV by sharing infected needles, while others are due to promiscuous sexual habits. The infection ratio in most parts of the world is an even split between men and women and the figures from Dr. Pradhan indicate the same. But these figures are far from accurate, as the testing facilities in Kalimpong are non-existent. There is no testing centre in Kalimpong and the nearest and only voluntary free testing centre for the Darjeeling District is located in Darjeeling. No-one will reimburse you for the journey and your day is spent travelling and waiting in line for your test. Most people opt not to go. The Kalimpong Sub-Division Hospital does test some people, but they are very few and far between. If a doctor suspects the worst and after confirming his suspicions with a colleague, only then does the patient get tested. This is not a very common practise unfortunately as the hospital does not have the capacity or the funds to test every single suspected patient. But nevertheless the doctors have started to take action, even if the scale of the operation leaves much room for improvement. The free blood tests that the hospital provides are only reserved for the good Samaritans who willingly donate their blood to save others. The blood – donors are given a mandatory test to identify whether the blood is safe to give to patients. The test searches for signs of malaria, Hepatitis C and B, HIV and other sexually transmitted diseases in the blood. So unless you are willing to spare a few pints of blood or your doctor fears the worst, there is no other way to know for sure that you have a clean bill of health. In light of such circumstances and with such inadequate data, the number of infections in the town is impossible to know, but it is safe to assume that it is much higher than the 25 reported cases.

Drugs in Kalimpong

It is even harder to believe that only one case is due to drug abuse. According to Dr. Pradhan and the counsellors working for the newly formed Himalayan Anti AIDS and Narcotic Drugs Society, also known as HANDS, every other household in Kalimpong suffers from drug-abuse, whether it is in the form of alcohol, marijuana or harder drugs like Spasmo-Proxyvon. In the past 10 years, the chemical abuse of prescription drugs has become a major problem. Youngsters are the ones mostly in danger, due to reasons of peer-pressure, curiosity and the fashionable status drugs have acquired through heroes in the music and film business. Youngsters think that it is very ‘cool’ to try drugs. But no-one becomes a junky over night, or is born into the life of a drug addict. It is a gradual process, starting with cigarettes, alcohol, a few occasional joints to swallowing painkillers. It can be a gradual progression over a 10 year period, when the soft drug addict, no longer content with marijuana or alcohol, has to look for the ‘high’ in hard drugs such as brown sugar or Spasmo-Proxyvon. Mr. Dipendra Subba, a counsellor working for HANDS, has seen many families destroyed by substance abuse.
‘It’s a rough estimate, but usually the people over 30 years of age battle an addiction with alcohol, while the under 30-year-olds are using drugs. The horrible thing is that there is no availability of disposable syringes and needles in the pharmacies, as the police made a point of stopping the issuing of disposable syringes and needles. Now the addicts share or re-use needles and syringes, which might cause a wave of new infections,’ Mr. Subba worries. He is right to worry, as Spasmo-Proxyvon, or SP, is more dangerous than brown sugar. It is also a prescription drug, which means that is legal, if you have a prescription that is. Most peddlers and users don’t have one and all the police can do, is lock them up for a night and let them go in the morning. A case is started, with the police keeping an eye on the peddler, but there is no law as yet, which specifically comes down on SP peddlers. This fact drove the Gangtok paper NOW! to write a series of articles on the dangers of SP and demand something to be done about the problem. After a long battle of being at the receiving end of public criticism, the ruling Sikkim Democratic Front Party in 2004 promised a new law to deal with the peculiarities of abuse of the ‘legal’ drug of Spasmo-Proxyvon. In 2006 the Drug Addiction Act was passed, which gives the police the power of the law to deal with peddlers of SP. This law however is only for Sikkim and does not apply here in Kalimpong. What they came to realise in Gangtok was the awful truth about the drug. The drug is at its most lethal, when it is mixed with water or rum, then cooked and injected into the vein. If used extensively and for a long period of time, it can affect your central nervous system, as SP black-outs and sudden loss of consciousness can kill thousands of neuronal cells in your brain. The drug addict will eventually experience mental illnesses and suffer from emotional imbalance. The constant injecting can block the arteries and thus can cause heart attacks or even paralysis when the artery to the brain is blocked. The problem is that the tablet does not fully dissolve when it is mixed with water or rum and cooked, so sediments start slowly to build up and creates an abscess. The blood flow slowly but surely gets blocked and the limb starts to rot. Many SP addicts have lost limbs to gangrene. The definition of drug abuse, taught by HANDS, is when any chemical alters the mental or physical state of a person. Spasmo-Proxyvon users go through drastic changes and very visible changes in their behaviour. An addict’s rhythm is co-ordinated by the drug, so he / she might start sleeping during the day and staying awake at night. The circle of friends, who are not addicts, will disappear to be replaced by people who are paranoid about conducting their affairs behind closed doors and through mysterious phone calls. Money starts to disappear along with some valuables from the house. He or she will loose interest in personal hygiene and appearance, becoming more withdrawn with sudden burst of anger or tears. Nothing and no-one seems to interest them anymore as the drug has taken hold of the mind and spirit and the only thing that matters is the next injection. A strip of ten tablets of SP can be bought easily for 100 INR on the black market here in Kalimpong.

HANDS
One newly formed NGO, the Himalayan Anti AIDS & Narcotic Drugs Society, or better known as HANDS, has begun to fight the evils of drug addiction and educating the masses on safe sex. This organisation was formed only a few months ago by a group of Kalimpong residents, who felt that action must be taken immediately. The ambitious people responsible for the organisation have big plans for the future, like setting up the first testing centre and a rehab centre for addicts in Kalimpong. At the moment, they are only plans, as the organisation is only funded by a handful of local people. More is needed so that these plans can be realised. The co-ordinator of HANDS, Mrs. Zoramhmangaihi Vuite is already busy organising sex education and drug awareness classes in such schools like Rockvale Academy and St Joseph’s Convent. These lectures given mostly to children approaching their teenage years are crucial, as at this age they are very vulnerable to peer-pressure. From a questionnaire on HIV / AIDS given to year 9 students of Rockvale Academy reveals that some misconceptions are still very much alive. Many thought that AIDS can be cured, if medical treatment is given at an early stage and that HIV positive people are easy to spot, as they are always skinny and look very sick. The most alarming fact was that many would not go to a clinic even if they felt that they had been infected with a sexually transmitted disease. The powerpoint presentation given to the students of Rockvale Academy explained in detail the difference between HIV and AIDS, the symptoms and how they are contracted. HIV and AIDS awareness was followed by a descriptive lecture on drug-abuse. The children, happy to be able to miss a class, listened intently at first, but such detailed subject matters produced a few yawns and bored faces. The people of HANDS estimated that if 10 % of the children take something home from this one short class, their work has had purpose. It is frustrating for people with such dedication and volunteer spirit, that they are unable to do more and teach the children regularly. Hopefully in the future, with more residents contributing to the good cause of HANDS and their work, the energy and money coming from within the society will end up saving the society. The people of HANDS have the right attitude, by not running away from the social taboos of drug-abuse and HIV infections, but by taking the bull by the horns and doing all they can, to teach, help and assist. It is time the society found out, for real, how bad a problem it is facing, because inadequate data brings nothing but false hope. The Principal of Rockvale Academy, Captain Pradhan urged the children to be brave and honest, when dealing with these issues, because one day you might end up saving your friend’s life. So let’s be brave and honest and confront these issues.