“You NGOs are encouraging the drug users to continue injecting drugs by giving them free needles and syringes (N/S). And you are also encouraging sexual promiscuity by promoting condom use”. These are often the standard comment we get from almost all sections of the society, particularly the church and a bulk of the general community. Some have even gone to the extent of accusing NGOs as abetting sex work (prostitution) for the fact that NGOs carry out free distribution of condoms for safer sexual behavior among sex workers to prevent the transmission of HIV and other infectious diseases. Some have even alleged such intervention (promoting condoms and N/S) as ally to crime subject to punitive action. NGOs as service providers and guardians of the health of the society are accused with unfair characterizations. These accusations are impeding the implementation of health and treatment programs aimed at preventing and reducing the transmission of HIV and other infections. When NGOs are accused unjustly and there is undue discrimination and harassment of the marginalized, the services that are made available for safeguarding their health are not accessed. When it is not done so the community’s health as a whole is put at stake. So who is at risk? Who is vulnerable? Who is the loser?
We do admit that it’s not the fault of the community at large for the misconception about the work of NGOs, maybe ignorance is at the root of this misconception and consequently the negative attitude towards this noble effort of NGOs to reduce the transmission of HIV and other infectious diseases. Perhaps we have not done enough to educate and sensitize our people. Or perhaps some know about it but remain simply laidback, indifferent. Why needles and syringes? Why condoms? Are there malicious intents behind such interventions? Or is it motivated and driven by the will to fulfill the mission of protecting society from the further spread of HIV?
If drug abuse, sexwork or promiscuous sex could have been stopped by force or compulsion through punishments, harassments and confinement, Nagaland would not have been in the grip of HIV today. Nor would we be cringing at the fact that today our state stands 2nd position in the HIV prevalence scenario. Every concern group, individual or whoever has a say or have concern for the well being of the society have tried and still persists with their efforts with different approaches in their own capacities with good intentions. With due respect allow me to say that every problem has its own unique characteristics and an approach that worked with one may not work with the other. A blanket approach of force and punishment may work fleetingly but is not the solution to the situation we are faced with. As for instance striking off the name of a drug user or a woman gone astray, from the church rolls pushes him/her away further from the fold making it all the more difficult to come back to the fold. Force and punishment and discrimination pushes the vulnerable underground and further marginalizes them. They become hidden populations who cannot be reached with services which can help them stay safe and uninfected and also prevent them from infecting others if they are already infected. What do we do in such a situation? Do we drive/chase them away? Do we extend our helping hand ?
In the face of HIV infection soaring day by day and when young men and women are getting infected with HIV through sharing of infected needles/syringes and through unsafe sex behaviors, what then is the option before us? Before them? When injecting drugs cannot be given up overnight, and when unsafe sexual practices continue despite all efforts in preaching and pushing for abstinence, do we tell them about safer practices till they can be motivated towards total abstinence or do we out rightly condemn them and give them no option? In being too moralistic/judgmental are we not somehow overlooking the fact that not all can be as moralistic as desired? What then is the most viable option? Harm Reduction? Perhaps and even perhaps not; But we are then talking of reducing harmful effects. And since the road to abstinence is a long process, can’t we at least make them reach the stage of “abstinence” HIV free?
Time is beckoning each one of us to move towards an environment that enables the vulnerable to open up, access services, and to change from unsafe to safer behaviors.
What then is Harm Reduction? It is a temporary measure to protect any individual vulnerable to HIV infection before he/she is ready for abstinence. It involves the approach of motivating such individuals to shift to less and lesser risky behaviours.
Harm Reduction Approach
NSEP
An example of the phases of an Injecting Drug User (IDU) slowly adopting safer practices and eventually into abstinence.
Jan: Injecting and sharing (Not cleaning)
Feb: Injecting and cleaning (now cleaning)
Mar: Injecting but not sharing
April: Not injecting but using orally
May: Reducing dose
June: Home detoxification
July: Drug Treatment Centre
Aug: Abstinence
Sept: Mainstreaming ( member of SHG )
Oct onwards: A role model and a path finder for other friends who are still practicing high risk behavior and still on their way to safer behavior and eventually to abstinence
CONDOM PROMOTION
1st Phase: Unsafe sex with multiple partners
2nd Phase: Safer sex with multiple partners
3rd Phase: Safer sex with single partner
4th Phase: Abstinence till marriage
5th Phase: Remain faithful to spouse
Thus Harm Reduction approach by the NGOs is NOT about encouraging drug use and sexual promiscuity BUT it is about changing high risk behavior of individuals towards safe and sustained responsible behavior.
So then, with a better understanding of the Harm Reduction Concept by everyone who has the concern for the well being of the society, how do we create an enabling environment for a safer society? Will harassing an injecting drug user for possessing one’s own syringe (that is crucial to prevent him from getting infected and infecting others) solve the problem of drugs and HIV and other infectious diseases? Will harassing a person possessing condoms stop that person from having sex? Harassment would egg him/her to dispossess his/her own needles, condoms and could well force him/her to share needles and also go for unsafe sex under such circumstances. At the same time these very rights makes him/her duty bound (if infected) to prevent others from getting infected. Rights and duties are inalienable. And thus so long as each one of us have misconception about the Harm Reduction efforts of the NGOs and the society as a whole do not create a supportive and enabling environment ,we can never hope for a healthier society. Positive Correctional measures (not harsh measures which alienate them from the community) from law keepers and civil societies are equally important looking into the issue of drugs and HIV but it should be Complementary efforts not Conflicting measures.
It is now open to us whether to try to understand what we have to do to help and co-operate with public health initiatives or simply take a narrow and ignorant stand and let HIV/AIDS prevail.
K.Ela
Prodigals’ Home
