Helping drug addicts kick the needle

Providing tablets to drug users will help cut HIV incidence

Mapping to know the number of drug users to start soon

Oral substitution therapy will be initiated in 7 cities

The switchover: The programme will first get the person to switch from using needles to tablets. The end point of the programme is to rehabilitate the person.

Five years after starting the needle exchange programme for the injection drug users in Chennai, and after three years in Madurai, the Tamil Nadu State AIDS Control Society (TANSACS) is taking an important step in its battle against HIV.

Roll out

Starting September 2008, TANSACS will roll out the Oral Substitution Therapy (OST) in Chennai and Madurai and five more cities. The State is starting the programme along with other north eastern States despite the fact that the number of injection drug users in Tamil Nadu is small.

Under the OST programme, the injection drug users (IDU) will be provided a tablet (Bupernorphin) a day. The tablet will not only help kick the needles but has the capability to slowly wean away the users from drug addiction.

The needle exchange programme will not be abandoned but will run concurrently with the oral substitution therapy for those not opting for the oral substitution therapy.

The OST programme, if successfully implemented, will go a long way in reducing the number of people getting infected. This is important as injection drug users have the highest prevalence amongst the high-risk groups.

For instance, in 2006, the prevalence of HIV among the IDUs in TN was 24 per cent while it was only 3.6 per cent in the case of sex workers. Similarly, in 2005, it was 19 per cent in the case of injection drug users while it was only 5.4 per cent in the case of sex workers.

Higher incidence is seen among the IDUs as the virus gets into the blood directly.

Preventing infection

“Oral substitution will totally take care of HIV infection,” said Ms. Supriya Sahu, Project Director, TANSACS. “It is also less harmful.”

But will it be easy to get people to abandon the needle and switch over to tablets? “Yes, it is going to be difficult to take a person off needles. It is an emotional thing when they do it in groups,” said Ms. Sahu. “There is need to bring about a change in their thought process, and get their acceptance too.”

The success of the programme will thus hinge on the ability of the authorities to sensitise and convince the drug users to make the switchover, and create a demand for the OST services.

While Ms. Sahu surely knows how daunting that task is going to be, the fact that many IDUs are looking forward to getting off drugs will make things a bit easier.

The State’s initiative will be a great boon to such people as it is not just restricted to replacing the needle with tablets; detoxification and rehabilitation are part of the programme as the end point is to get the person off drugs.

The fact that China, Australia and Thailand have successfully adopted this strategy does indicate that though challenging, it will be successful in the end.

Mapping exercise

And to make the initiative more meaningful, TANSACS will undertake a mapping exercise across the State to have a better understanding of the number of drug users. The mapping exercise will start very soon and the results will be available by the end of July.

The last mapping exercise was undertaken in 2003. This showed Chennai and Madurai as the two cities with the most number of drug users. The needle exchange programme was thus started based on this data.

Ms. Sahu expects five more cities to show more number of drug users and is thus planning the OST programme for seven cities.

The cost

The oral substitution therapy, apart from being challenging on many fronts, is also going to be more expensive compared with the needle exchange programme. For instance, 10 needles would cost only Rs.30 while ten tablets would cost Rs.150.

Ms. Sahu notes that more than the cost of the treatment, the cost of setting up the infrastructure and providing the services would be more.

For instance, a drop-in-centre should have a doctor who would decide the dosage for each individual and provide the drugs. The outreach workers would be responsible for getting the drug users to the drop-in centres where treatment, counselling, detoxification and rehabilitation services would be provided.