WRESTLING THE RAGING TIGER OF HIV

Government Action On Combatting Drug Use And HIV Infection In India
Has Been Very Little, Very Late, Writes Matt Wade

Prem Singh is an injecting drug user living on the streets of India's
capital, Delhi. Weeping sores mark his face, most of his hair has
fallen out, and his knees are swollen beyond recognition - a symptom
of tuberculosis.

Singh, 21, started inhaling heroin when he was 10 but, two years ago -
searching for a cheaper high - he started injecting low-grade heroin.

When that became too expensive, he began shooting up common
pharmaceuticals, such as antihistamines and painkillers, bought from a
makeshift chemist in a local slum. India's lax regulations mean an
array of cheap injectible medications are freely available.

Singh developed huge abscesses on his legs from the dangerous drug
cocktails and filthy needles. Unable to walk, he gave up scavenging
rubbish - his only source of income. He was lying on the street
waiting to die when social workers found him and took him to one of
the city's few drug treatment clinics.

Singh now takes a daily morphine substitute, but his life hangs in the
balance.

Most days he lies in a desolate city park struggling with addiction,
eating only twice a week when the local Hindu temple offers free meals.

The park is home to hundreds of other addicts like Singh. Users sit in
the dust helping one another to inject. Some are so desperate they
crush headache tablets into bore water and inject the murky mixture.

The appalling conditions mean that most addicts develop huge abscesses
on their limbs. Gangrene is rife.

Local drug counsellors said last year it was common to find a number
of bodies in the park, especially on winter mornings. Yet new addicts
arrive at the park every day, storing their few belongings in plastic
bags in the trees.

The numbers are bolstered by vulnerable migrants from rural villages
who get caught up in the city's chaotic drug culture.

Injecting drug use was virtually non-existent in Delhi a decade ago
but now an estimated 40,000 addicts are shooting up across the city.

It's a growing problem with an estimated 100,000 injecting drug users
in five major Indian cities, which poses a much larger public health
risk.

According to the United Nations, India has 3.7 million people with HIV
- - second only to South Africa in sheer numbers. The surge in injecting
drug use is a dangerous catalyst for the spread of AIDS.

Many drug users are illiterate which means safe injecting practices
are not widely understood: needle sharing is common.

Studies have shown almost half of all injecting drug users in Delhi
are HIV positive and more than 60 per cent have hepatitis C. In some
parts of north-east India, more than 80 per cent of users are infected.

In Delhi, 44 per cent of users are married with children, underscoring
the potential for the infection to pass rapidly into the wider community.

The director of the Drug and Alcohol Unit at Sydney's St Vincent's
Hospital, Dr Alex Wodak, has worked with Indian drug treatment
organisations to improve their programs. He says the rise of injecting
drug use in India will have catastrophic consequences.

"We now have, in one of the most populated parts of the world,
hundreds of millions of people living in the shadow of HIV because so
many young men and a few young women are injecting drugs," he says.

Dr Anindya Chatterjee, a drug control specialist based in Delhi, says the
rise of injecting drug use has been an important factor in the rapid rise of
HIV infection in India: "It has already kicked along the HIV epidemic here."

But drug treatment services are woefully inadequate and, according to
local drug workers, the Government has been slow to respond to the
crisis. "Official recognition of this problem has unfortunately come
rather late and even now it is not well understood by all levels of
policy makers," Chatterjee says.

Jimmy Dorabjee, once a homeless drug user, is now program manager at
the community organisation where Singh receives treatment.

"There is a huge gap between the current need and what's available,"
he says. "We have about 100,000 heroin inhalers in Delhi and around
40,000 injecting drug users, but when you look and total up that
number of treatment slots available in Delhi, it's only 350. So, what
can treatment achieve really?"

Drug users are highly stigmatised and are often turned away from
overcrowded public hospitals in Delhi.

Wodak says the rise of injecting drug use in India and other parts of
Asia has not received the recognition and policy responses that it
requires: "I don't think people have fully realised the health, social
and economic problems that are going to arise from this. It is going
to take a generation to get this problem under control."

Note: India's Fix, a report by Matt Wade on injecting drug use in
Delhi, ill be shown on SBS's Dateline at 8.30pm tomorrow.