Associated Press - November 29, 2006
Nirmala George

Men sidle down the lane, an infamous hangout for addicts, to a sparsely furnished whitewashed room that's become a front line in India's battle against the spread of the deadly HIV virus. There, protected from prying eyes by a striped curtain strung across the open door, addicts young and old exchange dirty needles for clean ones.

Such programs are common, if controversial, in many parts of the world. But they are just beginning to take off in India, where most anti-HIV efforts largely focused on promoting safe sex among high-risk groups such as sex workers, truckers and migrant laborers, with an emphasis on distributing condoms and encouraging their use.

But as World AIDS Day is marked Friday and the year draws to a close, health authorities are shifting direction in an effort to curb the spread of HIV in India, where 5.7 million people are infected, giving it the world's highest number of HIV and AIDS cases.

"Our priority for the new phase of the AIDS control program has shifted to take in the rise of injecting drug users," says Sujatha Rao, director of India's National AIDS Control Organization, or NACO.

Rao and others are hoping to repeat the success health authorities have seen in southern India, where University of Toronto researchers found this year that the number of HIV infections among young people had dropped by more than a third between 2000 and 2004.

The researchers singled out efforts by the Indian government, the World Bank and other nongovernment groups to educate sex workers and those who visit them about AIDS dangers. But they warned that it was important to reach wider audiences, such as injecting drug users, most of whom are addicted to cheap cocktails of over-the-counter pharmaceuticals.

Estimates of how many Indians use intravenous drugs vary widely. Indian authorities put the number at around 100,000, while the United Nations says it could be as high as 1 million.

According to 2005 NACO estimates, about 10.1 percent of injecting drug users had contracted HIV, the virus that causes AIDS.

The majority of India's injecting drug users are thought to be in the country's northeast, a poorly developed region near the heroin-producing "Golden Triangle," where the borders of Myanmar, Laos and Thailand converge.

But officials say the number of intravenous drugs users elsewhere in India, especially in big cities like New Delhi and Chennai, has grown in recent years due to the easier availability of drugs in urban centers.

Now they are reshaping their anti-HIV efforts to take on the trend.

"We are already scaling up programs for harm reduction and to wean away users from illicit drugs," said Rao.

The needle-exchange center in the Kotla market is part of that effort. Opened earlier this year by the Society for Promotion of Youth and Masses, it is one of nearly 114 needle-exchange facilities across India.

Volunteers at the center help addicts and are supported by former drug users known as "peer leaders."

"The HIV risk is much higher with injecting drug users," says Denis Broun, who runs UNAIDS' India program. "With unprotected sex, the risk of contracting HIV is about 1 in 200. However, when people inject directly with a tainted needle or syringe, the risk is as high as 1 in 10."

Those using unclean needles also run the risk of getting abscesses and sores, which in extreme cases can lead to gangrene, requiring the amputation of the affected limb.

Activists and officials say the ideal way to stop the HIV spread among drug users is to free them of their addiction. But that is easier said than done, so they are looking to other methods, like needle exchanges, to reduce the risks of contracting the virus.

Methadone, a synthetic heroin substitute long used around the world to help heroin addicts kick the habit, is another way to combat the spread of HIV among injecting drugs users.

"The idea is to get people to stop injecting. Methadone is in syrup form, so it is taken by mouth and reduces the withdrawal from heroin," Broun said.

But methadone is not approved in India, a fact that UNAIDS and other groups are pressing the government to change.

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