Why are HIV cases among people who inject drugs still a challenge?
India faces a serious challenge regarding the spread of HIV among injecting drug users, which requires comprehensive community-based interventions to prevent the spread.
As the HIV epidemic in India affects vulnerable populations, particularly people who inject drug users (PWID), interventions are needed to prevent the spread of the virus.
People who inject drug users (PWID) are one of the groups most affected by HIV. HIV is a virus that interferes with the body’s ability to fight infection.
With HIV prevalence being approximately 45 times higher among persons with disabilities than the general population, health experts have stressed the need for comprehensive, community-based strategies to address this public health challenge.
Sunil Solomon, professor of medicine in the infectious diseases division at the Johns Hopkins University School of Medicine, said although there is still some stigma and discrimination associated with HIV, there have been significant improvements over the past two decades.
“One of the biggest challenges is that when people are diagnosed with HIV, they don’t know what their parents, siblings or society will think of them,” said Solomon. Solomon is also the chairman of Chennai-based YRGcare. YRGcare was founded in 1993 by Suniti Solomon. She is known for documenting the first case of HIV in India (1986).
Higher risk in PWDs: A growing concern
About 2.4 million people in India are living with HIV, making it the country with the second highest number of HIV cases in the world.
Although significant efforts have been made to reduce HIV infections among the heterosexual population, other groups, such as people who inject drugs, are disproportionately affected.
According to Sunil Solomon, “The prevalence of HIV infection among persons with disabilities in India is approximately forty-five times higher than in the general population. This population is at increased risk not only for HIV but also for hepatitis and other blood-borne infections.”
The HIV specialist, along with his organisation, has been providing services to high-risk groups since 2012, with a special focus on people who inject drugs. His work in Delhi, especially in the Yamuna Bazaar area, has been fruitful in addressing the unique needs of this community.
In fact, Sunil Solomon has collaborated with the Abbott Pandemic Defense Coalition, a global partnership focused on early detection and rapid response to future pandemic threats, to launch an initiative to detect HIV among people who inject drugs.
One of the major initiatives of this collaboration in Delhi is ‘The Blue Shed’, located in Yamuna Bazaar, an area known for HIV infection.
The project helps meet the immediate and long-term needs of people who inject drugs.
Gavin Cloherty, head of infectious disease research at Abbott, told IndiaToday.in that their model of decentralising healthcare and meeting people where they are could help increase access to testing and overall care.
“By providing a welcoming environment that gives people access to essential health services and education, this initiative can reduce the spread of HIV and other infectious diseases among people who inject drugs,” Cloherty said.
Apart from testing for HIV, the facility also tests for viral hepatitis and other infections.
The Delhi State AIDS Control Society also played a vital role in providing Opioid Substitution Therapy (OST) and HIV testing kits to Solomon and his team.
Opioid replacement therapy is a treatment for people who are dependent on injection drugs. In this therapy, they are given safe, long-acting medications that work like the drugs they are addicted to, but under the supervision of a doctor.
Along with medication, they are also given counselling and support to help them recover.
“Currently, around 800 individuals are registered at the clinic and the number is increasing every day,” Solomon said.
Challenges in Detecting HIV Cases
While initiatives like Blue Shade are making an impact, both Solomon and Cloherty agree that broader systemic changes are necessary to effectively prevent the spread of HIV among people who inject drugs.
“The biggest shortcoming of the programme is in finding people who are infected. It is estimated that only about 77% of people living with HIV have been diagnosed,” Solomon said.
“Several new strategies such as network-driven testing, contact tracing and virtual testing are being adopted by the government and NGOs to bridge this gap. Once diagnosed, efficient systems are in place to connect and retain most of them in care,” he added.
Cloherty highlighted the importance of public-private partnerships in combating infectious diseases, including testing and treatment.
Both experts emphasized that although progress is being made, continued investments in community-based initiatives and public-private partnerships can help sustain and expand the fight against HIV among persons with disabilities in India.
