Manipur's 2.4 million population grapples with an HIV/AIDS epidemic that stems from heroin addiction directly related to poppy cultivation in the area. It can take two days for people to reach a government hospital for treatment and more time and money to access the ART centre in Imphal. Underdevelopment and decades-old insurgency compound the problem, reports Dilnaz Boga
India’s north-eastern state of Manipur is paying a high price for its proximity to the notorious Golden Triangle, the region incorporating mountainous areas in Myanmar, Laos and Thailand and one of Asia’s two main illicit opium-producing areas. With a land area of approximately 22,327 sq km, Manipur state shares its border with Myanmar (fomerly Burma). Its population of 2.4 million grapples with an HIV/AIDS epidemic that stems from heroin addiction that is directly related to poppy cultivation in the area.
Opium extracted from poppies is used directly or refined into heroin which can be smoked or injected. While both products are illegal and highly addictive, the sharing of infected heroin injecting equipment is also responsible for HIV transmission.
The prevalence of HIV in Manipur is among the highest in India.
The National Aids Control Organisation (NACO) reveals that 0.75% of pregnant women in the state are infected by HIV (according to 2007 estimates), more than twice the national average of 0.36%. Andhra Pradesh tops the list with 1% and Manipur and Mizoram share second ranking with 0.75%.
Three per cent of pregnant women in Chandel and Churachandpur districts and an alarming six per cent of pregnant women in Ukhrul district are HIV-positive.
When the HIV prevalence among pregnant women in a district is more than one per cent, it indicates that HIV has moved from groups at high risk to the general population in that district.
Almost 18% of injecting drug users in Manipur are HIV-positive. Some 16.4% of men having sex with men and 13.1% of female sex workers are HIV-positive. The high prevalence in all three groups is considered a matter of great concern.
More than 43% of the state’s people living with HIV are aged between 21 and 30.
“Most problems stem from poverty and insurgency, so easy money is always welcome,” says Brigadier Balbir Singh, Commander, 26 Sector of the Assam Rifles, a paramilitary unit of the Indian Army. He says that the Underground Groups (UG) seeking independence from India resort to poppy cultivation and extortion to fund their terrorist activities. “Youngsters have more material expectations and ambitions, and their resistance to the lure of money is also weak, so they get sucked into these problems. Poor economic structures are the best breeding ground for resistance movements,” he says.
The youth of the state have to contend with unemployment and lack of opportunities. “Despite the fact that our children are qualified, they are asked to give a bribe of Rs 7-10 lakh to officials to get a teacher’s job in a government-run school here,” says B S Agnes (48) of Lamphoupasa village, 1.5 km from Chandel town. Such high levels of corruption have made matters worse, pushing young men towards militancy or drugs.
“This is a complex problem. It is difficult for us to keep track of every part of the jungle – the areas are remote and the terrain is treacherous. The insurgent groups use the money from poppy cultivation to buy arms from Myanmar and Bangladesh. The border can be infiltrated despite the presence of security forces,” says Colonel Neeraj Shukla, also of the Assam Rifles.
Manipuris grapple with HIV/AIDS as well as the closely-related, spiralling heroin problem. A major cause for the high incidence of HIV cases is the sharing of injecting equipment by heroin users. “Intravenous drug users constitute 70% of the HIV-positive population here,” says T Issac Zou, secretary of the Network of Chandel Positive People (NCP+), a non-governmental organisation in Chandel district in South Manipur, one of the remotest and poorest districts in the state. “Authorities are turning a blind eye to this problem. Villages like Joupi, Khaimi and Churachandpur are notorious for poppy cultivation. Official agencies operating in the area take cuts from the drug cultivators. So who will bell the cat?”
Despite the alarming HIV/AIDS statistics, in June 2008, NACO stopped funds to the Manipur AIDS Control Society (MACS) following reports that funds were being embezzled. Three accountants were booked under the National Securities Act. These reports were confirmed by the director general of NACO, Sujatha Rao. “Yes, it’s true. Their accounts are not in shape, so we didn’t provide funds.” Shortly after Rao gave this telephone interview, NACO released funds to MACS.
Despite such restrictions, many HIV-positive people have taken it upon themselves to educate people and encourage them to fight the virus with the help of care and treatment. Some of them, like Zou, do not restrict themselves to the budget provided to their organisation; they even spend from their own pockets to visit far-flung villages and spread awareness about the virus, and hope for those living with it. Despite the odds against them, and despite their own limitations, the people who work for NCP+ have managed to rope in many others like them. Says Zou proudly, “It gives me a chance to do something good for my people, in my own capacity. Who else will help my people? Day by day, many more are joining our struggle to spread the message.”
Zou predicts that “if the rate of spread of the virus is not stopped, there will be few people left between 30 and 40 years of age in Manipur.”
“Out of the 3,300 people targeted for anti-retroviral treatment (ART), only 200 visit Chandel district’s only hospital,” says Nungchandai, a 28-year-old counsellor at the ART centre in the hospital. According to the president of NCP+, Donny Ngoni, the reason for this is that people expect more financial support from NGOs and when they don’t get this support they don’t come back. “When people have to go back empty-handed, they won’t listen to us. We need more financial assistance. We don’t even have a proper office; we won’t be able to sustain our project beyond 2010.”
Poor facilities compound the problem. The x-ray machine at the Chandel district hospital doesn’t always work. The CD4 machine also often does not work, a source reveals. Then people have to go to Imphal, which is 65 km away, for treatment. It takes them a day to get there and it costs money to travel, says another social worker. In addition, no one wants to be posted in this remote district – they reach the hospital by 11 am and leave by 1 pm as they have to make it back to Imphal before dark.
Manipuris follow the matriarchal system, yet it is the women who suffer the most. Many have lost their husbands to drugs, militancy and AIDS. To make matters worse, condoms are not encouraged by local churches; the state has a large Christian population.
In Aigajana, a village 25 km from the Myanmar border, people have to depend on the security forces for medical care, and even water. Headman Onkhothang Haokip (70), who has lived there for 60 years, says: “We have to carry ill people on foot as there is no mode of transport.” And those with HIV have no choice but to trudge over mountains before making it to the hospital. Zou of NCP+, who frequents these remote districts to counsel HIV-positive people, confirms this: “It takes two days for people to reach the district hospital.”
Such a situation is fertile recruiting ground for some parties, enabling them to take advantage of marginalised groups. The underground groups have trapped minors into working for the cross-border arms and drug trade. “They kidnap villagers and force them to ferry arms or drugs across the border,” says a member of the security forces.
United Kuki Liberation Front (UKLF) general secretary, T L Jacob Thadou, a political science graduate, denies the involvement of his cadres (approximately 300) in the drug trade and agrees that the heroin problem is destroying his people. He says his aim is to unify all the factions of his Kuki tribe who are fighting to control territories in different parts of the state. He claims, “We banned poppy cultivation in 2006. It is cultivated in the more backward districts, where access is difficult.” But the cross-border drug trade thrives.
The Indian security agencies continue to seize drugs and weapons that are being smuggled to Myanmar on a regular basis. On February 16, 2009, the 20 Assam Rifles seized Actifed-DM tablets (a medicine for colds that is abused; it has the effect of brown sugar and is a synthetic opioid substance) worth Rs 4 lakh in the Indian market and four times more in the international market, from a vehicle check post at Byongyang. On January 2, 2009, the same paramilitary unit had seized 98 kg of opium from four individuals travelling on a bus plying between Imphal and Moreh. Each kilo of opium is worth Rs 1 lakh.
Villagers allege that the UKLF runs poppy plantations in the district along the border. Incidentally, the group is also holding tripartite talks with the state and the central governments. As a result, the armed struggle has been suspended since 2005 and the security forces have been advised not to use harsh methods under the ceasefire mandate. But Thadou retorts, “Developmental schemes don’t reach the villagers because the money is siphoned off. The government is using politics to divide our tribes, which is why we want our own Kuki nation.”
This cycle of drugs, poverty, terror and HIV/AIDS will continue to wreak havoc in the lives of the Manipuris until such time as the state and the central government decide to address these issues effectively through policies that benefit the people. Despite the emotional turmoil of living in a volatile conflict zone, and with little or no help from the national media to highlight their problems and the injustice meted out to them over the years, the people of Manipur have not only survived but continue to raise their voice to demand their basic right to life.
(Dilnaz Boga is a freelance journalist based in Mumbai)
InfoChange News & Features, May 2009