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The percentage of HIV infection through drug routes has increased from 15.9% in 2007-08 to 33.1% in 2017-18.
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Mizoram continues to battle twin menace of HIV and drugs

Percentage increase of HIV infection via drugs has witnessed a 108.2% increase over the ten-year period from 2007-08 to 2017-18

Aizawl: Mizoram has been battling the menace of HIV/AIDS for a long time. However, what is turning out to be of great concern is that, apart from unsafe sex, drug abuse is emerging as another critical route for the potentially life-threatening disease in the state.

The severity of the situation can be gauged from the fact that the percentage of HIV infection through the drug route has increased from 15.9% in 2007-08 to 33.1% in 2017-18, and the percentage is showing an upward trend at 35.1% for 2018-19, as per the data accessed from the Mizoram State AIDS Control Society (MSACS). This means that the percentage increase of HIV infection through drug route has witnessed a 108.2% increase over the ten year period from 2007-08 to 2017-18.

Mizoram has the highest prevalence of HIV/AIDS in the country at 1.19%.

Another worrying trend is that the rate of HIV-positive infection is the fastest in the age group of 15-24 years, which is a fairly young population of the state to be affected by the disease.

While HIV infection through drug routes has seen a jump over the past few years in the hilly Northeastern state, the infection has registered a decline so far as the unsafe sex route is concerned, from 76% in 2007-08 to 64.5% in 2017-18, a 13.7% decline within ten years.

The rate of HIV positive infection is the fastest in the age group of 15-24 years
The rate of HIV positive infection is the fastest in the age group of 15-24 years
Source: Mizoram State AIDS Control Society (MSACS)

Although HIV/AIDS is often concentrated among high-risk group populations consisting of those having unprotected sex, sexual indulgence with multiple partners, and injectable drug abuse, among others, Mizoram is witnessing a rise in the percentage of HIV positivity among the general public (apart from high-risk group) as well -- from 3.6% in 2008-09 to 4.3% in 2017-18.

The trend is showing a further rise of about 5.5% during 2018-19. The trend had, however, remained comparatively low between 2011 and 2016, when it was reported to be within 2.7 and 2.9%. The number of general patients tested on a yearly basis for HIV/AIDS has seen a steep rise from 4,987 in 2007-08 to 56, 750 in 2017-18. Similarly, the number of general public diagnosed being HIV positive has risen from 233 in 2007-08 to 2,093 in 2017-18.

Shedding light on the twin menace of HIV/AIDS and drug abuse in the state, Dr Lalmalsawmi Sailo, project director of MSACS, pointed out, “In Mizoram, the spread of HIV/AIDS is not limited to the so-called high risk groups but it is also spreading among the general public at a high rate. And, over the past few years, we have witnessed a drastic increase in the number of injecting drug users, comprising a sizeable population prone to HIV/AIDS.”

The number of general public diagnosed being HIV positive has risen from 233 in2007-08 to 2,093 in 2017-18
The number of general public diagnosed being HIV positive has risen from 233 in2007-08 to 2,093 in 2017-18
Source: Mizoram State AIDS Control Society (MSACS)

She added, “The cheap availability of drugs, especially heroin, trafficked via Myanmar, makes it very difficult to address the issue. The drugs being smuggled from Myanmar is killing the people of my state, especially the younger generation.”

Dr Lalmalsawmi Sailo, project director, MSACS, highlighted the issues behind addressing the twin problems of HIV/AIDS and drug trafficking
Dr Lalmalsawmi Sailo, project director, MSACS, highlighted the issues behind addressing the twin problems of HIV/AIDS and drug trafficking
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She added, “Apart from the drug addicts, the easy availability and cheap rate of drugs attracts a whole new lot of injectors. It also leads to an increase in the frequency of injecting episodes, which in turn makes them more vulnerable to HIV infections.”

With Mizoram sharing porous borders with neighbouring countries of Myanmar and Bangladesh, as well as three state borders with Assam, Manipur and Tripura, its geographical location makes it particularly vulnerable to drug traffickers. Mizoram shares a 510-km unfenced border with Myanmar, and both the governments of both India and Myanmar permit a ‘free movement’ regime up to 16 km beyond the border. This region also lies cheek-by-jowl to the infamous Golden Triangle of Thailand, Laos and Myanmar, arguably one of the world’s biggest drug trafficking route and one of the largest source of opium and heroin.

As per the data accessed by the reporter from the Mizoram Excise and Narcotics Department, there has been a spurt in the smuggling and seizures of a variety of illegal drugs and alcohol in Mizoram over the past few years, particularly through Myanmar. Among the drugs seized by the department, heroin has reported an increase from 4.088 in 2015 to 6.463 kilogram up to October 31 this year.

The deaths attributed to heroin (which can also be used as an injectable drug) abuse was recorded at nine in 2015, 36 in 2016, 28 in 2017, and 16 as on November 27 this year. Apart from heroin, ganja seizure has also risen from 163.742 kg in 2015 to 392.018 kg in 2017 and 178.160 kg as on October 31 this year. Some other popular drugs include Nitrazepam, Alprazolam, Tramadol, cough syrup and pseudoephedrine, among others. The official figure of drug related deaths in Mizoram between 2007 and 2018 (as on November 27) stands at 417.

Heroin seizures from Mizoram have reported an increase from 4.088 kg in 2015 to 6.463 kg up to October 31 this year
Heroin seizures from Mizoram have reported an increase from 4.088 kg in 2015 to 6.463 kg up to October 31 this year
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While Champhai district of Mizoram, which shares a border with Myanmar, is particularly witnessing an increase in the number of drug users and hence HIV/AIDS cases, other prone districts include Lawngtlai, a district sharing its border with both Myanmar and Bangladesh, Siaha, and Kolasib, besides Lunglei town. Considering the increasing instances of drug trafficking and abuse, the Mizoram Excise Act, 1973, which had earlier included Siaha, among other districts, has now been extended to include Lawngtlai district as well. State capital Aizawl continues to serve both as a transit as well as destination for drug peddlers.

Talking about the most prominent places in the state with high prevalence of HIV positive cases, Sailo said, “More than 70 % of all the HIV positive patients are in the Aizawl district, and the other places recording a very high number of HIV positive cases include Champhai, Kolasib and Lunglei, mainly due to drugs.”

The chronic and potentially life-threatening condition of HIV/AIDS is seen to be more prevalent among the low literacy groups, mostly school dropouts, and those engaged in the unorganised sector. It must be noted here that Lawngtlai district, which is a major point of drug abuse and smuggling, recorded 66% literacy rate, lower than the state’s 93.91% literacy rate and a national average of 70.04%.

According to the India HIV Estimations 2017 Technical Report, Mizoram had the highest adult HIV prevalence among states in India in 2017, with the infection being detected in 2.04 per cent of the people whose blood samples were tested. A state with a population of 10 lakh, as many as 18,081 people in the state were found HIV positive between October 1990 and August 2018. Over 1,760 people have died in Mizoram because of AIDS/HIV-related complications since the first case was detected in October 1990, as per a HIV Sentinel Surveillance 2016-2017 report of National AIDS Control Organisation.

Although MSACS has been undertaking several measures to address the issue of HIV/AIDS through its information, education and communication division, targeted intervention, drop-in centres where they distribute condoms, conduct syringe and needle exchange programmes, counselling, care, support and treatment (CST) programme, etc, they don’t seem to be enough, as these treatments and programmes are mostly designed to target the high-risk groups, despite the fact that the spread of the disease is not just limited to them but also the general public.

There are total of eight Antiretroviral Therapy (ART) centres, which provide crucial treatment by preventing the growth of the virus in the state.

Apart from an incomprehensive strategy to treat the condition and failure to address various issues associated with it, the state AIDS control society is also struggling with fund crunch. Sailo said, “Mizoram State AIDS Control Society still faces serious shortage of funds, to the extent that it becomes difficult for it to continue with its programmes.”

In 2014, the budget meant for the National AIDS Control Organisation (NACO) was slashed from Rs 1,700 to Rs 1,300 crore for 2014 and 2016 by the Central government. Until 2014, NACO used to receive funds by both the Central government and foreign agencies such as UNICEF and others as part of the global fund to fight diseases such as HIV/AIDS.

After a year of disastrous experiments with NACO’s funding pattern, in 2016, the central government decided to revert to the system of NACO funding the state AIDS control societies (SACS), instead of the respective state government treasuries funding them. The fourth phase of one of India’s flagship health interventions — National AIDS Control Programme (NACP-IV) — also struggled with stock-outs of essential life-saving drugs due to inordinate delays in state governments releasing money. Although SACS are now being funded directly by NACO, and its annual budget has been raised to the previous 1,700 crore.