IDU intervention prog – a success story in Pfütsero
Avnish Jolly
http://www.morungexpress.com/frontpage/74489.html
One of the ‘hotspots’ (a term used for places where IDUs converge to
have their daily shots) identified by RWA in Pfütsero. IDUs are
sensitized on the consequences of sharing needles by peer educators,
while gradually encouraged to give up drugs.
A quaint little place atop the hills, Pfütsero is like any other small
town in Nagaland – serene and scenic. Beneath the calm and the quiet,
this town of hardly 40000 people, overlooking the majestic Mount
Saramati is now riding high on the successful implementation of an
‘injecting drug use’ intervention progamme under Project Orchid
supported by the Avahan initiative of the Bill and Melinda Gates
Foundation.
Spearheading the movement against drug abuse, though with a humane
touch, is Rukizumi Welfare Society (RWS) Pfütsero, who are advocating
a substitution therapy for victims of drug abuse. Called Oral
Substitution Therapy (also known as OST), it involves substituting the
regular illicit drugs like heroin and spasmoproxyvon with a prescribed
replacement medicine. Simply put, it means that people or victims of
drug abuse, registered under the programme, are administered a daily
dose of Buprenorphine (under medical supervision), thus eventually
ridding them off their earlier dependence on illicit psychotropic
substances.
“Substitution treatment is the most effective option for heroin
dependence treatment related to HIV transmission and the care of drug
users with AIDS,” states the World Health Organisation. Buprenorphine
is a WHO prescribed drug and is included in the organisation’s
‘Essential Medicines List’. Not only does it keep at bay withdrawal
symptoms, it also allows the clients to engage in productive
activities whilst under the programme. It is estimated that at present
only 8 percent of IDUs have access to OST worldwide; whilst, in India
it is accessible to only 3 percent of IDUs.
According to statewide figures released by Centre for Advocacy and
Research (CFAR), 1395 IDUs have been enrolled so far under OST in
Nagaland; out of which 316 have successfully completed the therapy. By
successful completion, it means 0% report of injecting or drug use at
the time of discharge. Further, it has not only reduced intravenous
administration of psychotropic drugs and sharing of syringes, a
decrease in unsafe sexual practices and increased condom use has been
observed, stated the report. Other significant developments have been
in employment, reemployment and greater financial stability as a
result of reduced spending on drugs.
For a town, as small as Pfütsero in area and population, the menacing
effect of drug abuse on a sizeable number of hidden populace of IDUs
was at its peak, before the current intervention programme happened.
RWS is now operating in 27 villages and three towns in Phek district –
reaching out to estimated 1200-plus IDUs. Formed in 2000, it started
implementing the IDU Targeted Intervention project in October of 2004.
The OST was introduced in 2006 with a target of reaching out to 80
IDUs for a start. It now has 72 IDUs under OST while registering 118.
It has to its credit 18 IDUs to have successfully completed the
therapy, while 23 dropped out and 2 referred to rehab. According to
RWS, there are about 20 female IDUs, who were reluctant to come
forward for help. Outreach workers now go to them. Social stigma
remains high for women IDUs which prevents them to come out in the
open.
Recently, a team of media persons from the mainland as well as the
state was taken on a site visit to Pfütsero to have a hands-on
experience of the project ongoing, courtesy CFAR. Supported by Avahan
- the India AIDS initiative, CFAR is an advocacy and communication
research organisation working to improve understanding of HIV & AIDS
and the response shaped; led by the vulnerable communities in
partnership with state governments, NGOs and the community.
There goes a saying ‘Seeing is believing’. Indeed, the visit was an
awakening for the media team, interacting with the outreach workers
and the OST clients in particular. And the work of RWS awe-inspiring.
The beginning was however not that easy facing much opposition from
the church and the civil society. “When we initiated the project in
2004, the Church and women’s group leaders felt we were encouraging
drug use by ‘distributing’ needles and syringes and condoms. They
visited us or we were called by them to discontinue the intervention,”
says project Director of RWS, Vetsyuri.
Today, the same people who opposed the project are endorsing RWS and
their work. It was the result of their unyielding effort to take the
church into confidence and the civil society. Over the last five
years, project volunteers have visited every church in the town and
its surrounding areas, interacting with the pastors and other church
leaders.
“We met with the Chakhesang Baptist Church initially, to inform of
them of our work. Initially they were not convinced, but agreed not to
oppose the services. We then visited each church and told them of the
harm reduction approach. In 2008 at the annual conference of the
Chakahesang Baptist Church, the women department made a resolution to
participate and support in the prevention and awareness of HIV and
AIDS. Once OST came, it became easier to speak to the church leaders,”
adds Vetsyuri.
The success of the project is somewhat summed up by the pastor of
Pfütsero Town Baptist Church, Rev. N. Chiero. His comments in the
record of project workers states, “When RWS started working we were
sceptical. They met us, spoke to us about their work, we listened
quietly. But after the programme started petty crimes and deaths
reduced and we began to take interest in their work. They are doing
good work, we support them. The church has also introduced HIV & AIDS
as a part of the syllabus at the Baptist Theological College in
Pfütsero. When the students pass out will be better equipped to deal
with issues like drug use and HIV & AIDS.”
Twenty-six years old, Ato, is currently under OST. Married with a 14-
month old daughter, by profession, he is a carpenter and an
electrician, while also working as a peer educator at RWS drop-in
centre in Pfütsero. “I started to spend a lot of money buying my daily
dose as well alcohol and always worried about the next dose and never
think of working. My family rejected me and stopped talking to me. My
relationship with my wife declined,” says Ato, who took to drugs about
11 years back.
Now, under OST, he testifies that there has been a big change in his
life, albeit, for the better. He says that his physical health has
improved and importantly, regaining his mental composure injecting in
him the desire to lead a normal working life. He hopes to eventually
come out of OST even stronger.
There are many like Ato, whose lives have been turned around. They
have banded together to form a support group. Christened ‘Espor’,
meaning hope, it was established in 2008 by the clients of RWS.
Starting with 28 members, the group is now 64 members strong. Some of
the members are currently under OST, while most are clean. The main
objective of ‘Espor’ is to ‘support one another towards better
knowledge, awareness about drug use and HIV & AIDS, train & orient one
another, practical support in accessing services etc’. The network
plays a crucial role in intervening as and when a crisis arises. “Once
we were leading a hopeless life, disowned… but with the effort of RWS
and ESPOR we are able to reach out” says Joseph, president of Espor.