Emerging IDU-HIV scenario in Chennai

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IDU-HIV scenario: Chennai

North and South Chennai are more affected than Central Chennai.

There are approximately 20 000 IDUs in Chennai (North- 6000-8000;

South- 4000-6000; Central- 3000-4000) and perhaps small pockets

of 100-200 IDUs in the rest of Tamil Nadu. Main drugs being

injected are a cocktail of epam/ Calmpose, Avil and Titigesic,

which in local drug use slang is known as CAT. This has replaced

injection of Brown Sugar in recent times. Injection Drug Use

became prevalent after the assassination of Prime Minister Rajiv

Gandhi with the subsequent crack down on the LTTE movement and

its supporters and consequent drying up of opium and opium

derivative drug supply.

The bulk of users are fishermen, casual labor, slum dwellers,

transport workers and Truck drivers. Some middle class localities are

also affected. However the visibility of the middle class is limited

in terms of actual sightings or use of existing services. Two

Organizations have initiated Drug Substitution strategies and

services, namely Sahai Trust working in North and South Chennai and

TTRCRF working in Central Chennai. They are actively networking with

each other and referring cases belonging to their area of

service/influence so that addicts do not abuse the system. Oral

Buprenorphine is prescribed and treatment is under direct observation

of the service provider. Services include counseling, health checkup

and abscess treatment, self help group support, other group dynamic,

family therapy, referral for VTCT and TB etc. The Organizations have

actively networked with other NGOs and Organizations working with HIV

issues such as YRG CARE (VTCT), CHES (CSW counseling and HOPE Club for

HIV positives), ACT (DOTS program for TB cases), IMH (Government

De-addiction Center).Referrals are also made to the Government

Hospitals in Killpock, Tambaram etc for health and HIV related issues.

NGOs supporting this network are Desh & Purush for MSM services and

male sexuality issues, Saraswati for nutrition counseling and support.

These organizations also use the drop in centre at TTRCRF for

sensitization of the clients who gather for services. Average client

load in both places visited is 200-250.The main pockets of

concentration of IDUs are as under:

Velacherry, Perambur, Pulianthoppu, Ice House- Triplicane, Rayapuram,

Peryamedu, Mylapore, Kodambakkam, Vadapalli, NMDA Colony, Choolaimedu,

Adyar, Harbour- Clive Battery, St Mount, Adambakkam

One of the gains of the service is a drying up of abscesses, better

health, savings on drug related expenditure and consequent extra

resources for household expenditure. This has actually made the

affected spouses come to the services to thank service providers and

made them to stay on for their own needs. Stability is slowly

returning to the lives of these addicts who otherwise would not be

ordinarily reached and they are now looking for stable employment and

are being supported in this to some extent. Buprenorphine substitution

dose is related to the drug being taken and the quantity thereof. As

this is mainly Tidigesic, substitution rarely exceeds 6 mg divided

dose daily. Scaling up such a program would invariably reduce costs

further as better dialogue with Pharmaceuticals would result and it

would be one way to trace all vulnerable and reach them with care,

support and preventive messages. The advantage of a drug substitution

program over a needle exchange program is obvious in terms of

effectiveness in spite of unknown HIV status, not having the problems

associated with disposal of used needles and the obvious objective

above all of reducing injecting drug use in the first place in an

environment where loss of control for ensuring safety issues while

using due to drug use per se exists.

A sensitization meeting hosted by Dr Gopal, Project Director, TNSACS,

for about 17 NGO representatives resulted in active participation and

dialogue and led to a request for the following:

a)More information and identification of NGO resources for initiation of Drug

Demand Reduction initiatives.

b)Better utilization of existing services by the clients who are affected by

both addiction and HIV

c)Need for undertaking rapid assessments of the emerging IDU pattern in TN

Dr. Anand Chaudhuri

E-mail:<anand.chaudhuri@...>