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Manipur and AIDS



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                            Manipur and AIDS

Manipur is a small land-locked State in the north-east of India. Its
borders include the Indian states of Nagaland to the north, Assam to the
west, Mizoram to the south, and a 358 km border with Burma to the east.
The Burmese border includes the large Sagaing Division and a section of
the northern Chin Hills. Manipur is one of the poorest and least
developed regions in India, with a 1996 per capita income estimated at
3500 rupees/year, about one-third of the Indian national average.
Manipur has been governed under Indian security laws since the 1950s,
and is currently patrolled by five Indian military services, in addition
to two Manipuri security agencies. The political situation is complex,
with a large and long-standing insurgency seeking autonomy, many smaller
ethnic insurgencies, numerous armed groups, and several thousand
political and economic migrants and refugees from Burma. A state of
low-intensity chronic civil war pervades, and armed clashes, human
rights abuses, and violence are endemic.

Manipur appears to have no significant indigenous tradition of opium
poppy cultivation. Local officials and drug users are consistent in
reporting that heroin form Burma, called locally ?Number 4?, began to
appear in Manipur in 1982-84. After 1984 the availability and use of
heroin increased steadily, reaching epidemic proportions after 1990.
Although precise numbers of addicts are difficult to assess, a 1991
estimate was 15000 IDU (Injecting Drug Users), it is clear that heroin
use is common and has been attributed to widespread availability of
Burmese exports (Note: Burma produces approximately 60% of the world?s
heroin.)

Nearly all heroin users studied were injectors. Needle sharing appears
to have been common until quite recently; this has begun to change in
the last 2-3 years among addicts seeking care and those involved with
local information networks.

Local heroin use, however devastating for local people, is only a small
fraction of the heroin trade in the state. Since the early 1990s,
Manipur has increasingly become a major trade route for Burmese heroin,
particularly across the border zone of Moreh (Indian side)-Tamu (Burma
side). According to local traders and official, the bulk of heroin
moving across the Moreh border is from north-east Burma, from the Shan,
Wa, and Kokang growing and manufacturing areas to Mandalay, then across
the Sagaing Division to Tamu and inland to Mandalay to purchase heroin.
They also report ?self-testing? heroin, and consequent needle sharing
with traders in Mandalay as part of their drug purchasing behaviors.
?Self-testing? is the injection use of heroin by the prospective
purchaser to assess the potency and quality of the drug through its use.
Key informants in Manipur reported that sharing of both drugs and
injection equipment among buyers and sellers was a common feature at
these exchanges.

The first HIV infection in the state was detected in an IDU in 1989, the
same year that HIV became an epidemic among injectors in Burma and
Thailand. Between 1990 and 1991, the HIV prevalence rose form under 1%
among addicts to over 50%, and reached 80.1% by 1997. HIV spread to
other risk groups has since been remarkable rapid; after the epidemic
among injectors, there has been subsequent spread to their sex partners,
wives and children. Although the data are far form complete, a
comparison of Manipur with the rest of India is illustrative: Manipur
has about six times the HIV prevalence of the next most affected state,
Maharashtra, and 20 times the HIV rate of the India?s third most
affected region, Tamil Nadu. An estimated 2% of pregnant women were HIV
infected in 1997, and 14.4% of tuberculosis patients in 1996, a figure
which had risen form 3.3% only 2 years earlier. Using cumulative data
form 1990, however, 73.9% of known HIV infections have occurred among
injecting drug users. Surveillance data suggests that the bulk of cases
are in the capital, Imphal (69%). However, this is likely to be an
artifact of increased screening and testing facilities.

(From AIDS ? http://www.AIDSonline.com -, Vol. 14, No. 1, January 7,
2000)



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<center><b><font color="#0000FF"><font size=+3>Manipur and AIDS</font></font></b></center>

<p><font size=+1>Manipur is a small land-locked State in the north-east
of India. Its borders include the Indian states of Nagaland to the north,
Assam to the west, Mizoram to the south, and a 358 km border with Burma
to the east. The Burmese border includes the large Sagaing Division and
a section of the northern Chin Hills. Manipur is one of the poorest and
least developed regions in India, with a 1996 per capita income estimated
at 3500 rupees/year, about one-third of the Indian national average. Manipur
has been governed under Indian security laws since the 1950s, and is currently
patrolled by five Indian military services, in addition to two Manipuri
security agencies. The political situation is complex, with a large and
long-standing insurgency seeking autonomy, many smaller ethnic insurgencies,
numerous armed groups, and several thousand political and economic migrants
and refugees from Burma. A state of low-intensity chronic civil war pervades,
and armed clashes, human rights abuses, and violence are endemic.</font>
<p><font size=+1>Manipur appears to have no significant indigenous tradition
of opium poppy cultivation. Local officials and drug users are consistent
in reporting that heroin form Burma, called locally ?Number 4?, began to
appear in Manipur in 1982-84. After 1984 the availability and use of heroin
increased steadily, reaching epidemic proportions after 1990. Although
precise numbers of addicts are difficult to assess, a 1991 estimate was
15000 IDU (Injecting Drug Users), it is clear that heroin use is common
and has been attributed to widespread availability of Burmese exports (Note:
Burma produces approximately 60% of the world?s heroin.)</font>
<p><font size=+1>Nearly all heroin users studied were injectors. Needle
sharing appears to have been common until quite recently; this has begun
to change in the last 2-3 years among addicts seeking care and those involved
with local information networks.</font>
<p><font size=+1>Local heroin use, however devastating for local people,
is only a small fraction of the heroin trade in the state. Since the early
1990s, Manipur has increasingly become a major trade route for Burmese
heroin, particularly across the border zone of Moreh (Indian side)-Tamu
(Burma side). According to local traders and official, the bulk of heroin
moving across the Moreh border is from north-east Burma, from the Shan,
Wa, and Kokang growing and manufacturing areas to Mandalay, then across
the Sagaing Division to Tamu and inland to Mandalay to purchase heroin.
They also report ?self-testing? heroin, and consequent needle sharing with
traders in Mandalay as part of their drug purchasing behaviors. ?Self-testing?
is the injection use of heroin by the prospective purchaser to assess the
potency and quality of the drug through its use. Key informants in Manipur
reported that sharing of both drugs and injection equipment among buyers
and sellers was a common feature at these exchanges.</font>
<p><font size=+1>The first HIV infection in the state was detected in an
IDU in 1989, the same year that HIV became an epidemic among injectors
in Burma and Thailand. Between 1990 and 1991, the HIV prevalence rose form
under 1% among addicts to over 50%, and reached 80.1% by 1997. HIV spread
to other risk groups has since been remarkable rapid; after the epidemic
among injectors, there has been subsequent spread to their sex partners,
wives and children. Although the data are far form complete, a comparison
of Manipur with the rest of India is illustrative: Manipur has about six
times the HIV prevalence of the next most affected state, Maharashtra,
and 20 times the HIV rate of the India?s third most affected region, Tamil
Nadu. An estimated 2% of pregnant women were HIV infected in 1997, and
14.4% of tuberculosis patients in 1996, a figure which had risen form 3.3%
only 2 years earlier. Using cumulative data form 1990, however, 73.9% of
known HIV infections have occurred among injecting drug users. Surveillance
data suggests that the bulk of cases are in the capital, Imphal (69%).
However, this is likely to be an artifact of increased screening and testing
facilities.</font>
<p><font size=+1>(From AIDS ? <a href="http://www.aidsonline.com";>http://www.AIDSonline.com</a>
-, Vol. 14, No. 1, January 7, 2000)</font>
<p>&nbsp;</html>

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