Another Uganda in Manipur
— HIV/AIDS scenario in Kamjong —
By S Neken Singh
Kamjong – 121 km. from Imphal is a remote sub-division of Ukhrul district situated near the International border of Myanmar. Rampant drug-use and numerous immature deaths due to AIDS are indicators that may project Kamjong as a future Kampala in Manipur. Kampala is the capital of Uganda, an eastern African nation famous for an advanced AIDS crisis the world over. The situation in Kampala in the beginning of AIDS epidemic was no less different from what is happening at Kamjong today. In 1985, HIV prevalence among pregnant women in Kampala was 11 percent. This figure rose to 25 percent in 1990 and to 29.4 percent in 1992. Today 3% of the pregnant women attending ante-natal clinics in Kam-jong (Ukhrul) is estimated to be HIV infected. Without any quick and efficient response, it will soar in the near future and Kampala-like situation will occur in Ukhrul and Kamjong. “U for Uganda” will then be “U for Ukhrul” and “K for Kampala” will be replaced by “K for Kamjong” in the HIV/AIDS alphabet.
With all out efforts by international donor agencies and the U.N, the HIV/AIDS problem is almost stabilized in this poor and underdeveloped region (Uganda, Kampala). In 19-96, prevalence among pre-gnant women in Kampala had fallen to 15 percent. In 1998, it had declined to 13.8 percent and to 11.3 percent in 2000. However, innumerable number of people are carrying the virus, many have died young and many children have been orphaned due to unchecked growth of the epidemic in Uganda. The situ-ation in Uganda has worsened in only one decades time. There is no guarantee that such a similar situation will not happen in Kamjong, Ukhrul and Manipur in the near future.
As compared to Ugan-da, the problem in Ukhrul particularly Kamjong is worse. Both Intravenous drug use and heterosexual transmission are rampant in Kamjong whereas in Uganda the main mode of HIV spread is heterosexual transmission. Cases of pre-marital sex among young boys and girls are also not absent in Ukhrul. Hence, without any specific concern, the progress of the epidemic in Ukhrul will definitely be faster than that happened in Uganda in the past one decade.
The first AIDS cases in Uganda were identified in 1982. In 2001, overall HIV prevalence among women attending ANCs was 6.5 percent, an increase from 6.1 percent in 2000. Most of the new HIV infections (84 percent) in Uganda occur through heterosexual transmission. Parental transmission accounts for about 15 percent of cases. Unsafe blood/blood products account for up to 5 percent of all HIV cases. The portion of HIV transmission attributable to homosexuals and Intraveno-us Drug use is not known.
By 2000, there had been 1.3 million AIDS deaths in Uganda. In December 2001, out of about 2 crore 33 lakhs people of Uganda more than 10 lakhs were living with HIV/AIDS. Among them, 56.3 percent were women. Nearly 80 percent of those infected with HIV were between ages 15-45. Since the beginning of the epidemic through 2001, 20 lakhs Ugandan children had been orphaned by AIDS. The disease is responsible for 12 percent of annual deaths and is the leading cause of death among 15-49 age group.
AIDS epidemic in Ma-nipur is now 16 years old. The state is ranked first among others for having highest HIV prevalence rate. According to Sentinel Surveillance 2005, Manipur is estimated to have 13 HIV infections out of eve-ry 1000 population. The rate of prevalence among the Intravenous Drug Users has come down from as high as 80% in 1997 to 24% in 2005. The alarming increase is seen among innocent housewives who are considered as low risk general population. Ukhrul district is now the most al-arming region in Manipur.
The state is also, on the other hand considered as a pioneer in regard to HIV prevention and control efforts. Among the recent achievements of the state, mention may be made of the success of the harm reduction programme (RIAC), launching of 4 ART centres, 21 VCCTCs for HIV testing/counselling, PPTCT centres at all district hospitals, at some selected CHCs and PHCs and at Shija Hospital, Langol, working of Blood component separation unit at RIMS, installation of CD4 count machines at JN Hospital, RIMS, Ukhrul and Churachandpur district hospitals and many more. But the services and programmes are yet to reach the interior villages of the state. The sincerity, commitment and sacrifice of those working in Government and non-government sectors are lacking, thereby making the people of remote villages suffer like anything. Kamjong – may be one example.
As per the Sentinel Surveillance report 2005, the rate of HIV prevalence among ante-natal women in Ukhrul is 3%. It means that out of every 100 people in Ukhrul, three are HIV infected (technically, ante-natal mothers represent the general population). So out of 13,000 population of Kamjong, there may be around 390 HIV infections. If we calculated on the basis of Crude Birth rate (CBR), the estimated number of pregnant women in Kamjong in a year is 236 and among them 3% may be considered as HIV infected. Hence, 7 pregnant mothers will be HIV infected as per calculation and they may transmit the HIV to 2-3 children born to them. (as chance of mother to child transmission is only arou-nd 30 %). So, without any intervention for pregnant mothers, 2-3 HIV positive children will be born in Kamjong each year.
Unchecked drug trafficking, cheap and easy availability of Heroin- No. 4, sharing of contaminated needles and syringes among drug users have caused widespread HIV infections among the youths of this place and consequently untimely deaths among them. “During the last one decade, I have taken part in at least 26 funerals of AIDS deaths”, Mr. P.S Sword, 50 year old local Pastor of Kamjong Church expressed with shock. While visiting the Baptist Cemetery at Kamjong, this writer witnessed numerous graveyards of young people born after 1970 and died most likely of AIDS leaving behind wives and children. According to friends and relatives there, most of them had used drugs and died of HIV/AIDS unaware and unreported.
It is only about 20 kms from Kamjong one has to go to reach the Myanmar border. Myanmarese people used to frequent Kamjong for illicit trafficking of drugs and other materials by road which is jeep-able and bereft of any check and governmental reinforceme-nt. “Drug trafficking from the Golden triangle via Myan-mar border to Kamjong invol-ves cows in whose anus the drug packets are inserted and the pulling of the animal from across the border takes place. After reaching the destination, the packets are collected from the dung of the cows” narrated one of the local youths in Kamjong.
The late arrival of HIV preventive messages and intervention services among drug addicts have let loose the uncontrolled epidemic and devour of innocent adolescents for the past 10 years in Kamjong. “It is too late today, many sons have already died prior to arrival of AIDS control services and prevention messages”- an old churchman lamented during interactions held at Kamjong Town Hall as part of the Mass AIDS Awareness programme organized by MACS in collaboration with Tangkhul Katamnao Long. On 4th October 2006, two resou-rce persons from Manipur SACS delivered lectures in the Town Hall where more than 500 students, youths, women and religious leaders enthusiastically gathered for the programme.
At night, a Mega AIDS awareness music concert with the ever famous Pho-enix band from Imphal roc-ked Kamjong entertaining the people with their most popular Tangkhul and En-glish numbers. Hegen, Viv-ek and Source Mashangva announced AIDS awareness messages to the gat-hering in between songs. The mega event at Kamj-ong public ground was the first of its kind in this cosmopolitan hill station. 2YC of 1st Bn. Assam Rifles Ch-eema was the chief guest and almost all inhabitants of Kamjong jam-packed the ground for the whole night. In fact, people of Kamjong are ready to listen to AIDS awareness mantras and are willing to establish a drug free- AIDS free Kamjong, the only need is the sincere and whole-hearted efforts of the governmental and non-governmental sectors related to HIV/AIDS prevention and control programmes.
Immediate intervention in the form of Needle syringe exchange, detoxification, counselling and awa-reness campaign, condom promotion, Nevirapine therapy for positive pregnant women and ART for AIDS patients is called for saving the people of this place. One RIAC project, one PPTCT support service project, one ORCHID project under Melinda and Bill Gates Foundation are operating in Kamjong. Under the Govt sector, VCC-TC and PPTCT centres have been opened at CHC Kamjong where there are lots of complaints regarding irregularity of medical staff and inefficiency of services.
Although the most important service centres (VCCTC and PPTCT) have been opened, people are still going to Ukhrul and Imphal for HIV testing thereby revealing the non-functional government health sector in Kamjong. Fortunately, the 1st Bn. Assam Rifles situated at Kamjong is also delivering HIV testing services to cases referred to by NGOs. The AR high-ups in the Bn. take keen interest in fighting AIDS/HIV in Kamjong, reported a local-man. An ART centre is also on demand because those adhering to ART have to face difficulties in getting drugs from Ukhrul as Ukhrul is at least 80 km. from Kamjong. At present 8 persons are taking ART drugs, still more patients are qualifying for it but to no avail due to poverty to afford bus fare to Ukhrul.
People of the area demanded improved services of Manipur SACS, NACO and NGOs. Their only concern is – Save Kamjong from AIDS. They are ready to save the next generation and they are willing and committed. They are waiting for help.
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An audience with his Excellency the Governor of Manipur
By Lt Col H Bhuban Singh
On 11 October, a team of leaders of Manipur Peoples' Party led by Dr L Chandramani Singh, had an audience with His Excellency Dr SS Sidhu, the Governor of Manipur. I was a member of that team. After the initial introduction of all us by Dr Chandramani, the MPP president, we settled down for talks. Dr Chandramani pleaded that Irom Chanu Sharmila had undertaken fast unto death since 2nd November 2000, when ten innocent lives were killed due to firing by personnel of Assam Rifles at Malom. He urged that since His Excellency had good rapport with the President of India and also with the Prime Minister, he could kindly influence them and repeal Armed Forces Special Powers Act (Assam and Manipur) 1958 as recommended by Jeevan Reddy Committee Report on AFSPA and save the life of our Irom Lady Sharmila. The Governor replied that he would do so whenever he goes to Delhi. That was very kind of him.
Then I was told to speak, I never had an interaction with our Governor, since I am a lone type of person. I do not hang around the Bungalow of Chief Minister or at the Manipur Secretariat office. I am always miles away from Raj Bhavan.
The only occasion when I had a glimpse of our Governor was at a function of Manipur Public Service Commission when Dr Sidhu was the chief guest and I was in president of that function. It was a casual 'How-are-you' - type of interaction and was not a serious one. Moreover, the MPSC function started the moment His Excellency arrived and there was no time to indulge in idle gossip.
I spoke to the Governor on this 11 October meeting that the main lacuna of AFSPA was lack of accountability for all acts of commission/ omission by State agencies. In other words, State terrorism was accepted officially and legally.
No personnel of Armed Forces (Army, Assam Rifles, CRPF, MR, State Police etc) could be made accountable. No courts of India, including the Supreme Court can issue summons to even a rifleman without permission from Ministry of Defence or Home Affairs, Govt of India. They are immune to the laws of the land and are allowed to go berserk. His Excellency replied that they conduct their own courts of Inquiry and punish the guilty. To this, I replied that I was a soldier and commanded an independent military unit in 1965-68 at Chakabama, Zakhama and Dimapur and our on Military Courts of Inquiry were perfunctory in nature. It as just a paper-eye-wash.
Then the discussion went to other members of the delegation. When my final chance to speak again came up, I said that the litmus test of efficacy of any law, was to see if the law was able to fulfil the purpose it was intended to perform. AFSPA was introduced in India to curb terrorists who endanger State administration. It failed.
Also I pointed out that Anti-Defection Law in its original form was full of lacuna. Now, any defection, singly or collectively attracts disqualification. Defection is almost stopped. Limiting the size of Council of Ministers has stabilized ministries. The Governor nodded in agreement and actually remarked that the stability of the Ibobi Govt depended on those two laws.
Then, I finished my argument by saying that AFSPA, had achieved in raising the level of insurgency rather then curbing it. The law has not achieved its goal. Therefore, this failed law must go as early as possible, and that it should be replaced by a more humane, people-friendly law, in a democratic India.