ABOUT AIDS IN MANIPUR
                                                                                  
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    Background  Information
     Situational Analysis
     Intervention for IDU
     Manipur State AIDS Policy
     Blood safety Programme
     Information, Education and Communication (IEC) and   Social Advocacy
     I.E.C Activities during  1998-2002
     STD Clinics and Condom Promotion
     Achievement & Performance of 1999-2002
     Intervention for Injection Drug Users
     OBJECTIVES OF RIAC
     voluntary Counselling and Testing Centres (VCTCs)
     Objectives of State Aids Policy
     Policy on Multi-Sectoral action and Programme Management
     Policy on information, education and 1998-2002 communication (IEC)
     Policy on Medical Care
     Policy on STD and Reproductive Health
     POLICY ON DRUG ABUSE TREATMENT SERVICE
     POLICY ON HOSPITAL INFECTION CONTROL
     POLICY ON EMPLOYMENT
    POLICY ON ANTIBODY TESTING
     POLICY CONFIDENTIALITY
     POLICY IN THE PRISONS/JAILS
     POLICY ON SOCIAL SERVICE PROVISION
     POLICY ON APPROPRIATE LEGAL FRAMEWORK :
     POLICY ON NON DISCRIMINATION


         Designed and Developed by National Informatics Centre
          Imphal-East District Unit, Porompat-795005
        Email - mnimpest@hub.nic.in
        and
             Data maintained by District Administration Imphal East

 

BACKGROUND INFORMATION

    Manipur is a small state with a population of 23.89 lakhs (2001 Census) and a land area of 22,327 Sq. Km. having an international boundary of 358 Km. with Myanmar. The State has 9 districts, 33 Community Development Blocks and 2182 villages. The average literacy rate is 77.87% for males and 59.70% for females. The per capita income is Rs. 12,198.00 against the all India figure of $440(Rs.21,120.00) .

    The State has one Medical College (Regional Institute of Medical Sciences, RIMS-883 bedded Medical College with Post Graduate Medical Education facility), one State Hospital (J.N.Hospital-200 bedded), five District Hospitals, 16 Community Health Centres (30 bedded CHCs), 72 Primary Health Centres (PHCs), 420 Sub-Centres and 42 Dispensaries. The per bed population ratio is 1:1200. Altogether 724 doctors, 1286 Nurses, 2012 Paramedics are working in the Government Sector. There are about 120 doctors and 200 Nurses unemployed in the State.

    Manipur is geographically very close to the notorious "Golden Triangle" (between Myanmar, Thailand and Laos) where more than 20% of World's Heroin Drug is reported produced. Due to its proximity to the  "Golden Triangle" with perforated borders, Manipur became an alternative route  for illegal international drug trafficking in the late seventies and early eighties. Soon Manipur became an "User state" by early eighties. Pure Heroine which is the injectable form, locally known as "No. 4" is easily available. The problem of "Heroin addiction " reached an explosive situation in 1984 when many gruesome murders connected with drugs occurred in the state. 

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SITUATIONAL ANALYSIS

AIDS (Acquired Immuno-Deficiency Syndrome) has emerged as a new and serious public health emergency in Manipur. The first HIV (Human Immuno Deficiency Virus) positive case in Manipur was reported in February 1990 from the blood sample of October, 1989 among a cluster of injection Drug Users (IDUs). As of 31 March, 2002 , a total of 13,184 HIV positive cases (1758 females) and 1151 AIDS cases (203 deaths) was reported out of 84,097 blood samples screened giving a sero-positivity rate of 156.77 per 1000 blood samples screened against the all India figure of 40.63.
    Manipur with hardly 0.2% of India's population is contributing nearly 8% of India's total HIV positive cases. According to the Epidemiological Report published by the National AIDS Control Organization (NACO), Government of India, Manipur ranks third highest as regards the total number of HIV positive cases-the the first is Maharastra state, the second is Tamil Nadu State. However if we calculate the sero-prevalence rate per one million Population, the sero-prevalence rate of Manipur is at least 6 times higher than that of Maharastra State, 20 times higher than that of Tamil Nadu State. The HIV sero-prevalence rate among IDUs in Manipur had increased from 0 to 50% in just one year during 1990-91. As per preliminary reports of the Sentinel Surveillance conducted during February-March 1994, 1995, 1996 and 1997; the sero-prevalence rate among IDUs in Manipur has increased from 59.9% in 1994 to 80.70% in 1997. However, it showed a declining trend from 1998 onwards with a sero-prevalence rate of 72.78 in 1998 and 66.02 in 2000 and 56.27% in 2001.Still, the sero-prevalence rate among IDUs in Manipur is one of the highest in the world.

 

CHANGING HIV/AIDS SCENARIO IN MANIPUR                               Home I Top

 

The HIV/AIDS epidemic is now no longer confined to the Injecting Drug Users (IDUs). The infection has now spread to the female sexual partners of IDUs and their children .We are now beginning to see waves and waves of HIV epidemic among women and Children.

    Similarly , the sero-prevalence rate among pregnant women has increased from 0.8% during 1997 and 1.69% in 1999 and 2.04% in 2001.

    The sero-prevalence rate among pregnant women in Bishnupur and Thoubal districts are found to be around 2.5%, whereas in Moreh, it is around 3% and Tamenglong , it is around 1%. In Senapati District, we could not do the survey due to the social upheaval. We are beginning to see a generation of young widows-below 21 years of age and below 25 years of age, whose husbands have already died of AIDS. Similarly, we are also seeing an orphan generation. How to prevent infection of women and children is the major challenge of the Manipur State AIDS Control Society.

    The HIV sero-prevalence rate among TB patients increased from 3.3% during 1994 to 14.35% during 1996, 11.2% in 1997 and 15.17% in 1998 and more than 60% of HIV positive cases developed TB as an opportunistic infection of AIDS. TB associated AIDS is becoming a public health emergency in Manipur. How to prevent TB infection among the people living with HIV/AIDS is a challenge facing the Manipur State AIDS Control Society.

   The report also indicates a disturbing finding that the HIV sero-prevalence rate among STD Clinic attendees has increased from 4.8 during 1994, to 5.79% in 1998 and 10.00% in 2001.

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ACHIEVEMENT AND PERFORMANCE OF 1999-2002 :

The number of Targeted Interventions (TIs) in position under the Manipur State AIDS Control Society is 28 .

Sl.No

Name of the Targeted Intervention Projects

Number of TIs during 2000-2002

Number of TIs Projects in position by March,2002

Remarks

1.

RIAC Injecting Drug Users

14

18

Two NGO have been black-listed during 2001

2.

CSWs

1

3

 

3.

MSMs

1

1

 

4.

Health Highways/Truckers

1

2

 

5.

Migrant Workers

0

3

 

6.

Street Children

0

1

 

 

Total

17

28

 

 

 

                                                                                                                   

 

 

Intervention for Injection Drug Users

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The basic message for prevention of HIV infection among injection drug users are :-

1.    Total abstinence from drugs- Say No to Drugs and Yes to Life.

2.    If you can do that, use orally, do not inject. It is only because of injection that the drug  addict is getting HIV infection and not because of drug use. You should use legal and less harmful drugs like Biprenorphine instead of more harmful and illegal drugs like Heroin.

3.    If you are a hard core drug users and you can not give up injecting drugs, at least you should not share needles and syringes with others in all situations. You should not do indirect sharing like water for injection, cooker, cotton etc.

4.    If you have to share needles and syringes under some compelling circumstances, then you should sterilize needles and syringes with 5% Bleach with the standard sterilization procedure of 2X2X2 before injecting yourself or your drug using partner.

      The strategy is based on "Harm Reduction " or "Harm Minimization ". In order to ensure effective implementation of the Harm Reduction Programme in Manipur, the programme is integrated with care component and it is called Rapid Intervention and Care (RIAC) project. Manipur is the first state in India to have adopted Harm Reduction programme.

 

 

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The objectives of RIAC is as follows 

>    to reduce further spread of HIV infection among and their sexual partners

>    to monitor and evaluate behavior change of IDUs

>    to achieve complete abstinence from drugs in the long run

>    to minimise spread of HIV infection to the female spouse of IDUs.

 

 

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The components of RIAC are as follows 

            Community sensitization and mobilization
            Risk Reduction Education,
            Outreach work
            Voluntary counseling and HIV testing
            STD treatment
            Condom Promotion and social marketing
            Needle Syringe Exchange Programme
            Drug Substitution Programme
            Bleach and Teach Programme
            Home Detoxification
            Home care
            Creation of helpful, supportive and conductive social environment
            Referral Services
            Formation of Self -Help Groups

 

 

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STD Clinics and Condom Promotion

        Nine STD Clinics are functioning in Manipur. The STD Clinic Imphal has been strengthened and there  was an extension of the building of the clinic with provision of toilet and water supply.  STD Specialist , Medical Officers ,Nurses, Technicians working in all STD Clinics and also in all district hospitals, CHCS, PHCs have been trained in STD Syndromic management

        IEC materials and condoms are made freely available in all STD Clinics .Regular supply of STD drugs are available in all the nine STD Clinics. The list of STD drugs available are :-

          1.    Tab.    Ciprofloxacin
          2.    Tab.    Norfloxacin
          3.    Tab.    Cotrimoxacin
          4.    Tab.    Erythromycin
          5.    Podophyllum
          6.    Co-trimoxazole Vaginal tablets/Cream
          7.    Inj.    Benzathin Penicillin
          8.    Cap. Doxycycline
          9.    Bezyl Benzoate
         10.   Cap. Tetracycline

        19 Condom Outlets are functioning for the last three years in various parts of Imphal town. Condoms (Nirodh) and folders on STD Syndromic management of ST/STD are made available in all STD Clinics.

 

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Blood Safety Programme             

There are three licensed blood banks at the regional Institute of Medical Sciences (RIMS), the J.N. hospital , Imphal and the District Hospital, Churachandpur.

The performance of the three licensed blood banks in Manipur during the year 1995-2002 was as follows :-

Year

No. of Blood units collected

No. of Blood units Screened for HIV

No. of Blood units Screened for VDRL

No. of Blood units Screened for Hep.B

No of Blood units Screened for Hep.C

HIV +ves

1995

3596

3596

3596

3596

-

85

1996

4993

4993

4993

4993

-

90

1997

5218

5218

5218

5218

-

126

1998

5707

5707

5707

5707

-

83

1999

6451

6451

6451

6451

-

86

2000

7577

7577

7577

7577

-

65

2001

7786

7786

7786

7786

-

75

2002

1708

1708

1708

1708

1708

17

The performance of the Zonal Blood bank of J.N. Hospital, Imphal

Year

No. of Blood units collected

No. of Blood units Screened for HIV

No. of Blood units Screened for VDRL

No. of Blood units Screened for Hep.B

No of Blood units Screened for Hep.C

HIV +ves

1995

2089

2089

1779

1785

-

27

1996

2039

2039

2039

2039

-

25

1997

2384

2384

2384

2384

-

35

1998

2782

2782

2782

2782

-

27

1999

2100

2100

2100

2100

-

25

2000

1912

1912

1912

1912

-

25

2001

2294

2294

2294

2294

-

22

2002

706

706

706

706

706

4

The performance of the Blood bank of District Hospital, Churachandpur

Year

No. of Blood units collected

No. of Blood units Screened for HIV

No. of Blood units Screened for VDRL

No. of Blood units Screened for Hep.B

No of Blood units Screened for Hep.C

HIV +ves

1995

376

376

376

376

-

9

1996

479

479

479

479

-

7

1997

243

243

243

243

-

5

1998

176

176

176

176

-

6

1999

563

563

563

563

-

41

2000

663

663

663

663

-

117

2001

607

607

607

607

-

78

2002

109

109

92

97

90

14

 

 

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Information, Education and Communication (IEC) and Social Advocacy

 

   The State Government has accorded top priority to the IEC campaigns and social advocacy programme for effective and efficient implementation of the AIDS Control Programme in the state.

   On the recommendation of the first state level workshop for media personnel and media experts , the first media strategy was developed in 1996.The workshop recommended that there should be one IEC Committee to plan , develop and supervise implementation of IEC activities and IEC campaigns in the state. The workshop pointed out that the AIDS prevention message should be accurate and the language should be simple and clear and acceptable to the people. The language should not be ambiguous, double meaning, confusing and embarrassing. The media channels most commonly used by a particular section of people or population should be utilised for spreading the HIV/AIDS prevention message to that particular section of people. The workshop also recommended that specific targeted messages should be developed for a specific target group. various communication channels such as print media including newspapers and journals, electronic media like TV, Radio, Films, Video and Audio Cassettes and traditional media like Shumang Lila, Dramas, Folk Plays, Music Ensemblee etc. shall be used.

   All IEC materials will be produced in Manipur, major tribal dialects, English or any other language spoken by the target group group of people to ensure widespread understanding ,suitability, acceptability and popularity among people.

   An intensive and systematic approach for informing the youths, the students, women in the reproductive age group and general population should be used through various media channels to enable them to protect themselves from HIV infection and to obtain help as easily as possible. The IEC campaigns must aim at creating public awareness giving information, which will facilitate changing attitudes, behavior and practices.

   The basic message will include information on how the HIV is spread, how it is not spread, the importance of voluntary participation of people with high risk behaviors, facilities available for voluntary HIV antibody testing, the services available, the importance of non-discrimination, respect for privacy, human rights and human dignity of patients with HIV/AIDS, the influencing patterns of behaviours which may put an individual at risk, rehabilitation of recovering drug users, people with HIV/AIDS and various aspects of the Manipur State AIDS Policy. Targeted messages will be given to the people with high risk behaviours such as Injecting Drug Users (IDUs), Commercial Sex workers (CSWs), MSMs, Migrant Workers etc. so that they may choose the intervention options which may reduce the risk of HIV infections.

 

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I.E.C. Activities during 1998-2002

Sl. No

Activity

1998-99

1999-00

2000-01

2001-02

1.

World AIDS Day No. of Sub-Divisional H.Q. and state H.Q.

24

27

29

40

2.

No. of women leaders trained

-

600

2250

3750

3.

No. of Community leaders trained

1860

2100

3120

3300

4.

No. of Youth Leaders trained

-

1700

2020

2480

5.

No. of Political Leaders trained

240

270

270

270

6.

No. of District Officers trained

480

780

660

660

7.

No. of NGO/CBOs representative trained

180

330

630

660

8.

No. of Union Leaders trained

-

300

540

360

9.

No. of Religious Leaders trained

-

-

-

660

10.

One day Awareness Camp

750

760

935

1317

11.

One day Awareness Camp with Video Projection Camp

68

61

-

84

12.

AIDS education in school
No. of schools covered

256

464

320

523

 

Teachers trained

512

928

640

1050

 

Peer students trained

-

-

-

1050

13.

Hoardings

19

Nil

93

54

14.

T.V., Quiz on HIV/AIDS through cable network

-

-

-

3 episodes

15.

Election issue on HIV/AIDS T.V. based interview of Political Leaders during General Election Feb'2002 through cable network

-

-

-

2 episodes

16.

Folk Play (Shumang Lila)

-

362

108

245

17.

Street Play (AIDS ta Nokphade)

-

-

-

40

18.

AIDS Alert Qtrly. Journal

-

2000

4000

3000

19.

Status Report (Annual)

 

 

 

 

20.

Newspaper Advertisement

-

200

218

238

21.

radio Spots

210

480

180

545

22.

I.E.C. Material

 

 

 

 

 

Poster

37,700

65,000

87,500

49,500

 

Folder

 

50,000

30,000

1,80,000

 

Leaflet

4,22,400

3,42,000

68,000

4,00,000

23.

No. of Condoms distributed

 

 

 

 

 

(NIRODH)

 

1,84,360

1,37,000

1,96,000

 

DELUX

-

-

99,000

85,000

24.       Communication Needs Assessment Report completed(10th September,2001)

25.         A 2 days workshop of the Political Leaders was held on the issue of HIV/AIDS on the eve of     General Assembly Election Feb.2002

26.         AIDS Tableau got first in the Republic Day 26th January 2002

 

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School Education 

   The School AIDS Education training manual has been translated and printed about 1000 copies. We have selected one state level NGO namely the Indian AIDS Consortium (IAC), Imphal, which is an umbrella organisation having about 20 member NGO is implementing the School AIDS education comprising of training of peer students and follow up of the school AIDS education programmes in all the districts as per guidelines given by NACO, Government of India .Altogether 523 Schools have been covered and 1050 teachers and 1050 Peer Educators have been trained.

   The AIDS education has been included in the school curriculum for students of Class VI to Class-X in consultation with the School Authorities. IEC activities has been intensified and expanded using all possible media. I

 

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Shumang Lila

   A training programme for Script writers and another training programme for Shumang Lila actors and actress was conducted in June,2001.The fourth Shumang Lila Competition was conducted in the month of September,2001.

   The Family Health Awareness campaigns could not be conducted during February-march, 2002 due to State Assembly Elections. The Campaign is being conducted w.e.f. 15th April ,2002.All nine districts is being covered in the campaign. A series of poster, slogan, essay, debating competitions were also organised at state, district and institution levels during 2001-2002.

Year

1998-1999      1999-2000      2000-2001      2001-2002

No of Play

-                      362                108                245

 

 

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Voluntary Counselling and Testing Centres (VCTCs) :

Two Counselling Centres are functioning at present at the VCTC (Blood Testing Centre), RIMS and the J.N. Hospital, Imphal. These two Centres are operated entirely by one NGO namely the SASO, RIMS Road, Imphal. Altogether 2181 Clients attended VCTC, RIMS during 1999-2000 and 2386 attended during 2000-2001 and 2721 during 2001-2002.Altogether 1255 Clients attended at VCTC, J.N. Hospital, Imphal during 1999-2000 whereas 2486 attended during 2000-2001 and 1105 attended during 2001-2002.

Telephone Counselling Centre :

    On the recommendation of the Executive Committee, one Telephone Counselling Centre has been approved on the NGO sector namely the Meitei Leimarol Shinnaishang, The electronic telephone counselling machine (Voice Response Computerised System) has been procured. The centre will start functioning as soon as machine is installed. The centre start functioning by the 1st week of June, 2002.

The emerging issue and challenges :-

    (1). The HIV sero-prevalence rate among IDUs in Manipur is now stabilized below 60%.  How to reduce the HIV sero-prevalence rate from 60% to below 5% is a major challenge of the Manipur State AIDS Control Society.

    The State AIDS Policy (1996) clearly encourages and supports the Harm Reduction/Harm Minimisation intervention measures such as "Needle Syringe Exchange Programme", Bleach and Teach Programme for reduction further spread of HIV infection among the IDUs in Manipur.

    Our experience from the NGO sector during the last five years showed that the Harm Reduction intervention Programme is found more acceptable to the client, the family and the Community when it is integrated with care programmes. The present coverage of IDUs under Rapid Intervention and Care project based on :Harm Reduction" is 6000. With the approval of NACO, we have already expanded the project to cover 18,000 IDUs. We need to cover 1000% of te IDUs in order to make the programme more effective.

    (2). About 44% of the female spouse of IDUS are HIV infected. There is an increasing spread of new infections among women. Out of the total 1758 HIV positive women, more than 90% of women acquired the HIV infections from their husbands. The need of the hour is to develop intervention strategies to prevent further spread of infections among women. women controlled HIV prevention methods like female condoms and vaginal microbicides need to be introduced in Manipur in order to protect the female spouse of injecting drug users.

    (3). Increasing number of people are developing AIDS. It is estimated that at least 10,000 young adults and 1500 children have already developed AIDS by now. There is an urgent need to expand home care service with provision of nursing care, medical care, essential drugs for treatment of opportunistic infections including T.B. Drugs. The number of beds at the J.N. Hospital, Imphal is not sufficient to meet the minimum essential needs of the patients. At least a well equipted and an adequately staffed 100 bedded ward unit will be required at the J.N. Hospital, Imphal for providing standard quality patient care services to the people living with AIDS. There is an urgent need for providing one PCR for RIMS (Medical College Hospital). None of the hospital in Manipur are equipped with the basic minimum laboratory facilities to diagnose and monitor the progress of the disease of people with HIV/AIDS. There is a need and demand for provision of Viral Load testing facilities at Imphal (RIMS).

    (4). The state requires research support for effective implementation and evaluation of the National AIDS Control Programme. There is no research support to the programme .Even the ICMR Imphal Unit which was working in Imphal for more than five years could not provide any meaningful research support to the programme. The state should be allowed to conduct research support studies which are appropriate in the local context with the active involvement of local experts and the State AIDS Control Society.

    (5). The state will require a well-equipped resource centre to meet the needs and demand of both the professionals and the public and need to work with international agencies and foreign universities/research organizations.

    (6).  There is a need for opening of District level Blood Banks and Blood transfusion Services at Chandel, Ukhrul, Tamenglong and Jiribam by providing buildings, staff, equipment etc.

    (7). There is a need for providing integrated STD and reproductive health care services for women in all districts-phase-wise.

    (8). There is a need for strengthening and modernizing the Hospital Infection Control System in all major hospital in Manipur (RIMS, J.N.H., five district hospitals,7CHCs)-by providing minimum bio-safety measures, installation of incinerators, autoclaves, sterilizers etc. We need to provide incinerators to at least two major hospitals namely the J.N. Hospital, Imphal and the District Hospital, Churachandpur. 

    (9)    The three projects of HIV/AIDS intervention for migrant workers have started functioning in Imphal, Moreh and Loktak Project. The three CWS projects need to be expanded to cover Jiribam Sub-division, Ukhrul, Senapati. The MSM project and the two Truckers Project need to be taken up with renewed vigour.

    (10)    The number of people living with HIV/AIDS is increasing every month. The number of people requiring health and medical care is also increasing. We have already three Community Care Centres at Imphal, Churachandpur and Thoubal Districts. We need to provide four more Community Care Centres - for Ukhrul, Senapati, Chandel districts (Moreh) and one for the Manipur Network of +ve People (MNP+).

    (11)    The distinctive features of HIV/AIDS epidemic in Manipur is that in Manipur more than 60.85% of the HIV transmission is through sharing of needles and syringes among the injecting drug users whereas in other states like Maharastra, Tamil Nadu, Delhi, West Bengal etc, more than 80% are through sexual transmission. That is  why Manipur needs a separate Policy and a separate Strategy, which will be appropriate  in the local context of Manipur for combating HIV/AIDS.

12.    The emerging facts/Problems and Issues :-

The emerging facts and also the problems and issues faced by the Manipur State AIDS Control Society while implementing the National AIDS  Control Programme are as follows :-

12.1    The coverage of the Injecting Drug Users (IDUs) under the Rapid Intervention and Care (RIAC) is hardly 30%. the 100% coverage of the IDUs under the intervention programme is of paramount importance for reduction of spread of HIV in Manipur.

12.2    More and more female sex partners of  IDUs are infected. There is increasing spread of new infections among women. Out of the total HIV positives, more than 80% of women acquired the HIV infections from their husbands. The need of the hour is to develop intervention strategies to prevent further spread of infections among women.

12.3    More and more young people are getting infected. AIDS is a disease of the young people. Students, teenagers, adolescents and out-of-school-youths are to be educated about HIV/AIDS prevention. 100% coverage of schools, school teachers and students are to be ensured.

12.4    The coverage of migrant workers, labourers and urban poor under the programme is not satisfactory. Special projects targeted to the migrant workers, labourers, street children need to be taken up.

12.5    The HIV sero-prevalence rate among Commercial Sex Workers is around 22% in the year 2000. Special targeted intervention projects need to be taken up at Moreh, Churachandpur and Jiribam.

12.6    Increasing number of people are developing AIDS. It is estimated that at least 10000 young adults and 800 children have already developed AIDS by now. There is an urgent need to provide and expand home care service with provision of nursing care, medical care with provision of essential drugs for treatment of opportunistic infections including T.B. Drugs.

12.7    The number beds at the J.N. Hospital, Imphal is not sufficient to meet the minimum essential needs of the patients. At least a well equipped and an adequately staffed 100 bedded ward unit will be required at the J.N. Hospital, Imphal for providing standard quality patient care services to the people with AIDS. The ongoing construction of 100-beded ward expansion of J.N. Hospital, Imphal and Blood Banks under the National AIDS control Programme need to be completed by 2003.

12.8    There is an urgent need for providing PCR for the J.N. Hospital, Imphal or for RIMS (Medical College Hospital). None of the Hospitals in Manipur are equipped with the basic minimum laboratory facilities to diagnose and monitor the progress of the disease of people with HIV/AIDS. There is a need and demand for provision of Viral Load Testing and CD4 Counting facilities at Imphal (J.N.Hospital).

12.9    There is a need for opening of Blood Banking and Blood transfusion Services at Moreh, Ukhrul, Jiribam, Thoubal, Kakching,Bishnupur, Moirang and Kangpokpi - by providing buildings, staff, equipment etc.

12.10    There is a need for providing integrated STD and reproductive health care services for women in all districts - phase-wise.

12.11    There is a need for implementation of Revised  TB Strategy in five districts - Thoubal, Bishnupur, Ukhrul, Senapati, Tamenglong, and Chandel.

12.12    The State requires research support for effective implementation of the National AIDS Control Programme. The ICMR Imphal Unit which was working in Imphal for more than five years could not provide any meaningful research support to the programme. The State should be allowed to conduct research studies which are appropriate in the local context with the active involvement of local experts and the State AIDS Control Society.

12.13    The State requires a well-equipped resource centre to meet the needs and demands of both the professionals and the public and need to work with international agencies and foreign universities/research organizations.

12.14    There is a need for strengthening and modernizing the Hospital Infection Control System in all major Hospitals in Manipur (RIMS, JNH, five district hospitals, 7 CHCs) - by providing minimum bio-safety measures, installation of incinerators, autoclaves, sterilizers etc.

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MANIPUR STATE AIDS POLICY

1.    INTRODUCTION:

        The first cluster of HIV infection was detected in Manipur in February, 1990. Today, the HIV infection and AIDS has taken firm roots in Manipur. Further analysis of the data shows that the infection is now no longer confined to a particular group of peopled, rather it has spread to the general population. There is increasing evidence of HIV infection among pregnant women, attending ante-natal clinics and persons attending STD clinics. The social, economic and developmental consequences of AIDS in Manipur in the near future will be very grim unless an immediate planning is started from now onwards.

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2.    OBJECTIVES OF THE STATE AIDS POLICY:

    The objectives of the State AIDS Policy are :-

    2.1    To prevent the spread of HIV infection, both at the community at large and in the health care   environment.

    2.2    To promote better understanding of HIV infection in order to protect and support those who are at risk of or vulnerable to infection.

    2.3    To ensure that treatment and support  services both for those infected with HIV and for their family are  easily available and accessible.

    2.4    To ensure that services are efficient, effective and evaluated.

    2.5    To mobilise and unify intersectoral action, community initiatives and NGO/CBO support network for better co-operation among the participation agencies against AIDS.

3.    STATE AIDS POLICY:

    3.1    The State Government of Manipur consider the AIDS problem as a great public health challenge, a matter of great urgency and top priority, requiring immediate Government action.

    3.2    The State Government is fully committed to effective and efficient implementation of the AIDS Control Programme as a part of the overall health care system in the State. The State Government shall provide adequate budget for proper implementation of the programme at state, district and community levels.

    3.3    The Department of Health is designed as the State AIDS Authority, empowered to monitor the progress of implementation of the State AIDS Policy.

The Government, therefore adopts the State AIDS Policy based on:

*    Provision of accurate information and education ton make the people aware of and to protect themselves from HIV infection.

*    Voluntary participation of people with HIV/AIDS

*    Safeguard of confidentiality.

*    Respect for privacy, human dignity and individual human rights.

*    Avoidance of discrimination and stigmatization.

*    Provision of quality medical care.

*    Provision of social benefits and social support system for people with HIV/AIDS.

*    Creating a helpful and supportive social environment in the community so that people who suspect themselves to be infected can come forward for voluntary testing and for seeking help so that can live peacefully with other members of the society.

*    Avoidance or removal of fear psychosis in the minds of the people.

 

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4.    POLICY ON MULTI-SECTORAL ACTION AND PROGRAMME MANAGEMENT:

     In order to facilitate speedy and proper implementation of the AIDS control programme, the State Government will create appropriate bodies and also take up the following actions:-

    4.1    State AIDS Committee (SAC)

    The Committee will be headed by the Chief Minister with the Ministers in charge of Finance, Education, Social Welfare, Home, Health, Family Welfare, Youth Affairs and Sports, DIPR, MAHUD, Rural Development, Tribal Development, NGO representative as members. The Chairman of the Empowered Committee is the member-secretary of the committee.

    4.2    State Empowered Committee (SEC)

    The Committee will be headed by the Chief Secretary with the Commissioners/Secretaries in charge of Finance, Home, Health, Planning, Family Welfare, Education, DIPR, Youth Affairs and Sports, Rural Development, AIR, Labour and Employment, Social Welfare as members. The commissioner/Secretary (Health) shall be the member secretary of this committee.

    4.3   State Level AIDS Co-ordination Committee (SCC)

    The Committee will be chaired by the Principal Secretary/Commissioner/Secretary (Health) with the heads of departments concerned, representatives of RIMS, IMA, Nurses Associations, Media agencies. Women's organisations, NGOs etc. The Director of Health Services, Manipur is the member secretary of this committee.

    4.4 District AIDS Committee (DAC)

    Every District will have one District AIDS Committee under the chairmanship of the Deputy Commissioner with the Chief Medical Officer as the member-secretary and all the district heads of the departments concerned, Panchayat representatives, Village Authority and NGO representative as members.

    4.5    The Government Departments concerned will identity senior officers not below the rank of Joint Director as Nodal Officers to establish proper linkage with the State AIDS Authority and with all the participating agencies.

    4.6    The State Government shall ensure speedy and timely release of fund to the State AIDS Cell or any other organisation designated by the State Government for the purpose of implementation of the programme on prevention and control of AIDS in Manipur from time to time.

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5. POLICY ON INFORMATION, EDUCATION AND COMMUNICATION (IEC)
 

    5.1    Recognising that AIDS is preventable with education and information and that the public attitudes and social issues in relation to HIV/AIDS need to be addressed, a top priority is given to the IEC strategy to overcome the discriminatory attitudes wherever they are found and to prevent further spread of HIV infection in the population.

    5.2    The Health Department will play a leadership role in implementing the IEC Strategy. The production, presentation, display and distribution of education materials forms a vital component of this strategy .

            All IEC materials will be produced in Manipur, major tribal dialects, English or any other language spoken by the target group of people to ensure widespread understanding, suitability, acceptability and popularity among people.

    5.3   The Department of Health will follow an intensive and systematic approach for informing the youths, the students, the women in the reproductive age group and general population through various media channels to enable them to protect themselves from HIV infection and to obtain help as easily as possible. The IEC campaigns must aim at creating public awareness giving information, changing attitudes, practices or behaviour.

    The basic message will include information on how the HIV is spread, how it is not spread, the importance of voluntary participation of people with high risk behaviors, facilities available for voluntary HIV antibody testing, the service provision , the importance of non-discrimination, respect for privacy, dignity of patients with HIV/AIDS, the influencing patterns of behaviours which may put an individual at risk, rehabilitation of recovering drug users, people with HIV/AIDS and various aspects of this policy. Targeted massages will be given to the people with high risk behaviours such as Injecting Drug Users (IDUs), Commercial Sex Workers (CSWs) etc. so that they may choose the intervention options which may reduce the risk of HIV infections.

    Various communication channels such as print media including newspapers and journals, electronic media like, T.V. Radio, Films, Video and Audio cassettes and traditional media like Shumang Lila, Dramas, Folk Plays, Music Ensembles etc. shall be used.

    5.4    The State AIDS Authority will publish a report about the up-to-date information, latest situation of HIV infection and AIDS in Manipur.

    5.5    It is the responsibility of all Government departments, public sector and private sector undertakings to ensure that all staff have access to information and education about HIV/AIDS and have a through understanding of the State AIDS Policy.

    5.6    The Government Departments will render co-operation for conduction ongoing AIDS awareness campaigns among its employees in collaboration with the State AIDS Authority.

    5.7    The IEC materials will not contain any message or information which may create misunderstanding and fear psychology in the minds of the people.

 

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6. POLICY ON SCHOOL AIDS EDUCATION:

    6.1    AIDS Education, Adolescent Health and Family Life education shall be included in the curriculum of schools from class VI to XII.

    6.2    AIDS education shall be included in the curriculum of P.G. courses for training of secondary school teachers.

    6.3    Thke State Council for Education, Research & Training (SCERT), the Board of Secondary Education, the Council for Higher Education, Manipur shall take adequate steps to incorporate the AIDS education, Adolescents Health in the curriculum as a time bound programme.

    6.4    Regular extension programmes and school AIDS activities shall be organised in all educational institutions.

 

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7.    POLICY ON BLOOD SAFETY:

    7.1    100% blood safety must be ensured by subjecting every unit of blood to HIV antibody test before transfusion in conformity with the provisions of the Rules under the Drugs & Cosmetics Act. 1940.    

    7.2    Adequate stock of screened/tested blood will be made available to meet the emergency situations. Hospitals in collaboration with Indian Red Cross Society, Scouts, NSS, NYK, Private and Voluntary organisations and NGOs will help in organising voluntary blood donation campaigns and voluntary blood donations camps. voluntary blood donations without remunerations from healthy volunteers are encouraged. Every volunteer donating blood is entitled to get one blood unit free of charge from the hospital within one year in case of requirement of blood for self and family. This offer is renewable after each donation. The practice of paid or professional blood donating should be eliminated speedily.

    People with high risk behaviours should be discouraged from blood donation. Blood units available in the Hospitals should be issued only on replacement basis except in case of extreme emergency.

    7.3    Financial compensation may be given to any patient, who acquired HIV infection through blood transfusion in hospitals or to any health worker who acquired HIV infection through their routine occupational work as per the rate/amount which may be fixed by the State Government form time to time.

 

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8.    POLICY ON MEDICAL CARE:

    8.1    The State Government will provide quality medical and nursing care in State Hospitals and other medical Institutions to those suffering from opportunistic infection/AIDS. This however, does not cover expensive drugs like anti-retroviral drugs etc.

    8.2    The local and community organisations will be encouraged to provide support to those living with HIV/AIDs or self-help groups.

    8.3    The State Government will encourage home care of people with HIV/AIDS so that the continuum  based and will strengthened and supported by a strong referral network.

    8.4    The State Government will develop proper diagnostic and treatment facilities in all major hospitals.

    8.5    The State Government will provide quality medical and counselling services including telephone counselling services for HIV infected persons/people with AIDS in all major hospital, community health centres so that HIV infected persons and the people with AIDS can forward voluntarily to seek help and support.

    8.6    A cadre of counsellors with adequate qualifications, training and skill will be developed in order to ensure uniform standard and quality counselling services in the State.

 

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9.    POLICY ON STD AND REPRODUCTIVE HEALTH:

    9.1    The STD control programme will be integrated with the AIDS control programme. The SDT clinic staff will be given adequate training and orientation to make the clinics user-friendly. The existing STD clinics will be strengthened and equipped properly in order to provide an effective referral support to the programme.

    9.2    Syndromic approach in STD control programme will be introduced in all PHCs, CHCs, District Hospitals, MCH Clinics etc. So that STD treatment services are made easily accessible to the people who need it.

    9.3    All doctors including private practitioners and paramedics will be trained  in syndromic approach of STD treatment .

    9.4    Reproductive health/Maternity and child Health and STD will be given special thrust to make the programme women sensitive.

 

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10.    POLICY ON DRUG ABUSE TREATMENT SERVICE:

   10.1   De-addiction Centres will be established for detoxification, de-addiction treatment of Drug Users, Injecting Drug Users etc. at appropriate places.

    10.2    Withdrawal or total or lasting abstinence is the goal in the treatment of IDUs but short-term intervention options, harm reduction measures will be made available for those drug users who are not physically and psychologically ready for abstinence.        

    10.3    Various treatment options such as complete abstinence from drugs, safer Drug maintenance, safer injecting practices etc. may be examined and implemented taking into consideration the local situations, technical, social, political and economic feasibilities.

    10.4    Rehabilitation and training on stress management skills, survival skills of recovering drug users, people with HIV/AIDS will be tied up with employment oriented schemes/programmes of other development departments.

 

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11.    POLICY ON HOSPITAL INFECTION CONTROL

    Adequate hospital bio-safety measures and hospital infection control measures will be taken up by the Health/Hospital Authorities in conformity with the principles of "universal precautions" without the need for testing the patients for HIV antibody or isolation or quarantine. The State Government will ensure availability of minimum bio-safety measures in all medical/health institutions or in the field of situations.

 

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 12.   POLICY ON INTERVENTION MEASURES

    12.1   Harm reduction measures like "Drug Maintenance Therapy" "Needle Syringe Exchange Programme (NSEP)", Bleach and Teach Programme" and Safer Sex" will be introduced to minimise the risk of spread of HIV infection in the population.

    12.2    The State Government will encourage and support Social Marketing and popularisation of condoms as a means of preventing HIV infection/AIDS in the State.

    12.3    Notification of the partner should be done only with the consent of the patient and psychosocial support will be as far as possible, made available for the partner and the family.

 

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13.    POLICY ON EMPLOYMENT

    13.1   There shall be no discrimination in recruitment against applications on the grounds that the application has HIV or AIDS. No information will be sought under any circumstances regarding a person's HIV status.

    13.2    No employee or applicant shall be required to take the HIV antibody test.

    13.3    An applicant's medical fitness for employment will be assessed by the existing normal procedure.

    13.4    No employee shall be required to divulge his/her HIV status to his/her employer.

    13.5    Any variation in the conditions of employment or deployment of duties of HIV positive employees will be decided on the basis of "medical fitness" and after consultation with the State AIDS Authority.

 

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14.    POLICY ON ANTIBODY TESTING

    14.1    There will be no compulsory testing under any circumstances except the mandatory screening of donated blood, blood products and serum from donors of semen, ova, tissues and organs or under the order of the Court.

    14.2    Prisoners, prostitutes (commercial sex workers), injecting drug users (IDUs) shall not be compulsorily tested except voluntary confidential testing with their informed consent and appropriate counselling.

   14.3    There will be no requirement for pre-marriage testing except voluntary testing with their informed consent and appropriate conselling.

   14.4    There will be no need for testing of students for the purpose of issuing HIV-free certificates or for testing of military or paramilitary personnel except unlinked anonymous testing for the purpose of surveillance or research.

   14.5    The State Government shall encourage voluntary testing of people with high risk behaviours, their sex partners, people who are worried of being infected, accompanied with pre-test and post-test counselling irrespective of the result of test.

    This includes testing of patients for diagnosis. Testing of source patients in case of accidental injury of workers should be done only with their explicit consent and with appropriate counselling. HIV antibody test should not ordered as a routine test without the patient's informed consent and appropriate counselling.

     14.6    The attending antenatal clinics, people attending STD clinics, T.B. clinics etc. for trhe purpose of sentinel surveillance or people with high risk behaviours in order to monitor the trends of HIV infection over time in a given population.

     14.7    A single Simple Rapid ELISA (ERS) test shall be taken as adequate for the purpose of HIV antibody screening of donated blood. Supplemental tests are not required.

    14.8    For the purpose of sero surveillance, sentinel surveillance or diagnosis of HIV infection in a particular individual, the standard test protocol prescribed/approved by WHO and Government of India from time to time will be adhered to.

    14.9    HIV antibody testing will be carried out only in Designated Centre approved by Government of India or State Government. Testing by Private clinics or laboratories shall not be allowed unless a special licence is given to this effect by the State Government.

      14.10 Any form antibody testing for the purpose of research will be carried out only after getting clearance from the Expert Committee under the State AIDS Authority except for the purpose of research work carried out in partial fulfillment of post-graduate medical education at RIMS.

       14.11 The State Government shall not permit any form of HIV antibody testing in violation of this policy statement.

     14.12 or the purpose of quality assurance programme for HIV testing in Manipur, the Surveillance Referral Centre, RIMS shall co-ordinate with all other HIV testing centres in the state.

 

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15. POLICY CONFIDENTIALITY

15.1 Street confidentially about a person's HIV status whether HIV positive or negative will be ensured. No information will be released without his or her written consent or only on subpoena by the Law Court.

15.2 Breach of confidentially by the staff will be taken as a disciplinary matter and will be dealt with under the disciplinary procedure.

 

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16. POLICY IN THE PRISONS/JAILS

16.1 AIDS awareness educational materials shall be made available to the prison staff.

16.2 Prison/Jail medical officers shall be given orientation training in the diagnosis, treatment and counselling of prisoners with HIV/AIDS.

16.3 Prisoners shall be provided with adequate information/IEC materials about HIV infection/AIDS and in particular about the risk of homosexual contacts in prison and intravenous drug abuses.

16.4 adequate step shall be taken up to prevent the sharing of their illicit/unsterilised needles and syringes inside the jail premises.

16.5 HIV Antibody tests shall be made available on request to the prisoners. Facilities for pre-test and post-test counselling shall be provided to help them physically and psychologically. The results of the tests should not be communicated to the prison administration without prior written consent of the prisoners.

16.6 Imprisonment shall not be a bar to avail the facilities for getting detoxificatiion, de-addiction and counselling services if the prisoner happens to be a drug addict.

16.7 Discrimination and segregation of the sero-positive prisoners shall not be allowed inside the jail premises.

16.8 Medical services in the prison shall be oriented for introduction of necessary preventive measures for proper care of Drug users, HIV positive and AIDS cases.

16.9 Imprisonment shall not be a bar on an individual's access to responsible medical care if the prisoner happens to be HIV positive or AIDS patient. HIV sero positive status of prisoners should not affect an individual's access to treatment regardless of expenses and staff resources. 

 

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17. POLICY ON SOCIAL SERVICE PROVISION

17.1 No one will be denied of service such as education, accommodation, housing, travel, hospital services and social service benefits to which he/she is entitles solely because of his/her HIV status.

17.2 The State government will review the existing policies and practices in the Government department in order to ensure that the employees are adequately protected against HIV infection.

17.3 The State Government is committed to the active involvement of people living with HIV/AIDS in their own care and in the implementation of the programme.

 

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18. POLICY ON TRAINING AND RESEARCH

18.1 All categories of health workers including private practitioners will be trained in AIDS/Drugs abuse prevention.

18.2 Workshop for public leaders, community leaders, policy makers, decision makers, medical personnel, employees, teachers, students, youths, social workers, women's groups, NGO representatives will be organized from time to time.

18.3 Biomedical, behavioural, operational research, intervention research will be given special emphasis in the field of research. The State Government will support and sponsor research in the priority areas of the state.

18.4 Better co-ordinator with with ICMR and other research agencies will be ensured so that the benefits of research go direct to the patients and the communities. all research proposals involving the people of Manipur will be examined and cleared by a multi-disciplinary expert committee under the State AIDS Authority considering the local feasibility, cultural appropriateness, legal and ethical consideration, role of experts etc. However, this shall not apply to research activities carried out in partial fulfillment of post graduate courses at RIMS.

 

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19. POLICY ON NON DISCRIMINATION 

No patient will be denied of hospital admission, treatment, operation, delivery, investigations etc. solely on the ground of his/her HIV status. Respect for privacy, dignity, individual human rights and non-discrimination of people with HIV/AIDS will be ensured.

 

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20. POLICY ON APPROPRIATE LEGAL FRAMEWORK :

Appropriate legislation will be initiated for proper and effective implementation of the National AIDS Control programme in the State in the light of this State AIDS policy.

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