The total number of people living with HIV in India was estimated at 2.09 million in 2011. Approximately, 1,48,000 people died of AIDS related causes in 2011 in India. Maharashtra has the second highest prevalence of HIV (0.32 million). While the overall rate of prevalence of HIV among IDUs (Injectable Drug Users) at the national level is 7.14% (2010-11), the same statistic for Maharashtra is one of the highest at 14.2%. The good news is that these levels have been decreasing steadily. The statistics for HIV prevalence among IDUs stood at 9.9% for India and at 20% for Maharashtra in 2008-09. This has been possible due to the stellar work done by NGOs such as Sankalp Rehabilitation Trust.
Sankalp Rehabilitation Trust is a community of dedicated individuals working to stop the spread of HIV and empower drug users to take charge of their health and lives. Based on a unique and well-thought of philosophy of Harm Reduction, Sankalp aims to reduce the negative impacts of drug use and drug-related activities on individuals, families and communities. Understanding that abstinence is not always possible, they strive to create a safe environment for drug users by providing them with information on safe injecting practices, access to medical care, as well as opportunities for long-term recovery. Sankalp has a three-fold mission:
1. Minimize the spread of blood-borne viruses including HIV / AIDS,
2. Provide medical and psychological support for IDUs and
3. Rehabilitate and reintegrate drug users into society
When I was asked to visit the Sankalp drop-in center (DIC) at Mumbai Central, I was told to reach the golf course near the Tardeo RTO. Having stayed in South Mumbai all our lives, I had never heard of a golf course at Mumbai Central. But then, I had also never heard of committed individuals such as Dr. Eldred Tellis until my proposed visit to Sankalp through my volunteering assignment with GiveIndia. Ignorance indeed is not bliss! Stationed right opposite the mini golf course was the two room DIC, which in itself is charting the ‘course’ of the 600 plus active population of drug users (referred to as ‘clients’) visiting them.
Led by a project director, and run by a project manager, the center includes a support staff of counselors, doctors, and nurses. Besides this, there are three outreach workers (ORWs) and fifteen peer educators (PEs) actively involved in field visits and interventions at ‘hot spot’ locations in the city for over 20 days per month. Education and outreach programs are also conducted at schools; outreach stalls in train stations and other public places, street plays and community awareness programs. What makes this structure extremely effective is that the ORWs and PEs are themselves, individuals with a history of drug addiction. ORWs are those who are still on their journey to ‘come clean’ (total abstinence from drugs). They report to PEs who in spite of an active and long history of drug abuse, have now successfully managed to completely abstain from drugs through Sankalp’s efforts.
The center conducts a host of activities on a daily basis. This includes Group Discussions (GDs) which typically last an hour. GDs involve peer educators interacting with clients in a group to motivate them to abstain from drug use. We were lucky enough to be able to attend one of these GDs and it truly was an insightful experience. The clients at the DIC ranged from youngsters in their early 20s to older men in their 60s. Some of them seemed cautious, nervous almost as if they were terrified of their future. Others listened with intent, while a couple were facing severe withdrawal symptoms and started throwing fits at various points. Mr. Sanjay (PE) led the session with Mr. Mukesh (PE) and started off by talking about simple ways in which these clients could limit and finally quit their intake of drugs. He spoke about the importance of being united and staying in groups to divert their mind off drugs.
“Loneliness”, as he very rightly described is a poison that leads to drug use. “Do not worry about how to earn money to buy drugs. Instead, focus on whom to sit with, whom to spend time with and whom to talk to.” Later, the PEs went on to speak about their own success stories and what led them to completely abstain from drug usage after over 20 years of use. The one message that came out very provocatively was; “God helps those, who help themselves!”
Of the 30 clients attending the session, many of them participated actively and communicated their concerns and the challenges that constraint them; and these were well-addressed by the peer educators. The discussion ended with a powerful prayer (translated into English in this text) which said:
God, grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Other activities conducted at the DIC are:
– One-on-one counseling by counselors
– Oral/Opoid Substitution Therapy (OST) under the National AIDS Control Program (NACP) to avoid chances of drug addicts getting affected by HIV
– Abscess Management caused due to injection drug usage
– Recreation and entertainment options for clients such as carom, games, television, music; as well as ad hoc tasks such as kitchen work and cleaning.
– Serving nutritious lunch (dal khichdi) to clients once a day. Distribution of condoms promoting safe sex along with counseling on its usage. This is done at outreach locations as well.
– Distribution of needles and syringes promoting safe usage of drugs (targeted at harm reduction). This is done at outreach locations as well. While some including us may opine that distributing needles/syringes provokes these individuals to continue drug usage, Dr. Zufran Choudhary (Project Director) at the DIC corrected us by explaining that the goal was ‘harm reduction’ and not abstinence. Not supplying fresh stock of needles/syringes would not result in these individual abstaining, but would instead lead to sharing and multiple usage of needles resulting in the spread of blood borne diseases such as Hepatitis C and HIV.
– Running one ambulance to transport beneficiaries daily from their DICs to and from hospitals and clinics, so they may avail of necessary medical services and follow up. This service has been in operation since 2003.
Besides this, Sankalp facilitates visits to ICTC centers (Integrated Counseling & Testing Center for running HIV diagnostic tests and tests for sexually transmitted diseases) and ART (antiretroviral therapy to suppress the HIV virus) centers run by the government. They also offer long-term rehabilitation options through their detoxification center in Mumbai and rehabilitation center in Pune. Some of their other projects include:
1. ‘Project Hunar’ that offers skilled jobs to successful clients enabling them to earn a means of sustainable livelihood with no need to resort to drugs. Sankalp also offers two training programmes (in computer data entry and gardening) enabling street-based drug users to earn a means of livelihood.
2. ‘Project Nivara’ which is a 15-bed, 24-hour critical care shelter for drug users in need of holistic treatment.
3. ‘Project Nischay’ at Arthur Road Prison has directed a therapeutic community to help with the rehabilitation of incarcerated drug users and prevent HIV/AIDS transmission. Sankalp’s medical officers visit the prison three times a week to conduct health checkups.
4. ‘Project Disha,’which is a 15-day intensive programme during which clients undergo the detoxification process in a safe and supportive environment. After clients complete the programme, clients who are motivated and able are referred to their four month rehabilitation programme at the Good Shepherd Recovery Home in Pune.
5. Advocacy for clients who face discrimination due to their drug addiction or HIV positive status.
Sankalp runs four DICs in Mumbai (Vithalwadi, Kurla and Bhiwandi besides Mumbai Central), and the total active population of clients associated with Sankalp is close to 1,650. With new registrations growing at 10-15 per month, the client number looks set to touch 1,800 by the end of 2014.
With its committed efforts, Sankalp is contributing significantly towards reducing the prevalence of blood borne diseases in India. The HIV rate among IDUs (injection drug users) in Mumbai and its surrounding areas has reduced from 40% in 2002 to 9.5% in 2013, whereas the rate of prevalence of Hepatitis C among the same segment has reduced from 80% in 2002 to 43% in 2013!