News

Nossal Institute’s HIV program aids India’s troubled north-east

[ The University of Melbourne Voice Vol. 1, No. 19  26 November - 10 December 2007 ]

By Rebecca Scott

India has some 2.5 million people infected with HIV – an incidence of epidemic proportions which mostly reflects HIV’s spread among injecting drug users. An internationally funded program led by University of Melbourne researchers is working to combat the problem.

The north-east region of India is a particular challenge to development workers. The area is rife with insurgents and conflict, including extortion which impacts on the delivery of services.

In the early 1990s researchers in the north-east state of Manipur recorded a dramatic jump in incidence of HIV in injecting drug users from around 20 per cent to 80 per cent.

“The whole world was watching as the dramatic rise of an epidemic of HIV was reported,” says Associate Professor Peter Deutschmann of the University of Melbourne’s Nossal Institute for Global Health.

It was the expertise of Associate Professor Deutschmann and his partners in the region that assisted them in 2004 to secure a $7 million grant from the Bill and Melinda Gates Foundation to minimise the spread and prevalence of HIV in the troubled area.

Today the Nossal Institute team, together with the Emmanuel Hospital Association and the University of Melbourne-based Australian International Health Institute (which has since been incorporated into the Nossal Institute) coordinates HIV prevention programs in two out of six Indian states targeted in the Foundation’s grant program.

“This is one of the biggest, and most effective HIV prevention programs in the world,” says Rob Moodie, Professor of Global Health at the Nossal Institute and Chair of the Technical Panel of the Bill and Melinda Gates Foundation’s India AIDS Initiative.

Senior Project Officer at the Nossal, Beth Fuller, lived in north-east India for two years. Fuller says high levels of unemployment, drug addiction and youth apathy has made the region ripe for an HIV epidemic. She says that due to the unrest, commercial development and progress in the region have been slow compared to the rest of India.

Ms Fuller saw firsthand the situation of intravenous drug users (IDU), sex workers and men who have sex with men (MSM). All are vulnerable to violence and harassment by armed groups and police, making it difficult to provide HIV prevention services to marginalised populations who fear identification.

“The main focus of the program has been to resource the local service providers with the skills and means to work effectively with these key populations. A fundamental aspect of this has been building the trust of the affected groups,” she says.

The program focuses on the implementation of harm reduction services, including needle exchange, drop in centres and STI health clinics, using a peer education approach. “This means the people whom the services are trying to help are integral to the success of the program’s implementation,” says Ms Fuller.

She says the provision of oral dose substitution therapy, through an additional grant, has been much sought after as it helps the drug user to assimilate back into a normal life.

“This means we are providing more than just needle exchange, which may stop transmission of HIV but does not necessarily help people escape an illicit lifestyle.”

The project has gained substantial local and government support during the past four years. “We are now at the stage where local NGOs have increased capacity and are expanding services to incorporate other areas beyond HIV, such as tuberculosis treatment,” Ms Fuller reports. “The powerbrokers in the area are increasingly aware of the need to prevent HIV and to enable services to continue.”

The current research effort includes identification of the circumstances and entry points to drug use and sex work, and hence vulnerability to HIV infection, with the hope of determining early prevention interventions.

“The next challenge is to make the transition of these services back into the government system,” she says.




The Nossal Institute

The Nossal Institute for Global Health incorporates and continues the work of the Australian International Health Institute (AIHI) a not-for-profit organisation of the University of Melbourne which since 1998 has been working to increase the capacity of health workers and planners across the Asia-Pacific region to respond to the health needs of their populations through education, research, leadership development and technical assistance.

The Nossal brings a multidisciplinary approach to international health along with other centres and professionals from the Faculties of Medicine, Dentistry and Health Sciences, Law, Education, Arts, Engineering and Economics of the University of Melbourne.

Based on the Nossal’s commitment to building capacity and generating sustainable project outcomes, it has fostered alliances with governments and non-government organisations in the region, Australian and regional institutes and universities, as well as multilateral agencies, bilateral donors and global foundations.