People who inject drugs (PWID) in India represent a core group most at risk of contracting HIV, hepatitis C and other blood borne pathogens. Though a minority amongst four (4) classified most-at-risk populations in the country, the injecting drug use population is rapidly increasing, affecting new areas and populations including the younger generation and women. According to recent estimates there are roughly 177,000 PWID in India, accounting for at least 2.2% of all new HIV transmissions. Interventions critical to manage HIV transmission in PWID subpopulations include scaling up needle and syringe exchange programs (NSP), expanding opioid substitution therapy (OST), and ensuring PWUD (people who use drugs) living with HIV receive antiretroviral treatment (ARV).
Over the past year, drug treatment centers throughout Asia have been heavily criticized and scrutinized by various organizations due to its inhumane and unconstitutional modality of treatment. This has led to modifications up-to some extent (e.g. Conversion of CCDUs to CBTx in Cambodia) but these are still deemed substandard and lack quality. In India, the Ministry of Health and Family Welfare (MoH) and the Ministry of Social Justice and Empowerment (MSJE) sponsor both state government and voluntary organization run de-addiction centers. Despite decades of involvement by these ministries, infrastructure for drug treatment in India remains poor and woefully inadequate. While the Ministry of Health, for example, has supported the establishment of 122 treatment centers, the results of the two evaluations conducted in 2002 and 2008 were discouraging and revealed a large amount of variability in the functioning of Government de-addiction centers.
In general many are of the opinion that very few treatment centers in India are actually operational. In partnership with local nongovernmental organizations, the MSJE claims to currently operate 376 de-addiction and rehabilitation centers. Those working in harm reduction, however, assert that many of these centers are neither functional nor effectively operate, and that there is an extreme diversity in the quality of programs between those operated under the government health care settings and voluntary or non-governmental run treatment and rehabilitation centers. Both these settings have its own merits and demerits, but both lack clear deliverables, established minimum standards of care and robust monitoring and evaluation mechanisms.
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