The Northeast India Knowledge Network
Documenting HIV Prevention Learning and Impact in Nagaland and Manipur
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Summary
The Northeast India Knowledge Network in Manipur and Nagaland aims to document significant programmatic learnings regarding HIV prevention in a geo-politically complex setting where injecting drug use is an important route of HIV transmission, and to describe HIV transmission dynamics and assess the impact of HIV prevention efforts in the region. These goals are being realized through the collaborative effort of several organizations: Nossal Institute for Global Health (University of Melbourne); Public Health Foundation of India; and Emmanuel Hospital Association. The involvement of several regional institutes such as the Regional Institute of Medical Sciences (RIMS) in Manipur and the Regional Medical Research Centre (RMRC) in Dibrugarh is further strengthening the program of work. Collectively we are engaging in a process of data analysis primarily using existing data sources, along with documentation of the epidemic history and response. A consultative process ensures that our analytic efforts are prioritized to effectively meet the needs of relevant donor and government agencies, NGOs and affected communities. The findings will be widely disseminated across the life of the project in order to contribute to the evidence base for HIV prevention in India and beyond.
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Context
Manipur and Nagaland are located in Northeast India, a region characterised by a longstanding civil insurgent movement, a strong military presence, religious conservatism, poor infrastructure and unemployment. Bandhs (strikes) and curfews frequently restrict civilian movement, commercial activity and the delivery of public programs. Many people live in isolated hilly areas with long travel times to the nearest town due to both distance and poor road conditions.
Approximately 2% of the population in Manipur and Nagaland inject drugs, most commonly heroin and Spasmoproxyvon (SP). Consequently, these two states consistently report a high HIV prevalence, and in the case of Manipur, the highest in the country. As of 2009, 1.4% of the adult population in Manipur were HIV infected, and in Nagaland it was 0.8%. Among groups defined by high risk behaviours such as injecting drug users (IDUs) and female sex workers (FSWs), HIV prevalence is much higher. During the 1990s, studies identified HIV prevalence among IDUs in Manipur approaching 80%, which has since reduced and is currently 29% (2008). HIV prevalence among FSWs in Dimapur, the commercial capital of Nagaland, has increased from 4.4% in 2004 to and 14.1% in 2008.
In cooperation with the National AIDS Control Organization (NACO) and the State AIDS Control Societies’ (SACS) HIV prevention intervention programs, Project ORCHID works in seven of nine districts in Manipur, and six of eleven districts in Nagaland. The Project is funded by Avahan and is a partnership of the Emmanuel Hospital Association (India) and the Nossal Institute for Global Health (University of Melbourne). The first phase of the Project was implemented from 2004 – 09, and it has now entered the second five year phase, with the goal of consolidating and sustaining HIV prevention impact, mobilising affected communities, and transitioning the program to government.
Goals
The Knowledge Network in Manipur and Nagaland has three primary goals:
1. To document and disseminate significant programmatic learnings regarding HIV prevention in a geo-politically complex setting where injecting drug use is an important route of HIV transmission
2. To contribute to knowledge and understanding of HIV transmission dynamics in the region
3. To assess the collective impact of HIV prevention programs.
The achievement of these goals will provide timely information for use by local stakeholders within India to strengthen strategies for HIV prevention, especially in regions where injecting drug use is an important route of transmission.
Approach
The work primarily involves analysis of existing data sets. Small scale qualitative assessments may supplement this mainly quantitative approach when indicated. The analytic agenda is being determined in consultation with major stakeholders including relevant donor and government agencies (SACS and NACO), NGOs and affected communities, and will take into account the scope, quality, and accessibility of the data. The progress of the Northeast Knowledge Network and the key findings of the analytic activities are being disseminated to stakeholders through several mechanisms including dissemination meetings, monographs, peer-reviewed publications, conference presentations, and a six-monthly newsletter. This program of work is being guided by a Project Advisory Panel (PAP) that meets annually.
Timing
Start-up phase: March 2010 – August 2010
Implementation phase: September 2010 – February 2014
Publications and Reports:
Opioid substitution therapy in resource poor settings
HIV Surveillance in India - evolution and challenges
Nurse-led STI Management in Manipur and Nagaland
A secondary needle, syringe and condom distrubution programme in Manipur and Nagaland
Newsletters
Knowledge Network Newsletter 1
Knowledge Network Newsletter 2
Knowledge Network Newsletter 3
Contacts
Dr Michelle Kermode (Technical Director)
Email: mkermode@unimelb.edu.au
Phone: +91 8800500783
Ms Nandini Pillai (Project Officer)
Email: nandini.pillai@aihiindia.org
Phone: +61 3 83441992
Key Nossal Staff:
- Greg Armstrong - Research Fellow. Greg is based in Melbourne and travels to India frequently. Greg leads data analysis for several Knowledge Network activities
- Lakhikanta Athokpam - Research Officer. Lakhikanta is based in Imphal, Manipur and is working in collaboration with the Regional Institute of Medical Sciences (RIMS) – Imphal on an estimation of the numbers of women and children affected by HIV in Manipur
- Michelle Kermode - Technical Director. Michelle leads the Knowledge Network project, dividing her time between India and Melbourne
- Amenla Nuken - Research Officer. Amenla is based in New Delhi and is contributing to both documentation and analytic activities of the Knowledge Network
- Nandini Pillai - Project Officer. Nandini is based in Delhi and manages the Knowledge Network activities along with Melbourne based staff. Nandini is also contributing to the Knowledge Network documentation work
- Jennifer Sainsbury - Program Officer. Jen is based in Melbourne and works with Nandini to manage Knowledge Network activities and finances.