In the shadows: the Chanura Kol baseline study on women who inject drugs in Manipur, India

Women who inject drugs are largely neglected in the current HIV strategy in India. This study explores the accessibility, knowledge of and availability of HIV prevention services among women who inject drugs in Manipur, India. The paper points to a significant gap in existing services that are appropriate and sensitive to the needs of these women.

The paper finds that:

• these women experience significantly inadequate access to information and services to meet the full range of their needs
• exclusion, stigma and discrimination, and violence are part of their daily existence, which alongside unsafe injecting and sexual behaviour makes them vulnerable to HIV infection.

The author emphasises that involvement in sex work, coupled with low rates of consistent use of condoms and clean needles and syringes show that both sexual and injecting behaviours present risks to these women. On the other hand, low levels of income and financial security, literacy, access to social welfare schemes coupled with high spending on drugs, make financial considerations an important factor in these women’s vulnerability and lack of empowerment.

Recommendations include:

• the scale up of a response that provides appropriate, accessible, affordable, targeted and quality interventions is required
• a package of services addressing vulnerability through drug use, unsafe sex and rights violations is essential to meet the needs of this community
• while awareness of existing services is high, use remains low, requiring concerted efforts to address barriers to access
• a comprehensive approach to harm reduction and drug treatment at scale is much needed
• empowerment of women who inject drugs to engage in processes and decision-making that affects them is necessary.