Hepatitis C, aptly called the silent killer has long made its presence felt in Manipur. A study done in 1994 by ICMR showed figures of 98% of Injecting Drug Users (IDUs) in Churachandpur and 92% in Imphal as being both Hep C and HIV positive. The ICMR figures, were of the percentage of Hep C infections among IDUs but still highlights the risks among the IDU community. Over the years, there have been other smaller concentrated figures that have covered mostly pockets of injecting drug users in the state, but what comes clear from these studies is that Hep C infection, its management and treatment is a critical aspect of public health in the state. Unfortunately enough, there is not much noise on the matter, except of course among the population at risk on one hand while on the other, even nodal agencies remain uncaring about tackling this unseen epidemic. Increasingly in Manipur, there have been voices calling for a more strategic state response to Hep C since treatment regimens are costly and out of the reach of most people. Over and above the costs factor, is the fact that there is no total cure for Hep C infection with the best bet being Interferone injection that runs up a cost of lakhs per treatment cycle with the rider that there can be and there are relapse cases in which treatment regimens will have to be suspended and resume all over again.
Hep C is intrinsically linked to the HIV/AIDS scenario in the state for despite the HIV/AIDS scenario fast becoming a generalized epidemic that is no longer confined to a certain population but reaching and touching upon the ‘general population’, it still holds true that the majority of the HIV positive population in Manipur largely come from a background of being injecting drug users. Though the efforts of state nodal agencies following the initiatives set by the National AIDS Control Organization (NACO) has brought about a stabilized epidemic after its implementation of various intervention, care and treatment aspects in the context of HIV/AIDS, the reality is that what has been achieved through such programs is slowly getting undone because of the shadow of Hep C. This happens because people who are Hep C positive are reactive to the ART drugs that are given free of cost to people who are HIV positive. This in layman terms mean that taking of ART by a HIV and Hep C positive person does not help. This situation plays out because ART is needed to keep HIV at bay and boost up the body’s immune system while its impact would create complications on a person’s physiology in case he/she happens to be Hep C positive as well. The Government response to HIV/AIDS in the country is uniform and does not take regional specifics into consideration, which is why the National AIDS Program over the years have been ‘targeted’ at truck drivers, sex workers, MSMs and such. It took a local initiative in Manipur called the needle and syringe exchange program for the component to be replicated under the National program but largely, Hep C by its very nature of being prevalent among IDUs means that the silent epidemic is being borne without much support in Manipur, Mizoram and Nagaland where injecting drug use is the most rampant.
Activists working at the field say that the call for a more serious look at Hep C infection: its prevention, treatment and management or even research to zero in on a cure or even a vaccine is a grim reminder of the battle for a more humane treatment to people living with HIV/AIDS and the activism that went into bringing about free ART drugs that were still a distant dream back then in the 90’s. But poignantly enough, a lot of those activists who rallied then have since fallen to Hep C after having placed the spotlight on the needs of the HIV/AIDS affected community to be able to have affordable treatment mechanisms in place. Perhaps given the felt need of the affected community in Imphal and given earlier histories of grass roots activism over HIV/AIDS and its treatment/therapy starting from the state, the call might well have to start from Manipur and would then have to be taken further to ensure that the ‘killer’ dies not lie lurking nearby. It would have to begin with vocal calls for more research and a willingness to initiate path-breaking measures.