Life of a harm reduction field worker in the times of COVID-19

Anurag Paul 21 May, 2020

Ajay Sahini with ration for distribution

My name is Jayanta Kumar Singh. I have been working for the health and human rights of people who use drugs for the past 18 years. Currently, I am part of Alliance India’s Hridaya project and based in Lucknow, Uttar Pradesh (UP) wherein my work entails providing technical support to Uttar State AIDS Control Society (UPSACS) and Technical Support Unit (TSU) to enhance the service uptake of people who inject drugs in the state of UP. I am also involved extensively in community system strengthening of the existing state drug user forums towards meaningful involvement in policy development, program designing, and implementation of programs as a response to HIV.

I have been involved in direct fieldwork in the various districts of Uttar Pradesh meeting stakeholders like members of State Drug Users’ Forum (SDUF), beneficiaries of the national HIV program, OST (Opioid substitution therapy) and ART (Anti-retroviral therapy) services providers, as well as law enforcement. Through this field-level exposure, I was able to understand the issues faced by people who use drugs and brainstorm on solutions to address the barriers to accessing health services, while support in identifying advocacy agendas.

In the context of the global COVID-19 pandemic, the national lockdown triggered the need for a response since end-March and has made things difficult for people who use drugs as they are particularly vulnerable to COVID-19 due to underlying health issues, stigma, social marginalization, and higher economic and social vulnerabilities, including the lack of access to housing and health care. People in treatment or institutional care are facing severe problems and barriers to obtaining lifesaving medications (i.e., buprenorphine, methadone and ART) and obtaining services from needle syringe programs contributing to increased incidences of HIV, HCV, and drug overdose. Social distancing also decreased the likelihood of administration of naloxone to reverse overdose potentially resulting in more fatalities. While in prisons, COVID-19 risks are heightened due to overcrowding, poor ventilation, and inadequate health services.

Even though as a person working directly in the field “pre lockdown”; with the support of the Alliance India Harm Reduction team, we have been working relentlessly by leaving no stone unturned towards ensuring access to life-saving medication and services as well as protecting the rights of people who use drugs. While all the efforts are concentrated through virtual platforms, it has led to engagement with drug users forums to advocate for service provision at the state level, to fill for the shortage of health workers, to ensure delivery of life-saving medications for hard to reach community at the risk of death due to severe withdrawals and overdose, provision of food rations and other essential items through linkages with stakeholders like faith-based organisations as well as advocating and sensitization of law enforcement. Below are a few illustrations of our intervention in the state.

1) A 70 years old man from the PWID community from Prayagraj – a registered OST beneficiary – who worked as a daily wager had an accident while unloading materials a day before the lockdown. He has been advised by the doctor for bed rest for the next three months. He approached Gyanu Yadav, member of Purvanchal Drug User Samiti (PDUS) – a community led state network of Uttar Pradesh (UP) – through a peer to explain his current condition. Gyanu Yadav, in turn, took the responsibility of delivering his OST daily dose to ensure an uninterrupted supply of OST medication.

2) An e-auto rickshaw driver, who had gotten married two weeks before the lockdown and had to leave his family house due to opposition to the marriage, could not support his new family due to the lockdown restrictions. He approached the members of the state drug user forum for support of food rations. The forum assisted him in making his Aadhar card (unique ID) and ration card to link him to government schemes for food and essential items for marginalized people during the lockdown ensuring he and his family had access to basics like food to survive.

3) Three undertrial prisoners were released during lockdown from Naini Central Prison (Prayagraj, UP) who are also on ART medication. As they were recently released and were not linked to ART clinics, their medication started running short. Through the support of the state drug user forum, now they have uninterrupted access to ART medication ensuring HIV treatment adherence.

As a member of the community myself and as part of Alliance India, I work towards ensuring people who use drugs are not subjected to arbitrary detention, their rights are not violated and they have easy access to harm reduction services in the current context of CoVID 19 and related lockdown.

Through our efforts on community mobilization and collectivization we are able to address the issues of people who use drugs by keeping them at the centre of our response and all its aspects i.e., HIV, viral hepatitis, TB, overdose and most recently the crisis of COVID-19.

Communities make the difference!

Supported by Frontline AIDS, Alliance India is implementing Hridaya, current cycle 2016-2020, in five states of India: Uttarakhand, Uttar Pradesh, Delhi, Mizoram, and Sikkim. It is designed to address the capacity and service delivery gaps and raise the standards of the national HIV prevention programme.