Chanura Kol

Photographer: Prashant Panjiar

Funded by the Elton John AIDS Foundation, the Chanura Kol project provides care and support services to female injecting drug users to reduce drug relapse rates. The programme works in three locations in Manipur, which is a major transit route for heroin produced in the Golden Triangle. Drugs smuggled from Myanmar on their way to international markets make their way through this state which has also suffered from a violent separatist insurgency since 1964. One of India’s poorest states, Manipur is notorious for having the country’s largest HIV and drug addiction rates.

Usually women are introduced to heroin by their addicted partners who teach them how to inject the lethal drug into their veins. A number of pimps and sexual partners play on the fact that when women are drugged or addicted to drugs, they are vulnerable to participating in desperate acts such as sex work to pay for the couple’s expensive addiction. Sex workers often relapse when their pimps or clients force them to use drugs.

This street in Manipur is a hotspot for drug activity as well as sex work. Chanura Kol’s implementing partner in Imphal, the Social Awareness Service Organisation (SASO), is located in the midst of this hotspot to ensure the ease of access to essential services by female injecting drug users, a number of whom also do sex work in this location.

SASO is one amongst many service organisations in the area that administers Oral Substitution Therapy (OST) to wean addicts off drugs. This process could take 3 to 6 months but has proved to work more effectively than detoxification therapy for female injecting drug users.

Chanura Kol runs three Drop In Centres (DICs) in Manipur. Each DIC, such as this one in Imphal, has a television set and space for women to sleep, activities that these women enjoy especially given their stressful lives once they leave the centre. In order to increase the number of women entering this safe space, the Chanura Kol team members even started offering free coffee and the popular dish of chow Mein for visitors. Taking advantage of this free meal, female injecting drug users started coming here more often to meet with the doctor and counselor on duty, and to interact with centre staff, their self help groups and support groups.

This photo was taken at the DIC in Imphal where a counselor and outreach worker hold morning counseling and discussion sessions everyday. Counseling sessions include information sharing about STIs/HIV, healthy living for HIV positive injecting drug users, sexual reproductive and health rights and any other issues that community members at the DIC wish to discuss.

A nurse at the drop in centre carries out health checks on female injecting drug users who visit the centre. Over the last year, Chanura Kol has reached out to 140 women who inject drugs, many of whom are HIV positive and all of whom were in need of general and emergency care. Chanura Kol offered the women essential care and support services such as providing them with food and medication for sexually transmitted infections, which a large proportion of the women were at risk for especially those whose primary source of income was sex work. In addition to this, Women were tested for HIV and Hepatitis C.

Women who enter the Drop In Centre are registered by centre staff. Since 2010, 510 women who inject drugs have been registered with the Chanura Kol project to avail of the holistic range of services provided by the programme. Registered female injecting drug users have received psychological and social support through counseling services offered by Chanura Kol and have also received accurate information about issues and services related to HIV/AIDS. This information helps project staff members track the history and progress of female injecting drug users which also assists them in outreach efforts. The Chanura Kol Project aims on registering 700 women who inject drugs by the end of three years.

Attached to the Drop In Centre in Imphal is the night shelter for women in need of safe accommodation. A number of the women are malnourished and severely ill treated from a life of addiction and sex work, and have no one to take care of them. A number of them are also HIV positive. Here, a woman at a night shelter gets an IV infusion.

Chanura Kol runs a short stay home for women who inject drugs. The short stay homes provide detoxification therapy which could take up to 6 months. These homes tend to have 15-20 rooms most of which are occupied year round. Here, the slippers of residents are neatly stacked on top of a cupboard that contains their belongings.

Chanura Kol believes strongly in customising solutions to meet the needs of community members. When programme members realised that injecting drug users failed to avail of the short stay home because of a lack of accommodation for their children, team members provided housing in the short stay home for two children five years of age or younger for each woman enrolled in the detox programme. Toys, space for playing and child appropriate nutrition is provided at the Drop in Centres. So far, 45 women have accessed the services provided at the short stay homes. In this photo, the serenity prayer overlooks a shelf lined with utensils at the short stay home.

Women at the short stay homes are also provided the opportunity to learn vocational trades. 41 women have been provided with vocational training, and 16 women have initiated income generating activities with Chanura Kol’s support. Here, a woman stitches jute bags.

Women receive a great deal of trust and respect at the short stay homes from staff members and each other. The Chanura Kol project recognises the help that community members can provide to each other. In partnership with SASO, the Chanura Kol project has established four Core Advocacy Groups comprised of 10-15 members consisting of female injecting drug users, sex workers or their pimps. These groups address stigma and discrimination faced by women who inject drugs as well the frequently reported cases of violence experienced by them. Group members have received training on advocacy and documentation and, since the establishment of the groups in early 2011, have responded to 20 cases of violence, harassment and extortion by women who inject drugs.

To promote safer injecting practices, Chanura Kol outreach workers promote the use of clean syringes and needles. In Manipur, women inject drugs more frequently than men at an average of 6 to 10 times a day. The outreach worker in this photo cleans a drug hotspot of old, used needles.

Used needles that have been discarded.

Till now, the Chanura Kol project has provided 60,000 clean needles and syringes to women at the Drop In Centres or at the locations where many of the women do sex work. Here, an outreach worker gives a female injecting drug user clean syringes.

Project coordinators and outreach workers make home visits and provide women who inject drugs with information about sexually transmitted infections such as HIV and Hepatitis C. In a baseline study conducted by Alliance India on women who inject drugs, 85% of women said that they had received STI related information. Amongst these women, 93% reported that Chanura Kol’s partners were their main source of information on STIs. In this photo, an injecting drug user speaks to the project coordinator while the outreach worker looks on. In her hand, the young woman holds clean syringes that have just been given to her.