The states of Mizoram, Manipur, Nagaland and Arunachal Pradesh share long borders with Myanmar to the East, across hilly, forested, thinly populated terrain. This critical location has had major implications for HIV AIDS in the North Eastern Region. When the first cases of HIV were reported in India, beginning April 1986, specifically from Bombay and adjoining areas, there was a sense of confidence in the North Eastern States, because they were geographically isolated from mainland India, and with small secluded tribal communities, many had thought they would be safe from HIV. Still, in line with national policy, HIV surveillance was initiated first at Guwahati Medical College and thereafter at Regional Medical College, Imphal, and other places in 1986. The first case of HIV was detected in Manipur in September 1986 and there a steep rise in number of cases were detected and showed prevalence of HIV among specific risk groups in certain States of the Region, from thereon.
The shocking escalation of HIV cases led to the sightings of IV drug abuse as the chief cause in the Region. The single most critical factor for the intravenous drug abuse in the NE Region is its long boundary with Myanmar, part of the Golden Triangle, known as one of Asia’s main opium-producing areas and the centre of the world’s drug trafficking. The Golden Triangle was a minor source till 1980s. About 20% of the market for heroin in the USA was estimated to be met by the Golden Triangle formed by Myanmar, Laos, and Thailand, largely shipped through Singapore, Malaysia and Indonesia. With the crackdown of the international drug enforcement agencies and the national Governments on drug traffickers in Singapore, Malaysia and Indonesia, in the early eighties, drug traffickers found the quiet, unwatched route via the North Eastern States of India, very convenient to transport drugs into mainland India and thence via international airports to Western Countries. It is thought that the first State to be affected by widespread heroin drug abuse was Manipur, possibly Nagaland also. Manipur has the major portion of the critical highway in the North Eastern Region, NH 39 which starts at Moreh, a tower in Churachandpur District close to Myanmar border, runs north through the length of Manipur, to Nagaland, up to Dimapur via Kohima, and thence to Guwahati and mainland India. As found somewhere else in the world, drug abuse epidemics began along the transit routes, as part of fallout, i.e. a percentage of drugs being given as bribes to personnel of the enforcement agencies, to facilitate smooth movement of the drug consignments to the international centres. Manipur and Nagaland were the hardest hit by the IV drug abuse epidemic when a heroin explosion took place in the early 1980s. Other States, farther away from the NH 39, have also had some degree of drug problem, due to less intense drug trafficking which takes place along with traffic in smuggled essential goods and consumer goods with the Myanmarese, which is a regular feature in the region.
HIV entered the NE region together with IV drugs. Most of the drug addicts who were youth shared the needles. Initially needle sharing was practised out of feelings of peer group sharing and ignorance of HIV and disease risk. Since 1990, needle sharing became a compulsion, due to crackdowns by the police on drug addicts, on the force of the “Prevention of Narcotic and Psychotropic Drug Abuse Act of 1985”. As a result, in some States of the Region including Manipur, it was illegal to sell a needle and syringe without doctors’ prescription and was liable for the possessor to land in prison. Therefore, in spite of widespread awareness among youth of HIV risk due to needle sharing (almost 85%), many, who would not like to do so, continued to share needles. Ink fillers were being fitted to the needles, which withdrew some blood into the ink filler after the drug was injected into the vein. These factors exposed the entire group of addicts to HIV, when one in the group was positive.