Twin strategy for drug-free Assam

The alarming rise in HIV cases among Injecting Drug Users (IDU) in Assam has pressed the alarm bell on the shift in the transmission routes of infection. Increasing volumes of heroin and brown sugar seized in the state over the past five years is reflective of the rise in opioid injection among youth in the state. The persistent stigma against HIV prevents many infected to seek treatment and medical care and hide their health status which leads to unsafe needle use among IDUs infected with HIV. The HIV Estimation Report 2025, has put critical data relating to transmission of the virus in the public domain which calls for integrating AIDS prevention in the war against illicit drug trafficking in the state. The report points out that nearly 60% of the new HIV cases detected in the state are attributed to injecting drug use. During 2021 HIV detection through heterosexual route was as high as 77% but in 2025-26 it has declined to 27% indicating the success achieved in behavioural change through awareness drive against unsafe sex to curb transmission of HIV infection. However, the radical shift in transmission route from heterosexuals to IDUs shows that neither drug seizure nor awareness on HIV transmission can achieve the end objectives of a drug-free India and end AIDS as a public health threat in silos. Seizure of illicit drugs tells part of the drug crisis as consignments which go undetected are circulated among addicts precipitating the crisis. Between 2016 and 2025, illicit drugs worth Rs 4,000 crore have been seized in the state of which heroin and brown sugar alone accounts for Rs 2174 crore which highlight the alarming rise of opioids and IDUs over the past one decade. It is heartening to know that the state has inched closer to achieving the first goal of 95% of people living HIV knowing their status as their percentage has increased from 52.38 per cent in 2022-23 to 91 per cent in 2025-26, as stated by Project Director, Assam State AIDS Control Society Dr Indranoshee Das. UNAIDS has set three critical goals to end new HIV infection, zero discrimination and zero AIDS-related deaths by 2030. These three goals are 95 per cent of the people who are living with HIV know their HIV status, 95 per cent of the people who are detected with HIV taking lifesaving antiretroviral treatment and 95 per cent of those who are receiving treatment will achieve viral suppression. For the state to achieve the other two goals it is essential that the no new HIV cases are added and 95% of infected people know their HIV status. If IDUs continue unsafe needle use among themselves then the risks of alarming rise in new HIV infection will increase manifold. To ensure that the AIDS prevention initiatives are not derailed by rise in injecting drug use, the awareness against stigmatisation also needs to be combined with awareness against drug abuse and unsafe needle use. The focus of the renewed strategy must be to prevent stigma against HIV/AIDS being replaced with unsafe needle sharing among IDUs and make sustained efforts to remove both. The primary focus to make the state drug free must be on strengthening measures taken by Assam Police, Narcotics Control Bureau and other law enforcing agencies for detection and seizures to choke smuggling of illicit drugs into the state. Parallel to drug seizure, destruction of the drug cartels, adoption of hard reduction strategy such as opioid substitution therapy, safe disposal of used needles and syringes, distribution of sterile syringes are crucial. Increasing intervention under the Nasha Mukt Bharat Abhiyaan and the National Action Plan for Drug Demand Reduction are crucial to address the emerging drug crisis precipitated by rising injecting drug use in the state. The prevailing situation calls for these interventions to go beyond routine implementation mere government of schemes and programmes and achieving set targets and goals. Innovative approaches and strategies are needed to reach out to hidden groups of IDUs practicing unsafe needle use and motivate them to volunteer for HIV testing and seek Opioid Substitution Therapy (OST). Under the National AIDS control programme, opioids alternatives are administered under medical supervision to IDUs to reduce their dependence on injecting drug use and wean off the effect of drug. The NGOs can play crucial role in reaching out to the IDUs through their peers and promoting counselling, providing clean needles and syringes as part of hard reduction strategy. While twin strategy to curb drug trafficking and opioid substitution is pivotal to curb alarming rise in injecting drug use and HIV infection, the third pragmatic strategy to make the state drug-free is to spread awareness against illicit drug trafficking and drug addiction to every nook and corner of the state and reaching out to every student, youth, and vulnerable groups.