Eldred Tellis develops targeted and sustained interventions for the drug user community on the streets of Mumbai. His programs provide better healthcare and treatment facilities, offer counselling and assistance for recovery, provide livelihood building opportunities for the users, and, ultimately, help stem the spread of AIDS.
The New Idea
Eldred’s new idea lies in the design and implementation of a variety of programs that use the ‘harm reduction’ approach to offer a complete treatment package for drug users. His program also builds the vocational skills and earning capabilities of the rehabilitated user community. The treatment package includes drop-in centres, shelters, outreach, drug substitution, needle and syringe exchange program, detox programs, jail programs and motivational counselling for users. Once a user enters the system, he is tracked, counselled, motivated to enter detox or drug substitution and supported through the process of conversion. Participants in Eldred’s programs practice better hygiene and are healthy. Most importantly, however, dramatic reductions in the incidence of HIV transmission are occurring in a community that has long been neglected by mainstream health agencies. Eldred is now working on a livelihoods package for the drug user community so that they can find appropriate work opportunities after they are clean. He is setting up a waste recovery and recycling service in Mumbai and is in the process of seeking commitments from local municipal authorities.
Drug abuse has been central to the spread of HIV/AIDS in most parts of the world. This is also true for India where drug abuse victims are at risk not only on account of their own behaviour, but also because healthcare institutions prefer to look the other way when drug users who test positive for HIV gradually succumb to the disease.The problem builds up to catastrophic proportions in cities such as Mumbai. Home to a huge migrant population that lives in slums, drug use in the city often coexists with crime and prostitution. This makes for a vicious cycle where the drug abusers feed their addiction through crime which, in turn, denies them access to regular health care facilities as they become outcasts in the mainstream healthcare system.According to government statistics, nearly 50 percent of the city’s population lives in slums or on the streets. Poverty forces addicts to use the cheapest drugs available and these, for the most part, are administered via injections. A study shows that: “intravenous drug use accounts for about one-third of all AIDS cases and one-half of hepatitis C cases.” (Saraswathi K, Dutta A. “Study of Human Immunodeficiency Virus and HCV infections in intravenous drug users in Mumbai” Indian J Med Microbiol 2007;25:174 to 175). And the number of such users is on the rise as Mumbai attracts scores of migrants every day. They fall easy prey to the crime and drug culture prevalent in the slums and soon, often without realizing it, join the silent ranks of urban AIDS victims.Among drug abusers, HIV transmission takes place when they share needles and other things such as cotton swabs and water. Many are also at risk through the sheer act of taking drugs as it can interfere with judgment and lead to risky behaviour that puts them in danger of contracting or transmitting HIV. Furthermore, in India, the problem takes on a third dimension. While the unhygienic conditions in which most drug abusers live doubles the risk of infection and spread of the HIV virus, their low income levels deny them swift and sustained medical help.Currently, the problem of drug abuse is being addressed through narcotics control and law enforcement measures. The focus is on catching drug peddlers and punishing drug users while there is only a handful of health care and prevention agencies working on AIDS prevention issues in the community. Those few organizations, however, have limited capacity and are unaffordable for the low income, drug abusing slum dwellers in Mumbai. All in all, Mumbai today has a total of eight de-addiction centres and seven rehabilitation centres which can cater to approximately 400 clients at any given time. The number of drug users according to UNESCO, (Rapid Situation Assessment of Drug Use), on the other hand, is about 45,000 with up to 15 percent of them being Injecting Drug Users (IDUs). And, according to a survey carried out by Eldred’s group Sankalp, 39 percent are HIV positive. Many impoverished drug users also suffer from diseases such as Tuberculosis (TB) and Hepatitis, untreated abscesses and wounds.Conventional treatment centres typically cater to those who have family support or a steady income, but a large percentage of drug users are migrant street dwellers. Without a family to push them into treatment, the street dwelling drug user does not voluntarily access existing facilities.
Eldred has targeted the problem of AIDS within the street dwelling drug user community. . He has been able to develop targeted interventions, create a loyal support base for his programs, develop livelihood opportunities for those who want a new life and create a model that can be easily replicated across cities with large numbers of homeless migrants.His interventions are delivered through drop-in centres and follow the harm reduction approach towards drug abuse and AIDS. Each centre provides drug users with cleaning agents like bleach for needles and syringes, exchanges old needles for new and offers substitutes like Buprenorphine. The ‘harm reduction’ approach allows Eldred to deal with two problems— hygiene of IDUs and the spread of HIV and Hepatitis B & C. While ‘harm reduction’ has been an accepted approach to tackling the drugs problem elsewhere in the world, the concept was new to India when Eldred started propagating it. Its acceptance is higher today and due in part to the demonstrated success of the early centres set up by Eldred and his team of volunteers. One such aspect of Eldred’s program that seemed controversial at first was his proximity to the users and an approach that reflects care and concern rather than control and reprimand. All but one of the centres is located within the slums. The drop-in centres are easy to access for street drug users and offer help to those who are turned away by hospitals and institutions. Current estimates show that close to 3,000 drug users’ benefit from the interventions every year. This is more than twice the number of people who access conventional treatment centres in the city. Many of those who come to the centres for the exchange or substitution programs intend to be drug free but have no skills to earn their living and quit substance abuse. This led Eldred to look at vocational opportunities for the people he served. He drew inspiration from a venture by Resiclarazo in Sao Paulo, Brazil and set up a waste recovery and recycling service in the city. This helps provide employment to the drug user community and generates funds for his organization’s work.The approach also builds trust among the user community and allows Eldred to develop programs that are specific to their needs. For instance, the Needle & Syringe Exchange Programme was initiated in September 2000 as a strategy for harm reduction among IDUs who did not access the substitution programme at the drop-in centre. And though it is controversial, the program reduces the chances of IDU related HIV cases by giving street drug users the opportunity to access fresh needles instead of sharing used ones. The drug abusers also helped him identify areas with larger concentration of IDUs. The centres track the pattern of recovery and the failure rates very closely among the users and it has been seen that most of the IDUs who come to them have reduced their direct and indirect sharing. There has also been a reduction in risk behaviour and the adoption of safe sexual practices by regular condom use due to regular counselling at the centres. The success of the approach and the delivery model has resulted in a number of organizations following suit. The Government has also recognised the need to adopt a more humane approach and is working with similar intervention activities. Eldred has managed to take up issues on behalf of his clients with the hospitals in Mumbai and is working on changing the attitudes of the doctors and administration staff. Finally, he is collaborating with ‘The Lawyers Collective’ in an effort to amend the Narcotic Drugs and Psychotropic Substances Act. The model has also been adopted outside India. Eldred has been a consultant to the UN and to the German based organisation DO International. As a result, assessments and strategies have been undertaken in Kazakhstan, the Caribbean and are currently ongoing in Afghanistan. He is also encouraging more community based groups to join and work with the training and set-up of new centres in India and abroad. He expects these efforts to benefit an additional 4,000 people a year, though the indirect benefits will be greater. Through a number of innovative and holistic programs, Eldred Tellis is tackling the spread of AIDS and other diseases amongst a group of people once denied even access to public healthcare. In addition to this, his programs addressing the underlying problems of joblessness and abject poverty have been so successful that they are being replicated around the world.
Eldred is driven by his personal experiences as a drug user who managed to quit and stay clean. Having seen the trauma and neglect faced by the users up close, he is deeply motivated to develop programs that assist drug users and deliver on promises. In 1992 when Eldred was part of a project sponsored by OXFAM and the Delhi-based organisation, Sharan, that he first learned about the links between IDUs and HIV. This was a powerful experience for him that inspired and informed the design of his future model of intervention services with a focus on harm reduction.Eldred’s work began in the early 1990s with the setting up of the network, FORUM, of which he was a core member and coordinator for six years. FORUM offered the different groups working on drug abuse a platform for sharing their experiences, lobbying for changes in policy, and designing effective solutions. He first introduced the concept of harm reduction for drug abusers through FORUM. It took a lot of persuasion for people to accept this idea at first, even though it was well known in the developed world. The Government of India favoured abstinence as the only treatment option and it was only when there was a rapid increase in the HIV prevalence among IDUs in Manipur in 1990, from 0 to 50 percent in six months, that it was thought possible to experiment with harm reduction. Eldred was part of the program in Manipur where he saw the suffering among drug abuse victims and the difficulties they faced in their treatment. He also realised that the same thing was happening in the streets of Mumbai where drug use is as rampant and help is as scarce. After he came back to Mumbai, he decided to set up his own team of workers and volunteers and thus began his journey into the creation of a long term, targeted health and recovery program for the drug user community.