Focus on care and rehabilitation of drug addicts

Mohammed Jalil, a former heroin addict, hung his head in shame as he was yelled at and told what a fool he had been for taking the lethal drug. A few weeks ago he was at death's door shooting up five times a day in the southern Pakistani city of Karachi. But now he's at a drug rehabilitation centre - with an unconventional approach to addiction - trying to give up the habit that nearly cost him his life. "I feel humiliated when they talk to me like this but they are right and I know that what I have done is wrong," he told IRIN in Karachi. Statistics on Pakistan's drug problem are outdated and do not tell the whole story because experts say numbers are rapidly increasing. The last survey the government carried out in 1993 found 3.01 million drug addicts in the country, of which 51 percent were heroin users. Some 50 drug addicts live at the centre in the Federal B district of Karachi where they hold a daily meeting that focuses on ritual humiliation of participants. Run by the Pakistan Society - a local NGO, the addicts are made to wear different coloured shirts to indicate which stage of recovery they are in. Red for newcomers, yellow for those who have entered the second phase of the rehabilitation process and green for the those who are well on the road to getting better. Those in the green shirts preach and shout at the newcomers every morning, who are not allowed to answer back. "Do you know why you are here? I said do you know why you are here?," a man in a green shirt screamed at a newcomer. "By using this method we are putting the addicts in a position where they feel ashamed of what they have done and hopefully they will get back on the right track," president of the Pakistan Society and head of the UNAIDS project in Karachi, Dr Saleem Azam, told IRIN in the southern port city. Since the centre was established in 1982, thousands have passed through the doors and have been rehabilitated back into this Islamic society. Run primarily on private donations, local industries in the huge city have been a great help to the centre. Patients are provided with three hot meals a day donated by various hotels in Karachi and are treated with medicines to wean them off heroin and other hard drugs, given to the centre for free by local pharmacies. There are female addicts too, but they are outpatients. "The women cannot stay here for cultural reasons so they drop in for medicine and advice," he explained. Most of the patients are working during the day selling a newspaper being printed at the centre for the past 13 years, called Akhbar-e-Azam (the great newspaper). Some 20,000 copies are distributed every week. "By selling the paper the recovering drug users are also learning how to integrate into society again," Azam said. "Most addicts find they are shunned by society and nobody will go anywhere near them so it is important for them to learn social skills as part of the rehabilitation," he added. The drug users act as reporters and editors for the paper as well as vendors, and many articles focus on the dangers and problems associated with addiction. "They earn five rupees for every copy they sell and they promote advertising space, so it is also a means of income for them," Azam explained, adding that the users are also able to find other work when selling the papers. "There are plenty of shopkeepers who have been offering them work". "The doctors and staff here have worked miracles for us. I don't want to leave this place. This has become my home and these people are like my family. I do visit my family for a few days a month but I always look forward to coming back her," Sayed Liaqat Hussain, told IRIN. He had been living at the centre for the past three years. He started smoking marijuana some 15 years ago and ended up taking hard drugs such as heroin and valium. "I was shooting up three to four times a day," he added. Hussain had developed schizophrenia over the years of his drug abuse and was being counselled at the centre.> "When I came to this centre I only had one thing on my mind and that was not to take drugs ever again. Thank god I have been able to do this," the recovering addict cried. With an estimated 20,000 intravenous drug users in Karachi, mostly from the lower section of society, the problem is becoming worse in this sprawling metropolis, with numbers increasing day by day. Out on the streets of the former capital, clusters of drug addicts can be seen openly injecting themselves. Used needles are found scattered on the ground, usually with an addict lying somewhere nearby. Drugs like heroin are becoming more readily available at a cost of 50 Pakistani rupees (25 cents) per gram. Azam believed most of the illegal substances were coming in from Afghanistan via Pakistan's North West Frontier Province (NWFP). "A bumper crop is expected this year, following the fall of the Taliban," he warned. Abdul Bashir, who was in the second phase of his recovery period at the centre had been sharing needles while injecting himself with heroin for one month and was also snorting cocaine. "I didn't know the dangers of sharing needles before I visited the needle exchange centre and I would share one needle with one other person," he told IRIN. He started taking drugs 18 years ago and it was a difficult road to recovery for him as he had been so dependant on them for so long. Recognising that intravenous drug users are one of the highest risk groups for contracting HIV, a needle exchange centre located in the Essa Nagri district of Karachi has been set up by Pakistan Society and UNAIDS. "We have screened 2,000 drug injectors for HIV and they were clean. But this does not mean that HIV does not pose a threat," Azam warned. Although Pakistan is a low prevalence country, there are fears that the deadly disease could explode if awareness is not raised. There are 2,000 reported cases of HIV positive people in Pakistan according to statistics since the disease was officially acknowledged in the late 80's. However, many believe the actual figure to be much higher at 70,000. Five outreach workers and volunteers from the rehabilitation centre run the exchange, offering facilities and services other than just needle swapping. "They can get condoms from here, get tested for HIV and we also have a postal service so they can write to their loved ones and receive a reply from them at this address," recovered heroin addict and manager for the needle exchange centre, Zahid Nadeem, told IRIN. According to the centre's own statistics, more than 60 percent of users said they were sharing needles. To reduce this, more than 22,500 new syringes and needles have been given out in exchange for a similar number of used needles up until October this year. As a result, needle sharing is down to just four percent. "Most of the users had severely damaged their skin and resorted to injecting themselves in the groin," Azam said. "They had to stop injecting because they simply had nowhere else to inject themselves," he added. Social factors such as unemployment leading to pure boredom are the main reasons for the abuse. "I bought a TV to the centre which has made a huge difference. Instead of shooting up four times a day they only shoot up once a day and are happy to watch TV for the rest of the time," he remarked. With up to 150 addicts passing through the exchange centre every day, Azam said the only way to save lives was to open up more centres to stop the spread of HIV. "What we are doing is good, but it is just a drop in the ocean," he warned. He commended government efforts but said much more needed to be done. "You will find drug users in every corner of Karachi," he maintained.> The local government has established 46 clinics aimed at preventing sexually transmitted diseases in Sindh. "We also have 22 surveillance centres where we provide HIV testing and counselling," head of the Aids Control programme in Sindh, Dr Abdul Khalique Ghauri, told IRIN in Karachi. A total of 17 HIV positive cases have been reported in Sindh since 1987. "These were all foreigners who were jailed for drug related offences." The government official said that between 30 and 40 HIV positive cases were diagnosed every year and that the number was increasing. Although Ghauri said the programme in Sindh was being used as a role model elsewhere in the country, he added that manpower, expertise and political commitment at the country level was needed to keep the problem under control. "Luckily we have only found one drug user who is HIV positive this year. But we know the potential is greater," he said. Commenting on measures taken by the local authorities in combating the drug problem, he said: "They are very committed in ridding the streets of such substances and security has been tightened up to ensure that the problem is brought under control". Back at the rehabilitation centre, donning his green shirt, Mohammed Aftab said he would stay at the centre for as long as possible so he could help others who are in the same situation he was in five years back. "I thought I was already dead when I was taking drugs," he told IRIN. "I was left on the roadside unconscious most days. But I have now found a new lease of life," he added.