Injecting hope: working with those most vulnerable to AIDS on the streets of Delhi

Tackling HIV and AIDS in the developing world is an immense challenge which means going beyond merely treating the disease to focusing on prevention. There is no “one-size-fits-all” solution – any response must be tailored to the specific needs of each country and of the groups most vulnerable to AIDS.

The UK’s Department for International Development (DFID) works with governments and other partners in a huge range of programmes to target the problems that contribute most to the spread of HIV and AIDS across the world.

In India DFID works with the Indian government's much praised National Aids Control Programmes to target the problems that, according to the research, contribute most to the spread of HIV/AIDS. One example is the injecting drug users among the huge population of street people in Dehli, who inhabit the old city centre. The Sharan Centre sees around 200 such cases a day – it gives people in need food, substitute drugs, basic medical help and counselling. Many of the men – no women live on the street – are migrants who originally arrived from rural India looking for work in Delhi.

To mark World Aids Day, 1 December, the photographer Abbie Trayler-Smith has done a photo-essay from India, looking at a project tackling the spread of AIDS among street addicts in Delhi.

Click here or on the image (right) to see the Abbie Trayler-Smith's photo-essay.

First person: Ajita Madhu - "The people just keep on coming, more and more of them"

Ajita Madhu, 35, has worked for Sharan for 8 years. Currently she is a counsellor and the sole nurse at Sharan's drop-in centre for injecting drug users in downtown Delhi. Previously she worked in the organisation’s rehabilitation centre. Sharan’s work part of the UK's Department for International Development's (DFID) targeted interventions with the Indian government to address groups at high risk of contracting HIV, and continue the work of lowering India's infection rate.

Ajita spoke while in her tiny office, prescribing pain killers to a drug user with an abscess on his leg.

"I come in at 9.30 in the morning and I see client through to about 4.30 in the afternoon – usually about 100 of them a day. This guy is a fairly normal case. He’s someone we used to see a couple of years ago, and now he’s come back to Delhi again. I've asked him what drug he was injecting when he developed the abscess, and asked him if he’ll go onto drug substitution therapy. I've told him about the needle exchange. We'll dress the wound and then he'll come back on Thursday to see the doctor.

The people just keep on coming, more and more of them. The numbers who need our services are going up – almost all of them are poor people from rural areas, who’ve migrated to the city looking for a job, they end up on the streets and they slip into drug use. But we only have so much money, to get medicine and supplies for so many clients. We'd like to do more – help them so they can have a wash at the centre, get clean clothes and all the medicine they need, not just the basics. But we have just one shower.

Often hospitals we refer people to refuse to treat them – they say they are too dirty to see a doctor and won’t let them through the doors. But even with the limited resources we have I think we're doing a great job. There's no doubt that we've saved many people who were at risk of contracting HIV. And sometimes we have complete successes.

Take Binod here. He's from Nepal – he came to Delhi looking for work 20 years ago when he was 21. He was a client here, an addict of morphine and brown sugar for 15 years. Then he went to our rehab centre, detoxed, and now he works for us doing outreach. His job is to go into the community, onto the streets, and help people come the centre. People like Binod work very well for us, they've been migrants, they've been addicts, they know what people are facing out there. He's paid 5000 rupees (about £60) a month.

I like working here – I'd never do anything else. I was scared at the beginning, because the clients can become angry and violent, and you get threatened. Sometimes with a blade. But I've learnt to handle it with the team. Worse is the sad stories you here, of people being beaten up by the police, abused, losing everything.

I’m so glad to be doing this work, though there’s always more we could do. But we’ve helped change things: people are much more aware of HIV, and they understand it more. People here used to think you could get HIV just by touching someone – we’ve come a long way forward from that."

World Aids Day is on the 1st of December. Find out more about DFID at www.dfid.gov.uk