Photo: Naresh Newar/IRIN  | | A 30-year old woman with AIDS in Makwanpur District. Deserted by her husband and family, who considered her to be too much of a burden, she survives on few pieces of bread provided by her neighbours. |
Four years ago, Nareshlal Shrestha took the bold step of publicly declaring that he was HIV-positive in a society that still condemns and ostracises people living with the virus. He was one of the first people in Nepal to do so. Since then, others have followed his example, believing that the only way to fight HIV/AIDS in Nepal is to take matters into their own hands.
Shrestha and other people living with HIV/AIDS in Sunsari district, 220 km east of the capital, Kathmandu, started their own group, ‘Dharan Positive’, to help and support each other. They are also actively involved in organising HIV/AIDS prevention activities as well as providing care and treatment for nearly 185 others in the same situation, including 32 women.
Although they have been successful in giving moral support and intensive healthcare services to each other, they cannot prevent their friends from dying. “So many have died in front of our eyes,” recalled Shrestha.
There are other groups for the growing number of Nepalis living with the disease in the rest of the country but all are running out of patience with the government, which has failed to put in place effective measures to prevent HIV prevalence or to provide care for those already living with the virus.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), Nepal has a concentrated HIV/AIDS epidemic with an estimated 62,000 people living with the virus. There are serious concerns that AIDS could be the leading cause of death by 2010 if the current rate of infection continues to increase.
UNAIDS reported that HIV/AIDS is rapidly spreading in the 15- to 39-year-old group, among whom AIDS-related diseases are already a major cause of death. It added that without effective treatment programmes, between 10,000 to 15,000 Nepalis might die annually because of AIDS.
HIV/AIDS workers and those with the disease state that the government’s lack of seriousness is already evident with its underestimation of the epidemic. The latest government statistics in October 2005 reported that there were only 5,564 people living with HIV and 828 with AIDS.
Studies have shown that among the highest risk groups are sex workers and their clients, migrant male workers and their wives and injecting drug users (IDUs).
It is estimated that there are around 30,000 IDUs in Nepal, of which 40 percent are said to be HIV positive. According to a Family Health International (FHI) study conducted by New Era and STD/AIDS Counselling and Training Service (SACTS), the figures are alarming, especially in Kathmandu where nearly 68 percent of IDUs tested HIV positive.
Commercial sex workers (CSWs) are even more at risk. According to the government’s data, there are around 60,000 CSWs in the country, of whom 604 are positive, while 2,963 of their clients are HIV positive. According to Women Acting Together for Change (WATCH), there are an estimated 150,000-200,000 Nepali CSWs in Indian brothels and around 70 percent of the CSWs who returned to Nepal were HIV positive.
But activists complained that despite the serious growing threat of an HIV/AIDS epidemic, the government has failed to show commitment. It has been criticised in particular for its neglect towards the care and treatment of the people with HIV/AIDS. This year, it had planned to provide anti-retroviral treatment (ARV) to nearly 750 patients but records show only 150 in Kathmandu and 11 in Nepalganj, in far west Nepal, have received the treatment.
Many with the disease have given up their dependency on the government. Instead, they have started their own groups in many parts of the country. “Our main purpose is to help each other and organise ourselves so that our voices will be heard,” says Protsah Katuwal from an HIV/AIDS support group Sneha Samaj, which gives shelter through its crisis centre and has also helped to form more groups in the remote districts of Achham, Butwal, Chitwan, Pokhara and Nawalparasi in west Nepal.
Activists complain that despite huge financial and technical support from aid agencies, there are shortcomings due to a lack of leadership in the related ministries and departments. “In absence of political commitment and leadership, the campaign against HIV has proved to be ineffective,” said an official from one of the key funding agencies on condition of anonymity.
Since 2002, the National AIDS Council has had only one meeting. The National Aids Coordination Committee led by the health ministry has also failed to do much. Activists are frustrated with the National Centre for AIDS and STD Control (NCASC), which has been highly politicised for many years, even under the democratic regimes. In the last three years, NCASC has changed its director nearly nine times, which is reported as one of the main reasons for the failure to implement Nepal’s AIDS strategy for 2002-2006.
The District AIDS Coordination Committees (DACCs) have been established in more than 60 districts but only two or three are reported to be functioning while the rest merely organise functions on World AIDS Day.
Nepal’s government has allocated only a small portion of its national budget for HIV/AIDS intervention and is dependent largely on bilateral and multilateral aid.
“If we are to achieve our goal (Millennium Development Goal) of controlling the spread of HIV/AIDS, it will be difficult without effective management,” said Dr Pulkit Chaudhary, senior medical officer of NCASC, who added that the government had failed to take a lead in coordinating hundreds of local and international NGOs working in this sector.
Impact of conflict
“The ongoing Maoist insurgency and resulting conflict in Nepal have created large numbers of internally displaced people as well as economic and social instability, which may also contribute to the spread of HIV/AIDS,” said a report by United States Agency for International Development (USAID), a key bilateral donor to Nepal and the lead donor for family planning and HIV/AIDS programmes in the country.
Although there has been no in-depth study on how HIV/AIDS has been affected by the nine-year conflict between the Maoists and the state, several studies have reported serious indirect effects.
The conflict has fuelled displacement and large-scale male migration to Kathmandu and India for work. According to hospital records, many male migrant labourers return to their villages HIV positive. According to UNAIDS, at least 10 percent of 2-3 million Nepali migrant workers in India are HIV positive and they in turn infect their spouses upon return to their villages. This has been seen most notably in Maoist-controlled districts such as Accham, Kailali and Doti, where around 6-10 percent of migrant labourers were reported to be HIV positive.
“These men are now infecting spouses and others in many parts of the country. By pushing rural residents from war-torn areas to the capital, Kathmandu, the conflict may have helped spread HIV/AIDS,” said a recent report on HIV in Nepal, ‘Is the Violent Conflict Fuelling the Epidemic?’ published in July 2005 by a group of international and local specialists.
According to Care Nepal, nearly 34 of the 71 people in the remote Doti District Hospital were diagnosed as HIV positive in 2004. Among them were mostly widows under 40 and around 60 percent of them were mothers of children less than one year old.
[ENDS]
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