HIV awareness amongst MSM still low

As dusk falls in Ratna Park, a popular cruising area for men who have sex with men (MSM) in the Nepalese capital, Kathmandu, so too do inhibitions.

"I can always find someone here," bragged Pradip, 23, while his friends prompt him to tell more. He has been married for four years and has two children, but his wife knows little of his evening activities, nor would she dare ask. "She knows her place," he said.

The day labourer admits to having as many as three extramarital sexual partners a week - often without a condom - but knows little about HIV/AIDS, or the risk of infecting himself, his wife and others. "I'm always on top - you can't get infected that way," he asserted.

Such ignorance means that what happens in the darkened corners of Ratna Park may represent the next frontline in the Himalayan nation's battle against HIV/AIDS.

Nepal has recorded almost 9,000 cases of HIV since the first case was reported in 1988, but UNAIDS puts the estimated number of HIV infections at closer to 75,000, in a population of 27 million.

MSM are considered one of the groups most at risk and in need of HIV/AIDS education, but Narmada Acharya, acting country representative for UNAIDS in Nepal, said the stigma associated with homosexuality was preventing people from coming forward. "Many people have problems with their sexual identity and are afraid to seek information," she commented.

With MSM already a socially marginalised group and access to prevention services low, education and services from within the MSM community itself were the key to further prevention, Acharya said.

One group working to address the problem is Nepal's Blue Diamond Society (BDS), a community-based organisation that has the only national network representing MSM and other sexual minorities.

Photo: David Swanson/IRIN
Homosexuality is not explicitely criminalised, however, 'any kind of unnatural sex' can bring a year's prison term

The society's two drop-in centres and small army of outreach educators, who distribute condoms at over 100 cruising sites in the capital, are already having an impact.

"We believe a large number of males are involved in male-to-male sexual behaviour, but it's hard to reach everyone," said Sunil Pant, BDS's outspoken president.

Part of the problem, according to UNAIDS, is the common misconception that male-to-male sex happens only among men who identify themselves as 'gay'. In fact, most MSM living outside the West do not identify themselves as such and are often married with children.

Sex with transgender persons

"Many straight or straight-acting men who have sex with transgender persons [people who do not identify with the gender they were born with] won't come into any of our drop-in centres," Pant said, adding that the idea of being powerful and masculine in Nepal did not include using a condom, and condoms were also often difficult to find in rural areas.

Nepal has a sizeable transgender population that has long been involved in commercial sex work catering to MSM. In the "terrain", or low-lying areas of the country bordering India, transgender people are traditionally mobile, often crossing the border to India to sing and dance at weddings or other celebrations, as well as engaging in commercial sex work.

"When they travel they have many sexual partners and their mobility makes them more vulnerable to contracting HIV," Pant said, adding that the stigma attached to being a transgender person could hinder their access to health services.

MSM fast fact

HIV prevalence among Nepal's urban-based MSM is 4 percent compared to 0.3 percent among the general adult population.

Low awareness about HIV among MSM who engage in sex with transgender people heightens their risk of exposure, and may also prevent those already living with the virus from seeking treatment.

Fortunately, awareness is already on the rise in a number of towns across the country where BDS or one of its partners has a presence. Since early 2006, BDS has run a project that assists local groups outside the capital in building up their institutional capacity, services and advocacy work.

A BDS partner in the southern border city of Nepalganj, 'Paschimtara' (Western Star), a community-based organisation for MSM and transgender persons, is already distributing around 200 condoms a day at more than 20 locations that MSM frequent in and around the city.

"People need more knowledge about HIV," said Ram Avtar Tharu, one of six outreach educators at the Paschimtara drop-in centre. "Many people don't even know how to use a condom."

He estimates that around 60 percent of the people he speaks to know something about HIV, but says there is a need for more prevention funding to educate this high-risk, often-uninformed group.


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