Widows living with HIV in Nepal’s remote hill districts in some of the country’s poorest and vulnerable communities face a particularly bleak future.
“My husband died four years ago. We had to sell our cattle and farm to pay his medical bills,” 32-year-old Sumi Karki* told IRIN in the tiny village of Rakam in Dailekh District, about 700km northwest of the capital, Kathmandu.
Infected by her husband, a former labour migrant to India, she has no idea how she will care for her three children in the future, much less pay for their schooling.
Most of Rakam’s more than 2,000 impoverished residents depend on subsistence agriculture and remittances from relatives working abroad as migrant labourers to get by.
Now, struggling to put food on the table, Karki cannot even afford the travel costs to Surkhet, the nearest town, to check her CD4 count (a measure of immune system strength).
According to the National Centre for AIDS and STD [sexually transmitted disease] Control in the Ministry of Health and Population (NCASC), there are more than 50,000 adults and children living with HIV, and an estimated overall prevalence of 0.30 percent in the adult population (15-49 years old).
Most new infections occurred among adult males (58 percent), followed by women of reproductive age (28 percent), while 8 percent of infections occurred among children under 15 years old.
With an estimated 29.4 percent of all HIV infections occurring amongst labour migrants - although many believe the real number to be higher - the significance of this group, and the affected women, cannot be ignored.
Each year, tens of thousands of men leave home in search of work abroad, mostly in neighbouring India. Estimates suggest that more than 1 million Nepalese men live in India alone. However, it’s not just money they bring back with them.
Many of these men frequent commercial sex workers and practice unsafe sex while they are away, and then infect their wives with HIV when they return home.
A 2010 Integrated Biological and Behavioural Surveillance Survey of 600 women in Nepal’s Far-Western region found that HIV prevalence among the wives of migrant labourers was 0.8 percent, and 22.5 percent amongst widows.
But despite these figures, assistance and support for these women is low. “The women remain so vulnerable because they never use, or even dare to ask to use, condoms when their husbands return home,” said Deepa Bohara, coordinator of Parivartan Ko Lagi Pahuch (Access for Change), the only NGO supporting the women in Rakam village.
The group distributes antiretroviral (ARV) drugs once every two months. In Dailekh District alone there are 185 cases, and more than half of them are widows, hospital officials say. Like Karki, most of these widows are desperately poor after spending what little money they had on medical care for their husbands before they died.
“There is no humanitarian aid or HIV/AIDS care for these poor widows, who are living in total despair because of government indifference,” said Nani Devi, coordinator of HIV-positive single women’s support group, Nava Prabhat Ekal Mahila Samuha.
Government agencies in the capital and the district were too busy blaming each other for their own ineffectiveness while these women continued to suffer, Devi claimed.
“We are tired and frustrated asking in Kathmandu for the government’s help while we watch these poor women suffer,” said Dil Bahadur Shahi, chief development officer of the Dailekh District Development Committee, the top local governmental body in the district.
The NCASC reportedly provides just over US$2,200 per year to support all 185 people living with HIV and AIDS in Dailekh.
“We have requested aid for these poor women for many years, but have not received any concrete response,” said Khagendra Jung Shah, chief of the district health office.
The NCASC coordinates most of the funding for HIVAIDS at the national level, but has neglected this district, local government officials and NGO workers claim.
Meanwhile, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has expressed concern over the plight of these women and has pledged to follow up with the authorities.
“We will address this issue strongly with the government officials so that these poor women will get all the support they can,” said Maria Elena Filio-Borromeo, the UNAIDS country representative.
Hemant Chandra Ojha, a senior medical officer at NCASC agreed, saying, “We have to start a very serious discussion and decide how we should proceed with help for these single women.”
*Not her real name