Focus on the plight of rural people living with HIV/AIDS

With deep sunk eyes and parched lips, 30-year old Maya Rumba stares feebly from her broken bed. "Help me," is all she has the strength to utter. Her skeletal body weakened by severe malnourishment, Rumba is living all alone with full blown AIDS in her small hut at Sai Foot, a remote village in Makwanpur district in eastern Nepal, 128 km south of the capital city Kathmandu. She is so weak that she has to drag herself around with her hands. She has not eaten for days and is suffering from hepatitis C and tuberculosis. There are dozens of NGOs based in Hetauda town, 30 minutes from her village, but no health workers have come to offer her care or medicine. EXTENT OF HIV/AIDS Rumba is just another Nepali living with HIV/AIDS. Looking at her current condition, it's clear that without care it is only a matter of time before she dies. There are an estimated 60,000 people living with HIV/AIDS in the country of 23 million people, the majority living in abject poverty. UNAIDS estimates that between 10,000-15,000 Nepalis are expected to die of AIDS every year in the absence of treatment and care. A large number of people living with HIV/AIDS are unable to buy food or basic medicine. Their situation is becoming more desperate as many NGOs based in the capital, Kathmandu, are withdrawing their HIV/AIDS support programmes from villages due to fear of the Maoist insurgents who have been waging an increasingly vicious armed rebellion for the last nine years. World Bank figures indicate that one-third of HIV infections nationwide are among injecting drug users (IDUs). In the Kathmandu Valley, the HIV prevalence rate among IDUs in the early 1990s was about 2 percent. In 1999 it exceeded 50 percent. The prevalence among female sex workers also increased from less than 2 percent in 1990 to the current rate of 20 percent. IMPACT OF THE INSURGENCY As the insurgency drags on, seasonal and long-term labour migration to neighbouring countries, such as India, is becoming critical to the economic survival of many households. UNAIDS estimates at least 10 percent of the two to three million Nepalese migrant workers in India are HIV positive. These men are now infecting spouses and others in many parts of the country, boosted by women's inability to negotiate safe sex. Without effective interventions, it is predicted that there may well be a generalised epidemic by the end of this decade. People living with HIV/AIDS in rural Nepal are desperate for care and support. There are already cases of people committing suicide and children dying from malnutrition and lack of medicine. "People are not asking for ARV [anti-retroviral] drugs. All they need is a minimum form of support to buy ordinary medicines and food so that they can live longer," explained gender activist Kanchi Bhandari. The only hope for people like Rumba rests with under funded community-based organisations. "Small organisations are doing their best with the minimum funding to supply food and low cost medicines but for how long can they support people sick as a consequence of HIV/AIDS?" asked Chandani Rana, chief of one such organisation, the Hetauda-based General Welfare Pratisthan (GWP). LOCAL SOLUTIONS Village based health activists are committed to the fight against the disease. "We are ready to work in any village," explained Bhandari, who runs the Women's Pressure Group (WPG) in Sindupalchok, barely 80 km northeast of Kathmandu. WPG works in villages like Talamarang, Kiul, Mahankal, Ichok, Helambu, Duwachaur and Palchok that have one of the highest prevalence rates of HIV/AIDS in the country. These are the villages where most of the girls were trafficked to Indian red light districts - most of them returned home infected with the deadly virus. Despite an atmosphere of mistrust, prejudice and ignorance overlaid with poor security in many parts of rural Nepal, village based organisations like WPG are doing their best to reach out to those living with the disease, but money is drying up as they have to depend on Kathmandu-based NGOs for funding. "The NGOs want to get directly involved in our activities and don't trust us with their funds," said Bhandari. Many rural HIV/AIDS activists told IRIN that they do not have direct contact with donor agencies. "We have language problems. We cannot speak English and the donor representatives do not speak our language," explained Biswanath Bhandari, the health supervisor at a state-run Primary Health Care Centre (PHCC) that does not receive any government funding for the care of HIV AIDS patients. "The donor representatives do not really know the ground realities as they have not made any effort to visit our villages. They depend on the NGOs in the capital to give them all the information," added Bhandari. PHCC has to depend on donations and what charity it can get from the impoverished local community to help HIV/AIDS patients with food and medicines. It also provides travel expenses to poor villagers suspected of HIV infection to visit the National Centre for AIDS and STD Control (NCASC) in Kathmandu for HIV testing, the only facility of its kind in the country. SITUATION IN MAOIST AREAS There is no official data on HIV/AIDS situation in Sindupalchok, a district just 60 km northeast of the capital but controlled by the Maoists. Local activists estimate about 300 people are living with HIV/AIDS and the number is growing as most of the remote villages have no awareness about the disease. Local activists fear that the situation will significantly deteriorate if NGOs in Kathmandu do not provide funding for care, prevention and awareness raising. Most NGOs have withdrawn all their programmes from the region for security reasons. "The Maoist conflict has severely affected HIV/AIDS programmes on a national level. There has been a double impact. On one hand HIVAIDS prevalence is increasing and the response is reducing," said Bina Pokhrel, a local HIV/AIDS advisor with the UK-based charity Save the Children. Donor agencies have gradually realised the importance of care and support programmes for those infected and plans are underway to introduce the same starting from this year. "Plans are underway to introduce care and support programmes but this will take time," said Tara Chettri from Save the Children (US), a partner organisation of USAID. The need is critical say health workers on the front line in the fight against the pandemic. "The least we can do is start blood sampling so that we will know the conditions of the HIVAIDS patients who are dying in their homes," said Sabitri Shrestha, a midwife nurse who also works as a HIV/AIDS counsellor at the PHCC in Sindupalchok. There are 72 female community health workers in the district who are already working closely with the local community at a time when the work of most of local and national government bodies has been suspended due to the conflict. "They can be trained to identify people vulnerable from the disease and as counsellors they can help to raise awareness," explained Rohit Khadga, a health education technician from public health division.