NATIONAL8 (Spotlight Weekly]

Clear And Present Danger

The government says some 2,000 Nepalis are suffering from AIDS, but independent organizations put that number as high as 40,000

By AKSHAY SHARMA

AIDS patient : Poignant reflection

Rajiv Kafle, 29, has AIDS and speaks openly about it. "An AIDS/HIV patient doesn't grow horns in his head or a tail on his back. So why should I hide the fact that I have AIDS? Maybe I'm the first person in Nepal to come out in the open and say, 'I have AIDS'."

Earlier this year, the United Nations held a special session on AIDS to mobilize concerted international action to combat the disease. "I was a soldier. But I know of no enemy in war more insidious or vicious than AIDS, an enemy that possesses a clear and present danger to the world," US Secretary of the State Colin Powell said in an address to the UN session on July 15. "The war against AIDS has no front lines. We must wage it on every front. And only an integrated approach makes sense. An approach that emphasizes prevention and public education. But it must also include treatment, care for orphans measures to stop mother-to-child transmission, affordable drugs, delivery systems and infrastructure and medical training. And it must include research into vaccines and a cure."

World Aids Day was observed around the globe on Saturday, December 1. The US Agency for International Development organized a video satellite conference and discussion among experts in Shanghai, China, Bridgeport, Barbados and Washington DC. at American Centre at Gyaneshwor on November 29.

"Nepal is suffering from HIV/AIDS because we lack the needed infrastructure," Minister for Health Sharat Singh Bhandari said. "Poverty, lack of awareness, illiteracy only compounds the problem."

Earlier this year, US President George W. Bush pledge $200 million to jump-start a global fund to combat AIDS, tuberculosis and malaria. Experts have welcomed the fund as a bold new private-public partnership to combat the killer diseases. "Only through sustained and focused international cooperation can we address the problems so grave and sufferings so great," President Bush said.

The United States is the leading donor to anti-AIDS programs in developing countries. President Bush's budget for next fiscal year seeks $480 million for programs to combat AIDS, twice the amount allocated in the current fiscal year. The White House has also requested $3.4 billion for AIDS research.

In the 14th century, the Bubonic plague killed one third of Europe's population. People did not understand what caused the pestilence or how it spread. So they blamed God for punishing them for their sins. AIDS has emerged as the modern-day version of the Bubonic plague both in terms of the scale of its devastation and the sense of hopelessness it breeds.

"The best [developing countries] can do is try to slow new cases through preventive education and encouraging condomÖ[F]iguring out how to save the infected millions remains an agonizing challenge," TIME magazine recently said in a story "Who Should Pick Up The Tab For The Third World?" The

magazine added: "While access to antiretroviral would bring a medical miracle help, it would still provide no more than a holding action. Only a vaccine that could actually stamp out the virus for a lasting cure — and that remains tragically elusive."

The National Centre for AIDS and STD Control (NCASC) says 2, 097 people have been infected with HIV and 533 have progressed to the AIDS stage. But other organizations say the figure could be as high as 40,000, a fact that stresses the urgency to deal with the problem on a war footing.

AIDS is affecting the population through all the usual routes. According to official figures, people visiting prostitutes have the highest rate of infection in Nepal. Next on high-risk list are prostitutes. The third largest infected sub-group are Intravenous Drug Users (IDU), a fast growing category.

According to Life-Saving and Life-Giving, there are an estimated 60,000 drug users in Nepal of which 30,000 are in Kathmandu Valley. About 15,000 are Intravenous Drug Users and 30 percent are infected with HIV/AIDS. While the IDUs are a target group for awareness campaigns, the focal point for officials is the practice of unsafe sex, says an expert.

"The geographical situation of Nepal and the needed interventions are different from other countries," said Dr Jack Chow, Assistant Secretary for Health and Science, Bureau of Oceans International Environmental and Scientific Affairs during the USAID program. "We need to combat the problem through global reforms. And the private sector has a vital role to play. AIDS is also an economic threat to the world."

The first recorded case of HIV/AIDS was in southern Africa in 1970 and Nepal saw its first case in 1988. Today there are 72 million people suffering from AIDS around the globe.

Department of Health Services Director-General Dr. B.D. Chataut says it takes up to six to 10 years for a patient to show the symptoms of the disease. "The extent of AIDS-related deaths is just unfolding in Nepal. If the country doesn't start preparing in time, we will have a big problem in the years ahead."

About 20 million people have died of AIDS around the world. Officials here say the disease has claimed 149 Nepalis. "Nepal has chosen 2002 as the year to combat AIDS. A vigorous program is to be implemented on a national scale by a committee headed by the prime minister," Minister Bhandari said.

Dr Shahi Sharma, director of the HIV/AIDS department of the Tribhuvan University Teaching Hospital said, "There is no monitoring device available in the country to see if a person is affected by HIV/AIDS and the payload the virus is carrying in a patient."

Although there is no cure for the disease, drugs help in containing the spread of the disease in the immune system. But, Dr. Chataut said, "The medicine manufactured in the United States is very expensive. It costs around 80,000 rupees for a monthly dose and you have to take 12 pills per day."

Dr Sharma added: "When an HIV/AIDS patient comes to you, you cannot prescribe the medicine because there is none available in the market. This is a crime against humanity."

"Nine varieties of HIV/AIDS viruses have been found in other countries. But in Nepal, we have only identified one or two types of viruses," said Dr. Iswori Lal Shrestha.

"Silence Kills. Breaking the silence is a powerful way that people of all levels of society can combat the disease. I do not minimize the courage it takes to come forward, to challenge the taboos and change tradition. But that Kind of courage is needed or more people will die," US Secretary of State Powell said in his UN address earlier this year. "Opinion leaders from all walks of life must deliver the message that AIDS is real. That our enemy is the HIV virus not is victims. Those who carry HIV deserve compassion, not ostracism. That they deserve to be treated with dignity, not with disdain. All public officials must use their spotlight they are given to speak out and give AIDS a top priority."

Dr Gerald T. Keusch, a leading health expert, said at the USAID-sponsored videoconference: "Science plays a big part in combating this global threat. We need cooperation way down from the grass-roots levels. Cross-border issues also need to addressed to combat the disease that knows no barriers."

For a country like Nepal, where victims and their family strongly avoid openly discussing the deadly disease, the courage of people like Kafle becomes a powerful weapon in the anti-AIDS battle.