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HIV/AIDS |
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HIV/AIDS |
Capital Punishment With an increase in the
number of commercial sex workers, upsurge of violence, destruction of rural health
infrastructure and rise in intravenous drug users, the risk of HIV infections is
significantly higher in the country, particularly in urban areas. Can awareness generated
by an enormous publicity campaign prevent the alarming trend? By KESHAB POUDEL As Nepal Television broadcasts a spot
urging safe sex to avoid the risk of the deadly HIV virus and other Sexually Transmitted
Infections (STI) on its evening news bulletin, many young girls working at dance clubs,
cabin restaurants and on the streets of the capital are either fixing clients or engaged
in some phase of the flesh trade. Equally vulnerable are the Intravenous Drug
Users (IDUs) who share needles. Despite the continual publicity campaign and availability
of preventive methods, the behavior of a majority of such people is yet to change. The use
of drug is illegal as is prostitution. So one has to go through illegal ways even for
counseling and other campaigns.
HIV/AIDS Status It is estimated that HIV has infected more
than 60,000 Nepalese and the number of cases continues to rise alarmingly. According to
the UNAIDS, 30 people, including 14 adults, become infected in Nepal every day. UNAIDS has
declared Nepal an HIV "concentrated epidemic zone". The actual situation may be
worse, as reported HIV and AIDS cases are lower than estimates. The indirect economic loss
due to AIDS for Nepal in the year 2001 was approximately US$10 million, or $30,000 per
day. HIV rates in Nepal are reported to be 0.3
percent of the population between the ages of 15-49. But others say the number is much
higher since these low rates could be the result of faulty surveillance mechanisms and
poor data collection. After the first case was identified in 1988
in a foreigner, the disease has become common among high-risk groups in Kathmandu.
Poverty, low literacy and break-up of the basic health infrastructure and law enforcement
agencies make the country highly vulnerable to HIV/AIDS infection. If infections are allowed to climb beyond 5
percent of the adult population, scientists believe, the chances of keeping the disease
from greatly accelerating would be slim. It is like a fire, says one expert. In the
beginning it is easy to control because one can go to the source. Despite the massive awareness campaign
launched by various government and non-government organizations about the HIV virus and
preventive methods, a large number of sex workers either do not find condoms or are
compelled to undergo unsafe sex, transmitting various kinds of STI as well as the deadly
HIV virus. Thuli Khadka's Story The story of Thuli Khadka (not real name),
a waitress at dance restaurant in downtown Kathmandu, provides a typical example of how
STI and HIV infections spread even in the midst of awareness. A resident of Dolkha
district, 150 km east of Kathmandu, Thuli was trapped into the profession a year ago
through a job offered by her friend with a Rs.1,500 monthly salary and an additional daily
income ranging from Rs.100-200. Men often reject her request to use condom.
The demand and use of condom, studies
indicate, have dramatically increased among sex workers. But it is still very
insignificant in preventing risk of HIV infection. As the number of sex workers in various
parts of the country rises and behavior patterns change, the threat of a contagion is
real. "The majority of men want to have sex
without condom, saying they cannot get full satisfaction. In many cases, drunken clients
press me to do whatever they like. I am scared to go to the doctor to check my
blood," Thuli says. "I don't have any health problems except sometimes pain in
the lower abdomen and irregular menstruation. God will save me." Many Thulis realized too late that the
place they considered heaven was actually hell. They are paid as waitresses to entertain
guests and lure them to empty their purse. Waitresses in the cabin restaurants are awarded
in case they make guests spend more. The waitresses have to be humble even in case of
mistreatment. Worse, these girls are often caught in police raids and beaten up by local
gangsters. "I was trapped in a profession in
which I will be infected with the deadly virus. Although I know the risk of HIV and other
infectious sexually transmitted diseases, I have to entertain couple of guys aged between
20-55 to survive," says Barsha Rai, (name changed upon request) 17, a high school
dropout from the eastern hill district of Khotang. "I used to carry condoms in my
bags but most of the clients don't want to use them. Just a few days ago, I was raped by a
gang of five," adds Rai, who has been working in a dance restaurant in Koteswor.
"I came here to escape the insurgency, but I am in a more dangerous place." Several young girls and married women work
as sex workers in the valley in various cover professions. The law regards prostitution as
a crime punishable by up to ten years' imprisonment. The profession is commonly practiced
under the cover of massage parlors, cabin and dance restaurants and discos. The number of
street sex workers has also increased dramatically in the valley. Data indicate that risk
behaviors are widespread among female sex workers and their clients, IDUs, migrant workers
and young people. Publicity or No Publicity As the insurgency spreads, a growing number
of girls turn to Kathmandu for survival. Unfortunately, they are trapped in another cycle
of violence where life is much worse and unstable. Geographically, the highest prevalence
rates are found in the central region. There is evidence of an explosive increase of
infections since 1996.
There are a number of hoardings
conveying the message of safe sex and the threat of infections of HIV but people don't
seem to worry until they discover they have already contracted the deadly virus. More than
70 percent of the 55,000 IDUs are infected by the HIV virus. Experience has shown that generating
awareness through the mass media is not enough for prevention. The awareness level is very
much higher in Nepal about HIV, but it is yet to be translated into prevention.
"Generating awareness is now enough but there is a need for programs to provide
alternatives to those vulnerable groups of people," says Dr. Michael Hahn, country
program adviser UNAIDS. Since no license is required to start
massage parlors, small dance restaurants and cabin restaurants, there are hundreds of such
centers in the valley offering the service of young waitress and masseurs. Worse, many
waitresses are transmitting the HIV virus and other diseases to various age group of
population, mostly young and middle-aged married men. According to an estimate, more than 300
cabin and dance restaurants and 100 massage parlors employ 2,500 girls aged between 13 and
25 years. Over 70 percent of them are involved in the flesh trade. With the upsurge in
violence in rural parts of the country and strict vigilance along the border, a large
number of young girls are coming to the valley. As there is tough competition for jobs,
restaurants owners pay nominal salaries, forcing the girls to go in for flesh trade for
extra income. As the migrant population increases, so
does the demand for female sex workers. The cabin owners say the majority of clients
include males of middle class, police and army. The effect is that the HIV virus is
transmitting from cabins into middle class household in the valley. A study by various
local and international non-governmental organizations disseminated in June revealed a
high prevalence of HIV infection among the population of female sex workers and IDUs in
Kathmandu valley. Since the last two years, police have been
virtually ineffective in the valley to discourage IDUs users and commercial sex workers.
Cases related to unethical practices have increased. In many places, police are said to be
protecting dance restaurants and cabin restaurants. The report, the first of its kind, was
prepared by New Era, SACTS, NCASC, NRCS, CREPHA, Harvard School of Public Health though
funding from Save the Children/US, Dutch Development Assistance Agency, Harvard School of
Public Health, Asia Near East Bureau of the United Sates Agency for International
Development through the IMPACT project implemented by Family Health International, J.
William Fulbright Commission and American Association of University Women Educational
Foundation through the American Graduate Fellowship. The report discussed the dynamics of
HIV/AIDS epidemic in Nepal and its implications.
Alarmed by the situation, the
government set up a high-level National AIDS Council under the chairmanship of the prime
minister and a separate National Center for AIDS and STD Control (NCASC) but it is yet to
stabilize the cases. "Despite our strong efforts, we are yet to bring any tangible
change in the HIV/AIDS pattern," says Dr. Shyam Sundar Mishra, director of NCASC. HIV Epidemic HIV/AIDS is new to Nepal. For many years,
the disease was confined to foreigners and upper class population, which made it easier
for the rest of the country to pretend it didn't exist. And with a raging tuberculosis
epidemic, malaria and flu, there's been no shortage of health crises. But while nobody was
looking, HIV crept into the general population. Recent prevalence data suggest that there
has been significant increase in HIV infections and STIs in Nepal over the past five
years. The studies have shown that the predominant mode of transmission is sexual contact,
mainly heterosexual, and highest rates of HIV have been identified among IDUs. As Nepal's well organized health system is
gradually breaking down in the remote as well as the semi-urban places and distribution of
condoms is restricted to urban areas, there will be a major threat of HIV infection in
rural parts of the country. "If violence continues in the rural
areas and health workers are unable to visit the countryside and collect information, the
situation will definitely go out of control in the next five years," says a senior
official at the Ministry of Health. "When more than 50 percent of the rural health
posts have been closed down and many health posts have been destroyed, HIV-related
problems are bound to increase within a few years. In a large portion of rural Nepal,
there is virtually no medium of personal, inter-personal and mass communication." Challenges for Control Although religiously Nepal is not closed in
terms of sex, it is not a topic for polite conversation. Public health officials have long
confronted this taboo, which makes the task of raising public awareness of sexually
transmitted diseases all the more difficult. There are separate times for men and women
to take bath at rural water spouts and separate benches for boys and girls in school and
college. Marriages are arranged and sex education is virtually non-existent. Whether it is
highly educated family or illiterate, family members see sex as an offensive topic.
Despite the continual publicity campaign, no parent dares to speak about the use of
condom. "Even high class NGO workers who are
involved in the campaign against HIV/AIDS do not discuss sexual matters within the family.
As long as Nepalese consider sex as taboo, no effort will bring any result," says an
expert. With the upsurge of Maoist violence,
destruction of basic health facilities and breakdown of the administrative order, HIV/AIDS
seems to be definitely finding fertile ground. It's hard to imagine how the epidemic can
be stopped amid a health crisis already created by illiteracy, poverty and gender
inequality. |
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editor: spotligh@mos.com.np |
