NEPAL: Plight of rural people living with HIV/AIDS

[Guest guest]

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

24 Jan 2005 15:51:11 GMT, Source: IRIN

MAKWANPUR, 24 January (IRIN) - 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.

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