NEPALGANJ, 10 December 2010 (IRIN) – It was only after her husband died that Tika Thapa discovered he was HIV-positive. That was eight years ago. When her husband returned from working in the Indian state of Gujarat, he was severely ill. He told her it was probably tuberculosis (TB); they continued to have unprotected sex.
“I didn’t know anything about HIV then, so I never asked him to get tested,” she told IRIN. Now, 38 and HIV positive, she is telling others in Nepalganj, a city in Nepal that borders India, to be more vigilant.
As a worker with a grassroots group affiliated with the government’s National AIDS and STD (sexually transmitted diseases) Research Centre (NCASC), she said she had spoken to almost 500 people this year about how HIV spreads and measures that can be taken to avoid contracting it.
“When I share my experience with the wives of migrant workers, they tell me that I’ve opened their eyes and that they want to get their blood checked [for HIV].”
NCASC estimates that 0.49 percent of the population, or some 70,000 people, are living with HIV – a relatively low prevalence, but very few people in Nepal get tested.
The government estimates that 80 percent of HIV-positive people do not know they have the virus.
Most confirmed cases, 62.5 percent, are migrant workers and their wives, 41 percent and 21.5 percent, respectively, according to NCASC.
Migrating to work
Per capita GDP in Nepal is US$467, according to the Ministry of Finance, and the woes of the country’s job market – low pay, high unemployment – have been exacerbated by years of political turmoil.
These conditions push some 1.5 million Nepalis every year to seek seasonal work abroad, mostly in neighbouring India but, increasingly, in other countries in Asia and in the Gulf, according to the Nepali government’s Central Bureau of Statistics.
Away from their wives for long periods, some male migrant workers turn to brothels. This is how Thapa believes her husband became infected.
And the trend is showing no sign of letting up. Nearly half of all new HIV cases are recorded among people living in highway districts, which are home to high numbers of migratory workers, according to the 2010 UN General Assembly Special Session on HIV AIDS (UNGASS) report on Nepal.
Knowing the HIV risks faced by male migrant workers while abroad, Prativa Nepali, 22, decided to be unusually candid in discussing sex with her husband, who is working in Malaysia.
“I told him that that if you need a sexual partner while you’re there, that’s okay but be careful [use condoms],” she said.
Such frank discussions are much more difficult to navigate for Aayesa Seheba, 24, who lives down the road in Nepalganj’s Pragatisil community and whose husband is also working in Malaysia.
She is Muslim and she says her religion is strict in discouraging discussion about sexually transmitted diseases.
“When I brought up the issue with my husband, he said testing wasn’t necessary since he hadn’t done anything wrong,” she said. “And, in Islamic culture, this is something that’s very difficult to discuss.”
Trained by the Nagarjun Development Committee, a local NGO providing HIV/AIDS awareness and free anti-retroviral treatment, Chandra Kala Gurung works to broach such communication barriers between husband and wife.
Gurung said local attitudes towards discussing sexual health have relaxed somewhat in the 10 years she has been door-stopping men and women in the Pragatisil neighbourhood.
Resistance does not easily deter her. “If they don’t listen the first time, I go two, three, four or five times – however many times it takes,” she said.
“The first time I go I don’t ask direct questions. First, I just want them to know me. I try to make jokes. Later, I try to ask more: if they use condoms, if they have been tested for HIV.”
“If they get angry, I just laugh.”
She said the lives she can save are worth the awkward encounters.
[Published by IRIN on December 10, 2010]