Ignorance about HIV Still Prevalent in Nepal; Disease Becoming More Common Among Housewives

By Kamala Gautam

Nirmala Pandey, 33, is HIV positive. She has been living a lonely life ever since her husband, who knowingly infected her, died of AIDS two years ago. She is now living with her in-laws in Maitidevi, a central area of Kathmandu, Nepal's capital city.

Pandey, is from Dhading, a neighboring district of Kathmandu. She was married to Nabaraj Pandey, 34, three years ago in Kathmandu. Like many women here, she says she dreamt of marrying a loving husband with good status in society. Before her marriage, the matchmaker told her that Nabaraj Pandey, her husband to be, was an employee of the Nepali Government. She was told her future husband earned 7,000 rupees, about $1,000 USD, per month. After learning this, she says she was happy and thought she was getting the man of her dreams. She said, "I always wanted to marry a man with a permanent government job. I was happy to find him."

Nirmala Pandey, 33.

After the marriage, Pandey's husband took her to Delhi, India on their honeymoon tour. But Pandey's new husband had a surprise in store for her.

When the couple reached Delhi, she learned that her husband was really a newspaper hawker in the streets of the city. She says, "They tricked me into the marriage and ruined my life."

In Delhi, Pandey says her belief in destiny forced her to try to make the best of the situation. Soon after they arrived in Delhi, she says her husband and sister-in-law forced her to take birth control pills. She was devastated and could not understand why her husband didn't want children. "I didn't realize then, but now I understand that Nabaraj knew he had HIV even before the marriage. He knowingly infected me with this monstrous disease."

Nepal is one of the world's poorest countries and its weak economy has been further weakened by a decade-long civil war. It is well documented that thousands of Nepalese people, mostly men, migrate to foreign lands for work. According a survey of UNAIDS, about 2 million people have left Nepal for foreign countries in the search of employment. More than half of those men, choose to cross the border to India.

New evidence from UNAIDS reveals that as many as ten percent of the migrants who work in India, return with HIV. Dr. Padam Bahadur Chand, director of the National AIDS and Sexual Disease Prevention Center of the Health Ministry in Nepal confirms that data. "Since they remain alienated from their family for long time, many of them indulge into unsafe sex and hence are infected with HIV," he said.

Many, among the infected are unaware that they have HIV and unknowingly they infect their wives and children after returning home Dr. Chand adds.

Dharma Lama, an employee working with a local NGO, the National Association of People Living with HIV AIDS in Nepal, has a similar view. He says many women in Nepal get infected with HIV through their husbands. He said, "Many husbands, with the fear that the wives would leave them when they know of their disease, hide it and subsequently the wives also get infected."

Pandey was infected by her late husband three years ago.

The first case of HIV in Nepal was documented in 1988, according to National AIDS and Sexual Disease Prevention Center. On the basis of the records collected from various government run blood testing centers, the numbers of people infected with HIV/AIDS, from 1988 to March 2007, was 9,043, among which 2,733 are women. Of the total numbers of infected women, government statistics show that 1,778 are housewives.

But international statistics vary greatly from the numbers published by the Nepali government. In 2006 a UNAIDS report revealed that as many as 75,000 people in Nepal are HIV infected, among them 16,000 are women. The report shows that every year 3,000 more people are affected with the virus. The statistics of UNAIDS are collected from all the health sectors and hospitals, government and private providers here. Jagadhish Dhakal, an assistant in the UNAIDS office says, "The government data is based on recorded cases of government hospitals only while our statistics is collected from all hospitals, health posts and HIV test centers."

But in Nepal, ignorance of HIV, how it is transmitted and its symptoms are still not widely known or understood. Most people do not visit health posts or hospitals until they become very sick. Pandey's husband did not visit medical centers, even after her developed a bad cough and respiratory problems. He simply took cough syrups bought from a local chemist shop.

Pandey says that two months into their marriage he began to have chest pains and a chronic cough. He tried some over the counter medicines, but his condition did not improve. When Pandey and her husband returned to Kathmandu to attend a festival, Dashain, the biggest Hindu festival here, her husband's health further deteriorated. She says while they were back in Nepal, he started to lose weight and had a fever. Pandey says a liquid started to flow from her husband’s ears and a mass of muscle grew at his armpit. Doctors operated on his arm to remove the extra muscle growth and during the treatment the doctors, at Bir Hospital in Kathmandu, revealed that he was HIV positive. The doctors then advised her to take her husband to Sukraraj Tropical and Transferable Disease Hospital in Teku, a neighborhood in Kathmandu. Pandey admits, "I did not know anything about HIV until then."

Though the doctors at Teku Hospital tested Pandey's blood for the disease, her test results were given to her husband's family, not directly to Pandey, a common practice here. "After my family members hid my report, I could not sleep at night. So I went back to the testing center for my blood test and the report showed that I was positive. That time I was very angry with my husband and I felt deserted," she said. Wiping her tears, she added, "I took my report and threw it in front of my husband while he was on the hospital bed. He reacted to it simply by saying, 'Oh, even you have the disease.'"

Pandey said, when her husband became bed ridden none of his family members took care of him. "Seventeen days prior to the death of my husband my in-laws did not let me go home. They managed lunch and dinner for me at a restaurant near the hospital and I slept at hospital during nights," she recalled.

Now that her husband is gone, Pandey still lives with her in-laws. She says that none of her family members will touch the glass she drinks from or the plate she uses to eat. No one will sit on the cushion she sits on. "They say that HIV is not transmitted [that way] but they don't follow in practice," said Pandey. "But I have nowhere else to go."

While many discriminate against those with HIV, many more do not even know what HIV is or how it is actually transmitted. Surendra Shah, coordinator of the ‘Hard to Reach’ program, an organization working for the HIV infected says, "Our programs have not been able to reach the remote places."

The root of the problem, he says, is ignorance of safe sex practices. Shah says that facilitators often demonstrate how to use condoms by doing demonstrating on their fingers. "We have found that many people then use condoms on their fingers during sex," Shah said. Despite the high number of housewives who have the disease in Nepal, Shah says the dominant assumption is that HIV is a prostitute's disease. "Many elderly people and women do not want to listen about the disease saying that it is irrelevant to them and is a domain of sex workers."

While the ignorance about the disease is a serious problem, many say that male-dominated social structure of Nepal is also to be blamed for the increased transmission rates among women. Chiring Lama, president of Sneha Samaj, an NGO established by people with AIDS to assist HIV infected women, says, women in Nepali society are often not allowed to take their own decisions in choosing a life partner. They are forced to marry whomever their parents choose and the parents only consider the social status of the man, not his past.

After facing much criticism for its handling of the AIDS epidemic in Nepal, the government here has instituted new programs to raise awareness about the disease. As of this year, the government has established 83 consulting and testing centers in as many as 50 districts, according to Usha Bhatta, public health inspector of National AIDS and Control of Transferable Disease Center. (There are 75 districts in Nepal.) In the centers, patients receive HIV tests and are informed about the dangers of the disease and the ways to protect oneself from it.

Dr. Chand says the government has not been able to do much in this sector so far. He says, "Most of the programs are run in the central level." Chand holds the view that government should educate migrant laborers and their families about the disease and prevention strategies.

Back at Maitidevi, Pandey says that after the death of her husband she felt alienated and for months she spent her days in tears. She thought her life was ruined and had a hard time coming to terms with the fact that she would not live long. Her aunt then introduced her to a volunteer working for HIV AIDS, Roshani Karmacharya, who gave her consultations about the disease and introduced her to other HIV infected women in Kathmandu. After meeting with her several times, Pandey says she decided to turn her life around.

Pandey, with her patient, at Teku Hospital.

Pandey is now employed at Teku Hospital. She helps to take care of other HIV infected women. Jaya Moktan, 31, an HIV infected woman who Pandey visits regularly says, "She is taking good care of me and gives me moral support. She is like an angel to me."

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