CHITWAN, Nepal - It was a beauty pageant with a difference -- there were only a handful of contestants and it did not get the usual media attention such contests usually draw.

   All eight contestants were beautiful young ladies living with HIV and all of them had stepped on the ramp for a cause: to spread the word so that others can protect themselves from HIV/AIDS.

   All participants in the pageant, organised in June 2005 by the Family Planning Association of Nepal, belonged to the Chitwan Active Group (CAG), a non-governmental organisation of people living with HIV.

   The tall, graceful 23-year-old Dikhshya was adjudged ‘Miss HIV Stigma Free-2005’. What distinguished her from other contestants was her response to a question on her views about living with AIDS.

   “It is the beginning of a new, courageous life," she said. “Relationships today depend not only on education or wealth alone. It is wise to have a blood test done before marriage.”

   Dikshya was infected by her husband, an injecting drug user, and wants every girl not to take marriage for granted.

   Other members of CAG also got the infection from their husbands. Three of them are widows and three still live with their partners.

   The urban centres of Chitwan district in the plains south-west of Kathmandu—the Nepali capital—has one of the fastest growing population of job seekers, villagers fleeing the violent Maoist conflict, people headed to other parts of the country and tourists visiting the national park.

   The district has been experiencing rapid economic growth since the mid-1960s when malaria was eradicated and the thick forests there became habitable.

   Real growth began in the 1990s upon completion of Nepal’s main east-west highway, which connects the district—and its two major towns Narayanghat and Bharatpur—with the rest of Nepal and the Nepali capital.

   “It is good to have growth but there is another side to it,” says Ramhari Neupane, coordinator of the General Welfare Pratisthan (GWP), a NGO working to prevent the spread of HIV/AIDS. “Now our district is fast becoming a HIV time bomb that could explode any day,” he adds.

   Since 1994, GWP has been counselling people with HIV and AIDS and spreading awareness about safer sex among mobile populations on the main highways.

   The main reasons for Neupane’s alarm are risky behaviour among injecting drug users (IDU) – the highest number of HIV infections has been reported among them at above 50 percent in urban areas -- and the largely hidden but flourishing sex trade.

   A 2003-survey by Maiti Nepal, an NGO working to prevent the trafficking of women, identified 200 HIV-positive cases in the district. Even though this is a tiny speck among a population of 450,000, campaigners say the number in absolute terms is reason for alarm because reporting is low.

   GWP estimates there are about 1,000 IDUs in Chitwan district, whose risky behaviour makes them susceptible to HIV infection. But its more recent findings on prevalence indicate that HIV/AIDS may not be concentrated only among particular groups with risky sexual behaviour, but also the general population.

   There is a large gap in reported infections and the estimates. Recent official figures say there are 5,564 reported HIV cases in Nepal but these numbers are much lower than the estimates.

   In end-2002, the Joint U.N. Programme on AIDS (UNAIDS) and the World Health Organisation had estimated that around 60,000 people were living with HIV/AIDS and that HIV prevalence was around 0.5 percent. The 2005 UNAIDS estimate is 65,000.

   Nepal’s violent conflict has caused many young men to flee to India in search of jobs and security. These people are away from home for extended periods, and often engage in unsafe sex at Indian brothels.

   Many of the returnees pass on the virus to their partners in Nepal.

   According to UNAIDS, Nepal is said to have a “high potential” for a generalised epidemic, which even in a “low to moderate growth scenario”—without effective interventions—could be the leading cause of death in the 15-49 years age group in the coming years.

   “We are also working with housewives and children with HIV,” says Neupane of GWP. “It could be an early sign that the infection may be spreading across groups.”

   Its 1994 when GWP began work on HIV/AIDS prevention along the highway, it estimated there were about 150 sex workers. “The number has grown to over 500 today,” says Neupane. “Their clients number in the thousands”.

   Many of Chitwan’s sex workers are mobile and this has made continuous tracking and counselling difficult.

   “We teach them how to practice safer sex because unsafe sex is one of the main reasons for the spread of the infection,” says Sumita Khadka, an outreach worker at GWP. “But the people we work with move, making it very difficult to follow up on progress.”

   A 2005 GWP survey shows that most sex workers are from poor families and belong to the 22-29 year age group. Also most of the 322 respondents said they joined the sex trade because of economic problems, because they were abused by their husbands or had migrant partners who were away from home for long periods.

   Neupane says change is taking place but at a pace much slower than that needed to prevent the virus from spreading to other population groups.

   “Awareness is our best defence,” he says, explaining why GWP co-organised and provided technical advice for the beauty pageant of women living with HIV.

   “Here, even medical staff neglect people with HIV when they visit hospitals because they think the disease has no cure,” says Dikshya Rimal, president of Chitwan Active Group (CAG).  "After the event, many people have changed their attitudes.”

   A local children’s home has offered to provide free education to the children of mothers with HIV and the Bhatarpur municipality has promised CAG with loans for use in income-generating programmes.

   The CAG was set up by Rimal and a friend two years ago and now has 25 members, all of them HIV-positive.

   Her co-worker Mala was declared the first runner-up in the ‘Miss Stigma-Free HIV’ pageant. “We are looking for support to live dignified lives,” she says. “It is the future that now matters to us.”

Nepal HIV Hotline: toll-free number is 1660-01-33-000

Source: asiamediaforum.org