Tue, Nov 07, 2017 - Page 9 News List

Tide starts to turn in Nepal’s battle with HIV

Like many men from Nepal’s Accham District, Sarpa migrated to India for work only to return with HIV. Thankfully, a lessening of stigma — and a greater emphasis on treatment and testing — are making such stories less commonplace

By Kate Hodal  /  Guardian, ACHHAM, Nepal

Illustration: Yusha

Adarsh and Numa are the only two HIV-positive kids at their school and everyone knows it. In this mud-and-brick village, so high up Nepal’s far-western hills that it takes two days by 4x4 to reach the nearest town, no secrets stay secret for long.

Like nearly every other man of working age in Achham — a remote, mountainous district where many women are still banished to cowsheds when they menstruate — Adarsh and Numa’s father migrated to India for work.

Like many other migrants seeking wealth and opportunity beyond Nepal’s borders, he returned home with a very different legacy to the one he anticipated: a life-threatening virus.

No one knows this better than Adarsh and Numa’s mother Sita, 50, who discovered she too was HIV-positive after her husband fell ill five years ago.

“I know 10 other people in this village who have HIV,” she said, gesturing to the smattering of neighbors’ homes. “One is a school teacher and another one is a government health worker — we all know each other and support each other. Same story: Their husbands went away to work and one day came back with HIV.”

Just 10 years ago, such honesty about this stigmatized condition would have been unthinkable — even here in Achham, the district with the nation’s highest rate of poverty, HIV and AIDS.

However, years of community-led awareness programs, mobile blood-testing units and radio education series have helped to turn the numbers on their head. Overall HIV and AIDS rates have fallen 22 percent over the past decade, and stories like Sita’s show why.

Sita’s husband Sarpa left for India just after they married as teenagers, when she was still pregnant with their first child. Poor roads, lack of infrastructure and nearly zero communication meant it was virtually impossible for the couple to stay in touch.

Every two years, Sarpa, now 51, would return to Nepal and Sita would once again fall pregnant.

However, it was only when Numa, their sixth and final child, was born that Sita noticed the lumps on Sarpa’s chin. It took a whole year for Sarpa to agree to testing and admit the extent of HIV’s effects on the family: Sita and the two youngest children, Adarsh, then 10, and Numa, then five, all tested positive.

Like many other men interviewed in Achham, Sarpa has a well-rehearsed story that explains how he believes he contracted HIV, but it does not involve any sex workers, whom researchers believe are the primary source of migrants’ HIV infections.

In 2002, the same year Adarsh was born, HIV prevalence among Nepalese migrants returning from India was believed to be as high as 8 percent — double the rate of sex workers in Kathmandu valley, while in 2011, migrants comprised nearly one-third of all HIV infections in Nepal, according to the World Bank.

“It’s been an emotional journey, but we decided not to fight over it,” Sarpa said coolly.

Sita shook her head, indicating that she has had to accept the likelihood he visited Indian brothels.

“He was very depressed and embarrassed about it — he couldn’t face it at first, but our concern really is the kids. We just hope that we will find a cure in our generation and they can lead normal lives,” she said.

These days, “normal” means antiretroviral medication once a day for Adarsh, 15, and his parents. His sister Numa, 10, has not yet started her “medicine,” because her parents fear she will not be able to handle the side effects.

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