HIV/AIDS impacts on Nepalīs Environment
Surya B. Prasai
February 07, 2008
Surya B. Prasai
HIV/AIDS has quickly become a major environmental development problem in most developing countries in SAARC. Nepal is also caught up in a situation where the relationships between HIV/AIDS, development and environmental degradation have become a matter of serous concern. It was accepted in Bali recently by the UNFCC that the rise in HIV/AIDS led to increased use of sustainable environmental resources where time, energy and money were being unnecessarily diverted to relieve the effects of ill health and the loss in labour skills. In Nepalīs case studies show that HIV/AIDS prevalence is systematically making in-roads into the lives of the people living in the Far Western and Western regions, where people cannot even make a normal living without thinking about the Mumbai disease, as it is known. Average per capita income in the two regions is variably, 40% and 32% less than that in Kathmandu. The rate of rise in HIV/AIDS in certain households in these two regions has meant, in fact, negative effect on development projects and fuelled a shortage of essential agricultural skills. In Nepalīs case, the HIV/AIDs related problems were till now looked upon as a health problem, but now it is being thought of as a development bottleneck as well, which has huge drawbacks on the proper use of natural resources, declining health status of the people due to rising stigma and discrimination resulting in unemployment and it overall catalyzing effect on declining family livelihoods.
In the SARRC region and globally, the biggest shift in the global AIDS battle so far has been in India, because so many epidemiologists have been looking upon it as the next big crises zone, largely fueled by the rise of AIDS cases in the middle class and its huge overconsumption of environmental resources. Similarly China was also portended as having a hidden epidemic which needed to be monitored carefully. However, both the countries have been able to introduce wider surveillance and a population-based survey to produce a much better picture of the epidemic. However, in Nepalīs case there is a lot to worry. Most of the donors are facing operational complications created by poor quality sub-contractors, data congestion and over-competition to suit oneīs funding needs, outdated sentinel information that works at cross-purposes to the lop-sided monitoring of programs and ART patients, lack of consultation with the PLHA community in program designing, and turf wars between powerful funding agencies that eventually lead to program collapse or desertion. Most of the programs operating are also in the sub-sectors than main theme development priorities identified recently by Nepalīs National Planning Commission. Thus, many of the donors do not have well rounded off integrated strategies that tie-up HIV/AIDS to the post-transitional conflict scenario in Nepal focusing particularly on youth intake, re-education, and community mobilization and launching HIV/AIDS national fairs in the remote districts. The tie-up between the environment and HIV/AIDS is also considered insignificant. Only a few such as USAID, EU and JAICA are fully active in having cross-sectoral planning linking AIDS to the environment, when UNAIDS has been globally calling for more responsive integrated programming in the Asian region. Also, I wonder, how many among our Nepali aid practitioners see the need to link up humanitarian intervention and social integration, and community forestry training and grassroots mobilization to HIV/AIDS prevention and control in Nepal? Very few, although the scope is existing in generating multi-sectoral response to HIV/AIDS impact mitigation in Nepal tied to the post-conflict scenario.
This article thus comes at a time when Dr. Peter Piot from UNAIDS has been increasingly lobbying in Washington DC to start the new realization in improving methodology across the donor line. According to Dr. Piot, the latest estimates of 30 million based on the UN's admission that previous figures were overstated by millions still shows 2.5 million new infections globally, though it is a drop of nearly 40 percent from last year's estimate. Nearly 75% of these infections globally are in environmentally risky countries and 65% are in the agricultural sector. Still, more than two-thirds of the cases are in Sub-Saharan Africa where both droughts and famine have taken a cruel toll on the population. But also there are growing numbers in Asia and other regions such as East and Central Asia and Eastern Europe. In Nepal, the figures are anywhere between to 75,000 to 90,000 with nearly 5,600 deaths officially registered. In Nepalīs case most of the deaths are occurring in the poverty line zone, that is Far Western and Western regions. Some experts believe that not all deaths related to HIV/AIDS in Nepal are made known by the family, particularly the poorer rural families who know nothing about the disease. Also, most of the deaths occurring in the Western and Far Western region where migration and trafficking of Nepalese women to Indian brothels located in Mumbai, New Delhi,, Bangalore and Kolkata are rampant, show that poorer economic returns or no financial returns of the migration process at all, meaning either the families left behind have to fend for themselves or prove their total l destitution of living below $1 a day, otherwise.
There are three important things one ought to know about AIDS and its proliferation and how it affects our daily lives and resource use. One, a disease that was not even known 26 years ago is now the fourth largest cause of death in the world leading to increasing poverty and over utilization of natural resources particularly forest wood in an unprecedented manner. Two, the feminization of the epidemic means more women are getting infected in every single region in the world and in Nepalīs case nearly 60% of the rural household are composed of women. While, there are some effective gender mainstreaming programs to contain HIV/AIDS impact in Nepalīs rural regions, particularly those run by DFID, AusAID and EU, the majority of the people who run these programs are not women, but rather men taking gender role advantage of the resources in the name of the women folk. Women in Nepal spend a lot of time cutting fodder for cattle, sheep and other livestock, if not, taking out the livestock for grazing. Women affected with HIV/AIDS means an underproduction of livestock and dairy products. Three, the real impact of this epidemic is unfurling in the worst-affected countries, particularly in Sub-Saharan Africa, Russia, the CIS and South Asia, where Nepal is well positioned to fuel the next epidemic if the unchecked migration of Nepalese women to India is not halted. Precisely the majority of out migration cases in the form of Nepali women trafficking for prostitution in the South Asian neighborhood remains loose.
Therefore, one should realize that AIDS is a reverse form of development - an underdevelopment - because of the tremendous human and social capital loss due to over reliance on environmental variables. And this is where real futuristic interventions are required in Nepal. In Nepalīs case what is also more important than just judging the epidemic by the rising numbers is to take stock of prevalence, incidence, and mortality and its overall impact on the environment and local resource base. We can no longer speak of the natural history of this epidemic because we know that since the first AIDS case was detected in Kathmandu in 1986, there has been growing evidence that it is only leading to development of short-term strategies that seem to tie up the national health policy instead of fostering a more holistic development outlook in which environmental resource preservation has a strong role to play. Donor investments in HIV/AIDS programs in Nepal are simply not paying off. Thereīs little progress on treatment. Thereīs even lack of universal access to basic services in the rural regions such as preventing mother to child transmission of HIV. Little is happening in the rural areas where the brunt of cases is coming out stronger. According to Peter Piot again," Weīre focusing on increasingly on filling the prevention gap. But to have real impact, work on HIV prevention must be much more grounded in peopleīs needs and realities. We can have the best technical response imaginable, but it wonīt be effective if thereīs no demand for it". He has quite well summed up Nepalīs HIV/AIDS impact mitigation dilemma.
In Nepalīs case there is nothing so far to indicate that the environment and natural resource sector outside agriculture is immune to the effects of a reduction in human and financial resources. Nor is it protected from changes in priorities in the environmental field, including assessing the increased vulnerabilities of families with HIV/AIDS and the pressure on natural resources influenced by economic poverty. It is widely acknowledged though that the AIDS epidemic has started to have negative effects on the use of the environment and natural resources at all level, and these effects are growing with the deterioration of the health conditions of the most affected families, until people eventually die. Even in death, precious wood is used to burn the dead bodies.
However not all the Nepali rural households affected by HIV/AIDS are equally vulnerable to its effects. Studies in India and Thailand show that the effects of HIV/AIDS vary considerably both among individual households ad among areas situated close to each other. This is dependent, among other things on the type of agricultural system and resources of the households. The households that are most vulnerable to loss of labor are young households with few working adults and limited resources access in the form of land and other assets. These results in a small number of crops being planted, distinct peak workloads maintained, and a clear division of agricultural work existing between the sexes, with few alternative methods of making a living. In Nepalīs case few households have wider flexibility besides agriculture on other possibilities of making a living. In the initial stages of the epidemic between 1986-2000, relatively well-off urban groups with extensive geographical and social mobility were affected by the HIV infection. Now the spread is more in urban communities which has quickly globalised due to high paced out migration of Nepalese labor in large demand in South East Asia and the Middle East. If they have not changed to understand the impact of AIDS , their ways of life have not changed either, the risk of infection is thus high for relatively small groups particularly in the 19-39 year age group but still existing for the others as well. As the epidemic spreads itself further, the return migrationīs effect is considered more dangers, particularly those engaged in commercial sex work in India, and remarried into Nepali homes. Increasing Nepali poverty also means that there are fewer possibilities to make choices and thus fewer possibilities to protect those vulnerable to new HIV?AIDS infections, diversifying entertainment patterns of behavior also leads to a high risk of infection. Poverty also induces labor migration in Nepalīs case with increasing risk of exposure to infection. Poverty can also put pressure on women to offer sexual services in exchange for food and other resources. All of the aforementioned have a definite over grazing impact on Nepalīs environmental safe keep.
In parallel with the spread of AIDS cases in mid hilly and mountainous regions of Nepal, there are growing signs of cyclical or long term climate change in the area. This change can be characterized by both less rainfall and more irregular rainfall, more flooding during monsoon and lessening of agricultural land available to plant crops. This change has also meant an increase in average temperature and humidity with variable rainfall patterns. This in turn stimulates the spread of HIV/AIDS, malaria and other infectious diseases. In combination with HIV/AIDS, climate change constitutes a serious threat to the agricultural base throughout the hilly and Terai regions. The effects of HIV/AIDS on livestock production are equally serious. In Nuwakot, Dhading and Sindupalchowk districts, various donor studies including some carried out by FAO in the past have show that AIDS might indirectly enforce people to sell of their livestock to pay for medicine and funeral expenses. There is also the decline in livestock production coupled with a rise in meat prices, and often unqualified labor is used for the purpose of tending to livestock resulting in poor stock quality. Not only does this result in a lessening of manure and draught animals used for ploughing the fields, it ultimately leads to the lessening of ploughable land as there is a decrease in households. Similarly commercial forestry is also serious affected by HIV/AIDS since the forest workers and technicians are affected by higher rates of ill-health and mortality. When people working in professions of this type spend long periods of time away from their families or partners, they can be tempted to have temporary sexual contact with the risk of being infected, particularly among civil servant and non-technical workers. In severely affected countries, AIDS can have a serious effect on activities in local forestry projects.
HIV/AIDS also increases demand for wood for fuel. When an increasing number of adults and children die, more timber is required to cremate them. An HIV/AIDS infection also means more water has to be used to maintain the personal hygiene of those infected. In Kathmandu valley, there is already a serious water shortage where nearly 40% of the population does not get regular daily supply due to wide leakage and unavailability of drinking water resources. Increased cases of hospitals, hospices and homes using unsafe water will further accentuated improper case handling of AIDS. Thus when Nepali society is exposed to this wide strain on resources, it leads to general overall degradation of the environment and natural resources. It makes Nepal relatively les prosperous, economically and socially less stable and vision-wise non-committal in fighting a major health battle. The 11 year old civil conflict further exacerbated local resources use because increasing bundhs, strikes and lack of transportation resulted in families relying entirely on local forest resources. Natural resource degradation has thus taken place in Nepal in an unprecedented scale due to HIV/AIDS cases proliferation.
Therefore, one has to truly understand the psychological effect of the Nepali AIDS epidemic and how it affects natural resource overgrazing leading to environmental degradation and loss. Nepalīs 45% below the poverty line households are already facing a big battle of daily survival, and it becomes at this moment, difficult for them to change their patterns of behavior that can reduce the spread of the disease. The psychological effects of the epidemic, with growing feminization both in the rural and urban regions has resulted on Nepal having to rely solely on foreign technical assistance to fight the epidemic. Environmentally sustainable development in Nepal is still a concept more than a practice, and it is time the HIV/AIDS nexus be tied into it. Falling sustainable agricultural patters and rural under- development must be over come in the long run and must be considered an inherent part of Nepalīs current post-conflict transitional effort to having a stable democratic system of national governance. Meanwhile, the AIDS epidemic is increasingly taking a large number of Nepali rural lives in the absence of an effective national country strategy and the donors fighting each other on the merits of their own approach rather than helping Nepal overcome the tyranny of AIDS.
This is why Nepal must focus in the days ahead on mobilizing am HIV/AIDS infected constituency that is ready and able to demand its prevention rights and the right to lead livelihoods free from terror and shorn of the daily traditional agricultural dependence. Everyone has the right think about proper resource use as a basic human right, but then resources properly used means having better access to economic choices and better alternate livelihood methods. It would be worthwhile if the donors concentrated on this aspect of HIV/AIDS prevention and overall impact mitigation in Nepal in the days to come than just sitting down in cozy offices supplanted by Nepali staff who appear too willing to please them than give the right answers to monitoring strategic plans that might have more current le value for those already living a life scourged by the deadly HIV/AIDS virus vis-ā-vis the poor state of Nepalīs environmental balance gauging by the Kyoto Protocol principles.
(Surya B. Prasai is an internationally acknowledged development and media commentator focusing on global advisory work in HIV/AIDS impact mitigation, protecting women and childrenīs health and rights, curbing international illegal labor migration in the US and the Asia-Pacific region, and analyzing and promoting US and UN global environmental safeguards. He is a regional contributor to the American Chronicle, World New Organization from Maryland and a Google Global Discussant on Environment, Climate Change and Bio-Diversity Networking. He can be reached at just_1_idea@hotmail.com).
HIV/AIDS has quickly become a major environmental development problem in most developing countries in SAARC. Nepal is also caught up in a situation where the relationships between HIV/AIDS, development and environmental degradation have become a matter of serous concern. It was accepted in Bali recently by the UNFCC that the rise in HIV/AIDS led to increased use of sustainable environmental resources where time, energy and money were being unnecessarily diverted to relieve the effects of ill health and the loss in labour skills. In Nepalīs case studies show that HIV/AIDS prevalence is systematically making in-roads into the lives of the people living in the Far Western and Western regions, where people cannot even make a normal living without thinking about the Mumbai disease, as it is known. Average per capita income in the two regions is variably, 40% and 32% less than that in Kathmandu. The rate of rise in HIV/AIDS in certain households in these two regions has meant, in fact, negative effect on development projects and fuelled a shortage of essential agricultural skills. In Nepalīs case, the HIV/AIDs related problems were till now looked upon as a health problem, but now it is being thought of as a development bottleneck as well, which has huge drawbacks on the proper use of natural resources, declining health status of the people due to rising stigma and discrimination resulting in unemployment and it overall catalyzing effect on declining family livelihoods.
In the SARRC region and globally, the biggest shift in the global AIDS battle so far has been in India, because so many epidemiologists have been looking upon it as the next big crises zone, largely fueled by the rise of AIDS cases in the middle class and its huge overconsumption of environmental resources. Similarly China was also portended as having a hidden epidemic which needed to be monitored carefully. However, both the countries have been able to introduce wider surveillance and a population-based survey to produce a much better picture of the epidemic. However, in Nepalīs case there is a lot to worry. Most of the donors are facing operational complications created by poor quality sub-contractors, data congestion and over-competition to suit oneīs funding needs, outdated sentinel information that works at cross-purposes to the lop-sided monitoring of programs and ART patients, lack of consultation with the PLHA community in program designing, and turf wars between powerful funding agencies that eventually lead to program collapse or desertion. Most of the programs operating are also in the sub-sectors than main theme development priorities identified recently by Nepalīs National Planning Commission. Thus, many of the donors do not have well rounded off integrated strategies that tie-up HIV/AIDS to the post-transitional conflict scenario in Nepal focusing particularly on youth intake, re-education, and community mobilization and launching HIV/AIDS national fairs in the remote districts. The tie-up between the environment and HIV/AIDS is also considered insignificant. Only a few such as USAID, EU and JAICA are fully active in having cross-sectoral planning linking AIDS to the environment, when UNAIDS has been globally calling for more responsive integrated programming in the Asian region. Also, I wonder, how many among our Nepali aid practitioners see the need to link up humanitarian intervention and social integration, and community forestry training and grassroots mobilization to HIV/AIDS prevention and control in Nepal? Very few, although the scope is existing in generating multi-sectoral response to HIV/AIDS impact mitigation in Nepal tied to the post-conflict scenario.
This article thus comes at a time when Dr. Peter Piot from UNAIDS has been increasingly lobbying in Washington DC to start the new realization in improving methodology across the donor line. According to Dr. Piot, the latest estimates of 30 million based on the UN's admission that previous figures were overstated by millions still shows 2.5 million new infections globally, though it is a drop of nearly 40 percent from last year's estimate. Nearly 75% of these infections globally are in environmentally risky countries and 65% are in the agricultural sector. Still, more than two-thirds of the cases are in Sub-Saharan Africa where both droughts and famine have taken a cruel toll on the population. But also there are growing numbers in Asia and other regions such as East and Central Asia and Eastern Europe. In Nepal, the figures are anywhere between to 75,000 to 90,000 with nearly 5,600 deaths officially registered. In Nepalīs case most of the deaths are occurring in the poverty line zone, that is Far Western and Western regions. Some experts believe that not all deaths related to HIV/AIDS in Nepal are made known by the family, particularly the poorer rural families who know nothing about the disease. Also, most of the deaths occurring in the Western and Far Western region where migration and trafficking of Nepalese women to Indian brothels located in Mumbai, New Delhi,, Bangalore and Kolkata are rampant, show that poorer economic returns or no financial returns of the migration process at all, meaning either the families left behind have to fend for themselves or prove their total l destitution of living below $1 a day, otherwise.
There are three important things one ought to know about AIDS and its proliferation and how it affects our daily lives and resource use. One, a disease that was not even known 26 years ago is now the fourth largest cause of death in the world leading to increasing poverty and over utilization of natural resources particularly forest wood in an unprecedented manner. Two, the feminization of the epidemic means more women are getting infected in every single region in the world and in Nepalīs case nearly 60% of the rural household are composed of women. While, there are some effective gender mainstreaming programs to contain HIV/AIDS impact in Nepalīs rural regions, particularly those run by DFID, AusAID and EU, the majority of the people who run these programs are not women, but rather men taking gender role advantage of the resources in the name of the women folk. Women in Nepal spend a lot of time cutting fodder for cattle, sheep and other livestock, if not, taking out the livestock for grazing. Women affected with HIV/AIDS means an underproduction of livestock and dairy products. Three, the real impact of this epidemic is unfurling in the worst-affected countries, particularly in Sub-Saharan Africa, Russia, the CIS and South Asia, where Nepal is well positioned to fuel the next epidemic if the unchecked migration of Nepalese women to India is not halted. Precisely the majority of out migration cases in the form of Nepali women trafficking for prostitution in the South Asian neighborhood remains loose.
Therefore, one should realize that AIDS is a reverse form of development - an underdevelopment - because of the tremendous human and social capital loss due to over reliance on environmental variables. And this is where real futuristic interventions are required in Nepal. In Nepalīs case what is also more important than just judging the epidemic by the rising numbers is to take stock of prevalence, incidence, and mortality and its overall impact on the environment and local resource base. We can no longer speak of the natural history of this epidemic because we know that since the first AIDS case was detected in Kathmandu in 1986, there has been growing evidence that it is only leading to development of short-term strategies that seem to tie up the national health policy instead of fostering a more holistic development outlook in which environmental resource preservation has a strong role to play. Donor investments in HIV/AIDS programs in Nepal are simply not paying off. Thereīs little progress on treatment. Thereīs even lack of universal access to basic services in the rural regions such as preventing mother to child transmission of HIV. Little is happening in the rural areas where the brunt of cases is coming out stronger. According to Peter Piot again," Weīre focusing on increasingly on filling the prevention gap. But to have real impact, work on HIV prevention must be much more grounded in peopleīs needs and realities. We can have the best technical response imaginable, but it wonīt be effective if thereīs no demand for it". He has quite well summed up Nepalīs HIV/AIDS impact mitigation dilemma.
In Nepalīs case there is nothing so far to indicate that the environment and natural resource sector outside agriculture is immune to the effects of a reduction in human and financial resources. Nor is it protected from changes in priorities in the environmental field, including assessing the increased vulnerabilities of families with HIV/AIDS and the pressure on natural resources influenced by economic poverty. It is widely acknowledged though that the AIDS epidemic has started to have negative effects on the use of the environment and natural resources at all level, and these effects are growing with the deterioration of the health conditions of the most affected families, until people eventually die. Even in death, precious wood is used to burn the dead bodies.
However not all the Nepali rural households affected by HIV/AIDS are equally vulnerable to its effects. Studies in India and Thailand show that the effects of HIV/AIDS vary considerably both among individual households ad among areas situated close to each other. This is dependent, among other things on the type of agricultural system and resources of the households. The households that are most vulnerable to loss of labor are young households with few working adults and limited resources access in the form of land and other assets. These results in a small number of crops being planted, distinct peak workloads maintained, and a clear division of agricultural work existing between the sexes, with few alternative methods of making a living. In Nepalīs case few households have wider flexibility besides agriculture on other possibilities of making a living. In the initial stages of the epidemic between 1986-2000, relatively well-off urban groups with extensive geographical and social mobility were affected by the HIV infection. Now the spread is more in urban communities which has quickly globalised due to high paced out migration of Nepalese labor in large demand in South East Asia and the Middle East. If they have not changed to understand the impact of AIDS , their ways of life have not changed either, the risk of infection is thus high for relatively small groups particularly in the 19-39 year age group but still existing for the others as well. As the epidemic spreads itself further, the return migrationīs effect is considered more dangers, particularly those engaged in commercial sex work in India, and remarried into Nepali homes. Increasing Nepali poverty also means that there are fewer possibilities to make choices and thus fewer possibilities to protect those vulnerable to new HIV?AIDS infections, diversifying entertainment patterns of behavior also leads to a high risk of infection. Poverty also induces labor migration in Nepalīs case with increasing risk of exposure to infection. Poverty can also put pressure on women to offer sexual services in exchange for food and other resources. All of the aforementioned have a definite over grazing impact on Nepalīs environmental safe keep.
In parallel with the spread of AIDS cases in mid hilly and mountainous regions of Nepal, there are growing signs of cyclical or long term climate change in the area. This change can be characterized by both less rainfall and more irregular rainfall, more flooding during monsoon and lessening of agricultural land available to plant crops. This change has also meant an increase in average temperature and humidity with variable rainfall patterns. This in turn stimulates the spread of HIV/AIDS, malaria and other infectious diseases. In combination with HIV/AIDS, climate change constitutes a serious threat to the agricultural base throughout the hilly and Terai regions. The effects of HIV/AIDS on livestock production are equally serious. In Nuwakot, Dhading and Sindupalchowk districts, various donor studies including some carried out by FAO in the past have show that AIDS might indirectly enforce people to sell of their livestock to pay for medicine and funeral expenses. There is also the decline in livestock production coupled with a rise in meat prices, and often unqualified labor is used for the purpose of tending to livestock resulting in poor stock quality. Not only does this result in a lessening of manure and draught animals used for ploughing the fields, it ultimately leads to the lessening of ploughable land as there is a decrease in households. Similarly commercial forestry is also serious affected by HIV/AIDS since the forest workers and technicians are affected by higher rates of ill-health and mortality. When people working in professions of this type spend long periods of time away from their families or partners, they can be tempted to have temporary sexual contact with the risk of being infected, particularly among civil servant and non-technical workers. In severely affected countries, AIDS can have a serious effect on activities in local forestry projects.
HIV/AIDS also increases demand for wood for fuel. When an increasing number of adults and children die, more timber is required to cremate them. An HIV/AIDS infection also means more water has to be used to maintain the personal hygiene of those infected. In Kathmandu valley, there is already a serious water shortage where nearly 40% of the population does not get regular daily supply due to wide leakage and unavailability of drinking water resources. Increased cases of hospitals, hospices and homes using unsafe water will further accentuated improper case handling of AIDS. Thus when Nepali society is exposed to this wide strain on resources, it leads to general overall degradation of the environment and natural resources. It makes Nepal relatively les prosperous, economically and socially less stable and vision-wise non-committal in fighting a major health battle. The 11 year old civil conflict further exacerbated local resources use because increasing bundhs, strikes and lack of transportation resulted in families relying entirely on local forest resources. Natural resource degradation has thus taken place in Nepal in an unprecedented scale due to HIV/AIDS cases proliferation.
Therefore, one has to truly understand the psychological effect of the Nepali AIDS epidemic and how it affects natural resource overgrazing leading to environmental degradation and loss. Nepalīs 45% below the poverty line households are already facing a big battle of daily survival, and it becomes at this moment, difficult for them to change their patterns of behavior that can reduce the spread of the disease. The psychological effects of the epidemic, with growing feminization both in the rural and urban regions has resulted on Nepal having to rely solely on foreign technical assistance to fight the epidemic. Environmentally sustainable development in Nepal is still a concept more than a practice, and it is time the HIV/AIDS nexus be tied into it. Falling sustainable agricultural patters and rural under- development must be over come in the long run and must be considered an inherent part of Nepalīs current post-conflict transitional effort to having a stable democratic system of national governance. Meanwhile, the AIDS epidemic is increasingly taking a large number of Nepali rural lives in the absence of an effective national country strategy and the donors fighting each other on the merits of their own approach rather than helping Nepal overcome the tyranny of AIDS.
This is why Nepal must focus in the days ahead on mobilizing am HIV/AIDS infected constituency that is ready and able to demand its prevention rights and the right to lead livelihoods free from terror and shorn of the daily traditional agricultural dependence. Everyone has the right think about proper resource use as a basic human right, but then resources properly used means having better access to economic choices and better alternate livelihood methods. It would be worthwhile if the donors concentrated on this aspect of HIV/AIDS prevention and overall impact mitigation in Nepal in the days to come than just sitting down in cozy offices supplanted by Nepali staff who appear too willing to please them than give the right answers to monitoring strategic plans that might have more current le value for those already living a life scourged by the deadly HIV/AIDS virus vis-ā-vis the poor state of Nepalīs environmental balance gauging by the Kyoto Protocol principles.
(Surya B. Prasai is an internationally acknowledged development and media commentator focusing on global advisory work in HIV/AIDS impact mitigation, protecting women and childrenīs health and rights, curbing international illegal labor migration in the US and the Asia-Pacific region, and analyzing and promoting US and UN global environmental safeguards. He is a regional contributor to the American Chronicle, World New Organization from Maryland and a Google Global Discussant on Environment, Climate Change and Bio-Diversity Networking. He can be reached at just_1_idea@hotmail.com).
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