Stop AIDS, halt trafficking in Nepalese women
Surya B. Prasai
February 22, 2008
Every once in a while, a major Indian newspaper or an international Nepali website carries a story about how a women trafficking ring has been caught and that the middlemen as well as the young Nepalese women in question have been locked up in some Indian city jail awaiting further judicial action or custody. In Mumbai and Delhi alone, there are nearly 80 INGO and NGOs that specifically look into issues affecting the trafficking of women, primarily from Nepal and Bangladesh. Every year, nearly 10,000 Nepalese women are illegally trafficked into Mumbai, New Delhi, Bangalore and Kolkata who are in the majority put into commercial sex work. With an estimated 2.5 million HIV infections in India, and the majority of these women channeled into the various brothels in Indian cities, it is hard not to imagine the number of sexually infected Nepalese women particularly those living with HIV infections. The first known case of AIDS in Nepal was in 1986 and in the period 1996-2006, the 10 year period of the Nepalese civil conflict, a total of 200,000 to 250,000 Nepalese young girls aged 12-29 were either sold or illegally exchanged for cash in various Indian cities by women traffickers. According to a Human Rights Watch survey done jointly in India and Nepal in 1996, the report which is available on the world wide web, the total amount paid for a girl ranged from just US$ 40 to US$ 600.
A recent Amnesty International report states, today many of the girls have now matured into grown women, and after paying their debts have either escaped the commercial sex life, or else managed to pay their owners with their life, by getting infected with HIV. There has been no respite from AIDS, neither any concept of protection of human rights of those infected. The Nepal Government has data on the number of women infected with HIV and AIDS available at the National Center for AIDS and STI Control website, but most of it is either considered useless or outdated by events. The government´s total comes close to 2,500 but the actual figure is quantitatively higher at 30 times the figure according to various Nepalese NGOs that have been working in this sector.
When BBC and CNN reported in 2004 through their news channels that nearly 40% of the returned Nepalese commercial sex workers had AIDS it was the first time that all eyes were focused on Nepal as the center of a possible large scale epidemic. The UNDP website You and AIDS has chronicled the birth of the Nepal HIV/AIDS as a concentric one. It has also highlighted the fact that like in the rest of South Asia, the sexual mode of HIV transmission through commercial sex workers and their clients has played a major role in the spread of AIDS in Northern India bordering Nepalese towns and cities. For instance, nearly half of them have been known to return from one or another Indian city after being infected with the virus.
Available Nepal Government reports show that only one in 200 Nepalese (0.05%) of the population are infected with HIV/AIDS in the 15-49 year age group, when the truth is at least 20 times that figure is known to exist. Other data show that 30% of those infected are female, when the figures among commercial sex workera show that 84% of females with HIV in Nepal are CSW's while nearly 18 % of the commercial sex workers in Kathmandu numbering 60,000 are known to have HIV/AIDS. WHO/UNAIDS estimated some three years back that 940 children were living with HIV and that nearly 13,000 children were orphaned in Nepal due to AIDS at the end of 2003, but the government acknowledged last year that nearly 2,500 children had HIV infections among those diagnosed in various health clinics and testing centers in Kathmandu and other Nepalese cities but most parents don´t want to openly acknowledge the truth. Similarly the prevalence among drug users is now known to be around 12%, and nearly 45% of Nepal´s 50,000 drug users are known to be HIV positive.
Thus, increased HIV infections in Nepal have brought in further confusion into the epidemiology of AIDS in Nepal. Although there are reclusive government figures of 75,000 infected, the actual number could be around 350,000 according to knowledgeable Nepalese health experts who have been dealing with the epidemic for nearly 15 years. Unlike India where large numbers of HIV infections have been detected, and under its planned health system, the cases isolated and Anti Retro Viral treatment provided, AIDS in Nepal remains virtually untreated, with most of the NGOs cashing in on UN and international donor money largesse focused on producing STI and AIDS brochures and holding high tea parties in five star hotels than attending to those truly infected. This kind of donor resource wastage argument has come in consistently from Nepal´s People Living with HIV and AIDS (PLHA) community.
On the origins of the first case, international virologists believe that a subtype C virus with restricted genetic diversity is thought to have caused the Nepali epidemic in Kathmandu, but it is quite common in the South Asian region particularly where Nepalese brothels exist. It is felt that concomitant hepatitis C infection is a major contributing factor to the rapidity and severity of disease progression in injecting drug users, and 94% of users in Kathmandu have tested positive for hepatitis C so far. Although the Nepal Government´s official prevalence figures might be low, the truth is it masks the fact that in high risk groups the prevalence is beyond control, infecting the highly susceptible groups that is commercial sex workers, migrant works, injecting drug users and the like. Among Nepal´s youth, risky promiscuous sexual behavior is quite common and new ´escape´ weekend recreation locations in Thankot, Shivapuri, Godavari, Nagarkot, and Dhulikhel are fueling an unprecedented infection.
Once the Nepalese girls trafficked into Indian towns and cities slowly begin to accept their lives in the sex industry, they are introduced to drugs in hopes of getting them addicted. Many also take alcohol as a sedative thus fueling in unprotected sex. A Mumbai based NGO´s 2006 survey revealed that nearly 23% of the girls interviewed there in the commercial sex alleys did not know the connection between preventing HIV/AIDS and condom use. Usually, the brothel owners also kept the girls in a secluded environment, torturing them mentally and slowly introducing them into a life of prostitution. But who would take care of them in the first place? Brothel owners often make the girls take injections so they don´t get pregnant and can therefore entertain more clients, since the owners are usually Nepali. The growing popularity of contraceptive injections poses a serious threat since in many cases the same needle is used for many women without sterilization and could be sourced to someone with an HIV/AIDS infection.
Nepal and India share a porous and open border which has remained this way for ages. Neither India nor Nepal have a desire to close the open border corridor where on an average day nearly 500,000 people criss cross for work, meet their families, exchange goods and buy commodities for the family. It is very hard to detect who is being trafficked or just visiting a family across on a daily basis. Past meetings between Indian and Nepalese border police authorities have failed to crack down on the problem since the women trafficking network is too clever for their intelligence analyses and day to day monitoring. Some also report of open corruption and involvement of officials on both sides in the trafficking business and usually politicians refuse to take action when alerted since they also receive protection money.
An American international anti trafficking blog site reported recently that in India, men preferred the Nepali girls because of their golden skin and "exotic" Mongoloid features. They were also perceived as docile and willing to drink alcohol, and more liberal and submissive to their client´s demands. In India´s red-light districts, these secluded areas where Nepali girls are available for commercial sex work are also known as "Nepali kothas" and highly popular among the business community. Most of the clients who visit them are middle class Indians, migrant workers, including of Nepalese origin and many from the local neighborhood.
Poverty in Nepal has forced hundreds of thousands of Nepalese girls to be sold to India, which has indirectly promoted the traffickers business. One clever trick is for a trafficker to get married to a half dozen girls and after taking the batch across the border, return back to Nepal and repeat the act with another group of women. Providing knowledge about HIV/AIDS prevention methods to those who have returned is one effective way to deter the sex trade, but the main problem is unless trafficking is halted with punitive measures for those caught in the act, spreading the message of behavioral change and exercising preventing safe sex alone might not help. The multiple transmission cycle is all too evident by now: a commercial sex worker can transmit to a migrant laborer who can infect his wife in India, or when he returns to Nepal; the same happens with the woman. The spread can involve a third Asian or African country client involved in a larger diaspora. If the infected women get married they have a higher risk of transmitting it to their husbands and also bearing HIV infected children.
The HIV/AIDS figures using statistical extrapolation by using current median numbers is quite clear: nearly 13,600 people died in Nepal´s civil conflict in the past ten years, nearly 15,00 will die eery year for the remaining part of this decade until the country comes with a clearer set of interventions and the right expertise to help Nepal. Some in the international media question: can a halt to commercial prostitution be the cure? The answer is NO! The chances of more young Nepali girls engaging in commercial sex work is intensifying with growing rural and urban poverty, and more disposable income available to returning Nepalese migrant workers who now also work in East Asian and Middle East countries in cycles so that the village is not left empty without men. When one talks about promoting the rights of commercial sex workers in Nepal, even knowledgeable eyes within Kathmandu´s rich donor community blink their eyes the other way. This leaves very little time to solve the riddle of India´s growing AIDS epidemic with a cross border tie-up. A visit to Maiti Nepal or one of the AIDS hospices in Bhaktapur in Kathmandu Valley should prove an eye awakener. Young innocent Nepalese faces stare at the visitor with little hope in front of them except to die with an HIV related illnesses.
According to the UN website You and AIDS, "a major challenge therefore is in controlling HIV in the country due to the trafficking of Nepali girls and women into commercial sex work in India, and their return to the practice in Nepal. About 50 percent of Nepal´s FSWs previously worked in Mumbai, India, and some 100,000 Nepali women continue to engage in the practice there. The National Network against Girls´ Trafficking, an Indian coalition of approximately 40 NGOs initially established to tackle the problem of girl trafficking, has also begun to address the issue of HIV/AIDS".
Is there an international solution to stopping this trend? Yes. At the international level, there is definitely ground for optimism that in the next few years the US President´s Emergency Program for AIDS Relief (EPAR) initiated by US President George W. Bush, a US$ 15 billion package launched nearly three years ago and arguably the most impressive intervention by the US administration to date encompassing nearly 100 countries, will also be able to focus more directly on Nepal since it happens to be an emerging concentric country that meets the ´emergency assistance´ profile.
President Bush in his recent visit to five African countries, bolstered PEPFAR´s bi-partisan initiatives challenging the U.S. Congress to double up AIDS money, also personally reinforcing the Abstain, Be Careful and Correct Condom Use messages. Nepal this year received US$ 76 million from the UN Global Fund for AIDS, T.B. and Malaria, which in most part is international donor money. But there is little change in vision and orientation among the national program managers in Nepal on what needs to be done. There must be strict modalities adopted to control the funding dispensation with more direct grassroots support to the rural communities. International humanitarian organizations could also be mobilized to gauge the true impact of the Nepalese AIDS epidemic and in coordinating recovery operations of trafficked women to be integrated with other programs in psycho-social post-conflict support and rehabilitation of affected families.
Nepal is also one country that certainly deserves such assistance because of its geo-strategic importance, its close ties with the United States and being a long term aid recipient. The existence of nearly 57 years of productive USAID-Nepal bilateral cooperation and the people-to-people level of exchange, the past contribution of Peace Corps volunteers who certainly helped the country´s development cause, and besides, the sheer importance of the Himalayan glaciers as a global environmental product worth international utilization, harvesting and sharing that first implies that all Nepalis must be able to live healthy, productive and essentially HIV/AIDS free lives is a part of economic diplomacy quest.
Other similarly affected countries which have received generous US assistance have implemented successful interventions that are helping them schematically ´wipe´ out AIDS as a human-created pandemic. Thus in 2008, PEPFAR must give more direct focus to non-African countries such as Nepal as well, because it falls in the direct path of President George Bush´s gospel message of assisting those countries which have a national soul of kindness, tolerant and kind to its people and democratic in conviction and interested in problem solvency. Such assistance will help both Nepal and India in the fight against AIDS. Thus, Nepal too can be another model like Tanzania, where President Bush spent considerable amount of time recently with the county´s youth driving home the message that HIV/AIDS impact mitigation efforts work only if there is a leadership commitment to back up the availability of resources and expertise with vision and foresighted groundwork. There is no doubt that AIDS and human trafficking are seriously affecting Nepal´s economic future and something must be done about it urgently. It would be helpful if this issue is discussed in the Nepal Development Forum 2008 and an International Consortium to Stop AIDS and Human Trafficking in Nepal and South Asia be established through it.
A recent Amnesty International report states, today many of the girls have now matured into grown women, and after paying their debts have either escaped the commercial sex life, or else managed to pay their owners with their life, by getting infected with HIV. There has been no respite from AIDS, neither any concept of protection of human rights of those infected. The Nepal Government has data on the number of women infected with HIV and AIDS available at the National Center for AIDS and STI Control website, but most of it is either considered useless or outdated by events. The government´s total comes close to 2,500 but the actual figure is quantitatively higher at 30 times the figure according to various Nepalese NGOs that have been working in this sector.
When BBC and CNN reported in 2004 through their news channels that nearly 40% of the returned Nepalese commercial sex workers had AIDS it was the first time that all eyes were focused on Nepal as the center of a possible large scale epidemic. The UNDP website You and AIDS has chronicled the birth of the Nepal HIV/AIDS as a concentric one. It has also highlighted the fact that like in the rest of South Asia, the sexual mode of HIV transmission through commercial sex workers and their clients has played a major role in the spread of AIDS in Northern India bordering Nepalese towns and cities. For instance, nearly half of them have been known to return from one or another Indian city after being infected with the virus.
Available Nepal Government reports show that only one in 200 Nepalese (0.05%) of the population are infected with HIV/AIDS in the 15-49 year age group, when the truth is at least 20 times that figure is known to exist. Other data show that 30% of those infected are female, when the figures among commercial sex workera show that 84% of females with HIV in Nepal are CSW's while nearly 18 % of the commercial sex workers in Kathmandu numbering 60,000 are known to have HIV/AIDS. WHO/UNAIDS estimated some three years back that 940 children were living with HIV and that nearly 13,000 children were orphaned in Nepal due to AIDS at the end of 2003, but the government acknowledged last year that nearly 2,500 children had HIV infections among those diagnosed in various health clinics and testing centers in Kathmandu and other Nepalese cities but most parents don´t want to openly acknowledge the truth. Similarly the prevalence among drug users is now known to be around 12%, and nearly 45% of Nepal´s 50,000 drug users are known to be HIV positive.
Thus, increased HIV infections in Nepal have brought in further confusion into the epidemiology of AIDS in Nepal. Although there are reclusive government figures of 75,000 infected, the actual number could be around 350,000 according to knowledgeable Nepalese health experts who have been dealing with the epidemic for nearly 15 years. Unlike India where large numbers of HIV infections have been detected, and under its planned health system, the cases isolated and Anti Retro Viral treatment provided, AIDS in Nepal remains virtually untreated, with most of the NGOs cashing in on UN and international donor money largesse focused on producing STI and AIDS brochures and holding high tea parties in five star hotels than attending to those truly infected. This kind of donor resource wastage argument has come in consistently from Nepal´s People Living with HIV and AIDS (PLHA) community.
On the origins of the first case, international virologists believe that a subtype C virus with restricted genetic diversity is thought to have caused the Nepali epidemic in Kathmandu, but it is quite common in the South Asian region particularly where Nepalese brothels exist. It is felt that concomitant hepatitis C infection is a major contributing factor to the rapidity and severity of disease progression in injecting drug users, and 94% of users in Kathmandu have tested positive for hepatitis C so far. Although the Nepal Government´s official prevalence figures might be low, the truth is it masks the fact that in high risk groups the prevalence is beyond control, infecting the highly susceptible groups that is commercial sex workers, migrant works, injecting drug users and the like. Among Nepal´s youth, risky promiscuous sexual behavior is quite common and new ´escape´ weekend recreation locations in Thankot, Shivapuri, Godavari, Nagarkot, and Dhulikhel are fueling an unprecedented infection.
Once the Nepalese girls trafficked into Indian towns and cities slowly begin to accept their lives in the sex industry, they are introduced to drugs in hopes of getting them addicted. Many also take alcohol as a sedative thus fueling in unprotected sex. A Mumbai based NGO´s 2006 survey revealed that nearly 23% of the girls interviewed there in the commercial sex alleys did not know the connection between preventing HIV/AIDS and condom use. Usually, the brothel owners also kept the girls in a secluded environment, torturing them mentally and slowly introducing them into a life of prostitution. But who would take care of them in the first place? Brothel owners often make the girls take injections so they don´t get pregnant and can therefore entertain more clients, since the owners are usually Nepali. The growing popularity of contraceptive injections poses a serious threat since in many cases the same needle is used for many women without sterilization and could be sourced to someone with an HIV/AIDS infection.
Nepal and India share a porous and open border which has remained this way for ages. Neither India nor Nepal have a desire to close the open border corridor where on an average day nearly 500,000 people criss cross for work, meet their families, exchange goods and buy commodities for the family. It is very hard to detect who is being trafficked or just visiting a family across on a daily basis. Past meetings between Indian and Nepalese border police authorities have failed to crack down on the problem since the women trafficking network is too clever for their intelligence analyses and day to day monitoring. Some also report of open corruption and involvement of officials on both sides in the trafficking business and usually politicians refuse to take action when alerted since they also receive protection money.
An American international anti trafficking blog site reported recently that in India, men preferred the Nepali girls because of their golden skin and "exotic" Mongoloid features. They were also perceived as docile and willing to drink alcohol, and more liberal and submissive to their client´s demands. In India´s red-light districts, these secluded areas where Nepali girls are available for commercial sex work are also known as "Nepali kothas" and highly popular among the business community. Most of the clients who visit them are middle class Indians, migrant workers, including of Nepalese origin and many from the local neighborhood.
Poverty in Nepal has forced hundreds of thousands of Nepalese girls to be sold to India, which has indirectly promoted the traffickers business. One clever trick is for a trafficker to get married to a half dozen girls and after taking the batch across the border, return back to Nepal and repeat the act with another group of women. Providing knowledge about HIV/AIDS prevention methods to those who have returned is one effective way to deter the sex trade, but the main problem is unless trafficking is halted with punitive measures for those caught in the act, spreading the message of behavioral change and exercising preventing safe sex alone might not help. The multiple transmission cycle is all too evident by now: a commercial sex worker can transmit to a migrant laborer who can infect his wife in India, or when he returns to Nepal; the same happens with the woman. The spread can involve a third Asian or African country client involved in a larger diaspora. If the infected women get married they have a higher risk of transmitting it to their husbands and also bearing HIV infected children.
The HIV/AIDS figures using statistical extrapolation by using current median numbers is quite clear: nearly 13,600 people died in Nepal´s civil conflict in the past ten years, nearly 15,00 will die eery year for the remaining part of this decade until the country comes with a clearer set of interventions and the right expertise to help Nepal. Some in the international media question: can a halt to commercial prostitution be the cure? The answer is NO! The chances of more young Nepali girls engaging in commercial sex work is intensifying with growing rural and urban poverty, and more disposable income available to returning Nepalese migrant workers who now also work in East Asian and Middle East countries in cycles so that the village is not left empty without men. When one talks about promoting the rights of commercial sex workers in Nepal, even knowledgeable eyes within Kathmandu´s rich donor community blink their eyes the other way. This leaves very little time to solve the riddle of India´s growing AIDS epidemic with a cross border tie-up. A visit to Maiti Nepal or one of the AIDS hospices in Bhaktapur in Kathmandu Valley should prove an eye awakener. Young innocent Nepalese faces stare at the visitor with little hope in front of them except to die with an HIV related illnesses.
According to the UN website You and AIDS, "a major challenge therefore is in controlling HIV in the country due to the trafficking of Nepali girls and women into commercial sex work in India, and their return to the practice in Nepal. About 50 percent of Nepal´s FSWs previously worked in Mumbai, India, and some 100,000 Nepali women continue to engage in the practice there. The National Network against Girls´ Trafficking, an Indian coalition of approximately 40 NGOs initially established to tackle the problem of girl trafficking, has also begun to address the issue of HIV/AIDS".
Is there an international solution to stopping this trend? Yes. At the international level, there is definitely ground for optimism that in the next few years the US President´s Emergency Program for AIDS Relief (EPAR) initiated by US President George W. Bush, a US$ 15 billion package launched nearly three years ago and arguably the most impressive intervention by the US administration to date encompassing nearly 100 countries, will also be able to focus more directly on Nepal since it happens to be an emerging concentric country that meets the ´emergency assistance´ profile.
President Bush in his recent visit to five African countries, bolstered PEPFAR´s bi-partisan initiatives challenging the U.S. Congress to double up AIDS money, also personally reinforcing the Abstain, Be Careful and Correct Condom Use messages. Nepal this year received US$ 76 million from the UN Global Fund for AIDS, T.B. and Malaria, which in most part is international donor money. But there is little change in vision and orientation among the national program managers in Nepal on what needs to be done. There must be strict modalities adopted to control the funding dispensation with more direct grassroots support to the rural communities. International humanitarian organizations could also be mobilized to gauge the true impact of the Nepalese AIDS epidemic and in coordinating recovery operations of trafficked women to be integrated with other programs in psycho-social post-conflict support and rehabilitation of affected families.
Nepal is also one country that certainly deserves such assistance because of its geo-strategic importance, its close ties with the United States and being a long term aid recipient. The existence of nearly 57 years of productive USAID-Nepal bilateral cooperation and the people-to-people level of exchange, the past contribution of Peace Corps volunteers who certainly helped the country´s development cause, and besides, the sheer importance of the Himalayan glaciers as a global environmental product worth international utilization, harvesting and sharing that first implies that all Nepalis must be able to live healthy, productive and essentially HIV/AIDS free lives is a part of economic diplomacy quest.
Other similarly affected countries which have received generous US assistance have implemented successful interventions that are helping them schematically ´wipe´ out AIDS as a human-created pandemic. Thus in 2008, PEPFAR must give more direct focus to non-African countries such as Nepal as well, because it falls in the direct path of President George Bush´s gospel message of assisting those countries which have a national soul of kindness, tolerant and kind to its people and democratic in conviction and interested in problem solvency. Such assistance will help both Nepal and India in the fight against AIDS. Thus, Nepal too can be another model like Tanzania, where President Bush spent considerable amount of time recently with the county´s youth driving home the message that HIV/AIDS impact mitigation efforts work only if there is a leadership commitment to back up the availability of resources and expertise with vision and foresighted groundwork. There is no doubt that AIDS and human trafficking are seriously affecting Nepal´s economic future and something must be done about it urgently. It would be helpful if this issue is discussed in the Nepal Development Forum 2008 and an International Consortium to Stop AIDS and Human Trafficking in Nepal and South Asia be established through it.
Print
Email
