I recently had a succesful visit to Doti where I was able to meet women and men ‘living positively’.
Doti District is a hill district in far-west Nepal. The neighboring district of Accham has the highest HIV prevalence rates. Doti has great needs with minimal presence of other working agencies due to lack of basic infrastructure and the nature of the terrain. The challenges include food insufficiency, poor education and lack of access to health care. Caste-based discrimination, negative cultural practices and violence against women are significant problems in Doti.
To support their families, many men, mainly productive youths, migrate to India as seasonal labour. Whilst in some ways seems positive, this also has had some negative impact. Unsafe sexual practices among the men (27% of migrants engage in high risk sexual behaviours in India) have resulted in HIV becoming a significant problem in this district in Nepal. In addition, farming has become neglected. Therefore, addressing issues of migration would try to curb the spread of HIV in Doti district.
In the village communities, virtually all the men had migrated predominantly to India for work and just women and children were left. The men return briefly to assist at harvest time. Children drop out of school to migrate and even those with a good education also leave. The groups of women who are HIV positive has been facing many challenges and often not particularly concerned about the longer term consequences of their HIV infection as their focus remains on the present and survival of each day. However, it is not just those who are HIV positive that find themselves in desperate circumstances since many have no opportunities for income generation. Since most of people are affected by HIV, stigma and discrimination seem to be reduced.
The greater need is to ensure improved sanitation, access to Antiretroviral Therapy (ARVs) and nutrition. The United Mission to Nepal, through its partner, has been working to support people living with HIV to have access to ARVs. Due to the remoteness of the communities, support with transportation to the main hospital for treatment and for CD4 count remains an area of need. I saw very few toilets in the village and UMN has been encouraging communities to install these. It takes time to change people’s attitude towards that but I was glad to see one toilet installed. This could reduce other infections for both children and adults.
