Being with people living positively ... in Doti

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.

Encouraging facts

An impressive majority of people now consider HIV as an issue to be addressed in Nepal. Some faith organisations both Christian and non-Christian  show willingness to educate young people in churches and in communities. Christian volunteers are supporting not only reproductive health education, but also care for people affected by Aids.

A number of leaders from other faiths have expressed their wish to do more if government departments would approach them and recognise their potential contribution.

The training of religious leaders is an area identified by many as a need, a positive way forward and financial assistance is essential to expanding the role of faith-based organisations in HIV prevention and care.

There is an apparent misconception about HIV though with geographical differences. Some of the religious leaders residing in rural and remote areas regard HIV as a divine punishment for sin or consequence of immoral behavior. Those who have been trained have shown a more positive view about Aids as a disease associated with ignorance and poverty and display a positive attitude towards those affected.

I visited Morang District and had a meeting with peer educators from the communities. One young man came to me inspired and he said “I want to do something to members of my community who live in abject poverty!” I felt the weight of those words and I learned that he came from a Muslim community, of course a minority group in Nepal. I encouraged him to share knowledge, skills and provide accurate information to his community especially on health related issues including HIV and that would create a more positive view and attitude in overcoming poverty to some extent. It was interesting to hear the positive side of their experiences and challenges they faced in the community. They took me round to see the condition that the community lives in and I found that poor sanitation was a common problem e.g. blocked water drainage systems and lack of toilets.

-Please pray for the community volunteers and local government institutions as do their plans to address the problems and priority areas.

Photo: These are the peer educators who have been raising awareness on HIV and other health related issues in various parts of Morang District.