Sex, Lies and the AIDS Epidemic in Nepal

Even a cursory glance at the sex trade in Indian cities reveals disproportionate numbers of Nepali women and children. This much we have known for many years. The recent emergence of AIDS, however, has thrown this issue into sharp relief, highlighting the various forces - of poverty, lack of education, lack of control over their own lives - that push Nepalis into this situation. At the same time, this same threat of AIDS has focused the energies of a number of volunteer and non-governmental organizations (NGO's). Different organizations have put together successful programs at different levels - from offering shelter and medical help to trying to tackle the root economic and social causes of sex trafficking. Here I'd like to present some of the insights I gained over the summer of 1995 in Kathmandu, from extensive interviews with NGO's, UN agencies such as UNICEF & UNDP, governmental organizations and health centers.

Exporting Women, Importing AIDS

AIDS is becoming a major threat to the people of Nepal. No longer is it a disease to be stereotyped as affecting only those in African and Western countries. According to estimates from the AIDS Control and Prevention Project (AIDS-CAP), about 20,000 of all new AIDS cases are in South and Southeast Asia alone. With an estimated 3 million HIV infected people, India is now the country with the largest number of people with the AIDS virus. By the year 2000, Asia's cumulative total infections is expected to reach over 10 million. Among the three major routes of HIV transmission, sexual transmission is the major source of the spread of infection in Asia, followed by blood transmission and mother-to-fetus transmission respectively. The rate of HIV infection is increasing rapidly among vulnerable population groups like commercial sex workers (CSW's) and their clients.

In Nepal, as in many of its neighboring countries, the sexual mode of HIV transmission through CSW's and their clients plays a significant role in the spread of the AIDS epidemic. Eighty-four percent of females with HIV in Nepal are CSW's. With increasing numbers of Nepali women and girls being trafficked to the brothels of India, the risk they face of contracting as well as transmitting HIV is tremendous. The epidemiology of AIDS in Nepal however, is believed to be at an early stage of its progress, although there is controversy surrounding the numbers of infected people. Unlike India where large numbers of HIV infections have been detected, AIDS has not yet affected a large portion of Nepal's population, which means there is still time to prevent the spread of AIDS in Nepal before it reaches uncontrollable levels like that predicted for other Asian nations. AIDS cannot be isolated to Nepal because of its location and ties with India.

Traditionally, Nepalis have crossed the border to India for work, whether it be women laborers, children working in factories, or men looking for migrant work. Trafficking of Nepali women and girls to India is yet another export to India. Nepal's economic dependence on India and the political relationship between the Nepali Congress Party and the Indian government prevented the previous government of Nepal from regulating cross-border crime or enforcing anti-trafficking laws. In 1950, a treaty with Nepal allowed for free passage and trade across the Nepal/India border. Although either country could terminate the treaty, and although subsequent Nepali governments were dissatisfied with the treaty, Nepal could not afford to lose its trade relationship with India. This open border policy has clearly aided in the trafficking of Nepali women and girls to India. With an estimated 1,00,000 people traveling through one border post a day, it is difficult for border police to check illegal activity. Even if there were fewer people passing through and police knew what was going on (as many do), their corruption and involvement in the trade would prevent them from taking just action.

Much of the transmission of HIV is due to the high number of Nepali men who work as migrant laborers in India and visit the brothels of Bombay. They then transmit it to their wives when they return home. In addition, Nepali CSW's working in India and Nepal contract sexually transmitted diseases (STD's) and HIV from their clients and transmit infection to other customers. If the women ever get married, they also face the risk of transmitting the disease to their husband or to their children. In addition, the large demand for Nepali women and girls in Indian brothels puts them at an even greater risk of contracting HIV, since they average more clients a day than others.

Indian men prefer Nepali girls to others because of their golden skin and "exotic" features. They are also seen as docile and more willing to submit to clients' demands. Nepali women are segregated in India's red-light districts, living in compounds referred to as "Nepali kothas." This way it is easier for clients who prefer Nepalis to find them. This high request for Nepali women and girls promotes traffickers even more, as they must supply the demands of the trade. Most Nepali CSW's are unaware of HIV/AIDS and are not familiar with prevention methods. Families who often agree to prostitute their daughters in return for money also lack knowledge of AIDS. Thus the girls' as well as their families' lack of awareness does not give them the opportunity to make an informed decision about their lifestyle and the health risks involved. Providing knowledge about HIV/AIDS and prevention methods is one possible way girls may be deterred from the sex trade. If given the choice, they may also be able to exercise preventive safe sex methods that would reduce the spread of HIV to their clients and to their families.

Reducing prostitution in order to prevent the spread of AIDS is difficult due to the extreme poverty in Nepal and the low status of women. However, addressing prostitution and acknowledging its existence is vital in order to educate vulnerable groups about AIDS.

Sex, Lies and Urban India

According to Human Rights Watch/Asia, in Bombay alone there are an estimated 50,000 Nepali women working in brothels, twenty percent of whom are girls under the age of eighteen. Even this average age has been dropping over the last decade. In the 1980s the average age of Nepali girls recruited was fourteen to sixteen years, and in 1991 the average age was ten to fourteen years. The recruiting of younger girls stems in part from clients' desire to be with a girl free from HIV as well as from other STD's. Clients believe the younger the girl is, the more likely she is to be a virgin, while others believe the myth that virgins cure STD's.

There are two basic patterns by which women and girls are trafficked from Nepal. The oldest form is enticement, which involves preying on girls from particular areas of Nepal, such as the hill communities, where the sex trade has become practically a traditional source of income. In these districts where it is a constant struggle for people to meet their basic needs, it is not difficult to persuade the girls to leave home. Their lives consist of backbreaking work around the clock which still leaves their families poor and hungry. In such circumstances, any alternative would look more favorable. The road to India is seen as a chance to end the poverty and hardship of their everyday lives. By not telling the girls of the slavery-like conditions they will be subjected to in the brothels, traffickers are easily able to con girls into leaving.

The second pattern of trafficking which is even more insidious is that which is physically against a woman's will. This occurs across all castes and ethnic groups and is on the rise. The girls are physically taken and even beaten and raped if they fail to cooperate. The main victims of this trafficking are poor migrant women and children whose families have moved to Nepal's urban areas in search of jobs. Families, neighbors and friends all play an active role in trafficking. They promise the girls false marriage or job offers, contact recruiters, or lure girls away from home on outings and then kidnap and sell them. This is not difficult to do since it is done by people whom the girls know and trust. Once the girls are lured into lives of prostitution, they confront numerous health threats.

Women and girls are ill-treated from the moment they arrive in a brothel. There is an initiation process for "breaking in" new workers. Those who refuse to have sex could be physically abused or confined to a room with no food or water. If a girl still refuses to comply after several days, she is raped. Once a girl has been "broken in," she continues to face a multitude of physical and psychological abuses. Some of these abuses include physical torture like branding with a hot iron, beating, tying with ropes, and rape, as well as brainwashing the girl into believing she will not be accepted back into society so that she will stay in the trade. Brothel owners also remind the girls of how much debt they owe, which is always more money than the girls have.

Once the girls begin to accept their lives in the sex industry, they are slowly introduced to drugs in hopes of getting them addicted. This is yet another method used to trap girls into a life of prostitution, as their debt continues to increase every time they use drugs. The spread of the AIDS virus poses additional health problems for women and girls in the sex trade. Besides the sexual transmission of the disease, the growing popularity of contraceptive injections poses a threat as well, since many times the same needle is used for many women without sterilization. Brothel owners often make the girls get injections so they will not get pregnant and can therefore entertain more clients.

There is basically little time when women and girls are exempt from entertaining clients, which only adds to their host of health risks. They must continue to do business while menstruating, after treatment for STD's, and even up to the fifth month of pregnancy. Once prostitutes contract HIV they are sent back home. Since many people are not educated about AIDS, they are either afraid of the disease or do not know how to care for a person with it. As a result, families refuse to take their daughters back, leaving them to fend for themselves.

Girls who return with HIV are in a very desperate situation. If they are unable to find employment, they will continue to be prostitutes. Some girls marry and settle back into their village life, while others are rejected by their families who are scared that they might contract AIDS from their daughter. Regardless of the life the girl leads when she is taken back to Nepal, there is a strong risk of transmitting HIV to her partner, clients, or to her baby. Thus the connection can be seen of the passage of HIV from the brothels of Bombay directly to the villages of Nepal. In addition to being rejected by their families, many girls are ignored by health workers.

Many health personnel are resistant to being informed about HIV, let alone wanting to care for AIDS patients. Without education about the disease, families, health workers and especially AIDS patients are all at a loss. With increased information and AIDS education for prostitutes and their families, STD's and AIDS could possibly be a deterrent to prostitution. Families who are educated might think twice before sending their daughters to India. And since they would know that HIV cannot be transmitted through casual contact, they could care for their daughters with AIDS instead of abandoning them.

Grassroots Groups Fight Back

There are over 80 NGO's throughout Nepal which are addressing the issues of AIDS and/or prostitution. I only visited NGO's that were based in Kathmandu. I interviewed workers at 8 NGO's and found that through their analysis of the situation and input from clientele, they have reached the heart of the issues. Although each organization has its own goals and methods of achieving them, they have all done and are continuing to do important and inspiring work. The NGO I was most impressed with was started by one woman four years ago. This four bedroom house, called Maiti Nepal, is owned by a brave Nepali woman, Anuradha Koirala, who was abandoned by her husband to marry her aunt. Devastated by her plight and frustrated by the many abandoned women and girls she saw in Kathmandu, Koirala set up her house as a home for them.

Girls whose families did not want them because of their involvement in prostitution, girl children as young as one year who were abandoned, and wives who were deserted or who ran away from their husbands all live under this one roof. Started in 1992 with the help of friends, Maiti Nepal now houses over 60 women and girls, and also Koirala's two sons. Everyone takes care of each other. The older girls cook and make clothes for the younger ones who give them love and comfort in return. The main goal of Maiti Nepal is to help the women begin their lives again. Through loans from friends and a few relatives, Koirala helps them set up food stands to generate income. So far she has helped four women buy a house to share, some of whom even remarried. In addition, her house is a haven for abandoned girls, some of whose families rejected them because they have AIDS.

When dealing with the issue of prostitution, Koirala's activism goes even further. This was apparent the first day I met her. She was two hours late in meeting me because she was trying to keep a convicted pimp from going free. She also takes criminal cards to villagers, which allows them to anonymously provide information about suspected pimps or brothel owners who come to their village. Last year she gave out 3,000 cards and got 150 back, some of which helped locate traffickers. Her persistence struck me when she explained, "The gharwalis (gangs) might even come and kill me because they are angry with what I am doing. But I am not afraid of that. We are starting something new by standing up to traffickers."

Women Acting Together for Change (WATCH) is another NGO involved in helping women and girls affected by the sex trade. They take a very broad approach: they support villagers in addressing their problems, raise consciousness concerning gender issues, and provide information to other national and international organizations with similar interests. WATCH integrates AIDS awareness with the issue of prostitution, which they tackle through empowerment of the women involved. WATCH began their HIV education program by hiring two former prostitutes who had contracted HIV.

By listening to these women, WATCH learned that most families were not worried about contracting HIV because they believed they would not live long, and would probably die of some other disease if not AIDS. Thus WATCH made their main priority raising the confidence of people and their willingness to live. Without doing this, they felt that talking about issues such as AIDS would be futile. WATCH also discovered that girls returning from prostitution were rejected by their families not only because they had AIDS but because they were no longer bringing home money. Thus WATCH's initiatives focused on raising awareness in families about the horrors their daughters faced as prostitutes, and on providing them with other economic alternatives.

Women's Rehabilitation Centre (WOREC) also involves villagers in their AIDS education programs. One of WOREC's strategies in empowering women is getting the AIDS victims to live with other women from rural communities who have faced other forms of sexual trauma -- victims of rape, women who had been abandoned by their husbands or women with "illegitimate" children. This way the women can learn the skills they need to survive in an environment where they feel comfortable, and where they can get constant support from a community that shares similar struggles. It is in this setting that WOREC provides skill training, non-formal education and income generating opportunities. This has helped to build the confidence of women by giving them the skills to sustain themselves and their families, and is one of the most important aspects of the psychological structure in community based rehabilitation.

ABC/Nepal (Agro-forestry, Basic health and Co-operatives), another Kathmandu based NGO, has been working on the issue of AIDS and prostitution the longest. They also focus on a broad range of programs including literacy programs, income generation activities, and awareness about AIDS and trafficking. ABC/Nepal realized that a key to getting people interested in their awareness programs was emphasizing the serious nature of AIDS. Many villagers had not realized that contracting AIDS was fatal. As a result of their education programs, some women now make sure that their migrant worker husbands get tested for HIV if they came home looking thin or with a fever. ABC/Nepal strives to make their programs more interesting to people so they will take the initiative as these women did. This involves working with other NGO's and coordinating other issues with AIDS education such as STD's, family planning or trafficking.

After five years of educating families on AIDS and prostitution, ABC/Nepal's success can be seen by the parents' hesitation and even refusal to send their daughters into the sex trade. Therefore, it can be said that education and awareness about HIV/AIDS has served as a deterrent to prostitution. Much remains to be done, however. ABC/Nepal's main concern is the lack of rehabilitation centers to house and take care of the girls with AIDS. They do not believe rehabilitation centers should serve as a permanent home for the girls, but just as a transit center until their families are ready to take them back. They feel the girls need love and affection, especially in the last years of their lives, and that rehabilitation centers cannot provide adequate attention for all those staying there. Without the financial support of the government, it is unlikely that enough centers will be built. This lack of support from the government is one issue ABC/Nepal is working on for the future. They want to collaborate with other NGO's as well as with the Nepali government so that there will be adequate resources in the future when there will be more AIDS patients.

ABC/Nepal is also persistent in trying to involve the police, the government and other parts of society. They work closely with the National Pressure Group which has constructed a ten point plan of action that assigns specific actions for political parties and social organizations at the national level. They have also briefed the police at the India-Nepal border, reminding them of their responsibilities as officers, and providing them with material on how to detect traffickers and girls being forced out of the country. ABC/Nepal also tries to get the interest of political groups and parliamentarians by sending them copies of relevant publications and learning materials. It is this attempt to reach into the political arena that makes ABC/Nepal a good model for others to follow. Without forgetting their priorities at the grassroots level, they continue trying to convince the government that AIDS and prostitution in Nepal are serious issues that must be addressed.

Although NGO's such as these are doing useful work, what is lacking in Nepal is the government's intervention in the issues of AIDS and prostitution. The government's direct involvement in trafficking and its economic ties to India prevent it from taking action. Many politicians and policemen visit brothels or benefit from the sex trade financially. The open border to India where most border officials take bribes from traffickers makes punishing perpetrators even more difficult. And the stigma of AIDS is still prevalent in Nepal; many doctors and health workers refuse to care for patients. In Teku Hospital, one of the few which treats AIDS patients, volunteers noted that women with AIDS were ignored or badly treated because of the assumption that they contracted it through prostitution. Regardless of how the men got HIV, they were given care and compassion in the hospital. Until the government of Nepal takes AIDS and prostitution as a serious matter, NGO's will continue to fight this battle alone.

We hope that the leaders of Nepal will learn from their Asian neighbors such as India, what can happen when such issues are ignored. If it takes millions of deaths from AIDS before the government takes action, Nepal will be in a very tragic situation, as there will not be adequate facilities or enough trained workers to deal with an epidemic of that proportion. Until the government wakes up, it is the grassroots organizations of Nepal who will be striving to educate and empower its people.


I don't think that we should intrude in the life privates of other people no matter what they choose to do. Selling sex is not something new and this is the "oldest job" in the world. Maybe all the countries in the world should try and develop a legal system for this kind of service.

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