High HIV/AIDS rates among returning Nepalese women from India

from the American Chronicle

By Surya B. Prasai

Ever year, more than 10,000 women are trafficked from Nepal into India for commercial sex work through the infamous Makwanpur alley, which is a town situated midway between Kathmandu, Nepal´s capital and the Terai region of Chitwan which border India to the south. These women are sold to Indian commercial sex parlours in the cities of Mumbai, New Delhi, Bangalore and Kolkata involving nearly three to four middlemen. The girls who are impoverished in poverty until the ages of 12-16 years are sold off by their parents for as little as US$ 200 to the agents, who then group them in bunches of 10-15 and transport them across the porous border to the various Indian cities.

In 2007, the estimated number of Nepalese commercial sex workers in India was estimated anywhere between 200,000 to 300,000. Nearly half of the women in Mumbai, who ply commercial sex work totaling 120,000, are estimated to be Nepalese. The women are not only subjugated to various forms of torture, gang rape and different sexual acts, they have the risk of contracting HIV/AIDS openly.

According to recent available posted on BBC, HIV infection may have increased by more than 100 percent among Nepali women and by 200 percent among children in the past 18 months, according to several NGO officials working to bring relief to the Nepalese women in Mumbai.

The Nepalese government´s National Center for AIDS STI Control publishes figures regularly on the number of HIV/AIDS occurring in Nepal. But these figures are considered diminutive based on the actual number infected, particularly those forced to return to Nepal from Mumbai, New Delhi and Kolkata after contracting HIV/AIDS. For instance, the Nepal Government released figures that nearly 2200 housewives were infected with HIV in 2007, but the figure could be more as there is stigma and discrimination attached to revealing one´s HIV status in Nepalese society. The Family Planning Association Nepal (FPAN) also holds some figures of the numbers infected but though these appear more realistic, believe they hide the true outreach and sufferance of those infected. Also hide the true figures of those already suffering or dying. The government states that the number of children infected with HIV reached 428 from 138 in 2005, but the actual reality is more than 2,500 known infections are recorded in various hospitals and clinics throughout Nepal. The same period.

According to Family Planning Association of Nepal in one of its recent reports "HIV infection has increased by 146.14 percent among women and by 210.14 percent among children within a short span of time. The outbreak is not concentrated in certain groups now." Infection through blood transfusion or organ transplant has increased by 144.44 percent while it increased by 47.66 percent among the clients of sex workers. Nine cases of infection among recipients of organs and blood were reported until 2005 but the number was 22 in May, 2007. Similarly, infection among Intravenous Drug Users has increased by 67.40 percent. Altogether 1,134 such cases were reported in 2005 but the number had reached 1,900 by May this year. The number of clients of sex workers infected with HIV has reached 4,421 from 2,994 in 2005. The number of HIV-infected sex workers is comparatively less than their clients. In 2005, the number of sex workers infected with HIV was 606. This had reached 675 by May, 2007. The overall number of HIV-infected people in the country reached 9,329 by May, 2007 from 5,647 in 2005, according to NCASC records.

The alarming fact is that among the Nepali women trafficked to India and forced into the sex trade found that nearly 40 percent of them were HIV positive by the time they were repatriated, US researchers have verified. Human Rights Watch has published an explicit report outlining the plight of Nepalese women who have been trafficked to India and exploited for commercial sex work there and abroad. The main cause of this inhuman crime seems to be the impoverishment of Nepalese women which forces their parents to marry them off to middle agents or else to sell them off for the remaining families´ survival. Another finding coming from a small study of 287 Nepalese women who found their way home after years of sex slavery in India's brothels, underscored the challenge facing public health authorities as they battled to contain India's HIV epidemic and prevent it from spreading throughout the region. According to a quote from Jay Silverman, Associate Professor of Society, Human Development, and Health at Harvard School of Public Health to BBC recently, "The high rates of HIV we have documented support concerns that sex trafficking may be a significant factor in both maintaining the HIV epidemic in India and in the expansion of this epidemic to its lower-prevalence neighbors."

India already has 2.3 million people living with HIV/AIDS, more than any other country in the world except South Africa and Nigeria, and is also a major hub for sex workers from across the region, such as Nepal and Bangladesh. Lacking formal employment, the tide of poor Nepalese women willing to provide these services seems to go unchecked. Currently Nepal is rehabilitating itself after an 11 year old civil conflict that left nearly 13,600 people dead. However with the current national infection numbers hovering anywhere between 80,000 to 120,000 more than 17,000 are expected to die each year throughout the coming decade due to HIV/AIDS related infection. Nepal earlier had traditionally very low rates of HIV/AIDS infection at less than 300 per 100,000 but now it cannot be sure with the returning commercial sex workers sent back from various Indian cities that in turn marry back into their villages, whether projected government figures are accurate. Many of the women are also giving berth birth to HIV infected children and continue engaging in commercial sex work.

A recent study found that the number of infected commercial sex workers in Nepal increased 24-fold in the decade from 1992 to 2002, a trend that experts say is probably reflected in the wider population. In Kathmandu alone, the population of sex workers is estimated to be around 40,000 of which 18% might be HIV infected.

While World Bank and UNAIDS officials have warned that the cross-border sex trade presents a potential public health threat to Nepal, there has been very little data or action to show what's happening on the ground. This all paints a highly disturbing picture of young women and girls being forcibly introduced to commercial sex work outside of Nepal, some as young as seven, most of whom were lured or forced into prostitution in cities such as Mumbai, Pune, Delhi and Kolkata, and outside in Bangkok, Taiwan, Hong Kong, the UAE and Qatar.

The authors of another study found that 38 percent of the returning women and girls tested positive for the HIV virus, and that infection rates were sharply higher among the youngest in the group. Girls aged 14 and under were four times more likely to be HIV-positive than the women in the group as a whole. More than 60 percent had the virus that can lead to AIDS - Acquired Immune Deficiency Syndrome.

In India, it is accepted that the fairer Mongoloid feature based Nepalese girls are considered a highly prized commodity in India´s flesh trade. The higher infection rates probably reflect the fact that the Indian men who frequent brothels tend to prize younger Nepalese girls, who are often presented as virgins, because they perceive them as less likely to be infected with HIV or other sexually transmitted diseases, the authors said. The widespread myth still persists that having sex with a virgin will cure one of sexually transmitted diseases. This weighs heavily into the equation of finding Nepalese girls than any other racial origin in the Indian brothers.

Unfortunately, as a result of the Nepalese girls´ popularity, brothel owners tend to keep these younger girls in captivity for longer - and the longer a girl is involved in prostitution, the greater her risk for contracting HIV, as Harvard researchers recently found out. More broadly, the women who worked in several brothels, and specifically in brothels in Mumbai, a city with a notable HIV/AIDS problem, were more likely to be infected.

Recent estimates suggest that nearly 40% of Nepali women trafficked into India working as sex workers there have been found to be HIV positive on their return home. But Nepali experts believe the figure could be as high as 90% because the women are not sent back to Nepal unless at first they are infected. Sex trafficking may be a major factor in the spread of HIV in India and the rest of South Asia, in Nepal´s case it is highly alarming. Trafficking of women and children to India and South Asia has fuelled in a very dangerous HIV/AIDS prevalence scenario in Nepal. Poverty is still the fundamental problem that underlies all trafficking in Nepal. Due to the prevailing poverty, most Nepalese girls are illiterate and easily lured by the tiny attractions of work, higher salaries, easy life, and promises of a foreign job. This is now beginning to take its toll on the Nepalese women´s lives, and spreading quickly through the rest of Nepalese society, where efforts at HIV/AIDS impact mitigation shows a lack of concrete national planning and realization on the need to do something more urgently.