17 May 2006, Source: IRIN
KATHMANDU, 16 May (IRIN) – There's no signboard outside the simple white-washed building at the end of the road – and neighbours have little idea of who its occupants are. But in this traditional Hindu society, where open discussion about HIV/AIDS remains largely taboo, that's not surprising.
Behind the well-trimmed lawn and flower beds of the two-story building lies Nepal's only hospice dedicated to caring for men who have sex with men (MSM) infected with HIV/AIDS, a particularly marginalised group in this impoverished nation of 28 million.
Funded by the Elton John Foundation and French NGO Sidaction, the hospice, located in a working class residential district of the capital Kathmandu, provides one of the few rays of hope for MSM members living with AIDS.
"I thought my life was over and even tried to commit suicide," Devya Gurang, a 24-year-old transgender person from the western city of Pokhara, said, recalling in vivid detail when she learned that she was infected with the virus.
Working the brothel circuit in the Indian film capital of Mumbai and popular for her effeminate features, she once serviced up to 25 men a day, and conceded to having unprotected sex on more than one occasion. Not knowing what to do, and with little money, she returned to Nepal only to find a less than hospitable welcome.
"People looked down upon me as a transgender person … Life was and continues to be terribly difficult," Devya maintained. "Nobody will give me a job and the fact that I am HIV positive only makes things worse."
A resident of the hospice since it first opened its doors over a year ago, she now looks upon it as her home, where she assists other transgender or gay men living with the virus.
Ramnath Shah, another caretaker at the hospice from Saptari district, close to the Indian border, agrees. "Life was unbearable for me there," he said, referring to his staunchly conservative village. "People didn't accept me," he explained, recalling how he too found sanctuary at the Kathmandu hospice, where residents receive room and board, along with literacy training and counselling, as well as antiretroviral (ARV) drugs and periodic group meetings to provide psychological support.
For the past five months, Devya has been receiving a daily dosage of ARVs, including Nevirapine and Duovir, drugs that otherwise would have been out of reach to her financially, while a doctor comes by once a week to check on her and other residents' progress.
"I still have recurrent bouts of diarrhoea and am not feeling very good – but at least now I have a chance to get better," she said.
Others, however, are doing less well. Chinak Tharu, 34, another resident from the midwestern district of Rupandhi and now physically disabled, laments he is paying the ultimate price for having unprotected sex. "I'm feeling better now. Before this I could barely walk," the five-month hospice resident said.
The brainchild of Sunil Pant, the Director of Nepal's Blue Diamond Society (BDS), the hospice, already operating on meagre resources, can mean the difference between life and death for some.
"The situation is particularly poor given the double stigmatisation of being gay and HIV positive in Nepal," the NGO director said, explaining how some people had actually been driven out of their homes by their families and communities. "The general understanding of HIV is that people have been infected by taking part in immoral or dirty behaviour," he said.
According to the United Nations, there are an estimated 70,000 people between the ages of 15 and 49 currently living with the virus in the Himalayan kingdom – with most people not even knowing if they are infected. But Nepal's HIV/AIDS epidemic is considered to be "concentrated" in nature, meaning a prevalence rate of less than 1 percent, concentrated among specific vulnerable groups such as injecting drug users, commercial sex workers (CSW) and their clients, as well as members of the MSM community.
"These are the groups that have shown high-risk behaviour and that's usually where a general epidemic will begin," Aurorita Mendoza, Country Coordinator for the Joint UN Programme on HIV/AIDS (UNAIDS), warned.
But while it is difficult to estimate how many HIV cases have actually been registered within Nepal's largely underground MSM community, it's clear more needs to be in terms of public awareness. There has yet to be any comprehensive study of the group, with many people remaining reluctant to divulge their HIV status, the UNAIDS official said.