Ranjana KC looks blankly at the floor, more in fear than remorse. Three years ago she lost her parents in Achham, first her father and then mother. She was only six when her uncle and aunt made her a servant in her own house. The villagers taunted her with "AIDS girl" or "She also has HIV" even though she was not infected with the virus.
Like so many other Achhamis, her father had been a migrant labourer in Mumbai who returned home ill. Everyone knew the cause of his death. Today, nine-year-old Ranjana, brought to Kathmandu by social workers, is living with strangers in a shelter in Lalitpur. Afraid of
Ranjana KC looks blankly at the floor, more in fear than remorse. Three years ago she lost her parents in Achham, first her father and then mother. She was only six when her uncle and aunt made her a servant in her own house. The villagers taunted her with "AIDS girl" or "She also has HIV" even though she was not infected with the virus.
Like so many other Achhamis, her father had been a migrant labourer in Mumbai who returned home ill. Everyone knew the cause of his death. Today, nine-year-old Ranjana, brought to Kathmandu by social workers, is living with strangers in a shelter in Lalitpur. Afraid of the stigma that pursued her in her village, she hasn't revealed her true identity or real place of birth to anyone in her school, fearing she will be kicked out and lose her friends. "It's very difficult without my parents," she tells us.
Ranjana is just one among tens of thousands of Nepali children orphaned after their parents died of HIV/AIDS. There are no accurate figures on the number of AIDS orphans. The only data available is a 2001 UNICEF survey which showed that about 13,000 children under 14 years were orphaned. About 56,000 Nepalis were estimated to be living with HIV/AIDS, and 13,000 of them are women between 15-49 years. By 2004, UNAIDS estimated that about 60,000 people were infected and in the absence of effective care and treatment, about 10,000 to 15,000 are expected to die every year
Since 1988, the HIV/AIDS movement in Nepal has focused mainly on the prevention and awareness about the disease. Yet, the disease is turning from a concentrated to a generalised epidemic and spreading out of control.
Little attention has been given to care and support, rehabilitation and anti-retroviral treatment. Children orphaned by AIDS are left to fend for themselves, stigmatised and victimised by ignorant family members or the community. The orphans don't even appear in the agenda of many donor agencies and NGOs: the reason why there is not even one survey on the extent of the problem and condition of the children.
"The issue of orphans should not be isolated from HIV/AIDS campaigns and policies. Their numbers are growing, and all the donors talk about are what they call large impact programs like prevention and awareness," explains Bishwo Khadka of Maiti Nepal, one of the few NGOs that takes care of AIDS orphans. "Their number is growing and the kind of support we give is just a drop in the ocean."
Among international NGOs, Save the Children (Norway) has started an orphan care and support with community-based programs for orphans who are provided with free schooling, books and clothes with the help of the local community and the District Education office. "Children who lost their parents to AIDS become traumatised at many levels," says Kalu Singh Karki of SCF (Norway). The organisation works through volunteers to reduce stigma against people living with HIV/AIDS and mobilises communities to support orphans. There are about 221 orphans in 12 VDCs in Achham.
But this is just one of those few examples where the local government administration and community make the effort to help such children. "Unless there is a national level policy and advocacy on this issue, such support will only be temporary," says Karki.
Close relatives often claim the parental property of orphaned children and force them to rear animals, till the farms and perform household chores. Teachers often ask such children to leave school in fear that they might infect other children. Karki adds that sometimes things becomes worse for the children when they are brought to Kathmandu for rehabilitation.
"Even in Kathmandu, when you tell the truth about the child expecting sympathy, they are not accepted," says Hem Thapa from House of Rest, a centre for women and children. "We were forced to hire a teacher and educate the children in our centre instead."
UNICEF's State of Children 2005 estimates that there are about 1 million orphans under 17 in Nepal, who have lost their parents mainly due to poor health conditions, accidents and various other causes. The number of children who have lost one or both parents has grown since the conflict began nine years ago. There are no figures but activists maintain that more children have been orphaned by HIV than by the conflict. It is also rare for both parents to have died in the conflict, whereas it is much more common for both the father and mother to die of AIDS.
"Our responsibility does not finish with just talking about combating the disease. We need to seriously think about the future and situation of children orphaned due to AIDS as it gets worse, especially in the remote areas," says Tarak Dhital of the group Child Workers in Nepal. On a global scale, there is an estimated 15 million children under 18 who have lost their mother or both parents to HIV/AIDS.
Ostracised
Babita BK knows she will be thrown out from school if the teachers find out that her father died of AIDS. Since his death last year, the entire community in Saigaun VDC of Banke began harassing 13-year-old Babita and her family. Even close relatives disowned them. Babita and her 15-year-old brother are unable to continue schooling because their mother cannot afford to pay the fees. "We lost all our savings on the treatment for my husband. I had to take loans to buy medicines," says Babita's mother. "I don't know how long we will survive, we can't even afford to buy food any more."
In Banke district, there are many children like Babita who have lost one or both parents to AIDS. The local community regards people infected with HIV as criminals whose children have to suffer after their parents die. They receive no support from the government and must depend on charity groups for food and shelter. "No one has shown any interest in helping the orphans," says AIDS specialist G Raj Sakya from Nepal HIV/AIDS Research Centre, which has established a rehabilitation shelter for orphans here. About 20 children are receiving support for their education, food and clothing with plans to house 50 more orphans. Rameswor Bohara in Nepalganj
Life or death
Time is running out for people living with HIV and AIDS but Nepali activists say donors have not shown much interest in starting care and support programs that could prolong their lives.
The only hope is the $11 million granted to Nepal by the Global Fund to fight AIDS, tuberculosis and malaria. Sources say the first instalment of $4 million has arrived and is stuck in UN bureaucracy. "I am dying and too tired to knock on donor doors," says activist Rajib Kafle.
The Global Fund agreed to release funds to Nepal on condition that an independent institution manages it and not the government. (See: 'Aiding AIDS', #214). The UN system was selected as the contracting agency months ago but agreement papers between the UN and the government is said to be waiting at the Ministry of Health. "The file is not moving because the government has not been able to reach a decision at the cabinet," an activist told us.
Sources say that the UN is reluctant about acting as the authoritative body to manage the funds and distribute it among Nepali activist groups. Nepal receives one of the largest funds for HIV/AIDS in Asia but they say the biggest chunk is controlled by donor agencies and channelled to partner INGOs and NGOs. Some donors are said to be willing to increase the aid substantially as long as the government is not involved in disbursement.
Meanwhile, the country and people with AIDS are losing time. The $4.6 million has to be used within the first two years of the grant period, failing which the rest of the $11 million will be cancelled.
The main concern is not who controls the funds as long as care and support systems are put in place. "The government is actually doing a better job, it has already upscaled the ARV (anti-retroviral) treatment program with its own resources," says Kafle.
Despite objections and lack of support for the government, National Centre for HIV/AIDS and STD Control (NCASC) began ARV therapy for 25 patients. By December, it increased the treatment to 75 patients. The centre also plans to set up an ARV treatment facility in Nepalganj. "It would be better for organisations not to go after regular funding mechanisms. I would rely more on local resources," adds Kafle.
The situation of people living with HIV and AIDS is getting worse. Most NGOs have withdrawn from outlying villages due to the conflict. "The conflict has a double impact," explains Bina Pokhrel at Save the Children UK, "While the rate of infection is growing, response has decreased."
Naresh Newar
Ranjana is just one among tens of thousands of Nepali children orphaned after their parents died of HIV/AIDS. There are no accurate figures on the number of AIDS orphans. The only data available is a 2001 UNICEF survey which showed that about 13,000 children under 14 years were orphaned. About 56,000 Nepalis were estimated to be living with HIV/AIDS, and 13,000 of them are women between 15-49 years. By 2004, UNAIDS estimated that about 60,000 people were infected and in the absence of effective care and treatment, about 10,000 to 15,000 are expected to die every year
Since 1988, the HIV/AIDS movement in Nepal has focused mainly on the prevention and awareness about the disease. Yet, the disease is turning from a concentrated to a generalised epidemic and spreading out of control.
Little attention has been given to care and support, rehabilitation and anti-retroviral treatment. Children orphaned by AIDS are left to fend for themselves, stigmatised and victimised by ignorant family members or the community. The orphans don't even appear in the agenda of many donor agencies and NGOs: the reason why there is not even one survey on the extent of the problem and condition of the children.
"The issue of orphans should not be isolated from HIV/AIDS campaigns and policies. Their numbers are growing, and all the donors talk about are what they call large impact programs like prevention and awareness," explains Bishwo Khadka of Maiti Nepal, one of the few NGOs that takes care of AIDS orphans. "Their number is growing and the kind of support we give is just a drop in the ocean."
Among international NGOs, Save the Children (Norway) has started an orphan care and support with community-based programs for orphans who are provided with free schooling, books and clothes with the help of the local community and the District Education office. "Children who lost their parents to AIDS become traumatised at many levels," says Kalu Singh Karki of SCF (Norway). The organisation works through volunteers to reduce stigma against people living with HIV/AIDS and mobilises communities to support orphans. There are about 221 orphans in 12 VDCs in Achham.
But this is just one of those few examples where the local government administration and community make the effort to help such children. "Unless there is a national level policy and advocacy on this issue, such support will only be temporary," says Karki.
Close relatives often claim the parental property of orphaned children and force them to rear animals, till the farms and perform household chores. Teachers often ask such children to leave school in fear that they might infect other children. Karki adds that sometimes things becomes worse for the children when they are brought to Kathmandu for rehabilitation.
"Even in Kathmandu, when you tell the truth about the child expecting sympathy, they are not accepted," says Hem Thapa from House of Rest, a centre for women and children. "We were forced to hire a teacher and educate the children in our centre instead."
UNICEF's State of Children 2005 estimates that there are about 1 million orphans under 17 in Nepal, who have lost their parents mainly due to poor health conditions, accidents and various other causes. The number of children who have lost one or both parents has grown since the conflict began nine years ago. There are no figures but activists maintain that more children have been orphaned by HIV than by the conflict. It is also rare for both parents to have died in the conflict, whereas it is much more common for both the father and mother to die of AIDS.
"Our responsibility does not finish with just talking about combating the disease. We need to seriously think about the future and situation of children orphaned due to AIDS as it gets worse, especially in the remote areas," says Tarak Dhital of the group Child Workers in Nepal. On a global scale, there is an estimated 15 million children under 18 who have lost their mother or both parents to HIV/AIDS.
Ostracised
Babita BK knows she will be thrown out from school if the teachers find out that her father died of AIDS. Since his death last year, the entire community in Saigaun VDC of Banke began harassing 13-year-old Babita and her family. Even close relatives disowned them. Babita and her 15-year-old brother are unable to continue schooling because their mother cannot afford to pay the fees. "We lost all our savings on the treatment for my husband. I had to take loans to buy medicines," says Babita's mother. "I don't know how long we will survive, we can't even afford to buy food any more."
In Banke district, there are many children like Babita who have lost one or both parents to AIDS. The local community regards people infected with HIV as criminals whose children have to suffer after their parents die. They receive no support from the government and must depend on charity groups for food and shelter. "No one has shown any interest in helping the orphans," says AIDS specialist G Raj Sakya from Nepal HIV/AIDS Research Centre, which has established a rehabilitation shelter for orphans here. About 20 children are receiving support for their education, food and clothing with plans to house 50 more orphans. Rameswor Bohara in Nepalganj
Life or death
Time is running out for people living with HIV and AIDS but Nepali activists say donors have not shown much interest in starting care and support programs that could prolong their lives.
The only hope is the $11 million granted to Nepal by the Global Fund to fight AIDS, tuberculosis and malaria. Sources say the first instalment of $4 million has arrived and is stuck in UN bureaucracy. "I am dying and too tired to knock on donor doors," says activist Rajib Kafle.
The Global Fund agreed to release funds to Nepal on condition that an independent institution manages it and not the government. (See: 'Aiding AIDS', #214). The UN system was selected as the contracting agency months ago but agreement papers between the UN and the government is said to be waiting at the Ministry of Health. "The file is not moving because the government has not been able to reach a decision at the cabinet," an activist told us.
Sources say that the UN is reluctant about acting as the authoritative body to manage the funds and distribute it among Nepali activist groups. Nepal receives one of the largest funds for HIV/AIDS in Asia but they say the biggest chunk is controlled by donor agencies and channelled to partner INGOs and NGOs. Some donors are said to be willing to increase the aid substantially as long as the government is not involved in disbursement.
Meanwhile, the country and people with AIDS are losing time. The $4.6 million has to be used within the first two years of the grant period, failing which the rest of the $11 million will be cancelled.
The main concern is not who controls the funds as long as care and support systems are put in place. "The government is actually doing a better job, it has already upscaled the ARV (anti-retroviral) treatment program with its own resources," says Kafle.
Despite objections and lack of support for the government, National Centre for HIV/AIDS and STD Control (NCASC) began ARV therapy for 25 patients. By December, it increased the treatment to 75 patients. The centre also plans to set up an ARV treatment facility in Nepalganj. "It would be better for organisations not to go after regular funding mechanisms. I would rely more on local resources," adds Kafle.
The situation of people living with HIV and AIDS is getting worse. Most NGOs have withdrawn from outlying villages due to the conflict. "The conflict has a double impact," explains Bina Pokhrel at Save the Children UK, "While the rate of infection is growing, response has decreased."
Naresh Newar
