Nepali Times
Money is not the answer



A woman in Kaiali was infected with HIV by her husband who was himself infected in a brothel in Punjab. How is she going to benefit from the $76 million that the Global Fund for AIDS, TB and Malaria approved at the fund's meeting Kunming on Tuesday?

If money was the only problem, Nepal would have solved its TB and AIDS problems long ago. These diseases are twin epidemics in Nepal and can't be managed only by money, they need a basic health infrastructure. AIDS was never a medical problem in Nepal, it is a socio-economic disease that thrives in political apathy and cultural norms that discriminate against women.

And we're not even talking about malaria because if the millions of dollars that have been spent on malaria eradication since the 1960s had been used properly the disease would have been eradicated from Nepal by now.

These are all communicable diseases. The first line of defence against communicable diseases is communication, spreading awareness about how it is transmitted. These are diseases in which knowledge literally makes the difference between life and death. But awareness is not the end of the story.

A migrant worker from Achham may know he can contract HIV if he has unprotected sex in a brothel in Chandigarh, but if he doesn't bother he will still be infected. His wife back in Nepal may know that her husband may be sick when he comes back from India, but if he beats her up when she suggests he wear a condom or get an HIV test it is likely she will also be infected.

Exactly where in this chain of events can the $76 million be most effectively spent? It is clear that the solution lies in addressing the issues of poverty, gender and ignorance. Everything else is a bandaid.

Ask the rickshaw driver in Nepalganj about AIDS and his answer will be: "Hujur, for us dal roti is more important than AIDS."

A Tharu woman in a remote village in Dang that we spoke to hadn't heard of HIV. Her husband is a migrant worker. There are hundreds of thousands of women like her all over Nepal. Yet, statistics show that 98 percent of Nepalis have heard of HIV. Does it really make a difference to have heard about HIV in Accham, Mugu, Bajura, Dadeldhura or Okhaldhunga? Or, for that matter, at a dance restaurant on Kathmandu's Ring Road?

It is difficult to see how the millions of dollars will make a difference in HIV control when there is no one in rural health posts to even test for blood pressure of someone infected with HIV, and there aren't antibiotics to treat TB patients, or to test an AIDS patient because the blood count machine is broken.

And what if the patient from Achham can't afford the bus fare to come down to Nepalganj for treatment? Is the money going to take care of AIDS orphans in the mid-western districts? How will they do that when the children are ostracized by villagers? Will the money go to the remote rural areas of Nepal where it is needed the most, or will it disappear along the way like most other funds in the past?

Most likely, only those who can write proposals in English will get the money. The Health Ministry keeps saying that our "female community health volunteers are the pillars of our health care system". Are the pillars going to get any of that money?
Probably not. It will go to the towns, it will go to the big names, it will go to the large NGOs.

Nepal's health activists have worked hard to rekindle the interest of the Global Fund on HIV, TB and malaria control in Nepal. Let's not waste their efforts by wasting this money.

(11 JAN 2013 - 17 JAN 2013)