PLHIV Stigma Index in Nepal

Verydiscriminatory(%)Discriminatory(%)Nodifferent(%)Supportive(%)Verysupportive(%)Notapplicable/NR (%)Community leaders 1.2 1.5 8.0 12.6 0.7 75.9Health care workers 2.7 3.2 15.6 44.8 4.1 29.6Social workers/counsellors0.8 0.7 12.7 42.6 3.8 39.4Teachers 0.7 0.7 8.3 7.4 0.6 82.3Government officials 0.4 0.4 4.6 7.7 0.7 86.3The media 0.1 0.2 5.8 8.3 0.8 84.8N 848More than two-fifths of the respondents (45%) stated that the disclosure of their HIV statuswas an empowering experience for them. A higher proportion of females found disclosure tobe an empowering experience as compared to males (49% vs. 41%) (Figure 7.5).Figure 7.5 Disclosure of HIV status: An empowering experience (N = 781)%5040302010041Yes49 4520 21 21NoCase Study 7. Kedar Bahadur Gharti (name changed to protect privacy)“HIV isn’t a big deal these days.”Not applicableKedar Bahadur Gharti, a migrant worker in India at the time, had never heardof HIV when he had tested positive in 1996; he had undergone an HIV test onlybecause it was mandatory for applying for the visa to Dubai.Kedar did not understand the implications of the results and thought he woulddie. Kedar began drinking heavily. “I experienced different feelings, and I didn’twant to return home. I was afraid that if I told my family or neighbours, they393034MaleFemaleTotalwould discriminate against me.” Kedar lost confidence in himself and avoidedsocial engagements. “I felt uncomfortable with my friends and with myself.”After having learnt his status, Kedar tried using condoms with his wife whenever hereturned to Nepal. However, Kedar’s wife wanted babies; therefore, he disregardedthe advice against impregnating his wife and risked the transmission of the virus tothe child. Kedar resumed the use of condoms after the birth of his two children—ason and a daughter.In 2000, Kedar confided in his brother about his HIV-positive status. He introducedKedar to a friend who had founded a support group for PLHIV. Kedar beganattending the support group meetings. His brother also helped Kedar disclosehis status to family members. Learning that Kedar was HIV-positive, his wiferesponded with resignation: “If you have HIV, I must, too. If you are going to die,so am I.” However, luckily, Kedar’s wife tested negative, as did his two children.Subsequently, Kedar became an outreach worker at the support group and gainedknowledge of HIV awareness raising and community organizing.Kedar emphasizes that the key to reaching the “hidden” population is a village-levelcampaign and persistence. Having seen many village-level interventions, membersof the “hidden” population of PLHIV have also voluntarily started coming forward.Kedar has disclosed his status to his children and they feel comfortable questioninghim about it, for example, they ask him, “Father, if we eat together, will we getHIV?” He uses the act of answering such questions as opportunities to teach themabout transmission methods; the family, of course, eats meals together.7.5 Antiretroviral TreatmentAt the time of the survey, 66 per cent of the respondents (68% males, 64% females and 41%transgender people) were taking ART, and 48 per cent of the respondents (43% males, 53%females and 59% transgender people) were taking medications for preventing or treatingopportunistic infections. In addition, 67 per cent of the respondents currently not on ART wereconfident that ART would be easily and readily available to them whenever they needed it inthe future (Table 7.9).Table 7.9 Access to antiretroviral treatmentCurrently taking antiretroviral treatmentMale(N = 424)(%)Female(N = 404)(%)TGperson(N = 27)(%)Total(N = 428)(%)Yes 70.0 63.6 40.7 65.9No 30.0 36.4 59.3 34.1Treating opportunistic infectionscurrentlyMale(N = 421)(%)Female(N = 401)(%)TG person(N = 27)(%)Total(N = 822)(%)Yes 41.4 52.9 59.3 47.660 61