United Mission to
Nepal (UMN) Sakriya HIV/AIDS Programme
Country: Nepal
Church or denomination: UMN is an international,
interdenominational Christian mission
Project summary: Training
in community-based prevention and care and support as well as establishing
a safe medical environment have been the two main activities of the United
Mission to Nepal Sakriya program. Materials have been developed to help
UMN hospitals in the care and support of HIV/AIDS patients and visits have
been made to encourage the development of policies and procedures. As these
activities come to completion, the focus is shifting towards the training
of much needed HIV Counsellors for Nepal.
Background/ History: The
epidemic in Nepal is considered a “concentrated epidemic”. It has not penetrated
far into the general population, where the adult prevalence of HIV infection
is thought to be about 0.5%. However it is high in two main groups: Intravenous
Drug Users (up to 60%) and Sex Workers (up to 17%).
Clients of sex workers are expected
to act as a “bridge” to the general population, leading to a risk of generalized
spread. Two social movements are important: migrant labour and girl trafficking.
Probably more than 1 million males per year seek work in India and elsewhere.
Many become clients of sex workers in India. This movement disrupts families
and there is a tendency for the wives who remain in Nepal to have extramarital
sexual relationships to an extent that was previously unknown. There are
also thought to be some 200,000 Nepalese girls and women in the sex trade
in India. They may become infected and many return to practice their trade
in Nepal.
UNAIDS predicts a prevalence
of 1-2% in the general adult population by 2010. AIDS would then be the
most common cause of adult death in the country.
At present, relatively few people
are affected outside the high-risk behaviour groups. In village and urban
communities, a few people may know of people living with HIV/AIDS (PLWHA).
Some community health workers have had contact with PLWHA.
UMN does not work directly with
intravenous drug users, though International Nepal Fellowship (INF) does.
Nor do we work directly with sex workers at present. However we do co-operate
with NGOs working in this field and expect to do so more in the future, especially
in the area of training counselors and peer counselors.
Hospitals are finding significant
numbers of HIV positives, but there is as yet no detectable pressure on services
resulting from these patients.
Goals:
Our goal is to limit and, if possible, prevent general spread of the epidemic
in Nepal and to reduce the impact of the epidemic on those already infected
and affected. On the basis of experience elsewhere, there is a significant
possibility that increasing HIV spread would obstruct development, increase
poverty and reduce life expectancy at birth by up to 20 years.
Objectives:
With respect to the United Mission to Nepal Sakriya
Unit, the original thrust was to equip our staff of over 1000 with the knowledge
to protect themselves and their families against HIV. The objective of setting
up independent HIV programs in all United Mission to Nepal projects was almost
fully achieved by July 2002. A more recent objective is to train sufficient
HIV counsellors for the needs of Nepal.
Main activities:
Training in prevention and care and support as
well as establishing a safe medical environment have been the two main activities
of the UMN Sakriya program. Materials have been developed to help UMN hospitals
in the care and support of HIV/AIDS patients and visits have been made to
encourage the development of policies and procedures. A policy for post-
exposure prophylaxis for occupational exposures has been implemented in UMN
hospitals. A sterile needle and instrument pack has been provided to UMN
staff to carry while travelling. Various tasks have been undertaken in co-operation
with other organizations, and classes or courses have been provided for them.
A Counseling Training Course
has been developed and used to train HIV counsellors both from UMN and other
organizations. Various improvements have recently been introduced and Sakriya
Unit expects to become the main source of counselling training in Nepal.
Whilst no formal theological
studies have been performed, a short statement of Christian Belief in relation
to HIV and AIDS has been prepared.
Informational and educational
materials have been developed to support the various efforts. They include:
§ Poster
§ Airmail letter with HIV
message (can be sent to husbands working abroad)
§ Two books in simple Nepali
§ Two flash card sets
§ Book of poems about HIV
and AIDS
§ Book on living positively
§ Video drama
§ Counselling training video
(translation into Nepali)
§ Regular newsletter
§ Email notification of important
news
Expected outcomes: See
objectives listed above.
Results:
Quantitative evaluation suggests that the following
numbers of people had been reached with HIV messages as of mid- 2001:
§ 919 UMN regular staff
§ 4,500 UMN temporary staff
§ 70,000 Community members
Who does the work?
Nepali Church response As there is no overall church
administration in Nepal and churches are mainly small, independent and loosely-
linked if at all, it is not possible to summarize any common response. To
date there are 4 known church-related responses to HIV/AIDS. Two are related
to the church attended by the coordinator of the Sakriya Project. There
are certainly others. Two Nepali missionaries, husband and wife, have been
seconded to work with sex workers in Mumbai. There is also a refuge for
HIV positive former sex workers in Kathmandu under the auspices of the Professional
Believers Fellowship.
Other efforts include a similar
refuge, started by an English lady and now run by a Nepalese lady and her
family as well as a church in Pokhara that contributes to social care and
counselling of poor patients at the Regional Hospital, including HIV positive
individuals.
Lessons learned:
There is a general failure to recognize the severity
of the HIV/AIDS threat, and this affects both the government and the churches.
The churches have historically given much higher priority to evangelism than
to social work, though there has been some degree of change recently.
There is considerable response
from national and international NGOs but a rather limited government response
so far. These efforts suffer from limitation of scale and poor coordination.
This may improve with the implementation of a large, internationally-funded
effort, the Nepal Initiative, and the adoption of a National Strategy.
Funding and other resources: N/A
Further reading and other documents: N/A
Contact information:
Dr. John Dickinson
UMN TB Consultant
PO Box 126
Kathmandu
Nepal
Telephone/fax: +977 1 251570
E-mail: john@sakriya.umn.org.np