Female Sex Workers: A MARP for HIV in Nepal

Sex trade exchanged in favour of kind and cash has been long practice in all socieity. In Nepal, the system has been seen and hidden since the long time ago.The majority of sex trade are carried out in market places. Namely the places are Kathmandu, Pokhara, Dharan, Biratnagar, Narayangadh, and major cities. Again, highway suburds are the major vulnerable places. Current development paradigm has made the rural people to have more access to roads and rapid movement of the populatons. This change in mobility ofthe population has led to an exposure to previosly unseen markets of sex trade in Nepal as well.

Legal Status of Sex Trade in Nepal:
Sex trade is illegal in Nepal.

Estimated Female Sex Workers in Nepal:

World Bank's estimates says there are 25,00-34,000 active commercial sex workes in Nepal. Besides Nepal, estimated 200,000 women are sold in Indian market of Nepal for sex trade the literatures suggest. Number of forced sex workers who are from Nepal and are serving in Circus of India are unpredicted.
Of all the sex workers; 15017% are street based. Five per sex workers are from outside of Nepal.



Profile of Female Sex Workers:

Kathmandu based sex workers' finding shows that 39% are street based, 32% are illeterate, 29% are single(divorced or separated). One third are less than 20 years of age. 60% had first sexual contact while they were of age 15-19 years showing the early initiation of sexual contact.( FHI IBBS,2006)
Another finding from highway district of Nepal reveals two third were illeterate, and one fith were less than 20 years of age. One fourth were single(divorced or separated. Median age of FSWs was 27 yrs. ( FHI, IBBS,2006)
World Bank estimates about half of the FSWs are returnees from trafficking from India(World Bank,2004).

Knowledge and Practice regarding HIV and AIDS:

Outside valley reseach shows 68% know sexual contact transmit HIV. However 98 % heard of HIV. 60% knew about the A.B and C method of HIV prevention. Kathmandu based research shows 99.4% FSW s heard of HIV and only 30.2% have heard of A,B,and C method of HIV prevention.(lower than others) (FHI,2006).

What ever the knowledge level is , only 11% of Capital based and 43% of out of Capital based FSWs use condom regularly. 1.5 is the average client per day for Kathmandu (the capital city) and 1.0 is for out of capital FSWs.

HIV prevelence in FSW is 1.5% which is similar in both studies.

More than 95% of FSWs were suffering from STIs but less than 5% has reached health facilities for treatment of the symptoms. Since STI presence significantly increases the risk of HIV transmission, this points suggests the gap to be filled immediately.


Access to Health Care:

The less than 5% FSWs who search for care of SITS has given private clinic, NGO run clinic and pharmacies as their preference over public facilities. Lack of confidenitialy, Discrimination by government health workers, negative attitud of service providers, poor communication and fear of being exposed were the some of the hinderances that makes FSW not to prefer government health facilities even if GON facilities are technically sound and well equipped. ( GHIMIRE Laxmi, 2009)
Right based approach to health service centre is not well established in Nepal. All the White coat holders(Health Workers) treat patients and clients as if they are giving them mercy or so. So, this is what the major policy lag in health system of Nepal which is making this risk goup out of reach groups to deprived of proper health care.



Changing Markets:
Soft prostitution, male prostitutes available for women, and international link of prostitutions in Nepal are some of the emerging issue in FSWs of Nepal. The current unofficial reports says that openness in sexual habits and rampant mobility has made more vulnerable groups. Some ameture sex workers are also in the markets. Some evidence has shown that someof the college students are involved in soft prostitution as well.



Deuki and Badi: Social Prostitution:

BADI system:
The badi were originally an entertainment caste - singers, dancers and musicians. Men of the community also fished and manufactured madal drums and fishing nets. Political, cultural and economic changes, particularly over the last fifty years, have contributed to and produced the development and practice of prostitution as a strategy of survival for many in the Badi community. Subsequently, it has been said that prostitution is the "traditional caste occupation" of the Badi and it has often been defined thus as a part of the caste system. In line with the socio-political transformations taking place in Nepal from the early 1950s and with the growth of prostitution, many male family members became economically dependent on the earnings of women. That situation was partially responsible for the loss of traditional community skills and professions.
As this sytem arised out of the social system,some of the Badi women show their anger like this'" "I eloped with a man from the low caste as my parents did not approve my marriage with him. We moved to Kathmandu and settled here. He was a micro-bus driver (one of the means of local transport), and I gave birth to two children, a son and a daughter. But as year passed by he stopped coming to home and when he did he used to become violent and beat me and my children and did not provide any monetary support. With no skills and education I had to make my children sleep with empty stomach and withdraw them from their school. And one day I discovered that he has been staying with the girl of his own caste in another part of the city. After that followed the arguments, verbal and sexual abuse and he finally moved to stay with that woman. I left my family for him and was so devastated and wanted to commit suicide but due to my responsibility to look after my children I could not do that also. Then with the hope to get into foreign employment I borrowed the amount of Nrs 35,000 and paid to the broker but during my health check-up, HIV virus was seen in my blood. So with no skills and nowhere to go I ended up as a commercial sex worker knowing I am infected with the virus. As he ruined me I want to ruin the men of this society by transmitting the virus"
This was the story told by one of the woman at Raksha Nepal and the essence of this statement might not be confined to one particular commercial sex worker but to many as women are into these situations as men they trusted and believed let them wander in the streets. Imagine yourself being born to the Badi community of Far western region of Nepal who has been given the tag of commercial sex worker right after the birth or yourself being offered to the temple as one of the offerings or imagine yourself being sold to the brothels or using commercial sex work as a last resort to sustain your life. How difficult is to imagine but the thousands of women in Nepal are going through this fate and are vulnerable to acquire and transmit HIV/AIDS. ( For readers' knowledge I have quoted this story from a case study by Ms. Anjana at http://www.worldpulse.com/node/12108).
However formally, this Badi system is abolished from Nepal. Many Badi women are taking lead to change their society to take out of this curse. State has made this act illegal now. Hence, the scenario will not be found in near future.


DUEKI Sytem of Nepal:

In 2007 according to a UN report, there werel nearly 30,000 deukis in Nepal compared to 1992, when there were 17,000 deuki girls according to the UN Special Report on Violence against Women.


Deuki is an age old vicious custom still practiced in many districts of Sethi and Mahakali zones in the far western region of Nepal. Deuki means to consecrate one's own or a poor family's newly born female child to god in order to fulfill a promise made earlier to gain religious merit.

Based on blind belief, the practice of deuki is to offer an innocent female child to the local temple to serve the god or goddess in order to gain a son, to cure a sickness, or to fulfill any other desires.

The center of this practice is located in Baitadi district's Melauli Devi temple. According to locals, around 2,000 such deukis exist in the various temples.Bought from poor families for Rs10,000 (U.S.$140) to Rs100,000 ($1400), no one takes on the responsibility to care for these children offered to the temples.
With virtually no one to take care of them, the children have to depend on and live off the offerings made to the temples. But because of the poor state of the nation and the frugal income generated by the area's temples, they are forced to find alternative ways to survive. As a result, they often end up selling their bodies.
The flesh trade of the deukis is on the rise. Misguided by their own selfishness, prominent locals spread the blind belief that sex with a deuki will give them religious merit. Is some cases, it has been reported that the families of those who sell such deukis to the temples have sexually exploited them.
Girls born from such copulations themselves are sold into deukis, while sons become religious healers. Meanwhile, people have started speaking out against the deuki custom. Many women's activist and human rights activists have called the deuki custom a transgression of human rights. But regrettably, the government has not taken any steps to put an end to this sick and depressing custom. Rather, it remains, staining the whole of Nepalese civilization with the tears of those unfortunate girls we call deukis.


Recommendations by Different Studies Regarding FSWs:

Some of the research findings have summarized the following recommendations to reduce HIV transmission among FSWs;
- Government should take ethical responsibility
-Free condom distribution should be made more intensive through more outlets
-Massive awareness and BCC intervention to transform safe habit
-Peer educator, outreach services and mobile clinics
-Expansion of functional VCTs
- Institutionalization of Right Based Approach to Health Care Delivery System.