The national consultation came at a time when Nepal is about to draft its National Action Plan on AIDS for the next couple of years. It is expected that the results of this consultation will highlight and design the strategic priorities of the country’?s response on HIV and AIDS, and resources will accordingly be allocated.
There are an increasing number of studies and reviews that have been carried out in South Asia, including Nepal, about the risks and vulnerabilities of MSM, TG and LGBTI to HIV infection. While there is a call to design and conduct further studies to fill in the information gap about TG and LGBTI and their environment, there has been encouraging development, according to the recently published review titled â?"Lost in Transition: Transgender people, Rights and HIV Vulnerability in the Asia Pacific Region"??, released by UNDP last month. This development includes: a developing transgender identity, growing pride and an increasing willingness on the part of transgender communities to advocate for increased participation in policy processes and organize peer support services at the national and local level. In Nepal, the establishment of BDS, an advocacy network of community-based organization working dedicatedly to empower and strengthen the MSM, TG and LGBTI community has been a laudable initiative. And we have seen much progress under the firm leadership of BDS.
Amidst all these efforts however, in Nepal, there is little effort to reach out to the MSM, TG and LGBTI communities for HIV prevention and education, treatment, care and support services. Let me highlight some key reasons behind this, while also laying down some progress that is finally being made now.
First, Nepal’??s socio-cultural environment is just starting to get friendly with the cause of MSM, TG and LGBTI. Significant progress in the area of HIV related human rights had been achieved. For example, in 2007 the Supreme Court of Nepal had issued a ruling on recognizing the third gender and the equality rights of LGBTI population in Nepal. In the recent discussions on the new constitution, anti-discrimination provisions had been included.
Progress is also evident in discussions between UN partners, government agencies and civil society organizations. For example, the National Human Rights Commission of Nepal has agreed to include sexual orientation and gender identity in its portfolio for the minorities. This initiative is being supported by the prime minister’?s office, Blue Diamond Society, UNDP, UNAIDS and the International Development Law Organization (IDLO).
Despite this, however, the situation on the ground remains disturbing. For example, I met members of the MSM, TG, and LGBTI community in Pokhara and Morang and some of their feedback was highly perturbing. Most community members still experience verbal and even physical abuse, discrimination and rejection primarily because of their sexual orientation. Full access to comprehensive HIV and AIDS services is still a daunting challenge. Hence, we need to continue to support and push for the translation of those policy pronouncements into action on the ground. We need to walk the talk in order to make these policies meaningful.
Second, targeted research on TG and LGBTI remains inadequate. This significantly impedes access to health services and blocks effective and timely response to HIV. An inclusive research, designed and implemented in partnership with the community, is imperative. Moreover, there is still a lack of understanding of the universe of MSM, TG and LGBTI, not only in Nepal but in Asia as a whole. To help address this, the regional DIVA project
(Diversity in Action) supported by Global Fund through its Round 9 regional HIV grant, is embarking on generating more quantitative and qualitative evidences about MSM, TG and LGBTI. This will help us re-design our programs and be more responsive to the genuine needs of the community.
Third, there is still no separate and specific approach to MSM, TG and LGBTI. These communities are lumped into one ‘salad??,’ instead of designing targeted intervention customized to the growing needs and realities of the community. In the new â??national strategy on HIV and AIDSâ?? 2012-2016, one of the priority strategies is related to MSM/TG. Note that TG continues to be part of ‘??MSMâ’?, even when studies have shown that the needs and vulnerabilities of TG and LGBTI in the context of HIV are different. So in the development of the National Action Plan on AIDS, or the operational plan to translate the NSP into activities and actions, we need to ensure that a more specific approach and set of activities for TG and LGBTI are incorporated.
The fourth is a challenge specific to Nepal and relates to the area of advocacy for action. There are a gamut of competing priorities for leaders in Nepal, leaving them with little space to take genuine action on issues related to MSM, TG and LGBTI in the context of HIV prevention and human rights programs. When we talk to leaders, either individually or in groups, they all agree that the issue has to be put forward, debated and acted upon. But with the long list of national priorities — from constitution drafting, to issues related to rule of law, food insecurity, economic progress and good governance – all core and fundamental to Nepalâ??s development- the issue of MSM, TG and LGBTI will perhaps be dwarfed or sidelined.
In Nepal, there is little effort to reach out to MSM, TG and LGBTI communities for HIV prevention and education, treatment, care and support services.
Clearly the issues, barriers and challenges that the UN faces in advancing the MSM, TG and LGBTI HIV prevention and human rights program are the same as what Nepal?’s national stakeholders face. AIDS is a behavior-driven disease and we are often confronted with strong cultural beliefs and biases that hamper effective HIV prevention programs. Our response is shaped by the political and legal environment. To a certain extent, from the UN, the degree of challenges could be different as we do not experience, first-hand, ground-level discrimination and stigma as community members do. And we continue to pursue what we believe in – the right of every individual irrespective of color, creed, religious affiliation and gender, to universal access to HIV prevention, treatment, care and support services, at relevant district, national, regional or international forum. This is in line with the 2011 AIDS political declaration that Nepal had committed to.
The UNAIDS family in Nepal continues to be prepared to help the country realize its national vision, goal and targets as enshrined in the 2012-2016 National Strategy on HIV/AIDS. The UN has a clear mandate and comparative advantage to assist the country in effectively responding to HIV and AIDS. Under our agreed division of labor, the "??empowerment of men who have sex with men and transgender people to protect themselves from HIV and to fully access antiretroviral therapy?" is being convened by the UNDP. We welcome the strategic support of UNDP, Nepal in this area, with the rest of the members of the UN joint team on AIDS. We continue to work with the hope and aim of making Nepal a truly equal and inclusive society.