In a residential area of Kathmandu, Nepal’s capital, neighbors are unaware of what goes on inside this three-story building. Neighbors stare at the men, often dressed in women’s clothing and makeup, as they disappear inside.
The building is a hospice center for HIV-infected men who have sex with men, MSM, and "meti," the term for transgender or "third gender" people here. Blue Diamond Society, BDS, an advocacy group for lesbian, gay, bisexual, transgender and intersex Nepalis, runs the center to provide services for the most critical cases.
"Third gender people are often disliked by the society," says Dibya Gurung, one of the residents at the facility. "Due to the fear of discrimination, we often don’t come out as HIV-infected."
Gurung, who is infected with HIV, comes from Tanahu, a district about 150 kilometers west of Kathmandu.
He wears a green vest and a sarong-like cloth called a "lungi." With pink bangles around his wrists, red beads around his neck, his nose pierced, ears decked with gold earrings and his eyebrows neatly threaded, the 32-year-old looks like a woman. His mannerisms and the way he talks are also feminine.
Although he has a man’s body, Gurung says he leads a feminine life. Because of this, he says he often has had to face social ridicule.
Growing up, he says that he liked sitting with the girls in school. But teachers disapproved, as girls and boys do not sit next to each other in most of Nepal’s schools. Because of this lack of acceptance, Gurung dropped out of school after the fifth grade.
Gurung says that he faced opposition at home, too. Unlike boys his age, he preferred to do household chores and wanted to wear his mother’s and sister’s clothes. Gurung’s family started to resent him, eventually forcing him to move to Pokhara, a tourist town in central Nepal, and work as a dishwasher.
"Though I’m born as a man, I’m trying to live as a woman," a tearful Gurung says. "It’s actually a very tough job."
Born as Nandu Lal Gurung, he changed his first name when he got older to Dibya, a unisex name that is popular mostly among women here. In Pokhara, he says he met a man named Manoj Thapa and soon fell in love with him.
After their relationship developed, Gurung says that Thapa told him that Nepali society didn’t respect people from the third gender and asked him to elope in India. He lured Gurung with the prospects of a good job and a better life in Mumbai, India’s largest city, notorious for human traffickers and prostitution. With a dream of getting married and also meeting other transgender people, Gurung traveled to Mumbai via the border town of Sunauli. Upon arrival, Thapa introduced him to the "aunties" in the brothel area for transgender people in Kamatipur, Mumbai’s infamous red-light district.
Gurung says he was happy to see people like him in the area. But in no time, he realized that the man of his dreams had sold him into the sex market.
"Manoj had actually duped me and sold me [to the brothel]," Gurung says.
Initially, Gurung worked in the hotel that the brothel owners operated. But two months later, they forced him into sex slavery. When he resisted, they forcefully restrained him, physically tormented him and allowed four or five men to rape him.
As a sex slave, Gurung says that he had to satisfy 10 to 12 men every day. He says it was painful. He says that some of the men who came into the brothel were handsome, and he liked some of them.
"However, it was like hell," he says, summarizing his experience.
And the experience only turned grimmer six years later when the brothel owners sent him for a blood test. His report came back positive for HIV. He says he thought the disease would kill him immediately.
Gurung says he wanted to return home and looked for opportunities to escape. During a festival, he escaped to Nepal.
But at home, nothing had changed. He says people still didn’t like the way he walked, talked and dressed – including his parents.
A decade ago, he decided to move to Kathmandu. Here, he met like-minded people from BDS at Ratna Park in the center of the city, where they usually hang out. He has lived at the facility ever since.
"I thought I would die immediately after contracting HIV," he says. "But I’m still alive.
Now he lives and works as a caretaker at BDS. His responsibilities include cooking for other HIV-infected residents and also distributing condoms to other third gender people.
Still, he says he is lonely and can’t be open with his family.
Gurung has been back to his hometown in Tanahu, but he didn’t let anyone know about his HIV status. He also had safe sex there with a man who promised to marry him, an elated Gurung says.
But this turned out to be just a ploy to have sex with him. Now he says he is alone, can’t talk about his feelings to anyone and is stressed.
"Most of the friends I have died of AIDS," he says. "I only wish I had a husband [until] the day I lived."
Third gender people and MSM living with HIV say they face a double stigma in Nepali society. BDS is one organization that strives to educate and treat sexual and gender minorities when it comes to HIV, as well as sensitize the community to reduce ridicule and abuse. The government is implementing various plans to address HIV here and is working on issuing citizenship cards to third gender Nepalis to ensure their rights to various services.
BDS is currently working with more than 300 HIV-infected MSMs across the country, says Malika Lama, BDS care and support program manager at the Kathmandu office.
About 6.2 percent of all HIV infections in Nepal occur in men who have sex with men, according to 2009 statistics from the National Center for AIDS and STD Control, NCASC, established under the Ministry of Health and Population in 1995. Of 140,691 Nepalis who identified as men who have sex with men in 2009, the HIV prevalence was 3.8 percent. But the report acknowledged limitations in these figures because data has only been collected in Kathmandu, with the prevalence for the entire country assumed based on these figures.
In Nepal, third gender people don’t have equal rights with other people, according to a BDS study. The society also doesn’t openly embrace them, citing religious and cultural reasons. Their families isolate them, and society discriminates against them on various fronts such as education, employment and inheritance of property.
Many end up in the sex trade either by force or by choice in order to make a living, which often leads to them contracting HIV and, therefore, the double stigma. In the sex trade, they are vulnerable to sexual violence, rape and mistreatment by customers and even the police.
Om Prakash Khanal, local police inspector, says there have been some cases of police abuse but that most reports are blown out of proportion.
Like Gurung, Mohini Sardar, 26, from Morang, a district in eastern Nepal, is also an MSM. Born as Gopal Sardar, he prefers to be called Mohini, a female name, and bears feminine traits. Sardar also has HIV, which he contracted two years ago.
The only child born to a family with moderate income, he moved out when his family started disliking his behavior. He says that living on his own, it was easier to be himself Â- to look at himself in the mirror, comb his hair, apply makeup and also have other male friends over.
He lived in a rented room in the industrial town of Biratnagar in southeastern Nepal, which is close to the Indian border. There, Sardar worked as a third gender entertainer, dancing during weddings and other functions.
"But financial woes are a part of life since I didn’t have a good job," he says.
One day he ended up in New Delhi, India’s capital, with the dance troupe. There, Sardar says he had sexual intercourse with several men – at first for pleasure, but then to make some extra money.
"When there were so many men, I didn’t have time to ask them to use a condom," Sardar says. "That’s how I contracted HIV."
But then Sardar found out about BDS and stopped having sex for money. Now Sardar works at the Biratnagar branch of BDS. He spreads awareness about HIV and also distributes condoms to other people like himself. During his leisure time, he still works as an entertainer for extra cash.
Like Gurung and Sardar, Kala Rai, 37, from Sunsari, a district in eastern Nepal, also has HIV. Though his name is Chakra Rai, he says he likes being called Kala or Kshitija, female names.
Rai says he came to Kathmandu to escape life in a poor family. He initially got a job as a dishwasher, but he quit after his employer didn’t pay him. When he couldn’t find any other work in Kathmandu, he says he got into the sex business.
But Rai says it wasn’t as easy as he had thought it would be. He says that customers used to run away after having sex without paying him. One time, a group of men took him to the outskirts of the city and had sex with him, but then they robbed and beat him instead of paying him.
When he went to the police, he says they put him in jail and also raped him. He says he has been in police custody multiple times, once for 17 days.
Khanal says that there have been some cases of police abuse but that most cases are exaggerated.
Rai says joining the sex business has also affected his health. He initially suffered from sexually transmitted diseases like syphilis and gonorrhea. He eventually contracted HIV.
"I sold my body to survive," Rai says. "I’m now living with the result."
Rai has since left the sex business and now works for BDS, helping other HIV-infected transgender people and also advocating for gender rights.
BDS was established in 2001 in order to protect and advocate for the rights of sexual and gender minorities. BDS, with support from Sidaction, a French nongovernmental organization, has been running a care and support program for people who have come forward as MSM.
The organization has 50 network offices in 30 districts that teach sexual and gender minorities about safe sex through the use of condoms and lubricants. The workers educate them about HIV tests and make them aware of their rights. So far, some 400,000 sexual and gender minority have been in contact with the organization.
Gurung says that BDS has become a forum for people like him to come and share their problems. He says that listening to stories from people all over the country makes him forget his ordeal in the Mumbai brothel.
"Though discriminated by family and society, we have a place to call home here," Gurung says. "It feels we have gained a lot in life."
BDS aims to spread awareness, find employment for MSMs and meti, enhance their capacity and advocate for their rights, according to its 2009 annual report.
"After BDS came to existence, who voices for us, we haven’t had to face such violence," Rai says.
The BDS hospice facility in Kathmandu treats people with the most critical cases of HIV. Personnel there are currently treating nine transgender people, while eight have died during the past year. Others have come to the facility but have been able return home after treatment and advice from the doctors there.
Still, BDS personnel say there are many challenges to providing care.
Although many come for treatment for HIV, most of them don’t disclose their sexuality for the dread of being a social outcast, says Shila Chaudhary, program coordinator of the BDS HIV/AIDS prevention office in Dang, a district in Mid-Western Nepal. She attributes their hesitancy to a lack of awareness and education in society. The officers must persuade them to disclose their sexual identity so they can receive treatment they need.
Lama says that the lack of social recognition of third gender people makes the situation even more difficult. They still aren’t seen as credible employees, face discrimination, often are confused as male or female at health facilities and also face problems when deciding whether to use the male or female restroom, she says, citing some of the issues.
"They face problems in every sector," Lama says.
And coming out openly as an HIV-infected MSM or meti would only add fuel to the problems, she says. So many remain silent.
"When you say third gender, and on top of that HIV-infected, the struggle is paramount," Lama says.
Lama says it was difficult to rent a facility for the hospice in Kathmandu because of the double stigma attached to HIV and third gender people. Before, they were forced to leave another property they had been renting in a different residential area of Kathmandu because the landlord found out that they were treating transgender people. So they are now operating without disclosing their identity, Lama says.
Lama says that the government hasn’t helped, and the funding they receive from foreign donors doesn’t allow them to maintain a satisfactory lifestyle for the patients.
In Kathmandu, services such as antiretroviral treatment, ART, for people living with HIV are most available at the Sukraraj Tropical and Infectious Disease Hospital. But the hospital is usually busy with patients with other infectious and waterborne diseases, Lama says. So patients have to go to other hospitals like Bit Hospital and Tribhuvan University Teaching Hospital for ART and for any surgeries they may need.
"Even to get [medical] treatment, you have to struggle a lot," Lama says.
Chaudhary says that because it’s awkward for MSMs to go to hospital in their villages, it also takes time to get the test results.
The government is currently implementing the National HIV/AIDS Strategy 2006-2011 and the National Action Plan 2008-2011. It has created advocacy programs across the country and offers free ART to Nepalis who are HIV-positive.
Nepal’s government classifies male sex workers and their customers, female sex workers and labor migrants as high-risk groups in its National HIV/AIDS Strategy. But Sanjay Dahal, public health officer at NCASC, says there isn’t a separate policy or programs for MSM.
"Nepal government’s treatment toward all HIV-infected is the same," Dahal says.
According to the NCASC report, it is difficult to reach MSM with HIV and AIDS programs because many MSM lead heterosexual lifestyles, thanks to social factors and cultural pressure, such as the push to conform to traditional male roles and the stigma of homosexuality.
Still, NCASC carries out regular studies of the behaviors, habits and lifestyles of the most vulnerable populations, including MSM, to improve services.
Meanwhile, the Supreme Court has ordered the government to recognize sexual minorities and issue them citizenship cards to reduce stigma. They have the right to choose a third gender option, so they aren’t limited to checking the "male" or "female" box.
But Sardar says that the decision hasn’t been implemented, and they haven’t been issued citizenship cards accordingly.
"We’re also a citizen of this country," Sardar says. "Discrimination based on sexual orientation means we’re being deprived of our basic rights. Our rights should also be respected."
Manisha Dhakal, president of the Sexual and Gender Minority Association, an umbrella federation for organizations nationwide working for rights for sexual and gender minorities, also agrees that the court’s order hasn’t been enforced yet. She says government officials tell people that it’s not possible to get a citizenship with a third gender option.
Hari Prasad Mainali, undersecretary for the Ministry of Home Affairs, says the government is preparing laws to enforce the Supreme Court order to grant citizenship to Nepalis of the third gender.
Until this happens, transgender people and MSM say they will continue to press for rights and are optimistic they will achieve them one day.
"Though we have gone through the pain [and struggles], we hope the future generation will not," Gurung says optimistically.