The government estimates that 80 percent of HIV-positive people do not know they have the virus.
Most confirmed cases, 62.5 percent, are migrant workers and their wives, 41 percent and 21.5 percent, respectively, according to NCASC.
Migrating to work
Per capita GDP in Nepal is US$467, according to the Ministry of Finance, and the woes of the country’s job market – low pay, high unemployment – have been exacerbated by years of political turmoil.
These conditions push some 1.5 million Nepalis every year to seek seasonal work abroad, mostly in neighbouring India but, increasingly, in other countries in Asia and in the Gulf, according to the Nepali government’s Central Bureau of Statistics.
Away from their wives for long periods, some male migrant workers turn to brothels. This is how Thapa believes her husband became infected.
And the trend is showing no sign of letting up. Nearly half of all new HIV cases are recorded among people living in highway districts, which are home to high numbers of migratory workers, according to the 2010 UN General Assembly Special Session on HIV AIDS (UNGASS) report on Nepal.
Knowing the HIV risks faced by male migrant workers while abroad, Prativa Nepali, 22, decided to be unusually candid in discussing sex with her husband, who is working in Malaysia.
“I told him that that if you need a sexual partner while you’re there, that’s okay but be careful [use condoms],” she said.
Such frank discussions are much more difficult to navigate for Aayesa Seheba, 24, who lives down the road in Nepalganj’s Pragatisil community and whose husband is also working in Malaysia.
She is Muslim and she says her religion is strict in discouraging discussion about sexually transmitted diseases.
“When I brought up the issue with my husband, he said testing wasn’t necessary since he hadn’t done anything wrong,” she said. “And, in Islamic culture, this is something that’s very difficult to discuss.”
Trained by the Nagarjun Development Committee, a local NGO providing HIV/AIDS awareness and free anti-retroviral treatment, Chandra Kala Gurung works to broach such communication barriers between husband and wife.
Gurung said local attitudes towards discussing sexual health have relaxed somewhat in the 10 years she has been door-stopping men and women in the Pragatisil neighbourhood.
Resistance does not easily deter her. “If they don’t listen the first time, I go two, three, four or five times – however many times it takes,” she said.
“The first time I go I don’t ask direct questions. First, I just want them to know me. I try to make jokes. Later, I try to ask more: if they use condoms, if they have been tested for HIV.”
“If they get angry, I just laugh.”
She said the lives she can save are worth the awkward encounters.