Treatment Issues: Newsletter of Current Issues in HIV/AIDS - Volume 19, Number 5 & 6, May / June 2005
Rajiv Kafle

A Danish musician from the sixties wrote a song about Kathmandu: "The streets are made of rubber — take off your shoes and walk on them." In a present day Kathmandu if you take off your shoes there is a chance that you will get pricked by a needle. Over 70% of drug users living in this historic city are infected with HIV. However this neither rings an alarm for the government nor for the development partners working in Nepal. Our government is silent because it is in denial. The development partners are silent because Kathmandu is neither strategically nor politically important for them. For example, the Global Fund has overtly ignored the challenges it is facing in this country. Some time back a former board member of the Fund wrote to me: "Unfortunately Nepal is not a priority for the Fund."

Tourists traveling to Nepal in the early sixties wondered if Kathmandu had more temples than houses where people lived. If so, then it obviously had more gods and goddesses than people. Maybe it was true for the sixties but not anymore. As far as gods and goddesses, though, in the past few years I have turned into one myself. And it is really a difficult job.

So what are my responsibilities as a god? One of my major roles is to decide who lives and who dies. In the Hindu religion we believe in reincarnation, so it is easier for me to decide who should die now and be reborn and who should live this birth itself. This year I have already permitted a few people to die. Can you believe it?

Recently a guy came to me and asked me for help. He had TB and was living with HIV for the past several years. He was poor and had no one to look after him. He was weak and weary. I decided to help him out since I had some funds for his basic checkups, for some ARV drugs, if he needed them, and TB treatment was available for free. I welcomed him to my care home. He was immediately put on anti-TB treatment and his CD4 was checked. He needed ARVs too. His CD4 count was less than 50.

Now the challenges begin. We only had a nevirapine combination (AZT, 3TC & NVP) available to us. We had to find money to put him on an efavirenz combination since he was also on TB medication. Then he showed signs of anemia and we changed his regimen again. Then he started complaining about losing his eye sight. The doctors suggested that it could be CMV or it could be toxoplasmosis, etc. And then it was time for me to decide if he is to live or be left to die. And he is not the only person I am looking after.

I cannot afford to keep him alive.

This is not the world we wanted for people living with HIV. This is not what activists around the globe are fighting for. AIDS has divided this world into two. One for the rich where clinical trials are underway for a new generation of improved ARV drugs, and one for the poor where people still have to live at the mercy of Gods like myself.

Rajiv Kafle is the coordinator of Navairan Plus, in Kathmandu, Nepal.

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