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Final Report for the
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Table of Contents II. Background and Country Context III. Country Program Description A. Introduction Country Program Description B. Situation Analysis The Terai area was specifically targeted for AIDSCAP/Nepal because at that time it was well documented that India had numerous pockets of high HIV infection, that there was high volume of human traffic between the two countries, and the high probability of sexual contact between Nepalese with infected persons in India or persons traveling from India. Several studies documented the situation of trafficking Nepali women to India, particularly to Bombay, for sale into sexual slavery, as well as the demand for sex workers in and around the major cities of Delhi, Calcutta and border cities and towns in the states of West Bengal, Bihar and Uttar Pradesh. This combined with the labor migration of rural-based Nepalese men to India for long-term and seasonal agricultural work, the migration of northern Indian men into southern Nepal for business and labor, and the internal, domestic migration of Nepali men and women from remote rural districts to Nepal's industrialized cities situated at the international border. This pattern of interaction posed a special risk for persons living, working and traveling in the heavily populated Terai region -- especially those involved in the commercial sex industry. The Strategic and Implementation Plan for Nepal had identified five major urban areas and adjacent satellite towns along Nepal's open border with India as the geographic focus for project interventions. At that time there was very little if any prevention programming supported by HMG, NGOs or INGOs ongoing in those areas. In light of the fact that very little data existed on the commercial sex industry of the international border areas in Nepal, it was jointly agreed by AIDSCAP, the NCASC and the USAID Mission that a rapid assessment was required to refine the strategic plan's proposed interventions. Detailed subproject planning could not take place without formative research providing more conclusive social and behavior data on the targeted populations. The rapid assessment, entitled Sexual Networking in Five Urban Areas in the Nepal Terai was conducted by a Valley Research Group (VARG) team including an expatriate anthropologist, a Nepali physician long-associated with HIV/AIDS programming, and male/female field interviewers. Five urban sites were selected for research including the major east-west border cities of Biratnagar (Eastern Region), Birgunj (Central Region), Bhairawa (Western Region), Dhangadhi (Far Western Region) and Mahendranagar (Far Western Region). The assessment utilized qualitative and semi-quantitative methodologies to interview 56 CSWs, 100 clients and 80 potential AIDS educators (health workers, education professionals, NGO staff, chemists and social workers). The assessment team experienced major difficulties identifying and arranging interviews with female sex workers in many sites. In the city of Birgunj no sex worker interviews could be facilitated. This situation resulted from the "underground" nature of the local commercial sex industry and the fact that a recent murder of a CSW had occurred. The team had relatively little difficulty interviewing clients or potential educators in all the sites. The findings of the rapid assessment affirmed the existence of an active commercial sex industry in Nepal's major border cities and confirmed the need for interventions with targeted population groups and further defined the geographical focus. The study also confirmed the existence of the commercial sex industry in communities outside the urban centers and provided new insights into the organization of the sector, the lifestyle of sex workers, and some of the difficulties encountered by members of the profession. The VARG assessment depicted Nepal's Terai-based sex industry as an underground and very mobile lifestyle. The industry differs from location to location, and sex workers themselves constitute a mobile, "floating" population. The sex industry in these regions is not an enslaved occupation as compared with the situation found in the Bombay brothels, but is an occupation "by choice", based primarily on individual/family economic need. Arranging interviews with clients of CSWs was simple compared with CSW interviews. Men were quite willing to be interviewed and were easy to identify. The majority of clients selected for interview were transport workers. Secondary clients interviewed included migrant workers, businessmen, students, laborers and civil servants. Due to the transient nature of men's lifestyles in a border region -- it was found that commercial sex is sought on both sides of the Nepal-India border. Probably the most significant finding resulting from the client research was a national road map on which transport workers were asked to designate the locations preferred for commercial sex. The resulting map identified small rest stops (halting points) along the major east-west and north-south highways leading from India into Nepal. Transport workers identified remote, highway-based tea shops, restaurants and lodges as the preferable rest and entertainment sites over similar establishments in the border cities. Nepali truck drivers prefer to rest and relax at small roadside locations where there is plenty of space to safely park and maintain their trucks, and are less bothered by police and others. Given men's preferences for the remote, out-of-the way locations and CSWs need to maintain transient lifestyles it was determined that the geographical focus of the project should expand beyond the five, border cities to also include smaller commercial centers, transport bazaars and halting points adjacent to Nepal's major transport highways. The rapid assessment also confirmed the importance of the intervention strategies proposed in the strategic plan. These interventions included the need to upgrade the skills of chemists as AIDS educators and STI providers, and the need for innovative condom promotion for disease prevention. As these facts were realized by AIDSCAP, the NCASC and the Mission -- other related factors were also considered in refining the focus of the AIDSCAP/Nepal project. Most importantly was the startup of new and large donor initiatives, including AmFAR's funding of 17 NGOs in Kathmandu Valley, northern districts, and localities in the Eastern and Western regions, and the EEC's confirmed plans to upgrade a public sector STI clinic for transport workers in Dhalkebar in the Central Region. These factors, combined with a more realistic analysis of the available project financial, manpower and NGO resources refocused AIDSCAP from an east-west urban city strategy to one focused on 435 kilometers of Central Region highway -- Nepal's primary access route to and from India. The project's target populations were individuals at highest risk -- commercial sex workers (CSWs) and their clients. Intervention activities targeted women engaging in commercial sex and men engaging in high risk sexual practices, most particularly transient population groups -- transport workers, migrant laborers, military, police, businessmen, travelers and campus students. To reach these populations AIDSCAP's geographical focus included Central Region and Terai communities along the nation's primary transport routes -- the Prithvi, Tribhuwan and Mahendra Highways -- and communities adjacent to the international border. Throughout the life of the project interventions were implemented in the nine districts of Dhading, Chitwan, Makawanpur, Parsa, Bara, Rautahat, Sarlahi, Mahottari and Dhanusha. |
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