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GUEST COLUMN |
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'Opportunity
is Knocking' Countries at the Crossroads - Is Anyone Listening?
Kevin Osborne |
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| "Grab the bull by the horns!" It was
with these clichéd words that my grandmother instilled
in me the need to tackle my problems with determination and
gusto. With fearlessness and vigor. But as a five-year-old growing
up on a farm that did actually raise bulls, I was more than
just a little afraid of both her words and the sight of those
bulls! It was only sometime later that I realized what she actually
meant; it is only now that I can truly appreciate the value
of her words. |
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| The dynamism of the HIV/AIDS epidemic
possesses many consequences. Chief among these is its ability
to present varying scenarios across different cultural, social
and geographic settings. Many countries are currently at a pivotal
crossroads -- the HIV/AIDS policy decisions made today will
set both the tone and magnitude of the future epidemic. |
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| It seems quite logical, then, that
the global policy lessons made during the past two decades of
HIV/AIDS will be considered when these future decisions are
made. And while this is indeed happening with greater regularity,
it is the ability of countries to find creative and innovative
means of contextualizing and operationalizing these lessons
that is the true test of inspired leadership. |
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| This is perhaps no truer than in
Nepal, a country which has moved in recent years from a low
prevalence of HIV to a concentrated epidemic -- female sex workers
(FSWs), injecting drug users, the mobile populations and group
of men who have sex with men (MSM) are displaying the greatest
numbers of infection. The significance of both the mobile population
and MSMs emerging as critical cross-over groups vulnerable to
HIV/AIDS, and further transmitting from concentrated populations
to generalized populations, may be serious. |
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| But it is perhaps the issue of injecting drug users (IDUs)
in Nepal that is currently raising some of the most interesting
debates. Studies from the early 90s disclose that 2 percent
of IDUs in Nepal were HIV positive. However, recent studies
in 1999 reveal that rate of HIV positives among IDU's to have
risen to 49 percent. It is clear that current policies to address
this problem are obsolete and inadequate, for HIV/AIDS policy
decisions are best made from a broad human rights perspective
for this allows the developmental threads of the epidemic to
be addressed in a comprehensive manner. |
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| Use of narcotic drugs in Nepal has existed for centuries,
from the mythical era of gods and goddesses to the present day
kaliyug. Although reasons for use and types of narcotic that
prevailed have dramatically changed over the period, its utilization
has rather alarmingly escalated due to criminalization of cannabis
and easy availability of other cheaper substitutions for drugs.
Furthermore, increased availability and an increase of dependency
on pharmaceutical drugs have led to the induction of users from
different sectors of society and different age groups in urban,
as well as rural settings, throughout Nepal. |
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| Unpopularity of internationally acclaimed efforts based on
a notion that harm reduction does not necessarily reduce drug
habits and, because usage of drug habits in itself is perceived
as an illegal act, getting the government's policy endorsement
has been difficult. This in turn leads to increased police harassment
and extortion, lack of adequate care and support services, and
increased stigma and discrimination. There are pleasing signs
that the policy tide is, however, slowly beginning to turn,
but it is based on the shaky foundations of yet untested political
commitment, the very cornerstone of ensuring that the synergy
of collective efforts, -- government, donor communities and
civil society -- are maximized. |
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| Windows of policy opportunity exist. And these opportunities,
such as an IDU intervention in the 90s when the prevalence was
low, should not once again be squandered. Nepal, like many other
countries, is at an important crossroads. Should we blandly
follow the accepted recipe or, instead, challenge, at the very
highest levels, those policies that subtley ensure the vulnerability
of those most at risk? That is the question. This will mean
looking at HIV through a developmental lens; ensuring, for example,
that MSM issues are on the policy table now; and that current
policy constraints for FSWs are addressed. This will require
that the tangibles of political commitment are put into action.
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| Political commitment to AIDS is not an end point but rather
the precursor to action. It is not emotive words and empassioned
rhetoric. It is not the relating of horror statistics and frightening
figures. It is not thick documents and policies that gather
dust. It is not only national political leaders but also those
at the provincial, regional and district levels. It is not about
protocol and procedure. |
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| It is the listening to the voices of people that are infected
and affected. It is the putting into place strong coordination
arms to avoid duplication and wasted resources. It is taking
up the challenges and forging a hope-filled path. It is the
willingness to take chances; to put in place new policies and
plans that may challenge our own earlier perceptions. It is
the provision of clear direction -- based on facts and research,
on seeking out answers. And it is making strategic choices.
It is the willingness to be bold and brave, human and humane.
It is the willingness to come out. To mention the very personal
impact that AIDS is having on all of us. It is the willingness
to break the silence about intensely personal matters. It is
the number of deaths that have been averted as a result of the
implementation of a particular initiative. It is the smile on
an HIV positive mother's face when her child has not been infected
at birth. It is needle exchange and harm reduction programs
aimed at IDUs. |
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| It is, in fact, the grabbing of a bull by the
horns. My grandmother was right. |
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| Reproduced with permission from
AIDS Link, Issue 73 |
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| (All the views expressed in this column are entirely
that of the author) |
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| About
the Author |
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