Monday, 19 May, 2008
HIV/AIDS a threat to Ladakh
HIV/AIDS exists in all corners of the world. On every continent, every country and every region. However, here in Ladakh, a remote part of the Himalayas, it seems that everyone including doctors denies its existence. This is alarming since India has the second highest prevalence in the world and 60 percent of South Asia’s AIDS cases. “AIDS is knocking on the door of Ladakh and wants to come in,” says a 17-year-old student. In reality, AIDS is very much present here. What I found was a culture that undermines the dangers of the virus and won’t let the epidemic taint a pristine picture.An understanding of the culture’s taboo approach to such matters is crucial in understanding why HIV/AIDS is not acknowledged in a public way. Dr. Ghulam Mohd of the Leh Government Hospital said that “AIDS does exist here, and we have seen cases.” Dr. Ghulam Mohd explained that the most common cause of death among young people included TB, diarrhea and pneumonia, which are all secondary infections of AIDS.I interviewed several students of Students’ Educational and Cultural Movement of Ladakh (SECMOL) as well as several students in villages. Almost every student said that HIV/AIDS does not exist in Ladakh. The way in which people in Ladakh have separated themselves from the virus can in part be due to the fact that they don’t like to talk about it. If they don’t talk about it, it doesn’t exist, and that concept is what reaches the people.Ladakh is made up of small villages scattered among high mountain passes. Their inaccessibility due to few roads can be part of the idea that they are completely separate from the world. The villages are secluded in beautiful valleys and along rivers.The remote sense of Ladakh is interrupted every summer when 50,000 domestic and foreign tourists come here. This makes it seems inevitable that the people of Ladakh would be exposed to the virus. Over half of a group of students reported that they had heard or believed that tourists sleep with tour guides. Several students mentioned that they thought that outsiders including Nepalis, Tibetans and Americans had AIDS. However, there was no connection drawn between the tourism and presence of Tibetans here, and their own vulnerability to the virus.Rural Development and You is a large non-governmental organization stationed in Leh. Its intern said that, “Yes, AIDS does exist here but mostly among non-Ladakhis.” From here my surety of its existence increased. The military’s presence in Ladakh is visible everywhere, from the second that you get off of the plane. The idea that soldiers from southern India were in Ladakh for three months triggered the idea of prostitution and its relevance in Ladakh. When a group of teenage boys were asked if they thought that there was prostitution in Ladakh, every one said yes. However when girls were asked, most said no. Several of the boys said that the presence of prostitutes could be attributed to the presence of the army. One student explained, “Prostitution is good for men who were away from their wives for a long time, but is not good because they sometimes spend all of their money and have nothing left.” However there was no mention of the effects on the women or potential health risks.Commercial sex workers play a key role in the spreading of the virus, especially in the early stages. When society doesn’t want to acknowledge that prostitution exists in Ladakh, these vulnerable women will continue to be at a high risk of both contracting and spreading the virus further. Without the knowledge of its relevance, women will not be able to be reached by prevention groups.Most students reported having some form of education about AIDS in school, whether it was through their science textbooks or guest speakers. But the message isn’t getting across if none of them know of its relevance here and how it can potentially affect them. The students had received education about AIDS in school, but their parents and grandparents still don’t know what the disease is. Students who are unable to discuss this issue with their parents feeds into the idea that AIDS is irrelevant. Because education hasn’t reached adults, the potential of it spreading among them without knowing it is a serious concern.Even though Ladakh has a very conservative society, students have no education about AIDS before age 15, leaving children uneducated about potential health risks when doing something as simple as getting an injection at the hospital where clean needles may not be used.Most students said that they would get tested if they thought that they had AIDS. However, none of the students knew where testing was available and they were afraid of social stigma. “We provide testing here, and do have people come in commonly for voluntary testing,” explained Dr. Ghulam Mohd. However the confidentiality and readily available testing is questionable.It is clear that HIV/AIDS is present in Ladakh, and will continue to be an issue until people acknowledge its existence openly. Without acknowledgement, the virus will continue to spread throughout Ladakh. The realization of its global impact, and that its relevance will not ruin their culture but strengthen it through a communal effort, can stop the virus.Thorough education should be required for all students including how the disease is transmitted, who are at the highest risk, where testing and treatment are available, as well as the proper use of condoms and other protective measures. Also, testing should be free, readily available and confidential. And finally the message of health officials needs to improve. There should be billboards, ads, propaganda and information in order to get rid of stigma. Addressing HIV/AIDS in Ladakh is crucial in keeping it from spreading further.