Reeta vividly remembered the day her father sold her.
She was 13. It was during the rainy season of 1999. Two men came to her village in the eastern hills of Nepal. They said they would give her work in Kathmandu.
But she was never taken to the capital. Reeta said she was trafficked across the border to India, where she was forced to work as a prostitute in the red-light district of Mumbai for four years.
When she arrived in Mumbai, India's most populous city, Reeta was a beautiful girl with smooth, rich brown skin, large round chocolate eyes, and long black hair. She was popular with the brothel's clients.
But by the time she turned 17, she was thin and frail. The daily routine of having sex with three or more men had withered her. Some of the sex acts were violent, and few customers used condoms. Soon her skin became discolored, pale. And her face appeared lopsided. (In 2001, a client shattered Reeta's left cheekbone. It never healed properly.)
Still, despite her diminished appearance, she continued to receive at least one client each day, though she had become too old for many of the clients' liking and she was sick much of the time.
Reeta finally left the brothel in late 2003 when she became too sick and unattractive to make the owners a profit. It took her nearly three weeks to complete the long journey back to her village.
When she returned home, she said, it was easy to tell which families had sold their daughters — they were the ones with tin roofs and FM radios. Reeta was quickly shunned and forced out by her family when she told them of her years of sex work.
With nowhere else to go, she set off for Kathmandu, where she found work in the Thamel District of the capital at a restaurant where waitresses often performed sexual favors for their customers — many of whom were police officers and army men.
The other waitresses, many having also previously been trafficked to India, recognized right away what was wrong with Reeta. She had Mumbaiya.
“Mumbaiya is common for us girls who have worked in India,” Reeta said.
Like more than half of the rural women in Nepal, Reeta was illiterate. If she had been able to read, she may have known about the reports of the spreading AIDS epidemic in Nepal. If she had known about clinics and services, she could have been told sooner that the disease she knew as Mumbaiya was really AIDS.
There are clinics in Kathmandu that do HIV testing and provide some treatment services, but Reeta didn't find them until it was too late.
“One day I could not make it to go to work. Some friends came to find me, and I was too weak to stand and I had a high fever,” she recalled during an interview in her small, one-room home in Kathmandu.
When friends took her to a clinic that day in the summer of 2004, Reeta learned that she was not only HIV-positive; she had AIDS. She had never heard those terms before — HIV or AIDS.
When a social worker asked Reeta if she had used condoms while in India, she admitted that she was not allowed to ask a customer to use one.
“But if he used it on his own, I was happy,” she said.
Reeta's story is not atypical for a young girl from the villages of Nepal. The United Nations estimates that brothels in India hold as many as 160,000 Nepali women and girls.
It is impossible to know when Reeta contracted HIV or how many others she infected. What is known is that at least 50 percent of the Nepali girls who are trafficked to Mumbai return to Nepal HIV-positive.
In an interview just three months after she was diagnosed with AIDS, Reeta seemed to have already lost her will to live. Throughout her life all Reeta knew was what she was told. She was both denied her human rights and unaware of them. The most basic right she lacked was access to information.
“I cannot read or speak English. I am just a prostitute,” Reeta said in September 2004. “I have no friends in this world during the light of the day. I lived a dark life.”
Reeta died in August 2005. She was 19.
Today, in Nepal, human trafficking remains rampant. And the AIDS epidemic has reached critical mass. Need for prevention and treatment efforts is still high, as more than half of the population is unaware the disease even exists.
But that number is now beginning to decrease, because information about AIDS is not as scarce as it used to be in Nepal. Thanks to the wonders of solar and satellite technologies and one San Francisco organization, information about health care and empowerment is streaming into Nepal more than ever before.
In 1999, the same year Reeta was trafficked to India, San Franciscan Ronni Goldfarb was in her basement office on Simonds Loop, creating a revolutionary way for women like Reeta to gain power through information.
Today, Goldfarb's basement operation has expanded into an international nonprofit organization that serves millions in the developing world.
From its offices in the Presidio, Equal Access creates original radio programming about HIV/AIDS, trafficking, and myriad other topics that are rarely discussed in Nepal. Then, using satellite technology from the WorldSpace Satellite company, the programs are broadcast to some of the globe's most rural people — to whom Equal Access has distributed thousands of satellite radios. In areas with no electricity, radio receivers are solar powered.
Equal Access provides programs and radios to communities in Nepal, India, Afghanistan, Cambodia, and Tajikistan. In Nepal, more than 650 satellite radios have already been distributed to places so rural that populations are often in the dozens and the concept of satellite radio is described as a miracle from God. [page]
The organization's radio programs use soap opera and chat show formats to avoid preachy medical messages. Instead, Equal Access creates entertaining shows to help people understand complex, growing social and health care problems, like AIDS.
“The information on health care and HIV prevention going out through radio is very important in Nepal,” says Nirmal Rijal, the country manager for Equal Access Nepal. He cites radio as the country's main information source due to the topography of Nepal's mountainous landscape as well as the low literacy rates of much of the population.
In addition to programming and broadcasting vital and entertaining information for Nepal, Equal Access has also partnered with Nepali organizations that create listening groups in each of the areas that have been given satellite radios.
“We don't just do mass media, we involve communities in conversations,” Goldfarb says.
In the small village of Ratomate, which is only a few miles outside of Kathmandu, issues of women's empowerment, HIV/AIDS, and trafficking are of constant concern.
For the last two years, women and teenage girls have gathered around their Equal Access satellite radio to listen to the programs. Favorite among them is the drama Kura Khasra Mitha, or Let's Talk Straight. Thuldidi, the main character, is a smart, bold woman who has come to inspire and inform the women of Nepal about issues of empowerment and HIV/AIDS.
Thuldidi was featured in a 136-part series that is currently being rebroadcast all over Nepal. The show focuses, in part, on reducing stigma for women and people with AIDS. And in the last episode of the show, Thuldidi reveals that she is HIV-positive.
In Ratomate, one member of the listening group said that after learning Thuldidi was HIV-positive, she treated a young woman in the village with HIV differently.
“We learned from Kura Khasra Mitha that you cannot catch AIDS just by touching people, and we also learned that it is very important to care for people living with HIV/AIDS. They need our compassion,” she told her Equal Access facilitator.
The shows soon became so popular that the government-controlled FM Radio Nepal partnered with Equal Access, broadcasting programs in prime-time spots on 18 different frequencies. Today more than 9 million Nepalis regularly listen to the radio shows.
“What Equal Access has achieved in Nepal is amazing,” says Purna Thapa, who is affiliated with the Ministry of Health in Nepal. “They have done brilliantly for the people of Nepal, who need this information almost more than anything else.”
In 2005, AIDS killed 3.1 million people and more than 4 million people were newly infected with HIV worldwide. The pandemic has reached a pivotal point in Asia, where the estimated number of people living with HIV grew by 25 percent in the last two years. The numbers are similarly skyrocketing in Nepal. But in a country of 24 million, Kathmandu's Teku Hospital has the nation's only ward for AIDS patients.
Nepal's government has long been quiet on the issue of AIDS, but as the numbers mount, the small Himalayan country will not be able to ignore its epidemic much longer. More money, treatment, clinics, and outreach are sorely needed throughout Nepal. But, like Reeta, what Nepalis need most is information.
Equal Access is one of many organizations working to eradicate some of the hardships of Nepal, but it is one of the few that have been able to continue working uninterrupted by politics and the changing face of U.S. AIDS funding policies.
Like those in many South Asian countries, Nepal's AIDS epidemic has for decades remained concentrated among the high-risk populations of sex workers, intravenous drug users, and migrant workers. But the country is now on the brink of falling into a generalized epidemic — a situation that the infrastructure of the small and already conflict-plagued nation could not endure.
The World Bank reported in 2001 that the trafficking of Nepali girls to India is a primary cause of what will be a full-blown African-style AIDS epidemic in Asia in the next 10 years. In Kathmandu, HIV rates among female sex workers have increased from less than 2 percent in 1990 to the current rate of more than 20 percent.
Adequate prevention efforts that provide sex workers with everything from methods for negotiating the use of condoms to educational outreach and treatment could mean the difference between an unstoppable generalized epidemic in Nepal and the ability to reverse the numbers.
Michael Hahn, the director of UNAIDS (the Joint United Nations Programme on HIV/AIDS) in Nepal, warns that AIDS will be the main cause of death for the 15-49 age bracket in the country within 10 years, especially as ignorance of the disease remains high. A recent government survey revealed that only 72 percent of males and 49 percent of females had heard of AIDS.
Another reason for the increased spread of the disease in Nepal is the escalating civil war with Maoist rebels. The Maoists began the People's War in 1996, and the government has been unsuccessful in quelling the increasingly powerful insurgents.
The Maoists now control most of the western districts of Nepal, where infection rates are on the rise as the conflict continues to force more than half of the male population to migrate to India in search of work. As many as 10 percent of men who work in India are likely to return to Nepal with HIV.
In 2003 the National AIDS Council was created in Nepal and chaired by then-Prime Minister Sher Bahadur Deuba. But on Feb. 1, 2005, Nepal's King Gyanendra disbanded the nation's parliamentary system and declared a state of emergency due to the Maoist insurgency that has killed nearly 13,000 people so far. Deuba and other government officials were unconstitutionally jailed by the king for much of the last year. [page]
Sadly, Gyanendra's near-dictatorial rule and ill-conceived state of emergency have only fueled the insurgency. The king's penchant for censoring media and cutting off all communication going in and out of Nepal has only further isolated his people. Needless to say, the country's nascent AIDS agenda has also been put on hold. The Nepali government admitted in its 2005 progress report that the country is now extremely unlikely to achieve its target of stopping the spread of AIDS and reversing it by 2015.
“If Nepal goes to being [a] high-incidence country, it cannot possibly cope with what that means in health care terms. There are no roads to reach people. It is the people from the remote areas who are going to Mumbai or the Gulf or Malaysia. If they bring HIV back, they are not going to be able to get treatment. That is the danger,” says Michael Bosse, the programs director of Equal Access in San Francisco.
Back in the Presidio office, Equal Access founder Goldfarb and her staff are fundraising and developing new programs and ways to measure the impact their programs are having abroad. It has been difficult to comprehensively gauge the influence the radio shows have had in terms of changes in attitudes and behavior.
But over the next three months, Equal Access will be conducting Nepal's first ever national radio survey. Partnered with ACNielsen, a global marketing research information company, it will conduct a 4,000-respondent survey in 55 of Nepal's 75 districts in order to develop a radio audience profile that can assess both what people are listening to and how Equal Access programs have changed people's knowledge and perception of issues like HIV/AIDS.
To date, all Goldfarb and the Equal Access staff of 21 in Nepal have had to go by are stories and letters that come in from listeners.
Some of the most compelling evidence of the impact the shows have is the letters that stream into a popular Equal Access show, Saathi Sangra Man ka Kura, or Chatting With My Best Friend, a talk show aimed at teenagers in Nepal.
“My girlfriend has threatened to commit suicide if I don't marry her,” wrote one boy from Pokhara, the country's second largest city. “I've promised to marry her, [but] I am very apprehensive that society will ill treat me and hate me for being involved with an HIV positive person,” he wrote.
According to Equal Access, the show receives thousands of letters each month, and they are all returned with personal advice.
While Equal Access continues to expand programming into new areas of Nepal, and new countries like Cambodia and Tajikistan, keeping programs funded and staying out of the political tussle over the appropriate use of U.S. aid money isn't easy. But so far, Equal Access has avoided political pressures from Washington on the subjects of AIDS policy and the new anti-prostitution funding restriction.
In the now-infamous 2003 State of the Union address in which President Bush first made his case for war in Iraq, he also announced the President's Emergency Plan for AIDS Relief (PEPFAR), pledging $15 billion over five years to help fight AIDS abroad.
The plan has been embroiled in controversy since its inception. While the United States' contributions to global AIDS funding should be lauded — the U.S. gives one-third of the worldwide intake for global AIDS programs — PEPFAR has come to represent all of the negative consequences incurred when AIDS becomes a matter of politics rather than health care.
Congress initially earmarked one-third of all PEPFAR funds for abstinence and “be faithful” programs. But a document leaked to the Baltimore Sun in December 2005 indicated that the administration plans to bump that number up to two-thirds.
In addition to the continual drone over abstinence, the new item on the conservative agenda is prostitution.
The U.S. Agency for International Development (USAID) issued a directive in 2003 that required foreign-based nongovernmental organizations (NGOs) to adopt a policy opposing prostitution as a condition for receiving federal funds. The directive was based on two pieces of legislation passed by Congress in 2003 that mandated that no U.S. dollars could be used to promote, support, or advocate the legalization or practice of prostitution.
The plan was quick to draw criticism from foreign-based organizations, which claimed this oath would hinder their ability to communicate with, treat, and provide prevention materials to sex workers in the developing world.
Then the U.S. government went a step further. In June 2005, USAID also began requiring U.S.-based organizations to sign the oath. The requirement is constitutionally questionable, and two lawsuits, filed by the Open Society Institute (OSI) and DKT International — organizations that work with sex workers as part of a larger goal to reduce HIV transmissions in the Third World — are challenging the restriction.
OSI and DKT International are suing on the grounds that this restriction violates free speech. The restriction forces U.S. organizations to take a mandatory policy position and also controls even an organization's private funds. According to the government guidelines, an organization's anti-prostitution loyalty oath must be applied “organization wide,” which means that any privately funded programs must also comply with the government's anti-prostitution agenda.
The PEPFAR office in Washington declined to comment on the rationale behind the policy because the matter is pending before two courts.
For years, UNAIDS has identified programs run by sex workers and for sex workers as model programs that yield good results on issues of safe sex and HIV health care, but these are just the sort of programs that are no longer being funded by the U.S. government.
In countries like Nepal, where sex workers are among the most at-risk for contracting and spreading AIDS, curtailing outreach and prevention efforts could prove disastrous.
“Until conservatives acknowledge [the] needs and rights of sex workers to health and human rights protection, anything groups can do to help sex workers stay alive needs to be done,” says Holly Burkhalter, the U.S. policy director for Physicians for Human Rights. “Forcing groups who work with sex workers to oppose it [prostitution] could threaten the survival of a lot of women in the world.” [page]
Though the PEPFAR office contends it has not kept track of organizations now refusing U.S. money or programs that have been defunded for noncompliance, anecdotal evidence reveals that many foreign- and U.S.-based organizations and the country of Brazil have rejected U.S. funds based on the new restriction.
Last May, the government of Brazil rejected $40 million in U.S. aid because accepting that funding would have forced the nation to halt some of its most effective strategies in addressing HIV. The country has recently seen a 50 percent decline in new HIV infections, in part because it has prioritized prevention and education efforts among prostitutes.
Because the terms of the anti-prostitution loyalty oath as set by Congress are vague, different programs are implementing the oath in varying degrees.
“In many Asian countries, organizations are refusing to provide services to prostitutes, even though policy technically allows for that,” says Phil Harvey, president of DKT International. Harvey points out that because the policy is so vague, many organizations are self-censoring their efforts for fear of losing funding.
Both the PEPFAR and USAID offices have declined to further define the restriction at the request of the Open Society Institute and DKT International.
“What we are seeing is that different USAID offices are coming up with different definitions. In one country, an organization was told the restriction would require that commercial sex workers say a prayer before receiving services,” Harvey says. “That is the kind of macabre you can get with this kind of policy.”
Many are incensed over the restriction, but others believe it will work to save the lives of prostitutes and trafficked women. For Dr. Janice Raymond, the co-executive director of the Coalition Against Trafficking in Women, by taking a direct stand against prostitution, groups and organizations are making an important statement. “The issue is, do groups supporting the legalization of sexual exploitation receive money to promote a policy that keeps women in sexual servitude and encourages them to be harmed and treated as sexual commodities?” she asks.
Unfortunately the vagueness of the policy has not just kept groups from promoting the legalization of prostitution, it has in many cases kept groups from being able to provide options and care.
Hundreds of nongovernmental organizations all over the world, including six in Nepal, have written letters to President Bush arguing that the restriction threatens their ability to target, treat, and educate sex workers.
“It is bullshit,” says Rajiv Kafle, one of Nepal's most celebrated HIV-positive men. As the founder of Nav Kiran Plus, an HIV counseling and rehabilitation NGO in Nepal, Kafle was asked to sign the anti-prostitution loyalty oath last year because he gets some funding from Family Health International, an organization that is primarily funded by USAID. Kafle reluctantly signed the oath in order to keep his program afloat.
Equal Access both receives funding from the U.S. government and provides programs and content that deals with sex workers. But it has not been asked to sign the oath.
Its determination to remain apolitical has allowed it to partner with an array of organizations, foreign NGOs, and Third World governments — including the feuding USAID and Open Society Institute.
“We are not an advocacy organization. We are focused on doing the best work we can do despite those political things that are going on,” Michael Bosse says.
While a lot of USAID dollars do fund Equal Access programs, much of that money comes by way of multilateral organizations, like the United Nations. The loyalty oath does not affect U.N. funds because the U.N. is an international organization that does not have to abide by U.S. policy.
Money that comes to Equal Access directly from USAID or from other U.S. organizations is used for non-HIV-related programming.
One such program is Desh Pardesh, or Home and Abroad, which focuses on Nepali men who are forced to seek work outside of Nepal. The program is funded by Family Health International as part of its safe migration initiative in Nepal. But the $90,000 that has gone to run Equal Access' production, outreach, and other efforts has all come from USAID-sourced funds.
FHI's own anti-prostitution requirement did minimally affect Equal Access' work on Desh Pardesh when the organization was asked to rephrase and carefully maneuver around the issue of Nepali migrant workers visiting brothels while working abroad in India in a recent episode.
Other Equal Access radio shows that do focus on HIV/AIDS are also indirectly funded by USAID. According to Bosse, the popular teen chat show is funded by UNICEF, which uses USAID money.
Equal Access is walking a fine, but important, line.
“We do talk about prostitution and sex work, and we do that in programs where the U.S. government is involved in some way,” Bosse says, referring to U.S. money that goes to Equal Access programs via other organizations.
Equal Access goes so far as to employ former sex workers as reporters for some of its programs, which Bosse says is not prohibited because Equal Access does not take any money directly from the U.S. government that is specifically targeted for HIV or reproductive health issues.
“We have sex workers, who are bright young women, participate in our programs as reporters, knowing that we are able to pay them some money and that they will be able to stop doing sex work at least temporarily. And for some that is a path out of sex work,” Bosse says. “And no one at the USAID office in Nepal is knocking on our door.”
But all of the political bickering over prostitution and funding is only a distraction. The fact remains that Nepal's AIDS epidemic is fast reaching a point of no return.
Faced with the realization that the AIDS epidemic will only continue to worsen as long as Nepal is in the midst of an increasingly brutal civil war, Equal Access has decided its next step will be to create a peace-building radio program.
It will aim to inform Nepalis about what is going on in their own country — much of the reporting about the conflict has only been in foreign newspapers — as well as about other grass-roots movements in history like the U.S. civil rights movement and Gandhi's nonviolent efforts.
The peace-building program comes at a time when NGOs throughout Nepal have recognized that civil war has paralyzed the government and in the country's current state it is unlikely that Nepalis will ever have access to enough information or better care. But Bosse says Equal Access is committed to Nepal for the long term. He and Goldfarb are hopeful that their apolitical approach to information will continue to give Nepalis new tools to carve out better ways of life.
“If they can begin to claim their own human dignity and understand that they have choices, that's what it is all about,” Goldfarb says.
Cristi Hegranes was a reporter in Nepal in 2004.