KATHMANDU, NEPAL -- It was 6 p.m. and people poured onto the roads as evening rush hour began. Amidst the crowd, Maya Thapa, 30, stood in small gully just behind Baneshwor, a crowded neighborhood in the center of the capital city. She was sweating heavily. She looked anxious and desperate. She was carrying a small bag filled with Buprenorphine, a painkiller derived from opium and known as Tidigesic on the streets. Tidigesic is illegal.
After waiting for 15 minutes, two young men approached her, paid her for the drugs and quickly left. As a reward from her dealer for making the sale, Thapa received a Tidigesic injection. She took the needle from her dealer and hurried to her rented room, giving herself the injection in the wrist. As the drugs entered her body, her desperation morphed into satisfaction and release.
Drug use and addiction have become exceedingly common in Nepal, though the available statistics are limited and published reports are often contrary to one another. According to a government report published in 2006, the most recent statistics available, the total number of drug users in Nepal is 46,310, among which 42,954 are assumed to be male and 3,356 female.
Advocacy organizations working with users here say the number of intravenous drug users in Nepal is likely to be closer to 150,000, about 5 percent of which are women.
Ananda Pun, executive director of Recovering Nepal, an NGO working for rehabilitation and treatment of intravenous drug users (IDUs), says, “We have estimated the total number of drug user on the basis that in every one user who is seen taking drugs, three users take it with him, unseen.”
Thapa, who chose not to use her real name for fear of reprisal, and her husband, were addicts for more than a decade. Thapa says at the height of her addiction both she and her husband required as many as three injections everyday. Each dose of the drug costs about 100 rupees, or $1.50 USD. Their $9 per day habit monopolized their meager income and left Thapa unable to care for herself or her infant son.
”We skipped lunch and dinner, but we never skipped having drugs. When we ran short of money, we used to sit with my husband’s friends and share their syringes,” Thapa says.
Journey into Addiction
Thapa’s journey into drug addiction started after she was married in 1991. She was just 13 years old when she eloped with her husband, a tour guide in Kathmandu. Thapa said after they married, her husband would come home late and always seemed quiet and indifferent.
”I was too young to understand why he behaved in such a way. I thought he was just tired after work,” she says.
One year after their marriage, at the age of 14, Thapa gave birth to a son. It wasn’t until her son was six months old that she discovered her husband was a drug addict. She vividly remembers the first time she saw her husband ”light a rolled paper with a narcotic substance in it.” The very next day, she says, she saw her husband inject drugs into his wrist.
”I tried my best to make him give up the drugs. But he never listened to me. He said it helped him to forget all his troubles,” Thapa recalls.
As her husband’s addiction grew, the financial status of her family began to deteriorate. She says she was constantly frustrated with her home life and her husband’s condition. Eventually, as her frustration and sadness mounted, she decided to ”escape from her troubles” too. She says she used a syringe discarded by her husband to inject drugs into her wrist one morning after he had left the house for work. At first, she said, she couldn’t understand what was happening to her, but minutes later she started ”feeling good.”
”After that, I started to take drugs with my husband. We used to get [high] together. I became so much stuck in it that I couldn’t live without it,” she says.
Drug Use on the Rise. HIV/AIDS on the Rise.
In the last two decades, there has been a marked increase in the number of drug users in Nepal. This increase has also spurred the skyrocketing number of Nepali men and women now testing HIV positive. Pun says that nearly 70 percent of IDUs in Nepal are infected with HIV, in notable contrast to just 1.57 percent reported in 1995. Testing facilities and HIV awareness were limited in the early 90s.
In all likelihood, the number of HIV positive IDUs in Kathmandu is even higher. A study by Family Health International, an organization working to increase HIV/AIDS education and access to testing and treatment, reports numbers that indicate as many as 69 percent of IDUs in Kathmandu alone are HIV positive.
Thapa, too, is HIV positive.
In 2007, her husband died of a drug overdose. After his death, Thapa says she continued to use, but had trouble procuring drugs with the same frequency without her husband.
”When I didn’t get drugs, I felt like I’d go crazy,” she said. So she began smuggling and selling drugs for local dealers in order to get drugs for herself. ”Sometimes the dealer paid me in cash and sometimes with drugs,” she admits.
During this time, Thapa’s older sister took her children away from her. Her sister and mother tried repeatedly to convince Thapa to stop using drugs, but she didn’t take their advice. Her sister raised her two children for years.
“I could not fulfill my motherly responsibilities when my children needed me,” she says. “Now I have gained back my senses, but my children do not want to call me their mother.”
The Journey to Recovery
Thapa's addiction lasted for nearly 14 years. In October 2008 Thapa’s neighbor, Bishnu Sharma, an employee at Richmond Fellowship Nepal, a local NGO that works for the rehabilitation of IDUs, took her to the organization.
But her journey to recovery was not easy.
”I fled from the [rehabilitation center] three times because I couldn’t get drugs there,” Thapa said. “My mother and sister convinced me to return there, saying I should change myself for the sake of my son and daughter.”
It took Thapa 18 months to stop using drugs. After she was clean, the Richmond Fellowship sent her to the Sukraraj Tropical Transferable Disease Hospital at Teku, Kathmandu for a blood test. It was there she learned she was HIV positive.
”I made mistakes and now [I'm] paying the price for it,” she says. ”I am now infected with HIV and I cannot do anything to get rid of it.”
Today, Thapa lives in the Shobha Bhagwati neighborhood in the western part of Kathmandu, with her two children, now ages 17 and 15.
Advocates Seek Government Support
Anti-drug campaigners here emphasize the need to widen government programs and resources that target drug users in order to control the spread of HIV.
According to UNAIDS, only 15 percent IDUs with HIV are receiving health services in Nepal. Pushpa Tandukar, a counselor with Youth Vision, a local NGO working to combat teen drug addiction, says, ”If the problem continues to remain unaddressed, a large portion of the productive youths between the ages of 20 to 29 are going to contract the life-threatening disease of HIV.”
Criticizing the government for its inaction, Tandukar says they have failed to pay proper attention to the problem in the country.
”The government has failed to make proper programs in the sector, like supply reduction, treatment, care and harm reduction,” Tandukar added.
Experts agree that the lack of harm reduction strategies put in place by the Nepali government is directly linked to the rise in drug use and the spread of HIV. In fact, the first HIV initiative, launched in 1991, has yet to be fully implemented.
Dr. Rajendra Pant, the deputy director of National AIDS and Sexual Disease Control Center, a government department that focuses on AIDS and other sexually transmitted diseases, admitted that the government has not done much to control the spread of HIV among IDUs. As a result, the HIV epidemic has begun to spread into the general population.
“The government has not been able to perform as it needs to due to the lack of resources,” Pant said.
Thapa now works with the Richmond Fellowship, the same place where she got clean. She says her goals is to create awareness about the link between injecting drugs and contracting HIV. ”I don’t know how long I will live, but until my death I want to create awareness among others, so that they won’t be victim to the virus like I am now,” she says.
