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Although the Taplejung District lies in geographic isolation, it does not necessarily follow that this same population lives in physical isolation, and is therefore safe from the spread of HIV/AIDS. In fact, the presence of a large border patrol of police, the constant trickle of traders to and from India and Tibet, the countless government administrative posts that are all manned by those whose home is days, even weeks away insure the opposite. This represents a large "at risk" floating male population.
In 1994-95 a district wide H.I.V. screening was performed, in conjunction with an AIDS PREVENTION and AWARENESS educational program. AIDS is a sensitive topic, and especially in traditional cultures. The subject of AIDS prevention, modes of transmission, symptoms and outcome was introduced by pre-recorded informal conversations on cassette tapes, in a Nepali tea shop setting. A number of expatriate Nepalese from the San Francisco Bay area helped to produce a highly successful Audio cassette tape that was the highlight of the program. Six tape players and around 20 cassette tapes were distributed to health-posts, schools, and tea-shops in the Taplejung District. It would be naive to believe that this program would make a significant change in already well established behavioral patterns, or remove the underlying causes of the spread of H.I.V., such as extremes of poverty and imbalances of power. Rather, the intention was to clarify misunderstandings of the modes of transmission, prevention, and disease course, and to address the issues of discrimination practices. In these areas the cassette tapes appeared to satisfy a real need, and were very well received.
After the educational program, a complete demographic survey was taken and blood samples collected and tested, in collaboration with Dr. Denis Henrad of Abbott Laboratories, to determine the prevalence of H.I.V. in the Taplejung district. All of the 350 subjects tested were negative. A further analysis of 100 subjects was undertaken, that in addition to H.I.V. screening, looked at wealth (as measured by acres of land), education, and health-care access (as measured by number of children and whether they are vaccinated).
A report prepared in collaboration with Dr Jerome Gournay, research fellow at the U.C.S.F. Medical Center, describing the methods and materials is available on request.
Our conclusions from this analysis are as follows:
The continued emphasis on HIV education is justified, even though there remain glaring inadequacies in the current educational system that is present not only in the Kangchenjunga Region, but throughout Nepal.
There is a statistically significant relationship between educational level and condom use. It is noteworthy that in the H.I.V. prevalence study, people who used condoms had a higher level of education than those who did not.
Educational level is associated with ethnicity and gender. Tibetan/ Sherpas in the Taplejung Region had a lower educational level than any other ethnic group. Amongst all ethnic groups, it was more than twice as likely for a woman to have no educational at all than a man. At the bottom of the educational level was the Tibetan woman, leaving her and her children in the most vulnerable of positions.
This kind of research helps plan where we should be directing our future efforts, and it appears we are on target.
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