Girl-trafficking, HIV / AIDS, and the position of women in Nepal

"Who is not an agent here?": The Collateral Damage of Anti-Trafficking in Nepal

In this paper, I explore how the diverse labour migration practices of people who challenge their state's restrictive policies produce a form of stigma that extends from people to the places where they reside. Drawing on the findings of Participatory Action Research (PAR) conducted in Nepal, I demonstrate how people residing in one such place attempt to undo stigma by adopting diverse practices amidst restrictive anti-trafficking and migration policies. I reveal a novel practice of prospective labour migrants negotiating and receiving money from their choicest mobility facilitators to assist their unauthorised labour migration. This exchange of money potentially criminalises prospective labour migrants, their family members, unlicensed and licensed recruitment agents, community leaders, anti-traffickers, government officials, hotel owners, transport service providers, and airport immigration officials as traffickers. Underscoring the collateral damage of anti-trafficking in Nepal, I assert that the exchange of money to facilitate unauthorised migration expands the remit of criminalisation of citizens as "traffickers".

Do Women in Nepal Like Playing a Mobile Game? MANTRA: A Mobile Gamified App for Improving Healthcare Seeking Behavior in Rural Nepal

In Low and Middle Income Countries (LMIC), one of the causes of maternal and child mortality is a lack of medical knowledge and consequently the inability to seek timely healthcare. Mobile health (mHealth) technology is gradually becoming a universal intervention platform across the globe due to ubiquity of mobile phones and network coverage. MANTRA is a novel mHealth intervention developed to tackle maternal and child health issues through a serious mobile game app in rural Nepal, which demonstrated a statistically significant knowledge improvement in rural women. This paper explores the perceptions and usability of the MANTRA app amongst rural women and Female Community Health Volunteers (FCHVs) in Nepal. Despite the challenges of a target user group with limited educational levels and low smartphone experience, all participants viewed the MANTRA app with approval and enthusiasm. They were willing to engage further with the mHealth intervention and to share their experience and knowledge with fellow community members. Participants also showed an increase in awareness of danger signs enabling them to make better informed health decisions in the future. FCHVs viewed the app as a validation tool providing and support for greater impact of their efforts in rural Nepal. Growing mobile ownership, network coverage and availability of smartphones along with acceptance of the prototype MANTRA app in rural communities suggest encouraging prospects for mHealth interventions to be incorporated in the national health infrastructure in Nepal and other LMICs.

Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature

BACKGROUND

Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients.

METHODS

The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age).

FINDINGS

From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%).

CONCLUSION

The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.

Using Peer Education to Promote Psychosocial and Occupational Health and Empowerment Among Female Sex Workers in Nepal

Female sex workers (FSWs) in Nepal are vulnerable to an array of occupational risks, which may compromise their psychosocial health and ability to engage in protective behaviors. A peer education (PE) intervention designed to empower and promote the psychosocial health of FSWs was pilot tested in Kathmandu, Nepal. FSWs who were exposed to the PE intervention (n = 96) had significantly higher scores on psychosocial health knowledge, perceived self-efficacy and ability to access resources, happiness, and job control compared with those who were not (n = 64). PE may be a promising way to promote psychosocial health and empowerment among FSWs.

Is economic dependence on the husband a risk factor for intimate partner violence against female factory workers in Nepal?

Background

Violence related injury is a serious public health issue all over the world. This study aims to assess the association between several socio-economic factors and intimate partner violence (IPV) in Nepal.

Methods

A cross-sectional study was conducted among 236 women working in carpet and garment factories in Kathmandu, Nepal. Interviews were conducted to collect quantitative data on three forms of IPV, namely physical violence, psychological violence and sexual violence, as well as on a number of potentially associated factors.

Results

Twenty-two percent of women experienced sexual IPV, 28% physical IPV and 35% psychological IPV at least once in the last 12 months. The variables independently associated with at least one form of IPV were: age of the woman >29 years [OR = 4.23, p = 0.025 for physical IPV; OR = 6.94, p = 0.008 for sexual IPV; OR = 3.42, p = 0.043 for psychological IPV], alcohol consumption of the husband [OR = 9.97, p < 0.001 for physical IPV; OR = 3.76, p = 0.004 for sexual IPV; OR = 4.85, p < 0.001 for psychological IPV], education of the husband above primary level [OR = 0.43, p = 0.013 for physical IPV; OR = 0.51, p = 0.033 for psychological IPV], and economic dependency of the woman on the husband [OR = 3.04, p = 0.021 for physical IPV; OR = 2.97, p = 0.008 for psychological IPV].

Conclusions

This study identified various factors associated with IPV and showed that economic dependence of wives on their husband was among the most important ones. Thus, for the prevention of IPV against women, long term strategies aiming at livelihood and economic empowerment as well as independence of women would be suggested.

Structural Violence in Health Care: Lived Experience of Street-Based Female Commercial Sex Workers in Kathmandu

Thirty-five in-depth, semi-structured interviews were conducted with female, street-based, commercial sex workers in Kathmandu, Nepal. The framework of structural violence guided this study in identifying the structural context that impacts the female sex workers' lives and may cause harm to their health. Structural violence in health care was revealed through thematic analysis as (a) discrimination, (b) forced choice, and (c) limitations to health information sources. Lived experiences highlight how the sex workers engaged with structural limitations in health care access, services, and utilization. Structural violence conveys a message about who is entitled to health care and what a society emphasizes and expects regarding acceptable health behavior. Examining the structural violence highlighted how the sex workers negotiated, understood, and engaged with structural limitations in health care access, services, and utilization.

Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya

Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence.

Sex Trafficking in Nepal: Context and Process

The aim of this study was to provide a clearer understanding of the process and context of sex trafficking from Nepal using data from trafficked women themselves. It develops a conceptual framework of the trafficking process and uses this to identify detailed strategies for reducing the risk of trafficking. Quantitative data were analyzed from case records of 202 sex-trafficked women at rehabilitation centers in Nepal. In-depth interviews with 42 sex trafficked women, mostly residing at rehabilitation centers in Kathmandu, provide contextual information on the process and circumstances of sex trafficking. The results of this study provide a clearer understanding of the stages of movement through the sex trafficking process; in particular that sex trafficking does not always begin at the village level, it may also occur after voluntary migration or after trafficking to urban areas for other purposes (i.e., labor exploitation). Interventions therefore need to target each stage of movement through sex trafficking. Respondents were most commonly sex trafficked by familiar persons, including relatives; and force and abduction are less common. Women exited from sex trafficking through rescue, escape or release. One of the outcomes of sex trafficking is a return to sex work upon return to Nepal.

Understanding the experiences and needs of female commercial sex workers in Kathmandu, Nepal

Through this exploratory study, we sought to better understand Nepali female commercial sex workers' (FCSWs') experiences in order to inform HIV prevention and health promotion interventions for this vulnerable and hard-to-reach population. Data were collected through phenomenological interviews with eight FCSWs. Through analysis we reveal promising intervention points to enhance FCSW health, empowerment, and overall well-being. Researchers suggest a combination of structural and individual programs is essential to improving the circumstances of Nepali FCSWs and preventing the spread of HIV. Given Nepal's limited resources and complex environment, it is imperative future prevention programs are focused and guided by FCSWs' lived experiences.

Sex Trafficking Related Knowledge, Awareness, and Attitudes among Adolescent Female Students in Nepal: A Cross-Sectional Study

Background

Sex trafficking has been a long-standing concern in Nepal. Very little has been achieved, however, in terms of actual reduction in the number of victims despite numerous anti-sex trafficking programs. This situation may be attributable to a lack of empirical evidence upon which to formulate anti-sexual trafficking interventions. This study aimed to assess sex trafficking-related knowledge, awareness and attitudes, and factors associated with sex trafficking awareness and attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns among adolescent female students in Nepal.

Methods

A cross-sectional study was conducted between August–September 2013 among 292 adolescent female students (>10 years old) using systematic random sampling from three high schools in Sindhupalchowk district, Nepal. As an initial step, descriptive analyses were employed to characterize the data and multivariate logistic regression analyses were used to explore factors associated with sex trafficking awareness and related attitudes.

Results

Seventy-six percent of sampled students reported that they were aware of sex trafficking and 94.6% indicated media (i.e., radio or television) as the primary sources of their knowledge. Fifty-one percent mentioned relatives/friends as mediators of sex trafficking, 60.4% reported promise for better jobs as the primary attraction behind sex trafficking, and 48.6% mentioned adolescent females as the most vulnerable group for sex trafficking. Over half (56.8%) of the respondents had positive attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns. Age (OR = 3.38, 95% CI:2.51–4.55), parents’ occupation (OR = 3.89, 95% CI:1.58–9.58), and having a radio/TV at home (OR = 6.67, 95% CI:3.99–9.54) were significantly associated with awareness, whereas being younger (OR = 0.67, 95% CI:0.55–0.79) and having joint-family (OR = 2.67, 95% CI:1.49–4.80) were significantly associated with having a positive attitudes towards the victims of sex trafficking and/or anti-sex trafficking campaigns.

Conclusion

Findings presented have important implications for anti-trafficking programs, in particular those designed to educate the adolescent females who are at most-risk of sex trafficking. Educational programs need to include specific interventions to improve knowledge and attitudes towards sex trafficking among adolescent females in Nepal.

Analysis of HIV Correlated Factors in Chinese and Vietnamese Female Sex Workers in Hekou, Yunnan Province, a Chinese Border Region

Objectives

To assess the prevalence and correlated factors of HIV-1 among Chinese and Vietnamese female sex workers (FSW) in the border county of Hekou, Yunnan province, China.

Methods

A cross-sectional survey was conducted collecting information on demographics, sexual behavior, medical history, and drug use. Blood samples were obtained to test for HIV/STIs. Multivariate logistic regression model was used to examine associations between factors and HIV-1 infection.

Results

Of 345 FSWs who participated in this study, 112 (32.5%) were Chinese and 233 (67.5) were Vietnamese. Vietnamese FSWs were significantly more likely to be HIV-1 positive (7.7%) compared with Chinese FSWs (0.9%) (p = 0.009). In multivariate analysis, sexual debut at age≤16 (OR 3.8: 95% CI: 1.4, 10.6), last client’s payment <150 RMB ($22 USD) (OR: 5.2, 95% CI; 1.7, 16.6), and HSV-2 (OR: 12.3; 95% CI: 1.6, 94.8) were significant for HIV-1 infection.

Conclusions

Differences in HIV prevalence in Vietnamese and Chinese FSWs may be indicative of differential risk. It is important to characterize the nature of trans-border transmission in order to gain a better understanding of the potential impact on the international HIV epidemic. Understanding the correlated factors for HIV in Vietnamese and Chinese FSWs is important for designing interventions for this vulnerable population.

Exploring the context of trafficking and adolescent sex industry involvement in Tijuana, Mexico: consequences for HIV risk and prevention

Coerced and adolescent sex industry involvement are linked to serious health and social consequences, including enhanced risk of HIV infection. Using ethnographic fieldwork, including interviews with 30 female sex workers with a history of coerced or adolescent sex industry involvement, we describe contextual factors influencing vulnerability to coerced and adolescent sex industry entry and their impacts on HIV risk and prevention. Early gender-based violence and economic vulnerability perpetuated vulnerability to coercion and adolescent sex exchange, while HIV risk mitigation capacities improved with increased age, control over working conditions, and experience. Structural interventions addressing gender-based violence, economic factors, and HIV prevention among all females who exchange sex are needed.

Unveiling the silence: women's sexual health and experiences in Nepal

Rising rates of HIV in Nepal signal an impending epidemic. In order to develop culturally appropriate and effective actions and programmes to reduce HIV transmission, it is necessary to understand attitudes, behaviours and norms surrounding sexual networking and safer-sex practices in Nepal. Nepali women are thought to be at increased risk of sexually transmitted infections (STIs) and HIV, sexual violence and exploitation and other sexual health disparities due to cultural scripts limiting access to education, ability to control sexual relationships and acceptability in discussing sex and sexual health. The present study comprises a series of interviews with 25 women living in Kathmandu (13 individual interviews and 2 focus-group discussions) about their knowledge and experiences related to sex and sexual health. Interviews were translated and transcribed and two independent coders conducted a thematic analysis. Overall, the women described sex as primarily a male domain. Sex and sexual health were viewed as taboo discussion topics and formal sex education was perceived as minimally available and far from comprehensive in its scope. This formative study can inform future interventions aimed at reducing the spread of STIs/HIV in Nepal and empowering women on issues of sexual health and well-being.

Lived experiences of street-based female sex workers in Kathmandu: implications for health intervention strategies

The lived experiences of women sex workers illustrate that sex work is frequently a manifestation of limited access to education, resources and jobs due to violence, oppression and patriarchy. However, some Nepalese sex workers reconstitute sex work as a viable form of work that provides food and shelter for their families and allows fulfillment of their duties as mothers. Through a culture-centred approach to research, which emphasis the voices of the marginalised and their own articulations of how marginalised spaces are negotiated, this paper offers an entry point to locating sex workers as active participants in their day-to-day lives. Thirty-five in-depth, semi-structured interviews were conducted with street-based female sex workers. Thematic analysis revealed the following three themes: (1) surviving through sex work, (2) financial security in sex work and (3) surviving sex work stigma. These findings have implications for health promotion involving members of this population. Lived experiences illustrate the need to move away from traditional, top-down, linear behaviour-change health campaigns to reconstitute health interventions within a participatory bottom-up approach that includes the voices of participants and is situated within their own context and needs.

Women's autonomy in negotiating safer sex to prevent HIV: findings from the 2011 Nepal Demographic and Health Survey

Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between women's autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face-to-face interviews. Autonomy was measured in Decision-Making Participation and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15-49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the highest decision-making participation. These women showed higher OR for 'ask for condom use' in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women's autonomy on sexual health. It emphasizes women's empowerment-based approach to curbing HIV/AIDS in developing countries.

Sex workers perspectives on strategies to reduce sexual exploitation and HIV risk: a qualitative study in Tijuana, Mexico

Globally, female sex workers are a population at greatly elevated risk of HIV infection, and the reasons for and context of sex industry involvement have key implications for HIV risk and prevention. Evidence suggests that experiences of sexual exploitation (i.e., forced/coerced sex exchange) contribute to health-related harms. However, public health interventions that address HIV vulnerability and sexual exploitation are lacking. Therefore, the objective of this study was to elicit recommendations for interventions to prevent sexual exploitation and reduce HIV risk from current female sex workers with a history of sexual exploitation or youth sex work. From 2010-2011, we conducted in-depth interviews with sex workers (n = 31) in Tijuana, Mexico who reported having previously experienced sexual exploitation or youth sex work. Participants recommended that interventions aim to (1) reduce susceptibility to sexual exploitation by providing social support and peer-based education; (2) mitigate harms by improving access to HIV prevention resources and psychological support, and reducing gender-based violence; and (3) provide opportunities to exit the sex industry via vocational supports and improved access to effective drug treatment. Structural interventions incorporating these strategies are recommended to reduce susceptibility to sexual exploitation and enhance capacities to prevent HIV infection among marginalized women and girls in Mexico and across international settings.

Individual, interpersonal, and social-structural correlates of involuntary sex exchange among female sex workers in two Mexico-U.S. border cities

BACKGROUND

To investigate individual, interpersonal, and social-structural factors associated with involuntary sex exchange among female sex workers (FSWs) along the Mexico-U.S. border.

METHODS

In 2010 to 2011, 214 FSWs from Tijuana (n = 106) and Ciudad Juarez (n = 108) aged ≥ 18 years who reported lifetime use of heroin, cocaine, crack, or methamphetamine, having a stable partner, and having sold/traded sex in the past month completed quantitative surveys and HIV/sexually transmitted infection testing. Logistic regression was used to identify correlates of involuntary sex exchange among FSWs.

RESULTS

Of 214 FSWs, 31 (14.5%) reported involuntary sex exchange These women were younger at sex industry entry [adjusted odds ratio (AOR): 0.84/1-year increase, 95% confidence interval (CI): 0.72 to 0.97] and were significantly more likely to service clients whom they perceived to be HIV/sexually transmitted infection-infected (AOR: 12.41, 95% CI: 3.15 to 48.91). In addition, they were more likely to have clients who used drugs (AOR: 7.88, 95% CI: 1.52 to 41.00), report poor working conditions (AOR: 3.27, 95% CI: 1.03 to 10.31), and report a history of rape (AOR: 4.46, 95% CI: 1.43 to 13.91).

CONCLUSIONS

Involuntary sex exchange is disproportionate among FSWs who begin to exchange sex at a younger age, and these women experience elevated risk of violence and HIV/STIs related to their clients' behaviors and their working conditions. These data suggest the critical need for evidence-based approaches to preventing sexual exploitation of women and girls and to reducing harm among current sex workers. Multilevel interventions for all females who exchange sex and their clients that target interpersonal and social-structural risks (eg, measures to improve safety and reduce exploitation within the workplace) are needed.

Mobility and HIV in Central America and Mexico: a critical review

Mobility is a key determinant of HIV/sexually transmitted infection (STI) transmission dynamics in Asia and Africa. Scant data exist regarding its dynamic impacts on HIV/STI risk in Central America and Mexico. Our objective was to critically review the epidemiology and social and structural context of HIV/STI risk among mobile populations in Central America and Mexico. Eligible articles were published in English or Spanish between January 1, 2000 and August 31, 2010; conducted in Central America or Mexico; specified the mobile population included; and described primary research. 2045 records were screened, 275 articles reviewed, and 22 studies included. Mobility is associated with increased HIV risk behaviors, though it also may increase preventive behaviors. Among mobile groups in Central America and Mexico, social isolation, the socio-economic impacts of displacement, gender inequalities, and stigma/discrimination shape HIV risk. Epidemiologic research and multi-level interventions that target and engage vulnerable groups in transit stations are recommended.

Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study

Background

Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal.

Methods

A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts.

Results

A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p =  0.014); alcohol use (OR = 12.89, p = <0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started ≤24 months (OR = 3.18, p = 0.009), travel time to hospital >1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence.

Conclusion

Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.

Exploring the impact of underage sex work among female sex workers in two Mexico-US border cities

Although sex work and younger age increase HIV vulnerability, empirical data regarding the impacts of underage sex work are lacking. We explored associations between features of the risk environment, sex work, and drug use history, and underage sex work entry among 624 female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico. Forty-one percent (n = 253) of women began sex work as minors, among whom HIV and any STI/HIV prevalence were 5.2 and 60.7%. Factors independently associated with increased odds of underage sex work were inhalants as the first drug used, forced first injection, number of drug treatment attempts, and recent receptive syringe sharing. Number of recent condom negotiation attempts with steady partners and depression as a reason for first injecting were negatively associated with underage entry. These results underscore the importance of efforts to prevent underage sex work and the wider factors contributing to HIV risk among vulnerable youth and underage FSWs.

Research and Activism Review: Sex Trafficking in Nepal: A Review of Intervention and Prevention Programs

Trafficking of girls and women for the purpose of sexual exploitation is a problem worldwide, particularly in South Asia. This review focuses on Nepal-to-India sex trafficking with an examination of current anti-trafficking intervention and prevention programs. The activities of both governmental agencies and nongovernment organizations are described and critically analyzed. Suggestions for evaluating and improving interventions, and thereby reducing the trafficking of girls and women, are discussed.

Dating and Sex Among Emerging Adults in Nepal

Social and cultural changes in Nepal, including better communication facilities and transport, more urbanization and a rising age at which people marry, have created more opportunities for young people for “dating.” Our qualitative study explores whether the existence of dating cultures influences young people’s sexual behavior in Nepal. Focus group discussions with a total of 75 participants and 31 in-depth individual interviews were conducted among young people in Nepal. Most urban and rural young people liked the dating culture. Although it is a new kind of culture in Nepalese society, it is gaining popularity. The mass media were regarded as encouraging and creating an environment for dating. Most participants believed that dating culture encourages premarital and extramarital sexual behavior. The authors underpin their findings by linking it to the “emerging adulthood” framework. In terms of public health, they recommend that dating practice should be discussed in formal and informal education to promote safer sex.

Sex Trafficking in Nepal

There has been little systematic research on therapy, rehabilitation, and social reintegration of women formerly trafficked into prostitution. This study examines characteristics and outcomes of Nepali sex trafficking survivors. Twenty case files of survivors rehabilitated in the shelter of an antitrafficking NGO were randomly selected. All individuals in the sample suffered somatic and behavioral sequelae. Three quarters of the survivors eventually returned to their villages to live. These results suggest that current rehabilitation and reintegration programs are producing positive results. However, there is need for more systematic diagnosis, record keeping, and outcome studies as well as education to reduce stigma and promote safe migration practices.

HIV/AIDS prevention in the Nepalese context

With their numbers now approaching almost 30 million, Nepalese feature importantly in the South Asian demography. Yet, it has been only 60 years since Nepal gained international recognition as a nation-state. Nepal at present is one of the world's poorest countries and is in dire need of development, especially in the area of health. Given the current civil instability coupled with rapid modernization, the health and well-being of the Nepalese people have been increasingly affected by newer threats, such as HIV/AIDS. The present study discusses the uniqueness of the Nepalese context in relation to HIV/AIDS prevention. The authors suggest that HIV/AIDS prevention programs in Nepal should now focus more on adolescents from rural regions. The authors also suggest the ways one may approach the task of developing a prevention program targeting rural youths.

Predictors of Life Satisfaction in HIV-Positive Nepali Women

In a cross-sectional design, the authors examined the degree to which indicators of physical, mental, and social domains and perceived health predicted life satisfaction in 98 HIV-positive women who were former commercial sex workers in Nepal. Measures included the Quality of Life Inventory, Medical Outcomes Study 36-Item Short-Form Survey, Center for Epidemiologic Studies Depression Scale, and the anxiety subscale of the Symptom Checklist-90-Revised. Life satisfaction was significantly associated with physical functioning (r = .32), role-physical (r = .31), bodily pain (r = .32), mental health (r = .39), anxiety (r = -.66), depression (r = -.47), social functioning (r = .47), and health transition (r = .49). Anxiety (beta = -.75), health transition, (beta = .45), role-physical (beta = -.43), physical function (beta = .24), and mental health (beta = -.23) explained 60% of the variance in life satisfaction. The authors discuss the challenges of international studies, including salience of the concept of quality of life, conceptual and cultural equivalence of instruments, identification of culturally relevant concerns, disclosure of private information, and instrument format.

A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal

OBJECTIVE

To systematically review information on HIV epidemiology and on sexual behaviour in Nepal with a view to identifying gaps in current knowledge.

METHODS

Systematic review covering electronic databases, web-based information, personal contact with experts and hand searching of key journals.

RESULTS

HIV-1 seroprevalence has been rising rapidly in association with high-risk behaviours, with current levels of 40% amongst the nation's injecting drug users and approaching 20% amongst Kathmandu's female commercial sex workers (FCSWs). HIV seroprevalence remains low in the general population (0.29% of 15-49 year olds). There are significant methodological limitations in many of the seroprevalence studies identified, and these estimates need to be treated with caution. There are extensive migration patterns both within the country and internationally which provide the potential for considerable sexual networking. However, studies of sexual behaviour have focused on FCSWs and the extent of sexual networks within the general population is largely unknown.

CONCLUSIONS

Whilst some of the ingredients are present for an explosive HIV epidemic in Nepal, crucial knowledge on sexual behaviour in the general population is missing. Research on sexual networking is urgently required to guide HIV control in Nepal. There is also a need for further good-quality epidemiological studies of HIV seroprevalence.