Bold for change How the women of LINKAGES Nepal are making strides against HIV. Interviews and photographs by LINKAGES Nepal and partners.

“I was pregnant when diagnosed HIV-positive. Being denied services from a health facility during delivery made me realize the degree of stigma and discrimination that prevailed as even the health care workers who [knew] about HIV refused to provide services. I delivered my baby at home after enduring labor pain for four consecutive days. That is when I decided to transform my pain into courage and stepped forward to raise awareness about HIV in my society. In the early days, I was blamed and accused for promoting HIV. Nevertheless, I moved forward with a firm determination to bring about change. Today, the society has honored my effort.” - Nirmala Poudel, president, Lumbini Plus, Nawalparasi District (Interview by Chettra Kumari Gurung, program officer, NFWLHA)

Nirmala is an HIV-positive activist striving for the rights and well-being of women living with HIV in Nepal. Lumbini Plus is led by people living with HIV in the Nawalparasi district who provide prevention education, care, and support to others living with HIV. The organization is affiliated with National Federation of Women Living with HIV and AIDS (NFWLHA) and NAP+N.

“Some men who have sex with men, male sex workers, and transgender people do not feel comfortable with other staff members. I feel more connected with our community people, as I interact with them every day and discuss with them their issues and challenges while accessing health services, including HIV services.” - Pareena Chaudhari, project coordinator, Western Star Nepal, Banke District (Interview by Prakash Lekhak, program officer, LINKAGES Nepal)

Pareena is a transgender woman. Western Star Nepal is a community-based organization and LINKAGES implementing partner led and run by men who have sex with men, male sex workers, and transgender people.

“That is when I realized that it is important to be bold. I… disclosed my HIV-positive status and began to raise issues faced by HIV-positive women like me. Disclosing my HIV-positive status, I believe, was one of the major contributions that I made for other HIV-positive women. It encouraged many other women to disclose their status, which in turn has increased their access to anti-retroviral treatment and other required services. I have helped people living with HIV receive job opportunities and supported other HIV-positive women for treatment.” - Indra Pariyar, treasurer, National Association of PLHA in Nepal (NAP+N) (Interview by Ashima Shrestha, senior program officer, LINKAGES Nepal)

Indra is an advocate for the rights of women living with HIV. She promotes capacity strengthening of community-based organizations under NAP+N across various districts in Nepal. As treasurer, she provides onsite support and coaching for system strengthening of the community-based organizations at the local level and is responsible for finance and governance.

“I take medicine regularly, and Rajendra visits me to provide further information about healthy living and safe behaviors. When I look back, I had multiple partners, and I was not using condoms. Even when Rajendra initially reached me with HIV and sexually transmitted infection information, I was not bothered. I feel sad about my careless behaviors. Now, I am thankful to Rajendra for reaching me with HIV- and STI-related information, motivating me to get tested, and helping me to be on treatment.” - Hanif, transgender woman, Western Star Nepal (Interview by Prakash Lekhak, program officer, LINKAGES Nepal, and Rajendra Dhobi, community-based supporter, Western Star Nepal)

Rajendra is a transgender woman and community-based supporter at Western Star Nepal. She provides HIV and STI prevention education and referrals for men who have sex with men, male sex workers, and transgender people in Banke district. Between October 2016 and September 2017, Rajendra educated 450 individuals, 73 percent of whom received HIV testing services from LINKAGES Nepal-supported clinics.

“I have been working with key populations at higher risk since 2006 and understand their dynamics. They are at higher risk of STI and HIV infection due to high numbers of sexual partners, delayed access to services, fear of stigma and discrimination, and gender-based violence. Many also have limited ability to negotiate condom use and are compelled to practice high-risk behavior due to financial need. Nowadays, the dynamics of sex work is changing. Many key population individuals use social media and other online or mobile platforms for sexual networking and for seeking health-related information. LINKAGES Nepal, in addition to face to face outreach, uses interactive voice response, short message services, and social media to reach these key populations and provide HIV prevention education and referrals." - Neela Thapa, program officer, LINKAGES Nepal (Interview by Bhagawan Shrestha, project director, LINKAGES Nepal)

"I think it is necessary to include key populations in HIV programming to improve their health seeking behavior, reduce stigma and discrimination, prevent and mitigate gender-based violence, and enable key populations to negotiate for safer behaviors. This addresses the structural barriers they face and reduces their risk and vulnerability. Furthermore, their involvement helps to design, plan, and implement key population friendly and sensitive services, which ultimately contributes to reach UNAID’s ambitious 90-90-90 goals by 2020.” - Neela Thapa, program officer, LINKAGES Nepal

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