By Lobsang Yeshi
“I guess every Tibetan is waiting for that one HIV positive Tibetan to cross his/her path to think seriously about the issue. And therefore, I have cause to worry for the community that I live in.”
-Dr. Yangchen Dolkar (MD), in a report titled, “How many with HIV/AIDS?” published in August 2005 in Tibetan Review
Regardless of the clarion call made by Dr. Yangchen Dolkar a decade ago, then serving at one of the largest Tibetan settlements in South India, the general approach and perception of the Tibetan community towards the virus oscillate between callous indifference to frantic intensity. Ironically this paradoxical mix of approach persists despite gradual swell in HIV/AIDS infection instances and a decade long awareness campaigns spearheaded by the Department of Health (CTA), CHOICE and other NGOs, community leaders and individual volunteers.
As early as 1990s, concerns over the prospective prevalence of HIV/AIDS in Tibetan Community were raised by numerous Tibetans and Westerners. In an article titled, "HIV/AIDS: A Vague Threat or Reality?" published in October 1996, Ms. Dechen Tsering, a nurse from California expressed her concern about the threats of HIV/AIDS to the Tibetan community. Similarly, Spencer Seidman, a Medical Counsellor wrote “AIDS in India and its potential impact on the Tibetan refugee community” in 1997, warning, “The HIV epidemic not only affects the present generation: it will affect all future generations of Tibetans”.
In December 2000 edition of Focus, in a report titled, “AIDS in Tibet — Assessing the Risk”, Dr. Alison Morgan warned, “Our fear is that unless appropriate strategies are taken, AIDS could blow out in Tibet as in other developing nations”. In February 2005, Mr. Renato Palmi, an independent Tibet analyst from South Africa, made a presentation titled “HIV/AIDS and the Tibetan Diaspora” at the University of KwaZulu Natal, warning that Tibetans “...face the distinct reality of HIV and AIDS devastating their marginalized community if preventative measures are not put in place with urgency.”
But the ensuing public indifference and apathy resulted in HIV/AIDS; the world’s deadliest and most misunderstood disease, making a deep inroad into the community leading to substantial growth of infections and AIDS deaths over the years.
His Holiness the Dalai Lama during the 46th Founding Anniversary of TCV School in Dharamshala, on 26th October 2006, expressed serious concern over the possible spread of HIV/AIDS in Tibet and the need to combat the same. This virtually spurred an HIV/AIDS prevention movement with the birth of CHOICE HIV/AIDS Initiatives and numerous prevention and welfare measures being initiated by the Department of Health (CTA) and others.
However, the responses and the effectiveness of the preventive campaign vary from settlement to settlement depending on the seriousness of the prevalence of the epidemic. Comprehensive Awareness Workshops involving mass participation of the residents, free HIV testing and network formation were launched successfully in some settlements whereas in others, campaigns and participants barely trickle. Joint public initiatives to curb the deadly menace are a far cry.
A more alarming development is the continued increase of cases of HIV/AIDS infection among young people. I was overwhelmed to learn 6 new occurrences in one settlement within a week's time in 2012. Additionally, more threats linger with the practice of increased liberal sexual behavior and unprotected sex among certain sections of young Tibetans.
Despite exhaustive guidance on safe sex and overwhelming humanitarian, financial and moral support to the HIV/AIDS victims, outrageous revelation of some HIV/AIDS carriers infecting others is appalling and tragic. And this criminal negligence continues in the absence of any social ramification and legal actions. This is indeed a serious pointer to the need of a more rigorous campaign to fight this global pandemic in our community.
It also pains to learn that almost all our HIV patients have undergone some kind of social discrimination and ostracization at the initial stage. Though situation has improved tremendously over the years, social stigma and discrimination prevail even today. Just recently in one Tibetan settlement, a victim was coaxed and cajoled out of cook’s job for fear of infection through food. In another instance, a victim’s child was forced to discontinue schooling as parents threatened to pull out their child if victim’s child (who is not infected) continues in the same school. After much counseling, the child got re-admitted.
That an instance of a weird and thoughtless ridicule of a Tibetan HIV/AIDS victim in one Tibetan colony had resulted in mass infection by the victim in vengeance proved a wise lesson that, in our fight against this deadly menace, we must, however stop criminalizing the HIV/AIDS victim for good.
Nonetheless, one impressive achievement in recent years is a dramatic drop in the death rate of HIV/AIDS victims. Initially, substantial numbers of the victims were, understandably, in a denial mode amidst fear of social stigma and discrimination. But gradually with an increased openness and acceptance of HIV status and with regular monitoring and accurate therapy the death rate declined most dramatically. In one Tibetan settlement where doctors once claimed an annual death rate of 10 affected, there were only 3 recorded in the last three years.
HIV/AIDS in China: a Reality Check
The first detection of HIV/AIDS in China in a dying tourist in 1985 led to the Government’s sarcastic terming of HIV/AIDS as Aizibing; loving capitalism disease. However the numbers swelled tremendously with the first indigenous cases reported outbreak in 146 infected heroin users in Yunnan province in 1989, followed by the tainted blood-selling fiasco in Henan and other provinces. Even UN report, “China’s Titanic Peril” published in 2002 made the horrific prediction of 10 million HIV infected individuals in China by year 2010, declaring that, “China is on the verge of a catastrophe that could result in unimaginable human suffering, economic loss and social devastation”.
Likewise, a prominent AIDS Researcher Dr. Zeng Yi at the Chinese Academy of Science, reported that: “If no measures are taken quickly, China will have the most AIDS victims in the world and spread of AIDS will become a national disaster”
From initial reluctance in acknowledging the HIV/AIDS epidemic to the launching of a much hyped, "Four Frees and One Care" policy in 2003, the Chinese Government failed miserably in addressing the HIV/AIDS crisis. Beijing’s initial ban on disclosure of information on HIV/AIDS as ‘State Secret’ and the lack of political will, undoubtedly, played a major role in worsening the crisis. China also feared that publicity about its AIDS problem will ruin the investment environment.
Today, estimated 840,000 to a million people in China are infected with HIV/AIDS. And HIV/AIDS became China's No. 1 deadly infectious disease for the first time in 2008, with 6,897 people dying from AIDS-related causes during the first nine months of the year.
On 2nd December 1999, just two days after China’s first television advertisement promoting the use of condoms was aired, China banned the advertisement citing, “the advertisement was illegally promoting sex products”. In fact the ban has been in place since 1989.
And China's first major television campaign to promote condom use was not launched until 2007.
However on World AIDS Day in 2003, Wen Jiabao became the first Chinese Premier to shake hands with an HIV positive person, ludicrously prompting Mr. Peter Piot, the executive Director of UNAIDS to affirm that, “I really feel there is a change going on…I know that for top state leaders in China today, AIDS is on the agenda.”
Yet, the XVI International Conference on HIV/AIDS held in 2006 in Toronto, Canada condemned China for massive discrimination against HIV/AIDS patients.
Recently during the World AIDS Day, China’s new Premier Li Keqiang promised more governmental support for HIV/AIDS activists. However, it should be reminded that Mr. Keqiang was relatively ineffective in curbing the HIV/AIDS epidemic in Henan province in early 2000 when he was the Governor.
Today, China boasts of its First Lady Peng Liyuan as WHO Goodwill Ambassador for HIV/AIDS and Tuberculosis. Yet these are mere rhetoric and an eyewash devoid any serious commitments.
According to Human Rights Watch, Aids activists working in badly hit areas of central China are regularly intimidated and have even been beaten up, some even killed by thugs, hired by the local government. In April 2007, more than 350 HIV/AIDS protestors were detained, beaten and arrested and house arrested by the police.
In its latest World Report-2013, Human Right Watch indicts China by condemning that, “Human rights defenders in China regularly face police harassment, house arrest, short-term detention, “reeducation through labor,” forcible commitment to psychiatric facilities, or imprisonment on criminal charges, often on state security or public order grounds.”
These harassments have compelled prominent HIV activists like Wan Yanhai, Gao Yaoji, Dr. Lu Guogan and Wang Shuping to flee overseas and others like Hu Jia, Zeng Jinyan, Tian Xi, Li Dan, Liu Di, Wang Guofeng, Li Shuzhi, Tan Zuoran, Pan Zhongfeng and Fan Zhenbang continue to face imprisonment or intimidation from state security forces.
In fact, Dr Wan Yanhai in his book on HIV/AIDS stated that China detain hundreds of HIV/AIDS activist before World AIDS Day. This indicates that despite Government promises, AIDS activists cannot be too vocal.
Li Xige, an aids activist got arrested and thrown out of Beijing in 2008 after secretly attending the much hyped World AIDS Day at the Bird’s Nest Stadium months after the much-trumpeted Beijing Olympics. Li Xige was fighting for reimbursement from the hospital that is responsible for infecting Li and her two daughters with HIV virus through blood transfusion in 1995. She lost her elder daughter to AIDS.
On 26th June 2008, RFA reported the shutting down of Snow Lotus HIV/AIDS Education Institute in Urumqi, East Turkistan, after it won a grant from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Chang Kun, the founder of the NGO and HIV/AIDS activist was expelled from the Xinjiang Normal University. Mr. Chang moaned, “They pretty much took away my goal, and my dream of helping my community”.
In September 2012, an HIV infected women died in Guangdong after more than three hospitals refused to treat her for the burn injury. Guizhon Government fired an HIV infected teacher from the job. To add insult to the injury, Guizhou Court dismissed his appeal for reinstatement on 8th September 2012. In Jiangzi province, Xiao Qi was rejected a teacher job after revealing his HIV status. In November last year, Beijing and Tianjin hospitals rejected lung cancer treatment for an HIV patient.
Even today, there is Government restrictions on entering the so-called AIDS village like Wenlou and Shangcai etc. The Government policy of classifying AIDS as a ‘State Secret’ is still maintained in many towns and villages.
Consequently, despite Chinese government’s boisterous claims of policies and campaigns to fight HIV/AIDS, its constant harassment of HIV/AIDS activists and intensified surveillance of AIDS support groups and petitioners raise serious concerns about its commitment to combating this threat.
In fact, China Watchers aptly ridicule that ‘No good deed goes unpunished in China’.
It is prudent to remind ourselves that the little successes that China has achieved so far in the fight against the HIV/AIDS are mostly attributed to the foreign governments and NGOs and the local Chinese activists. Therefore, it is vitally important for China to take steps to make their strategies to combat AIDS into concrete actions more than rhetoric.
Assessing the Threats in Tibet
The first case of HIV/AIDS in TAR was reported in 1994 and the first death by AIDS in 2001. First Tibetan infected with HIV was reported in 2003. The number swelled with 18 new cases being detected in 2005. In 2008, over 70 HIV cases were reported in TAR scaling to 130 in 2010. Today over 300 HIV/AIDS cases have been reported in TAR. (According to Xinhua report quoting Dr. Jiang Zugang and Yuzhan Lhaco, Deputy Directors of TAR CDC). This figure is restricted to TAR and could be fudged as usual. Figures in other Tibetan areas are unknown or is a closely-guided secrets.
During World AIDS Day function on December 1st, 2010, Mr. Li Bin, Tibet expert of NCAIDS/CDC issued a serious warning on HIV/AIDS situation in Tibet.
Dr. Jiang Hua, China's leading HIV experts told Telegraph in 2009 that Tibetans face HIV risk as sex workers migrate west into Ganzi and Aba. He added, “This crisis is not getting much attention as Karze and Ngaba are not recognized as HIV hotspots”. Expressing his concern about the same he added, “The potential risk is huge.”
“HIV/AIDS in China and its implication for Tibetans and other Minorities” by Spencer Seidman asserts, “HIV poses a threat to Tibetans both inside and outside the TAR. No one knows how many people have active AIDS or are HIV positive in TAR, Gansu, Yunnan, Sichuan and Qinghai, due to the lack of testing sites in these areas. What is known is that Yunnan has the largest reported AIDS rate in China, and that Sichuan also has a significant HIV positive population; both provinces have large Tibetan population”.
The Beijing based US Embassy in a report titled, “Environmental Protection along the Qinghai-Tibet Railway” published in April 2003 warned of Railway posing risk of HIV/AIDS in Tibetan area. Dr. Thupten Phuntsok of Tibetan Association of Prevention of Aids (TAPA, established in 2004) one of the leading NGO working on HIV/AIDS prevention told a Kham Television in 2012 that “Lack of AIDS awareness among Tibetans, especially in villages, and the liberal culture of sex make Tibet a vulnerable place for spread of HIV/AIDS.”
The Swiss Red Cross (medicusmundi) working on HIV/AIDS in TAR since 2002, in its September 2011 bulletin claims that though the Government had launched Free Counseling, Free Testing and Free Treatment etc in Tibet, they are doubtful about the actual implementation of the same by the local Governments. The Bulletin further states, “Official data on HIV prevalence in TAR are not published. However, the HIV prevalence is estimated to be on sharp increase. While 70 cases were reported by the local Center for Disease Control (CDC) during 1993-2008, the figure increased by 130 new cases in 2009-2010”.
The Bulletin further revealed that, “Even though officially the names and data of the positive persons are not disclosed, their exclusion from the workplace and forced return to their homeland indicates the high level of stigmatization and discrimination in the country”. It concludes, “Since condoms are not promoted as important family planning device, the potential of condoms for dual protection is not tapped at all. On the contrary, the family planning department claims to be always short of condoms”.
Therefore, numerous adverse situations threaten to swell Tibet with the HIV/AIDS pandemic. Factors including Beijing Government’s lackluster approach towards the HIV/AIDS menace, poor healthcare infrastructure in Tibet, presence of large number of China’s HIV/AIDS victims in Yunnan, Sichuan, Kansu and Xinjiang provinces, stationing of over 7 million Chinese military and civilian population in Tibet and the massive flow of Chinese tourists into Tibet (Official statement records 52.76 million Chinese tourists in Tibet through the Gormo-Lhasa Railway since 1st July 2006) puts Tibet in a vulnerable position.
Additionally, the influx of large number of Chinese sex workers into Tibetan towns and cities (London-based Free Tibet, estimates 1,000 brothels in Lhasa city in 2005), the polyandry system, Government’s sinister policy against activists and the lack of any sustainable state sponsored preventive programmes are some of the major concerns that threaten outbreak of HIV/AIDS pandemic in Tibet.
China’s campaign to arrest, imprison and execute Tibetan social activists, religious heads, writers, singers, teachers and students reveals vicious designs. The murder of prominent religious head Khenpo Jigme Phuntsok, arrest, imprisonment and torture of Tulku Tenzin Delek, Khenpo Bangri Rinpoche and an ace HIV activist Wangdue etc also confirms that ‘No good deed goes unpunished in Tibet too’.
Some of the prominent NGOs and individuals working in Tibet on HIV/AIDS are Burnett Institute of Australia, Tibetan Association of Prevention of AIDS (TAPA) headed by Dr. Thupten Phuntsok, Swiss Red Cross (www.medicusmundi.ch), AusAIDS, Swedish Tibetan Society of Sonam Jamyangling, Machik, Wangdue la (arrested in 2008 and imprisoned for life), Khenpo Tsultrim Lodoe of Sertha Monastery and numerous other religious heads and individuals.
Presently CHOICE is aware of over 120 HIV/AIDS infected Tibetans in India and Nepal. We suspect the actual number could be higher given the precedence of many HIV/AIDS victims consulting Indian hospitals directly without registering at the Tibetan hospitals.
However, several factors like lack of recognition of the threat of HIV/AIDS prevalence, lack of concerted effort from all stake holders, reluctance to participate in the awareness campaigns by the TPLHA, continues rise in new infections, laxity in care, medication and adherence by TPLHA, infection of others by TPLHA, lack of seriousness on HIV Testing (it is feared that a mere 12-15 % of Tibetans in India has undertaken HIV testing), jittery in the promotion of the use of condoms (some citing hindrance in Tibetan population growth, as if one goes around making babies with strangers and prostitutes. In contradiction, CTA Demographic Survey 2009 reveals that young Tibetan couples are reluctant to bear more than one child), highly mobile population, transmission of infection from the high-risk groups to the mainstream population amounts to greater spread of the HIV/AIDS in the Tibetan Diaspora.
Consequently, we must not underestimate the effect of HIV/AIDS on the social, political, economic, healthcare and social stability of the Tibetan Diaspora. HIV/AIDS is not just a health crisis but a social crisis requiring involvement of the entire stake holders or the community engagement. More vigorous involvement of the Tibetan NGOs and Tibetan Media could also effectively bolster the fight against this epidemic. In fact, constant reminder of the crisis could save many a lives.
HIV/AIDS is therefore, an unprecedented crisis that demands an exceptional response. Simply put, unchecked HIV/AIDS is a threat to the Tibetan nation and our struggle.
Finally, I wish to place on record that the Department of Health, especially under the leadership of former Kalon Tripa Prof. Samdhong Rinpoche and Health Kalon Chope Paljor had assumed a proactive stance against HIV crisis and spearheaded HIV/AIDS prevention campaign on war-footing leading to saving of many young lives.
Special love and hugs to Dr. Tenzin Namdol, Phuntsok Chomphel and the entire team of CHOICE for an awesome humanitarian achievement. Of course, this short yet humane journey with CHOICE will be cherished for life.
Finally, immense appreciation and gratitude is also due for the Indian Government Hospitals and ART Centers, Delhi based SAHARA and Shalom, Mysore based Asha Kiran, Ramakrishna Mission Hospital and Swami Vivekananda Charity Trust, Dharamshala based Gunjan, and many other Indian NGOs for distribution of free ART treatment, free testing and counseling, Monitoring and taking care of our HIV/AIDS patients. And for giving them all hope, help and Life. Thanks are also due to innumerable compassionate Tibetans and well-wishers for supporting our ‘Adopt HIV Family’ project and sponsoring our needy TPLHA. In fact, you are all a part of CHOICE’s Success. Thank You.
The author is a Member of the Tibetan Parliament-in-Exile and Co-Founder/South-India Coordinator of CHOICE HIV/AIDS Initiatives.
The views expressed in this piece are that of the author and the publication of the piece on this website does not necessarily reflect their endorsement by the website.