The time to act is now
South Africa - This is a shorten copy of a presentation given at the University of KwaZulu Natal, South Africa by Mr. Renato Palmi. Durban, South Africa will be hosting in June 2005 a conference on HIV/AIDS.
The exiled Tibetan community has survived for 46 years as a stateless minority group living in the most populated democracy in the world – India, which, according to UNAIDS and India’s National AIDS Control Organisation, has the second highest number of HIV infections by country in the world. South Africa has the highest.
Politically and economically isolated, the Tibetan refugee community in India, which numbers around 85 000, faces the distinct reality of HIV and AIDS devastating their marginalised community if preventative measures are not put in place with urgency.
Because the Tibetan government-in-exile (TGiE) is not officially recognised by any other of the world’s governments, it cannot obtain financial assistance from international institutions such as the IMF. Nor can it rely on its hosts, the Indian government, for infrastructure in the 48 Tibetan settlements, some of which are so remote that the communities have very little access to or communication with the outside world.
The Tibetan government is therefore reliant on its own means to support its people, and no doubt it is this reality that has stimulated the indomitable determination of the Tibetan exiles, evidenced by a demonstrable commitment to development, such as the building of some 44 health clinics, nine primary healthcare centres and seven hospitals since 1960.
According to the International Campaign for Tibet (ICT), an average of 2 500 Tibetans flee from Chinese-occupied Tibet every year. Their escape route takes them over the Himalayas and across three countries – from Tibet to Nepal and then to India - and can take anything from 30 days to three months.
According to the TGiE’s Department of Health, refugees who do manage to evade arrest and execution by the Chinese border-patrols, or rape, imprisonment and deportation by the Nepalese police and other officials, are processed at the Tibetan Reception Centre in Kathmandu before being sent to Delhi, and finally to Dharamsala, the central hub of the Tibetan government-in-exile. At no stage are the new arrivals tested for HIV.
The TGiE reports that, according to their statistics, there have been no cases of HIV infection or AIDS-related death within their community, but this claim can be attributed to the fact that testing for HIV is not obligatory.
The fact that Tibetan refugees are not tested within their own community poses a moral and ethical dilemma for the exiled government. How can prevention interventions be devised and implemented within their community without infringing on the rights of the individual, and furthermore without subjecting the new refugees to further trauma?
An official from the TGiE claims that if a Tibetan were diagnosed as HIV-positive or afflicted with AIDS-related diseases, the patient would be sent to an Indian hospital. As Indian hospitals become inundated with Indian citizens succumbing to the epidemic, and bed-space (as well as other infrastructural and service capacity) become increasingly limited, there is understandable concern that Tibetan refugees might not be accommodated ahead of Indian patients.
Social and cultural norms further exacerbate the impediments to managing HIV and AIDS within the Tibetan exiled community. Condom usage is not a traditional form of contraception in traditional Tibetan life, and providing access to and information about condoms in the remote refugee centres is not a viable short or medium-term solution.
Moreover, the TGiE’s Department of Health has indicated that there is still a strong reliance on traditional medicines, with many Tibetans preferring to consult traditional Tibetan doctors for remedies, rather than seek advice from allopathic practitioners and medication. This resistance to Western medicine and, more especially, the polarisation of the two approaches or the unsupervised melding of the two, obstructs progress in treatment of HIV and AIDS within the Tibetan refugee community.
As a stateless and, globally speaking, ignored nation, the characteristic Tibetan identity of international abandonment is debilitatingly stressful, and leads many of the youth, who have little chance of employment or alternatives for progress, to seek solace in alcohol and drugs. This, in turn, can lead to unsafe sexual behaviour, not only amongst the Tibetan community, but also through interaction with the busloads of Western tourists who frequently visit Dharamsala.
The only awareness programmes and prevention interventions visible within the exiled community are information workshops and the dissemination of literature on HIV and AIDS. However, not much is known about whether these training, materials and communication methods are effective for behaviour change or in promoting voluntary counselling and testing.
This renders the perception of there being few if any reported HIV/AIDS cases within this community as highly speculative, and it is not difficult to understand why denial, silence and stigma in this regard would be perpetuated. In such a vulnerable, disempowered setting, with the threat of displacement looming and little relief in sight, any suggestion or acknowledgement by the TGiE that the habitat of Dharamsala could constitute a hotbed of HIV infection could risk unimaginable negative reaction, and possibly decisive action, from the Indian government.
Grafted upon this is the anticipation that, as India comes to terms with the "New Wave" of the pandemic sweeping across the Asian continent, any changes adopted by the Indian authorities to address their own citizens’ needs could create a disastrous situation for the Tibetans in exile. Policies to curb and contain the spread of HIV would logically be focused along vulnerable borders, such as those near the tiny hill-station of Dharamsala, and in the territory through which Tibetan refugees must travel, on foot, in the hopes of a free life.
Both the exiled government and the international community cannot ignore the awful consequences that the HIV/AIDS pandemic will have for this isolated community. The world has a moral and ethical obligation to think about these implications in time to establish sustainable supportive mechanisms for facing down the pandemic when it does emerge within the Tibetan exiled community.
The research for the presentation was done remotely from South Africa.
Renato Palmi is an independent analyst of Tibetan affairs. He founded the first Tibet support group on the African continent and is currently completing an MA at the School of Development Studies – University of KwaZulu Natal, South Africa.