Background: Available evidences show that Nepal has now entered into a concentrated HIV epidemic phase, as HIV prevalence is found above 5% among CSWs, IDUs. Studies show that mobility is one of the factors behind wide spread of HIV in African countries. This study was conducted in a remote mountain district “Mustang”, bordered with Tibet of China. People here are mainly Buddhists and socio-culturally near to Tibetan culture. As a survival strategy, inhabitants of this district were involved in Trans-Himalaya salt trade in the past. Now a day’s mobility to other part of country and India documented and observed. Some unique cultural practices like polyandry marriage, the headman system and celibacy system (a tradition of the second born to remain unmarried) still exist there.
Objectives: To assess the vulnerability of mobile people to STDs/HIV/AIDS by comparing risk exposure, condom use and treatment seeking behavior between the mobile and non-mobile group. To define possibilities for involving the indigenous headman system for prevention and control of STDs/HIV/AIDS.
Methods: A cross-sectional survey was conducted in a random sample of 255 adult Nepali, where the mobile respondents and non-mobile respondents were 153 and 102, respectively. The survey questionnaire included behaviour related questions from the Behavioural Surveillance Survey package (FHI) and additional migration related questions. We did face to face interviewing with illiterates and used self-filling questionnaire with literates. Qualitative data were collected by Focus Group Discussion and focussed interviews.
Results: The median age for the mobile and non-mobile group was 31 (SD 9.2) and 33 (SD 10.3) years respectively. There were significantly, more men, higher educated and unmarried in the mobile group. The self-reported STDs were significantly higher among mobile group 30 (20%) vs. 8(8%), respectively, (P = 0.01). Out of a total 176 sexually exposed to, 30 (29%) of the mobile group had more than one sex partners while there were 11 (15%) in the non-mobile group (p= 0.036). Eleven (7%) mobile people had visited commercial sex workers, but none in the non-mobile group. Consistent condom use with non-regular partner was as low as 1% with both groups. Nearly a quarter did not seek care for their reported STDs problem. Though 70% seek care from health institutions, visiting multiple sources was found. The headman system was identified as having well established, positive norms, already pursuing community development activities and showing a willingness to take part in STDs/HIV/AIDS control.
Conclusions: Our findings support the study hypothesis that the mobile group have a higher risk for STDs/HIV/AIDDS compared with the non-mobile group. Consequently Nepal should expand STDs/HIV/AIDS prevention programmes to cover the so-called “mountain belt population”.Indigenous resources like the “headman system” could be tapped into for the prevention and control of STDs/HIV/AIDS.