Nepal’s Telephone Counselors Offer Life-Saving Sexual Health Advice

2016-10-10

As counselors for the Meri Saathi helpline, midwife Hima Mishra and her team field hundreds of calls a day from people with questions about sex, pregnancy and abortion, helping to shed light on reproductive health rights in Nepal.

Hima Mishra’s office in Kathmandu is a tiny room staffed with seven smiling women wearing headphones. It may look like a small operation, but the women receive up to 150 calls a day from men and women across Nepal.

“Morning to night, our voices are the same. We are always happy,” says Mishra, who runs the team. “You would think that we are very stressed and tired, but we’re not.”

In 2011, Marie Stopes International (MSI) launched a free helpline number called Meri Saathi, which translates to “My Friend,” to provide counseling on a range of issues from safe abortion, contraception, masturbation, penis size, menstruation and safe sex.

In mountainous Nepal, where it can take a woman days to get to the nearest primary healthcare center and where premarital sex is taboo, the call center is a lifeline for thousands of Nepalis who have little or no access to accurate information.

Although abortion is legal in Nepal during the first 12 weeks of pregnancy or up until 18 weeks in cases such as rape and incest, deaths from unsafe abortion still account for more than 5 percent of recorded maternal deaths.

Since abortion was legalized in 2002, more than 800,000 womenhave received safe abortion services from over 500 certified clinics, but challenges remain, including a lack of skills among health workers and overcrowding at referral hospitals, according to the latest Department of Health Services annual report.

Another major barrier to women seeking safe abortion services is that many don’t know it’s legal. Only 38 percent of women in Nepal are aware of the law on abortion, according to the 2011 Nepal Demographic and Health Survey, and only one in two know where to access services.

While the government last year pledged to make abortion services free across the country, it hasn’t happened yet. Women who don’t go through organizations like MSI have to pay the equivalent of $10, making safe abortion unaffordable for those living in rural areas.

Mishra has been working at the Meri Saathi call center since it launched, and has watched its popularity grow from 150 calls a month to 150 a day. The team is planning to move to a bigger work space, add more staff members and extend the hours the hotline is open to keep up with the number of requests.

“We’re overloaded with calls,” she says. “We don’t want to miss people.”

The main purpose of the hotline is to educate people about their sexual health and reproductive rights. The center also offers counseling via live chat on its website and through Facebook and Twitter, and the Meri Saathi workers follow up on existing clients whenever they can.

At the moment, the team gets more calls from adolescent boys than women or girls, asking questions about safe-sex practices, how to manage their sexual desires and the bodily changes they are experiencing.

“I tell them that masturbation doesn’t harm their body and they should keep busy, study, do sports and be creative. I give them tips for what is best for their future,” Mishra says.

For young women who call, the primary concerns are sexual propositions outside of marriage, contraception, menstruation pain and access to safe abortions. Stories of women inserting iron bars or using other potentially fatal methods to try to give themselves an abortion are all too common.

Determined to stop that happening, the Meri Saathi team callers to an MSI clinic or, if they live too far away from one, to a listed organization, healthcare center or government hospital that provides safe abortions

But women are often either too scared to tell their husbands, or their husbands insist on keeping the baby, particularly if they are hoping for a boy. “Often women don’t want another baby and they beg me not to listen to their husband and ask if they can get an abortion alone,” Mishra says. “Husbands call the center and ask about their wife’s abortion. I tell them [family planning] is also a father’s responsibility.”
Some of the calls haunt the counselors long after they hang up the phone – like the time a 22-year-old man asked for Mishra’s advice because he was having a sexual relationship with his mother. But then there are the times when the counselors see how one phone call can change a life for the better. One of Mishra’s happiest memories is when she was able to prevent a 14-year-old girl from western Nepal from getting married after speaking with her mother.

For Mishra, the biggest reward comes from guiding young women safely through some of the most difficult times in their lives. “I feel so proud that I have saved so many youths from unsafe sex and so many women from unsafe abortions,” she says.

“To fight HIV effectively we must insist upon the removal of anti-LGBT legislation globally”

2016-10-06

Criminalisation, stigma and HIV transmission

Anti-gay legislation, globally, is leading to higher rates of transmission for HIV. The countries with the highest populations of HIV positive people all criminalise gay men, or have a recent history of doing so. 77 countries still criminalise being gay. These countries do not allow LGBT people to openly express their identities, thereby preventing the development of LGBT rights movements and exacerbating HIV transmission rates.

Many LGBT people living with HIV face a dual stigma, that of being LGBT and that of being HIV positive. There is a clear link between criminalisation, stigma and HIV transmission. As we move out of the European Union, we must ensure that global LGBT equality remains a priority for UK legislators.

In Africa being gay remains illegal in 36 out of 54 countries. Africa has the highest prevalence of HIV in the world. Gay men in Africa are twice as likely to be HIV positive as their straight counterparts. Most African countries have European colonial era anti-LGBT legislation. Criminalisation entrenches homophobia. The African LGBT community is largely underground. Underground communities are harder to reach and are less informed about HIV or safe sex. LGBT people are less likely to use HIV testing services and are prohibited from accessing antiviral medication. Health professionals often discriminate against LGBT people and there are few government-led LGBT inclusive HIV initiatives.

Uganda and Senegal are among the worst on anti-LGBT legislation and its implementation. In Uganda the legislative situation is actually getting worse for LGBT people. In 2014, the Ugandan government attempted to bring in the Anti-Homosexuality Act, which was only overturned on a technicality. In Uganda, LGBT people are reluctant to discuss their sexual identities with health workers who, technically, are obligated to report them to the authorities for same-sex practices.

Senegal has had a number of arrests and convictions for LGBT activity in recent years. In Senegal homosexuality is punishable by up to five years in prison and it is also one of the few jurisdictions to have criminalised female homosexuality. Last year, in one raid, seven men were arrested and sentenced to six months in prison. Such raids are thankfully uncommon, and their sentencing caused international outrage, but this case is indicative of the hostile atmosphere LGBT people have to deal with in Senegal. Amongst the items found in their possession were condoms. The Senegalese government was effectively punishing these men for practising safe sex, the condoms evidence of their criminality. Ugandan and Senegalese health workers are reluctant to engage with LGBT people, as they may be perceived as encouraging illegal activity.

In Mozambique, unlike in Uganda and Senegal, the existing colonial era anti-LGBT legislation, a legacy of Portuguese colonialism, has been repealed. Although legally there has been an improvement in their status, LGBT people face continued discrimination from government organisations. The government remains reluctant to encourage LGBT inclusive training for sexual health workers, or even register the country’s one LGBT organisation, which is called Lambda. Some LGBT people have been refused treatment for sexually transmitted infections, while trans people have been made to change their clothing before health workers will treat them.

In Caribbean countries where same-sex relationships are criminalised, the rate of incidence for HIV is a one in four, while in Caribbean countries where there is no anti-gay legislation it is one in 15. Approximately thirty per cent of Jamaican men who have sex with men are HIV positive, compared to a rate of 1.6 % in the general population. In Jamaica homophobia is rife. Anti-LGBT legislation creates the perception that violence against LGBT people may be tolerated. LGBT people cannot discuss their sexual identities. Men who are diagnosed as HIV positive are often “accused” of being gay. Here, the dual stigma, of being gay and that of being HIV positive, is at its most apparent. LGBT people who are HIV positive are the most likely to be victimised and face violence.

The LGBT community have been at the forefront of the fight against HIV in the UK. Over the last thirty years, we have pulled together at a time of crisis to save our neighbours, friends and lovers. We ensured our community knew about the HIV virus. We cared for those living with HIV. We confronted the stigma associated with HIV. It was the LGBT rights movement in the UK and the USA which first responded in an empathetic and effective way to the HIV epidemic. Anti-LGBT legislation prevents LGBT people coming together to confront HIV.

To fight HIV effectively we must insist upon the removal of anti-LGBT legislation globally. Where criminalisation exists and homophobia has been institutionalised, access to HIV services is difficult and violence against LGBT people is rife. Moving out of the EU, we must not be shy of using our position as the world’s fifth largest economy to demand concessions for LGBT people. The UK can pride itself on being one of the world’s most tolerant countries on LGBT issues and we should not be afraid of advancing the rights of LGBT people globally. We should not allow our work to promote LGBT rights globally to be diminished by leaving the EU, but instead embrace our freedom to promote LGBT rights more assiduously. Let us embrace this opportunity to increase our global influence on LGBT rights. We are a core part of the global LGBT rights movement.

Follow Phillip on Twitter @philipcbaldwin