Fighting for Equality in Nepal

At the 25^th International AIDS Conference, activist Manisha Dhakal was honored with the Elizabeth Taylor Human Rights Award for her work to address the needs of the LGBTQI+ community, and men who have sex with men (MSM) and transgender people living with HIV. The honor is presented biennially at the conference by The Elizabeth Taylor AIDS Foundation (ETAF) and amfAR, whose Founding International Chairman was Dame Elizabeth.

When we communicated via email, Dhakal shared: “I’m not only proud and happy but also motivated to do even more meaningful work and continue to make contributions to advancing the rights of queer people in Nepal.”

She then joked about the pressure that comes with accolades: “On the other hand, the award gives me more responsibility to do justice to the honor in the coming days!”

As her past work shows, however, Dhakal has nothing to worry about. She is one of the founding members of the Asia-Pacific Transgender Network, where she represents South Asia, and serves as one of the co-chairs of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (Asia Region) board and a board member of IRGT, a Global Network of Transgender Women and HIV. In 2021, she received the Janasewa Shree (Fifth Class) national award from the government of Nepal for her contribution in advancing the rights of LGBTQI+ people in Nepal. Dhakal is also a Human Rights Campaign Global Innovator. As a scholar, she has published in The Lancet and PLOS Global Public Health, among other journals.

As executive director and a founding member of the Blue Diamond Society, which advocates on behalf of LGBTQI+ people in Nepal, Dhakal and her team played an instrumental role in the country becoming the second in Asia to recognize same-sex marriage earlier this year.

In 2007, Blue Diamond Society laid the groundwork for equality by participating in a Supreme Court hearing about LGBTQI+ rights, where Manisha spoke openly about her experience as a transgender woman.

“Because of my and our community experiences of discrimination, violence, stigma, and challenges, I thought I had to speak,” Dhakal told amfAR. “If I did not break the silence, the judges [would not have] internalized our lived experiences. After the court decision, one of the judges mentioned that they had gone through various desk reviews and analyses of evidence and reports to make the decision. In this regard, my sharing played a crucial role in making a positive impact.”

As a result, Blue Diamond Society immediately helped secure the recognition that LGBTQI+ people had equal rights as citizens, gender identity rights, and an audit of laws to remove any that discriminate against LGBTQI+ people, among other advances.

Equality, of course, helps ensure better health outcomes. When asked what she wanted readers to know about HIV/AIDS in Nepal, Dhakal first highlighted prevention needs.

“The incidence of HIV in Nepal is not declining at the rate to achieve the 2030 goals,” Dhakal said. “Routine mathematical modeling of NCASC [National Centre for AIDS and STD Control – Nepal] in 2020 shows men who have sex with men/male sex workers/transgender population together account for 26% of new HIV infections in the country. Hence targeted intervention towards key populations [such as these] focusing on HIV prevention is required to ensure we end AIDS by 2030.

“However, HIV prevention services are not currently widely accessible and utilization of PrEP is quite low among key populations. According to a study among MSM in Kathmandu, only 30.4% were PrEP users, and we can assume utilization is even lower in semi-urban and rural areas of the country. Generating the demand for prevention services, availability of services like condom and lubricants throughout the year through proper logistics supply, and introduction of new innovations like injectable PrEP are needed.”

Other resources that are needed, Dhakal shared, include diagnostic testing. “Alongside the continued supply of antiretrovirals, routine and uninterrupted viral load (VL) and CD4 count testing are essential for monitoring of VL suppression and effectiveness of antiretrovirals among PLWH. CD4 count testing is not practiced at all ART sites in Nepal and routine VL tests are also interrupted time and again. These services are essential in the context of rising deaths among PLWH worldwide due to advanced HIV disease.”

Chael Needle is amfAR’s senior staff writer.

Click Here to read more from the December 2024 issue of amfAR INNOVATIONS.