HIV/AIDS and the Tibetan Diaspora

Phayul[Wednesday, February 23, 2005 00:00]
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.

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