HIV and AIDS in Nepal: A brief note

HIV and AIDS in Nepal

Background:
Since the detection of the first AIDS case in 1988, the HIV epidemic in Nepal has evolved from a low prevalence to concentrated epidemic. As of 2007, national estimates indicate that approximately 70,000 adults and children are infected with the HIV virus in Nepal, with an estimated prevalence of about 0.49% in the adult population. As of Ashadh 2064, a total of 9756 cases of HIV, 1454 AIDS cases and 423 AIDS deaths had been reported to the National Centre for AIDS and STD control (NCASC). The sex ratio among HIV positive cases is 2:1.
Nepal is categorized as a “Concentrated” epidemic country as some of the sub population groups (IDUs, migrants) are having more than 5% of prevalence.
As in other countries in the region, IDUs, MSM and FSW are the groups most at risk with highest HIV prevalence. Most cases of HIV occur among labor migrants (46%) and increasing number occur among their wives (a combined 21% of HIV cases in low-risk women in rural and urban areas). Of all adults estimated to be living with HIV, a major proportion of HIV infections has consistently been among migrant workers travelling to India for work. In 2005, 46% of estimated HIV infections in Nepal were among seasonal labour migrants and similar pattern is found in 2007. Clients of sex workers account for 19% of HIV infections in 2005 and 16% in 2007. Spouses or female partners of migrant workers and clients of sex workers, now account for 21% of all adult infections. A 2006 study among Nepali migrants travelling to Indian cities for work found that 27% of men engaged in high risk sexual behaviors while in India and frequent sex workers.

Estimated Population Living with HIV and AIDS

Population groups Adult living with HIV
IDUs 10%
MSM 4%
FSW 2%
Clients of SWs 15%
Seasonal labour Migrant 42%
Trafficked women returned to Nepal 1%
Sub-total at risk 74%
Urban female at risk 5%
Rural female at risk 21%
Sub-total low risk 26%
Grand total 100%
Source: Annual Report , DoHS Nepal, 2007/08

Epidemics analysis:
National estimates of adult HIV infection for 2007 is similar to the previous estimates with increasing numbers of the cases. National records show the high prevalence of HIV in certain sub groups; IDUs (34%), FSWs(1.4%) and their clients, MSMs(3.3%) and returning migrants(1.9%) and trafficked women. (DOHS Nepal, 2007/08)

Age distribution of the cases of HIV in Nepal:

Population subgroup Estimates
Children (0-14) 1,857
Adult (15-49)
# of Women LWHA 64,585
16,387
Adults (50+) 3,348
Total 69,790
Source: NCASC, 2009.

Epidemic Regions of HIV in Nepal (of the total cases):








Changes in the prevalence as indicated by IBBS in Nepal:
Prevalence in IDUs has dropped from 68% to 34% in recent years. Prevalence amongh FSWs among the terai district of highway of Nepal is also decreased significantly. In Katmandu prevalence amongh FSW has dropped from 2% to 1.4%.

National Actions
National level commitment:
MDG commitment: Government of Nepal has commitment on MDG 6 ( Combat HIV/AIDS ,Malaria and other diseases). MDG target no.7 states ,” Have halted by 2015 and begun to reverse the spread of HIV/AIDS”.

Second Long Term Health Plan (1997-2017): Essential health program intervention as defined in SLHTP has stated as priority issue of HIV and AIDS. Main intervention no. 4 includes condom promotion and distribution for STD/HIV, Hepatitis B and Cervical cancer prevention method.

Policy and programming:
The following documents reveals the national government leaderships with the help of civil society for combating the threat of HIV and AIDS;

1988 Launched the first National AIDS Prevention and Control Program (short term)
1990-1992 First Medium Term Plan
1993-1997 Second Medium Term Plan
1993 National Policy on Blood safety
1995 National Policy on HIV/AIDS
1997–2001 Strategic Plan for HIV/AIDS Prevention
2000 Situation Analysis of HIV/AIDS - Nepal December 2000
2002–2006 National HIV/AIDS Strategic Plan
2003-2007 National HIV/AIDS Operational Plan
2006-2011 New National HIV/AIDS Strategic Plan
2006-2008 National HIV/AIDS Action Plan

Activities at district level:
In the district level district (Public Health) office is the leading body to take the action. HIV and AIDS focal person as designated at D(P)HOs. Starting of a position as District AIDS Control Coordinator under leadership of District Development Committee( the local government body) and DHO has been the new action to coordinate all the activities carried out at district level.

Major activities carried out in Nepal
 BCC interventions to prevent infections
 Harm reduction
 Voluntary counselling and testing service
 Anti Retroviral Therapy
 Prevention of Mother to Child Transmission

Conclusion:
Being a concentrated epidemic country with inadequate policy and legal frame, there is always a problem of ownership problem at government level. The activities regarding HIV and AIDS are always led by civil society. Majority of the activities and policy farming were provided with in put by civil society. However, without a strong government leadership, MDG is unlikely to be achieved.