Nepal has seen a remarkable turnaround in either decreasing or stabilising the prevalence of HIV among high-risk groups.
FOLLOW-UP: Gita Pun (left) of Bankhet, Dang, is visited by HIV counsellor Poshan Raj Basnet (centre) and nurse Bhima KC during a regular check-up at her home.
After containing a general AIDS epidemic, Nepal has seen a remarkable turnaround in either decreasing or stabilising the prevalence of HIV among high-risk groups.
The most recent data suggests that there are approximately 39,000 people living with HIV in Nepal, with 29 per cent of them women. However, in the 15-24 age group, women with HIV outnumber men by 1.5 times highlighting the vulnerabilities of adolescents and young women.
One of the reasons for Nepal’s success is that people living with HIV are at the forefront of community and home-based care. They provide regular support for people on Anti-retroviral Therapy (ART) and also ensure access to the drugs. Despite elusive vaccine and cure, continued stigma and discrimination, the introduction and expansion of ART has transformed the situation of people living with HIV in Nepal.
Nepal’s response has been backed by a sound national strategy that is grounded on evidence-based, tailored approaches. They focus on targeted interventions for female sex workers, people who inject drugs, men who have sex with men and transgender people, and male labour migrants and their spouses. This approach has yielded impressive results with stabilising or declining HIV prevalence among key populations, even though access to ART needs to be improved, and awareness campaigns maintained.
Of the people living with HIV in Nepal, 68 per cent were identified through HIV testing. Nearly 37 percent of them were women. The HIV programs have consistently tested around 2,000 people as HIV positive for the past seven years. The proportion of HIV positive among those tested has constantly dropped from around 4.5% in 2008 to 1.6% in 2014. This could be due to declining HIV prevalence among key populations, even though we need to ensure that we are testing the right people.
Nepal provides free ART through 61 sites (mostly government centres) in 55 districts. Nearly half the 11,089 people currently enrolled on ART are women. Of the 14,745 people enrolled on anti-retrovirals 24% have either died or have been lost to follow up. A recent survival study among ART patients in Nepal has shown that mortality is almost twice among men than women. Nearly 500 HIV positive women become pregnant every year, and only 33 per cent of infected women received ART in 2014.
Despite the successes, one disturbing element of Nepal’s HIV epidemic is that the number of annual deaths have constantly outnumbered new infections for the past seven years despite the expansion of anti-retroviral treatment. In 2014, it was estimated that there were more than 2,600 AIDS-related deaths while there were nearly 1,500 new HIV infections. Nepal has to improve the overall quality of lives of people with HIV to ensure their longevity. The best way to contain the epidemic is through a rapid decline in new infections.
Globally, HIV programs have come a long way in the past three decades.
From initial shock and fear, we have entered a phase where it is possible to see a world without AIDS by 2030. UNAIDS has come up with an ambitious fast-track targets of 90:90:90 by 2020 in Nepal: having 90% of people living with HIV knowing their status, 90% of people identified as having HIV enrolled in ART, and 90% of ART-enrolled achieving viral suppression.
The existing programs in Nepal need to efficiently scale-up focus on testing the right people to identify new PLHIV. There needs to be adequate support including active involvement of the communities so that those identified can be enrolled into ART which should aim for higher retention and better health outcomes and viral suppression. Ending AIDS as a public health threat is possible within our lifetime.
Prevention needs to be stepped up, as well as efforts to reduce overall stigma and discrimination.
The next five years are crucial for the donors, government, civil society and other stakeholders to show commitment and solidarity in order to accelerate HIV response. Maintaining status quo or slowing down the response will undo the successes attained so far. We cannot afford this for the present and the future generations.
Satish Pandey is a public health professional, and currently the Country Director of FHI 360 Nepal.
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