UNAIDS 2013

With the world on alert against the spread of Ebola, interest in another disease that originated in Africa and spread globally is diminishing because of awareness and treatment. Still, the theme for this year’s World AIDS Day on Monday is ‘Getting to Zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths’.

In Nepal the number of reported new HIV cases came down to below 1,000, down from 1,751 in 2012. But this doesn’t mean all is well, and experts warn that the goal should be zero new infections. Work also needs to done to address stigmatisation and ostracisation of people with HIV.

Nepal’s National HIV/AIDS Strategy aims to reduce new HIV infections by half, HIV-related deaths by 25 per cent and new infections in children by 2016. In Nepal, the disease is characterised as a ‘concentrated epidemic’ meaning a majority of infections (more than four in every five new infections) are spread through sexual transmission. People who inject drugs, men who have sex with other men and female sex workers are the key populations at higher risk of HIV.

In 2013, official records showed 23,000 adults and children were HIV positive which is 0.28 per cent of the adult population, but public health experts say there may be many more who have not been diagnosed. Out of the total estimated infections 8.3 per cent are children between 0-14, and 7.3 per cent are above 50. Two-thirds of the infected are men, and the rest are women of which 93 per cent are in the reproductive age group.

The good news is that there has been a decline in HIV prevalence among youth, aged 15-24. Most of the new infections last year were among clients of sex workers and housewives. The youth who are HIV-positive tend to be injecting drug users who share needles.

Still, despite the increasing number of drug users, HIV prevalence among injecting drug users (IDU) in the country has significantly decreased. HIV prevalence among the IDUs has gone down to 3 per cent from 68 per cent in 2002, mainly due to harm reduction measures and awareness.

The free distribution of anti-retroviral drugs has also resulted in a significant fall in the number of  deaths due to AIDS. The estimated number of annual AIDS deaths of all ages is projected to decrease from the current 2012 estimate of 4,136 to 1,672 in 2015.

Despite the positive trend, the government’s aim of reducing new infections of children by 90 per cent will be a chellenge. Prevention of Mother-to-Child Transmission has expanded to 41 sites in 33 districts and community-based interventions are available in primary health centres and sub health posts in 7 districts. The main challenge is to provide the service in all health posts in AIDS hot spots in the country.

While the HIV infection rate among vulnerable groups has gone down, it is still very high among migrant workers. The HIV rate among sex workers is 1.5 per cent, 2.2 percent in drugs users, 4.4 percent in customers of sex workers, 7.2 in gay sex workers, and 14.4 per cent among gay couples. However, a quarter of male migrant workers, especially returning from India, are infected and their wives have an even higher HIV positive rate: 27.3 per cent.

It is clear that if the HIV infection target are to be met, Nepal needs to concentrate on returning migrant workers and their families. More than 600,000 Nepali men go for season employment in India alone every year, and studies show migrant workers are major customers of sex workers in India.

The global attention and funding to fight epidemics is now strained by the need to combat Ebola but in Nepal there is still lots to be done to reduce new infections to zero.

Sonia Awale

Coming out time, Sunir Pandey

AIDS 2.0, Rajiv Kafle

An epidemic of stigma and discrimination, Bhrikuti Rai

The return of the microbes, Sunir Pandey

 “They don’t get rich, they get HIV”, Naresh Newar