The AIDS epidemic in Nepal is spreading into the general population because of unprotected sex and drug use. And it is no longer confined to "high risk\'\' groups like sex workers, truck drivers and drug user. Latest results from a survey conducted by the STD/AIDS Counselling and Training Services (SACTS) on behalf of Family Health International (FHI) show just how explosive the growth of the epidemic is. Of the 300 sex workers interviewed earlier this year, 17.3 percent were HIV positive. The sero-prevalence among injecting drug users (IDUs) was much higher, at 75 percent, says V.L. Gurbacharya of SACTS.

Between 30-60,000 Nepalis are infected, and in could reach up to 200.000 in the next 10 years. Nepal used to be a "low prevalence" country till recently, today it faces the prospect of a "concentrated epidemic".

Another FHI study reported some positive signs: condom use is up, especially among the "high risk" groups.

The Behavioural Surveillance Survey covered 400 truckers, 600 male labourers and 400 female sex workers in urban centres and settlements in 16 districts along the East-West Highway and compared results with the previous year.

Truck drivers were found to be the main clients of sex workers, followed by migrant workers, police and army personnel and rikshawallas. Over 80 percent used condoms at least once, and it was 68 percent among truckers and 58 percent among male labourers. "Consistent condom use" was also up in all three groups: sex workers, 40 percent, truckers, 51 percent, and male labourers, 32 percent. The findings from the previous year showed 33 percent for the first two groups and 23 percent for male labourers.

Despite this, the figures are fall far short of those needed for effective protection. That would be possible only with 80-90 percent condom coverage levels, says Steve Mills, Associate Director at FHI. That is the level Thailand attained five years ago when the anti-AIDS efforts started yielding results. And that was possible only because the Thai sex industry is "organised" in brothels.
Nepal\'s sex industry on the other hand is not brothel-based and relies on "street walking". This makes it more difficult to spread the word on condom use. Added complications emerge from trafficking and commercial sex work in India, and the large numbers of seasonal labourers who cross the southern border both ways.