Nepal faces increasing HIV prevalence among most at-risk populations (MARPs) such as sex workers, injecting drug users (IDUs), men who have sex with men (MSM), and migrants. Effective prevention interventions need to be scaled up, especially among IDUs. Nepal’s poverty, political instability, and gender inequality, combined with low levels of education and literacy, make the task challenging, as do the denial, stigma, and discrimination that surround HIV and AIDS
The first case of AIDS in Nepal was reported in 1988. By the middle of 2008, more than 1,750 cases of AIDS and over 11,000 cases of HIV infection were officially reported, with two times as many men reported to be infected as women. However, given the limitations of Nepal’s public health surveillance system, the actual number of infections is thought to be much higher. UNAIDS estimates that 70,000 people were living with HIV at the end of 2007. Nepal’s HIV epidemic is largely concentrated in MARPs, especially female sex workers (FSW), IDUs, MSM, transgender, and migrants. Injection drug use appears to be extensive in Nepal and to overlap with commercial sex. Another important factor is the high number of sex workers who migrate or are trafficked to Mumbai, India, to work, thereby increasing HIV prevalence in the sex workers’ network in Nepal more rapidly.
The epidemic in Nepal is driven by IDUs, migrants, sex workers and their clients, and MSM. Results from the 2007 Integrated Bio-Behavioral Surveillance Study (IBBS) among IDUs in Kathmandu, Pokhara, and East and West Terai indicate that the highest prevalence rates have been found among urban IDUs, 6.8 percent to 34.7 percent of whom are HIV-positive, depending on location. However, in terms of absolute numbers, Nepal’s 1.5 million to 2 million labor migrants account for the majority of Nepal’s HIV-positive population. In one subgroup, 2.8 percent of migrants returning from Mumbai, India, were infected with HIV, according to the 2006 IBBS among migrants. As of 2007, HIV prevalence among FSWs and their clients was less than 2 percent and 1 percent, respectively, and 3.3 percent among urban-based MSM. HIV and AIDS case reporting by the NCASC reports HIV infections to be more common among men than women, as well as in urban areas and the far western region of the country, where migrant labor is more common. According to Nepal’s 2007 United Nations General Assembly Special Session (UNGASS) report, labor migrants make up 41 percent of the total known HIV infections in the country, followed by clients of sex workers (15.5 percent) and IDUs (10.2 percent).
Many sex workers are also IDUs, migrants, or both, increasing the spread of HIV among at-risk groups. A large portion of men who purchase sex are also married, making them potential conduits for HIV to bridge to the general population. Poverty, low levels of education, illiteracy, gender inequalities, marginalization of at-risk groups, and stigma and discrimination compound the epidemic’s effects. Unsafe sex and drug injection practices, civil conflict, internal and external mobility, and limited adequate health care delivery multiply the difficulties of addressing HIV/AIDS. Moreover, existing care and support services are already overwhelmed as increasing numbers of HIV-infected individuals become sick with AIDS.
Street children are also one of the most vulnerable groups. The UNICEF report Increasing Vulnerability of Children in Nepal estimates the number of children orphaned by HIV/AIDS to be more than 13,000. The national estimate of children 0 to 14 years of age infected by HIV is 2,500 (2007).
Nepal has a high tuberculosis (TB) burden, with 81 new cases per 100,000 people in 2005, according to the World Health Organization. HIV infects 3.1 percent of adult TB patients, and HIV-TB co-infections complicate treatment and care for both diseases.
Courtesy Aswin Raj Kharel