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GUEST COLUMN - Nirmala Sharma
and Nur Prasad Pant |
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| A need for paradigm
shift in the fight against HIV/AIDS |
| An experience from Nepal |
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 HIV/AIDS
has been a well-recognised to be a serious challenge all over
the world. Despite several efforts to address the epidemic,
the trend of HIV spread is still unbroken and this is more apparent
in poor resource setting countries such as Nepal. As of March
2004, the Ministry of Health (MoH) has reported 715 cases of
AIDS and 3529 cases of HIV infections in Nepal. Given the existing
medical and public health infrastructure and the lack of continuity
in national HIV/AIDS surveillance systems, it is very likely
that the actual number of cases can be many times higher. |
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| UNAIDS, Nepal has estimated that about 60,000
People are Living with HIV/AIDS (PLWHA) in Nepal. The Far Western
Region of Nepal is considered by many to be one with the fastest
growing prevalence rates in Asia. The high migration rate (at
least one male member from 80-90 percent of the households)
in the Far-Western Region has contributed for the rapid spread
of HIV/AIDS. About 10 percent of the migrants who have returned
from Mumbai, India have been tested HIV positive. Most of the
PLWHA do not even know that they are infected. Many of them
may further engage in unsafe sexual practices. The socio cultural
norms and practices, the high level of stigma and discriminations
prevent these people and others in the vulnerable groups from
coming out in the open, practicing safer sex, seeking medical
attention and undergoing testing. |
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| Given the context, CARE-Nepal worked in two remote districts
(Doti and Bajhang) of the Far Western Region of Nepal, from
February 2002 to 2004 February. The objective of the Programme
was to reduce STI/HIV related high-risk behavior among migrants
and other vulnerable populations. The project was focused primarily
on migrant workers, and their wives. Secondary stakeholder groups
were potential migrants, sex workers and other young boys and
girls, focused primarily on awareness creation and promoting
the use of condom through Behaviour Change Intervention (BCI).
Our work on these districts during the last two years helped
to strengthen the institutional capacity of the local NGO partners
(Nepal Red Cross Society, and Group for Social Development)
and created higher level of awareness on STI/HIV especially
among the migrant men and their wives. |
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| While creating awareness, we concentrated on preventive aspects
and did not reach PLWHA. It is a common approach adopted by
most of the organisations and groups in addressing HIV AIDS
related issues in this country. Most of the efforts against
HIV/AIDS are directed towards creating awareness and promoting
the use of condom in the community, and don't include a support
mechanism towards helping PLWHA. |
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| However, The Need for VCT: Voluntary Counseling and Testing
(VCT) for HIV is now acknowledged within the international arena
as an efficacious and pivotal strategy for both HIV/AIDS prevention
and care. VCT is more than testing blood and offering a few
counseling sessions. It is a vital entry point for the services
under HIV/AIDS that includes prevention from parent -to-child
transmission; prevention and clinical management of HIV related
illnesses, tuberculosis control, and psychosocial and legal
support. |
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| VCT provides benefits for those who test positive as well
as those who test negative. It alleviates anxiety, increases
client's perception of their vulnerability to HIV, promotes
behavioural change, facilitates early referral for care and
support including access to anti-retroviral therapy and assists
reduction of stigma in the community. VCT offers a holistic
approach that can address HIV in the broader context of peoples'
lives, including the context of poverty and its relationship
to risk practice. |
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| So far Nepal doesn't have accurate figures on the HIV prevalence
rates, neither it has actual information on PLWHA, the type
and extent of stigma they are facing, and their coping/surviving
mechanism at the household and community levels. However, in
recent days the realisation has come up among the service providers
(GOs and NGOs), therefore, some initiatives are being undertaken
to understand the problem of PLWHA. The recently developed national
guidelines for Voluntary HIV/AIDS Counseling and Testing (VCT)
introduction of Anti-Retro-Viral (ARV) therapy to PLWHA by His
Majesty's Government of Nepal (HMG/N) are a milestone in terms
of recognising the graveness of the problems and giving priority
to the issue from the government level. The initial package
of ARV offers service to only 25 PLWHA through a selected hospital
of the capital city of Kathmandu. There is a long way to go
to make such services available to all PLWHA. The HMG's above
actions are an indication that the country is now moving ahead
from awareness creation to VCT in the fight against HIV/AIDS.
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| The way forward in the fight against HIV / AIDS is not easy.
There are number of challenges to be faced. Inadequate experiences
and competency to work with PLWHA among service providers, greater
level of stigma at home, community and health facilities, lack
of appropriate livelihood and other supporting mechanisms are
only some of these challenges. |
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| Despite all difficulties and challenges, the time has come
to combine awareness, prevention and care and reaching out to
the PLWHA. Non governmental organisations can complement the
government's efforts by creating awareness at various levels,
and making the affected people aware of the availability of
service provisions such as ARV and helping the households and
communities providing care and support to the affected people
through VCT. Then only the rights of the PLWHA may be established
and they can live in a dignified way and continue fighting against
HIV/ AIDS in countries like Nepal. |
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| References: |
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MOH/DOHS: National HIV/AIDS strategy, His Majesty's
Government of Nepal, 2002
Poudel, K.C: Cross sectional study on HIV/STI prevalence among
migrants and non-migrants, Kathmandu, Nepal 2001,
www.fhi.org/en/HIVAIDS/FactSheets/vctforhiv.htm
[Accessed: 06/04/2004] |
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