[PHP Nepal Vol 2 Issue 11 Dec 2012] | To combat HIV is one of the Millennium Development Goals (MDGs) — Goal six. MDGs are an international commitment and a developmental agenda which all member countries should abide by 2015. Nepal is on track to achieve number of goals such as those related to child mortality, maternal health and combating HIV/AIDS and other diseases.
The total number of people living with HIV for 2011 was estimated at 50 200 with an overall national HIV prevalence of 0.3 percent. As of July 15 2012, the total HIV infections reported were 20 583. Of these 13 157 were male, 7 417 were female, and nine were transgender. People who inject drugs, men who have sex with men, female sex workers and their clients, and male labor migrants are population at higher risk in Nepal. Integrated Bio-behavioral Surveys conducted in Nepal shows that prevalence of HIV has been decreasing over the years owing to targeted intervention programs in the community level and there has been increasing in access to counseling and HIV testing services.
Targets and Indicators of MDG related to HIV/AIDS
Target 6 A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
1. HIV prevalence among pregnant women aged 15-24 years
2. Condom use at last high risk sex
3. Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS
4. Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years.
Target 6 B: Achieve by 2010 universal access to treatment for HIV/AIDS for all those who need it
1. Proportion of population with advanced HIV infection with access to anti-retroviral drugs
Progress made related to MDG-6
HIV testing and counseling services are provided free of cost to the population at higher risk, including general population. 104 666 people were tested for HIV in 2010 in Nepal.
Nepal Demographic and Health Survey (NDHS) conducted in 2011 showed that 86 percent of women and 97 percent of men aged 15-49 have heard of AIDS. Among youth aged 15-24 years, it was 89 percent in women and 98 percent in men. Prevention knowledge has improved in recent years. As per NDHS 2011, 71 percent of women know that the risk of getting HIV can be reduced by using condoms and limiting sex to one faithful, uninfected partner which was only 55 percent in 2006.
According to National Centre for AIDS and STD Control, 2012, there has been a decline of HIV prevalence among youth aged 15-24 years from an estimated 0.08 in 2000 A.D to 0.01 in 2011 A.D. The proportion of HIV cases among youths aged 15-24 years is 10.2 percent. By July 2012, total 7 142 patients with advanced HIV infection were on treatment in 39 Anti-Retroviral Therapy (ART) centers across the country (54.6 percent male, 44.8 percent female and 0.3 percent trans gender). The government of Nepal is providing ART service free of cost for all those in need.
Barrier to achieving MDG-6
Though over the years, there has been extension of HIV related service sites, service coverage and utilization among high risk, to achieve the MDG needs is still low. Behavior change communication intervention programs have not reached to population at higher risk viz. male labor migrants, female sex workers and their clients, and people who inject drugs. There is a large gap in access to ART and community care services for people living with HIV. Nepal has to depend on international agencies to fulfill the funding gap in HIV program which could affect the sustainability and national commitment to combat HIV. Service statistics indicate that detection of HIV positive pregnant women and service received has increased over the time, but there is still challenge to provide 100 percent service to the mothers and babies who required ARV prophylaxis. Moreover, there are limited programs for HIV affected and infected children.
HIV prevalence has been declining in Nepal over the years but still concerted efforts are required to decrease HIV infections in male labor migrants and clients of female sex workers who are acting as bridging population groups that transfer infections from higher risk groups to low risk general population. Also, the service coverage of HIV testing and counseling, ART and PMTCT need to be increased through expansion of service sites. Since HIV / AIDS is a multi-sectoral concern, only integrated efforts from all sectors will help to achieve MDG-6 and bring us closer to realizing our collective vision of zero new HIV infections, zero discrimination and zero AIDS related deaths.
Pratik Khanal is a coordinator of District AIDS Coordination Committee at District Health Office, Gulmi, Nepal.