VOL. 05, NO. 10, November 25, 2011 (Mangsir 09, 2068)

As Nepal is celebrating the World AIDS Day 2011 with the slogan of Getting to Zero in new infection, discrimination and aids related deaths, the challenge is to manage resources to achieve the target

By KESHAB POUDEL

Jagat Shrestha, a resident of Kakarbhitta, an IDU and HIV positive, started to use new needles. “I don’t want to infect other colleagues. This is the reason we use a separate needle for each individual,” said Jagat.

As awareness grows due to the campaigns of various non-governmental organizations along with groups living with HIV, the situation has drastically changed. Even local NGOs are supplying safe needles for individuals.

Resident of Atariya village of Kailali district of far western region, Sarala Chaudhari (name changed), 22, a commercial sex worker is encouraging her clients to use condom for safe sex. “No condom and no sex,” said Sarala, whose clients are mostly the truck drivers. Although the number of commercial sex workers like Sarala is still few, the awareness level among commercial sex workers about possibility of HIV infections through unsafe sex is definitely increasing.

With the resources provided by various INGOs and the government, free distribution of needles and condoms has increased in the areas like Kakarbhitta and towns like Attariya. “The only problem is the police now. Police put us behind the bars in case we carry condoms,” said Sarala.

The situation with the IDUs is also similar. “Carrying a couple of needles is always a possible way to go to prison.”

Nepal is described as having a “concentrated” HIV/AIDS epidemic, with by far the highest prevalence rates among high risk groups (or Most At Risk Populations, MARPs) such as labor migrants, injecting drug users (IDUs), men who have sex with men (MSM), female sex workers (FSW) and their clients. Labor migrants currently account for about 30% of all HIV infections as a significant proportion of their population has unprotected sex with multiple partners while abroad (most commonly in India).

NCASC reported total HIV infection as of 17 September, 2011, was Male 11,964, Female 6,571 and total 18,535. The cases reported in the month of September is 139.

As more resources are available to support HIV and AIDs programs, they have brought about positive results. Even Accham district of Far Western Region has seen some impacts following the launching of various intervention and prevention programs targeting the migrant workers and their families.

In the far western region, the government hospitals and health centers failed to carry out intervention programs. According to a study,  most interventions for prevention for the most at risk populations  Female Sex Workers (FSW), Injecting Drug Users (IDUs) and Males who have sex with Males (MSM)are not implemented by the government  NCASC or HIV AIDS and STI Control Board (HSCB) but through some strong INGOs.

“I would like to request all Nepal’s development partners and other stakeholders, who had always been with NCASC in bringing NCASC to this point of achievements, to join hands to build more strong collaboration and partnership for greater achievements with available resources in responding to the HIV epidemic in Nepal effectively,” Dr. Ramesh Kumar Kharel, Director of National Centre for AIDS and STD Control (NCASC), said.

“Since its establishment, NCASC has focused its activities in increasing service coverage to reach Most-At-Risk-Population(MARP) of the country, minimize transmission of HIV and provide treatment, care and support services to the people living with HIV who are in need. Despite many challenges, NCASC has gained enough momentum in managing HIV services to the people of the country and has also obtained necessary support from the government counterparts, civil societies, external donor partners and UN agencies,” said Dr. Kharel.

Had the flow of resources been coordinated better, the prevention and intervention programs would have become more effective. As there is no strong and effective system to coordinate and harmonise the inflow of resources aimed at prevention amongst Most at Risk Population, there are always disparities in distribution of funds in terms of regions.

“Nepal’s problem is not inadequate resources but the problem is with the management. There is a grant of USAID, the World Bank and Global Fund. The problem is the management and coordination,” said HIV expert Mahesh Sharma.

Looking at the recent trends, Nepal needs to go a long way to meet MDGs. Nepal’s other challenge is now to reduce the duplication of the programs and use the available funds for maximization of results. Experts argue there is a need of a strong mechanism for tracking resources to ensure the continuity of ongoing program in order to clearly reflect the coverage of donor supported programs and the duration of their support.

The major sources for HIV response in Nepal are public, bilateral, multilateral and private/INGOs. According to a study, eight key sources provide the majority of funds for the HIV response in Nepal. A total of US dollars 20.5 million were spent in 2009 and USD 19.1 million obligated for fiscal year 2010.

Among the major donors, Global Funds constitutes the major source of funding which provided 31.3 percent of funds for HIV response for fiscal year 2009, followed by DfID (30.9) and USAID (26.8).

The theme for this year’s World AIDS Day celebration is “Getting to Zero - Zero New HIV Infections. Zero Discrimination and Zero AIDS Related Deaths.” This will only be achieved by using the available resources in a coordinated manner as well as mobilizing them to reach the targeted population.

The theme was announced on 9 September 2011 in Cape Town, South Africa. This theme is backed by the United Nations “Getting to Zero” campaign and runs until 2015. It builds on last year’s successful World AIDS Day “Light for Rights” initiative encompassing a range of vital issues identified by key affected populations.

The  overall WAD concept/overarching theme for the next four years will be “Getting to Zero” (till 2015) with the understanding that  different groups and regions will focus on a zero which is most relevant to  them.

 The World AIDS Campaign adoption of “Zero AIDS-Related Deaths” is its World AIDS Day focus for 2011 under the overarching theme of “Getting to Zero”.

“Nepal therefore needs to decide if it will also adopt Zero AIDS-Related Deaths as its World AIDS Day focus for 2011 or if it will focus instead on Zero New Infections or Zero Discrimination or all three zeros.”

Game Changer

A new report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), shows that 2011 was a game changing year for the AIDS response with unprecedented progress in science, political leadership and results. The report also shows that new HIV infections and AIDS-related deaths have fallen to the lowest levels since the peak of the epidemic. New HIV infections were reduced by 21% since 1997, and deaths from AIDS-related illnesses decreased by 21% since 2005.

“Even in a very difficult financial crisis, countries are delivering results in the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere.”

NCASC works as per the National HIV/AIDS Strategy developed and revised in regular intervals.  It is currently putting its efforts in achieving the Millennium Development Goal of 'halting and reversing the spread of HIV epidemic' and in controlling sexually transmitted infection in the country.

HIV/ AIDS
The Far West Story

Despite government efforts, migrant workers continue to bring HIV infections in Accham district of the far western region

UMID BAGCHUND reporting from Accham

Urmila  (name changed), 28, a resident of Oli Gaun of Accham district, lost her husband four years ago.  Rawal, a mother of two children, is infected by HIV. A dalit, Urmila has to face all kinds of discriminations in the village. Out of 3,504 people, there are 1,514 (43%) males, and 1990 (57%) females.

Urmila of Oli Gaun is not the only woman suffering that plight. A large number of women, particularly poor dailts, are the worst affected by HIV infections.

Despite several efforts of the government and non-governmental organizations, migrant workers continue to bring HIV infection and transmit it to their spouses. According to a recent report, 120 people have already died in Accham due to AIDS.

Little progress has been made in the isolated communalities in the remote areas as most of the uneducated people migrate to urban areas and Indian cities for greater economic and employment prospects leaving married women home. When these migrants return, most of them bring HIV to their wives. Women living with HIV of dalit community begin to face double discriminations.

As husband dies, the Women Living with HIV have to bear all kinds of economic burdens in the household. They have to go from house to house to seek support from all to save their children.

With the Human Development Index of Achham District at 0.325 and ranking of 69 among 75 districts of Nepal, Gender Development Index (GDI)) of Achham is 0.275, which one of the lowest of Nepal.

The biggest problems and issues of dalit, minority, women and youths are their ignorance and unawareness. The illiteracy rates for male are at 36.9% and for female at 83.8%, for dalit (untouchable castes) 68.5%  and for other ethnic and indigenous people at 54.8%. Dalits are treated as worse and excluded & discriminated from every social aspect. The stigma of HIV adds their burden further.

According to Achham District Development Committee, poverty is rampant in Achham district, 75.1% people have income of less than Rs. 5,000 per year; 12.5% have income at Rs. 5, 000-Rs. 10,000 per year. Therefore, population below the poverty line is about 75% . Likewise, 18.21 % population of Achham migrate to India as unskilled labor.

A large number of widows, whose husbands died due to AIDS, have been living under a severe financial crunch. “Accham’s poor people who left for India to make a little amount of money end their life with HIV infection,” said Yogendra Oli of Bayalpata Village Development Committee.

At a time when Nepal is celebrating the World AIDS Day with the global slogan with Zero infections, the far western region is yet to see such a zeal. The current indication is that a large number of people here die due to AIDS.

Health officials in the district argue that they don’t have enough resources to start the programs. According to District AIDS Coordination Committee of Accham, there are 359 people living with HIV and most of them are migrant workers. The committee said HIV has already spread in all 75 villages of the district.

According to Regional Health Directorate of Far Western Region, the region is not getting enough resources to deal with HIV. “Some 10 percent of total population of Nepal lives in far west, there are highest number of HIV infected people,” said HIV section chief Dayakrishna Panta. “We don’t have enough budgets to carry out the work,” Panta said. According to a recent report, epidemiological region-wise analysis shows that the large amounts of funds were allocated for the highway district, 45 percent in 2009 and 53 percent in 2010 and followed by Kathmandu valley with 35 percent in 2009 and 25 percent in 2010. Far-western hills were receiving 10 percent of funds allocated for the districts.

There are 2 ART centers here. Five ART centers are in other eight districts. There are 26 VCT centers in district level hospitals. Seven VCT centers are run by non-governmental organizations. According to the report, 2,036 people living with HIV were taking ART in 2010 and now 4,610 people living with HIV are taking ART.

Although the world community is celebrating the World AIDS Day with the slogan of making HIV Zero, it will take huge resources as well as an awareness campaign to reach the message to Achham. If the far western region should have zero HIV, the high level of poverty should go away before real results come out.

HIV/AIDS
Alarm Rings In East

Due to a low level of awareness, people in Jhapa are seeing high incidences of HIV infection

UMA KANTA KHANAL in Jhapa

Despite a huge spending of resources, the programs to prevent and control HIV and AIDS in the eastern parts of Nepal have proved insufficient as the number of HIV among IDU cases continues to rise here.

The number of people with HIV and AIDS is likely to go up if more effective programs are not held in the rural parts of Jhapa, Sunsari and Morang.

Sex workers in Jhapa are more vulnerable as only a few people know about safe sex. On the recently celebrated condom day, the organisations working in the HIV and AIDS field were distributing condoms free of cost in Birtamode, Jhapa.

People didn't pick up the condoms, which are used for safe sex.

They just looked in the box and went away. Nobody touched the box until the organisers started to fill air in it.

The thought of the people have not been changed although they know condoms are the weapons to defend HIV and AIDS and other sexually transmitted infections.

People feel shy talking about the use of condoms.

The trend of transmission of HIV and AIDS through unsafe sex is going up, according to the organisations working in this field.

It is estimated that more than seventy thousand people have HIV and AIDS in Nepal.

The medical officers say the proper use of condoms doesn't allow HIV and AIDS to get transmitted from one person to another.

Dr. B. P. Kharel, a gynecologist said, "But the campaign of this sort is not enough in the rural areas."

People who have gone out of the country for employment have plenty of chances to get HIV and AIDS, particularly from northeast India where the HIV is alarmingly high.

The rural men and women go to India and other countries and get involved in unsafe sex.
The Nepalese women are often sold to the brothels of India. Most women come back after getting HIV and AIDS.

Bhakti Sitoula, who runs a rehabilitation centre for people living with HIV and AIDS said, "The rural people should be aware about this."

He emphasizes that schools and colleges should run related courses.

Investments in HIV prevention programs as a whole have not been adequate or efficiently allocated. HIV prevention investments comprise about 22% of all AIDS-related spending in low and middle income countries. Medical officer of Mechi Zonal Hospital complained that they didn’t have enough budgets in the recent years.