Nepal's Prime Minister Jhala Nath Khanal should emulate Thai Minister Mechai Viravaidya by utilising his political capital because citizens look to their leaders for guidance and inspiration.  For one, Khanal’s activism can convince naysayers and promote the development of an open and accepting attitude, thus reducing stigma and fear associated with the AIDS.

In his first press conference in Kathmandu after the Millennium Summit, Girija Prasad Koirala, then Prime Minister of Nepal, was greeted by the cheers of a hundred thousand; Koirala exclaimed that Nepal would meet the eight MDG goals, rise out of its impoverished state, and join the industrial ranks.  Although extreme poverty, illiteracy, and the resurgence of AIDS stood as major barriers to industrialisation, Koirala asserted Nepal could triumph over its predicament.  Eleven years on, Nepal is far from fulfilling Koirala’s bold prediction; the nation is on track to miss many of these targets—deemed implausible by many a scholar.  Of these eight targets, combating the continued growth of HIV/AIDS remains one of the most difficult tasks.

A cursory glance at the statistics, however, reveals little about the situation.  Compared with other Asian nations, Nepal is a low prevalence country.  Unfortunately, the low population prevalence masks the disturbing frequency of disease in specific sub-groups: injecting drug users (IDU), female sex workers (FSW), and men who have sex with men (MSM).  The most dramatic change occurred in the Kathmandu Valley where HIV/AIDS prevalence was below 2 percent for FSWs and IDUs in the mid 1990s but exceeded 50 percent among IDUs and approached 20 percent among FSWs in 2003.  The government’s response has been surprisingly strong, and the expansion of prevention and care programmes has caused rates to decline among IDUs and MSMs. �

Although this figure seems to indicate stabilising trends in infection rates, and downwards trends among some high-risk groups, a number of large challenges remain.  Nepali people are unaware of the dangers of AIDS, and many even deny its severity.  People suffering from the disease receive little care from doctors, and little sympathy from a misguided and hostile public.  Additionally, current preventative education programmes, sex education for example, fail to teach people about HIV/AIDS, and safe-sex measures.  In each of these scenarios, the public’s perception of AIDS has played a phenomenal role in thwarting the progress made so far.  If Nepal is to reverse HIV trends, it must address this perception, a feat easier said than done.

The successes of AIDS policy in Thailand demonstrates that Nepal will see significant change if it implements the proper policies.  Thailand’s public policy on AIDS is widely cited as one of few effective national AIDS prevention programmes.  Since the Thai people share a similar moral code and cultural model with the Nepali, it makes sense to adapt their policy to Nepal’s situation.  Thailand’s success was especially remarkable because its response came after the disease appeared to have a foothold on the general population.  Evidence of HIV’s grip among the wider populace transformed the public perception of the disease, and established AIDS prevention and control as a national priority.  The Thai public health strategy had four key components which had profound and lasting effects. �

First, AIDS policy, formerly the responsibility of the ministry of public health, was brought under the direct control of the Prime Minister. This reorganisation not only demonstrated a heightened and sincere political commitment but also ushered in the formal participation of NGOs.  The plan emphasised mobilisation of communities to participate in prevention of HIV, to care for the sick, and to reduce stigma and discrimination facing those living with disease.  Second, the government launched a massive public information campaign using radio and television to promote public awareness.  Mandatory minute long AIDS education spots were aired every hour on TV and radio, emphasising prevention, behavior change, condom use, and AIDS as a social problem.  Third, several repressive policies against people with HIV/AIDS (PWAs) were repealed.  The AIDS bill, which required mandatory reporting of names and addresses of AIDS patients, was rebuked by the government and voluntary, anonymous counseling was established. Finally, the 100% Condom Programme was adopted nationwide to promote universal use of condoms in commercial sex.  Physicians screened sex-workers weekly at government clinics, and performed follow up visits in brothels to provide additional information and care. �

As a result of this four pronged attack, Thailand witnessed a dramatic reduction in risky behavior, STD consultations, and HIV infections nationwide.  Condom use in brothels rose from 14 % in 1988 to above 90 % in 1997; the number of male STD patients at public clinics dropped from 220,000 per year to 20,000 per year over three years.  Nepal can learn many lessons from Thailand’s successes and control its own epidemic.  Academician Jeffrey A Kelley argued for HIV prevention programmes “to be relatively intensive…provide attention to change attitudes, behavioral skills”.  This type of intensity requires political commitment from the highest level, something Nepal has lacked.  It is not surprising that countries deemed AIDS success stories—Uganda, Thailand, and Zambia—all had top government officials place AIDS on the national agenda.

Nepal's Prime Minister Jhala Nath Khanal should emulate Thai Minister Mechai Viravaidya by utilising his political capital because citizens look to their leaders for guidance and inspiration.  For one, Khanal’s activism can convince naysayers and promote the development of an open and accepting attitude, thus reducing stigma and fear associated with the AIDS.  Minister Mechai emphasised that fighting AIDS was a “patriotic duty” requiring openness, communication, and strong leadership from the village level to the State House.  Khanal should take note of Mechai’s charismatic directness as it encouraged constant and candid debate within communities.  When there is an open social and political climate for discussing AIDS, and when stigma associated with AIDS is reduced, PWAs become more involved with these processes.  PWAs in Thailand were invaluable during the nineties because they created support groups for the diseased, and discussed their experiences with fellow community members—especially children.  School-based AIDS education conducted by PWAs has led to a noticeable change in the children’s behavior.

The dramatic change that has taken place indicates that activism and political will can cause norms to change.  Nepal must continue its progressive action because equality is merely de jure—laws alone don’t convince the masses.  Nepal can once again look to Thailand when establishing a plan:  Thailand was successful in promoting de facto equality because it astutely employed the services of faith-based leaders.  For instance, monks in Ubon Ratchathani, located in the South-east, held weekly sessions to teach villagers how to accept neighbors, homosexual or heterosexual, with HIV.  The work of religious leaders undoubtedly changed the public in Thailand. �
Faith-based organisations and religious leaders can also play a tremendous role in shaping behavioral responses in Nepal.  HIV/AIDS deals with issues of life and death, care and compassion, hope and support, all core spiritual values.  Religion as a conceptual tool is powerful as it cuts across age, gender, class, and language.  Mainstream faith-based prevention will produce results.  Thai leaders recognised this power and enlisted the support of various groups in implementing HIV/AIDS communication programmes nationwide.  For example, in northern Thailand’s Mae Chan district, several hundred monks regularly incorporate HIV prevention messages into their sermons, pay home visits to PWAs, provide counseling, and distribute medicine.

The success of Nepal’s response will be determined by the execution of a multi-faceted plan.  Heightened political will brings HIV/AIDS to the forefront of public thought and subsequently educates the populace.  A community aware of HIV’s nuances will more readily accept PWAs, and encourage testing and condom use.  The four pronged attack succeeded in Thailand because each component worked in conjunction to attack stigmas holistically.  Thai leaders developed a plan which worked despite the nation’s initial state and the “intractable” beliefs of its people.  There is no reason why Nepal cannot emulate its Asian brother and overcome similar obstacles.  Adapting the plan to suit the specificities of Nepali culture should be more achievable.

Nepal, thus, should be prepared to address its HIV epidemic.  Even though its core values have hindered action up to now, Nepal can work around its limitations like other countries before it.  In doing so, it is only natural to apply Thailand’s approach to Nepal since the two face similar situations and share analogous values.  Prime Minister Khanal must do as Thai Minister Mechai did twenty years ago: act immediately to save lives.  Deliberation affords HIV the chance to establish a foothold on the general population.  If Nepal fails to execute a holistic plan, HIV will become a leading killer in the nation.  It is thus not a question of meeting MDG six; it is a question of whether Nepal can satisfy the inherent needs of its people.

(Neupane is a student at Duke University, USA.  Suvam volunteers for HIV/AIDS counseling and testing.  He can be reached at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

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