Nepal´s AIDS cases a matter of global concern
Surya B. Prasai
April 20, 2008
Recently the National Center for AIDS and STD Control (NCASC) under the Ministry of Health and Population of the Nepal Government released figures from a study conducted in 2007 which states that HIV/AIDS cases have supposedly stabilized in Nepal in the past two years. According to the report it claims the study was done using the latest available tools and methodologies. The NCASC, Ministry of Health, states ´the figures could be around 69,790, almost similar to the 70,352 numbers estimated by a study conducted in 2005.´ However, despite the Nepal Government´s good efforts in publishing regular statistics, which to the best of its knowledge, provide on grounds in seeking positive intervention, it is proven by Nepal´s top experts and international media reporting on AIDS in Nepal that every year 12,000-15,000 people have died for the past half decade and more. In 1997, UN estimates had put the deaths around 4000-5000 per year. If the total number of deaths were calculated for the past 10 years alone, it would largely offset the current government´s figures which are heavily drawn on foreign donor inputs. In Kathmandu, the number of female commercial sex workers is estimated between 50,000-60,000 of which nearly one in five has AIDS, according to authoritative Asia-Pacific news sources.
In fact it was estimated by the UN and various international organizations working in Nepal in 2005, the number of infections was likely to rise to 150,000 -- about 1.5 percent of adults --. The same sources warned that AIDS would be the main cause of death for the 15-49 age bracket within 10 years of the epidemic, if steps were not taken to bring it under control through proper behavior change communications, putting in place an effective national communications strategy that supports a proper government based national HIV/AIDs control plan, and the proper distribution of condoms and clean needles for Nepal´s rising drug users. So far, various donors pledges have shown in their reports that they believe the strategies, plans and logistics appear well placed, but not everything is being implemented as planned due to coordination difficulties among the donors and the low skills and logistic resource mobilization ability of the Nepal Government. The actual truth expressed by Nepal´s prominent AIDs activists point is there is massive diversion of attention of health resources to focus on lesser priorities which have added injury to insult among Nepal´s AIDS sufferers.
What are the real figures? According to the recent Nepal Government figures, of the total estimated 69,790 cases; 64,585 consisted of adults between the age 15 and 49 years (with 16,387 of them women), likewise, 1857 were children below 14 years of age and 3348 were adults above 50 years of age. The Director of the NCASC Padam Bahadur Chand states, "The number appears stable probably due to better technique of estimation used this time." However most donors believe there is still no visible coordination in efforts from the Nepal Government in curtailing HIV/AIDS or in coming up with periodic survey which contradict national operational goals. Thus, AIDS cases have been rising dis-proportionately with an increment in Nepal´s migrant worker population, younger age clients of sex workers, and, higher number of sex workers. On many highway routes, truck drivers serve as the spring board of transmission.
The Nepal Government might have a good reason to come up with such estimate, since it had received last year US$ 76.5 million from the UN Global Fund and the money needs to be used to maximize reporting feedback inputs which the UN desires. The amount is Nepal´s first major international assistance received in the field of HIV/AIDs in addition to regular and valuable funds being received through USAID, UN agencies and several INGOs who run substantive program interventions in HIV/AIDS prevention and control, which however focus on their individual program bent.
Nepal went through a major civil conflict between 1996-2006 and the country successfully conducted a national constituent assembly poll on April 10 to chart out a democratic and more inclusive future for all Nepalis. The 10 year civil conflict killed 13,600 Nepalis and displaced 400,000 children and 900,000 adults, of which nearly 60% were from the Far Western hilly regions. However, every year due to AIDS more than 15,000 Nepalis are dying. This is a matter of national concern. In many parts of Western Nepal, AIDS is known as the ´Mumbai´ disease since Nepali migrant workers working in India bring it back with them when visiting their families, particularly infecting their spouses, thus infecting a larger number of Nepali women in the rural regions. If one visits districts, such as Dhading, Nuwakot or Achaam, the rates are not only astonishing, they show an epidemic which is quickly migrating into the urban peripheral regions. Besides, the feminization of Nepali AIDS cases is on the rise, but due to the unstable security situation, neither donors nor local INGOs have ventured to go to these pockets of HIV/AIDS earlier. They hopefully will do so now on a regular basis.
International organizations are optimistic about Nepal´s new democratic future after the peaceful CA Poll but worry a lot more about the pessimistic conditions in the general country side where the estimate of true AIDS cases is known to be at least three times what the government quotes and chew into national development efforts. The Nepal Government needs to be more serious about two major issues, health and education. The lack of proper health and education programs fuel in the infections. Recently Prime Minister Girija Prasad Koirala stated that if these two issues were taken more seriously, Nepal could make immense gains in the road to national prosperity, he considered them the two major priorities of any future government. Also, due to this widespread illiteracy and ignorance of the disease in the isolated parts of the country, less than 27.5 percent of Nepal's inhabitants can read, and a recent government survey conducted in the nation's 75 districts revealed that 71.7 percent of males and 49.6 percent of females had never heard of AIDS. There is little doubt that those who have the highest figures are needle-sharing drug addicts in urban locations, migrant workers who work in India, female commercial sex worker who are highly mobile these days, and their clients who appear to be younger and have more money to spend. In urban Kathmandu, Pokhara, and Biratnagar, the cash credit card and car symbol has caught the mood of the younger generation who like to experiment a little with everything in life, including the availability of alternative entertainment. Drug use is on the rise in Nepal, particularly among the youth, needle sharing is common which sparks AIDS infections.
While the Nepal Government's attention appears focused on preventing the spread of AIDS among migrant laborers, intravenous drug users and sex workers, housewives have become one of the most vulnerable groups in the country with the rate of infection rising by more than 100 percent. In 2006, , the NCASC of the Nepal Government reported 1,883 housewives were infected with AIDS. Private hospitals in Nepal have recorded even higher numbers. There is wide spread stigma and discrimination attached in coming up with truthful disclosure on one´s status. This cannot go on for long, before the number of deaths from AIDS triples in the next half decade from 15,000 to 30,000 deaths per year. This is in truth is the reality of AIDS in Nepal in 2008.
Consider this, in the past two years, the figures might have gone up by quite a few percentage points. The growing labor migration to India and other destinations in East and West Asia is another cause of concern, since many of the women also are engaged in commercial sex in Mumbai, Delhi Madras, Kolkata and Bangalore. Nearly 250,000 Nepali female sex workers are involved in India´s sex trade working in Nepali brothels in the inner cities and vice dens. Some of Nepal´s donors have already expressed concern that the rising number of orphans in the Nepalese rural regions particularly in Western and Far Western region have resulted in 13,000 to 15,000 orphans being left out in the open. But who is going to take care of them in future?
The new Nepal Government must take a serious introspection on this issue. The joint report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) the United Nations Children's Fund (UNICEF) and serious donors such as the United States Agency for International Development (USAID), have stated in the past that social stigma has increased with the number of cases globally, including in Nepal. The Nepali AIDS infected children face discrimination both at the hands of adults and other children in both their villages and schools.
UNAIDS India estimates at least 10 percent of the 2-3 million Nepalese migrants working in India are HIV positive, but the figures could be anywhere between 30-40% based on an independent study done by some of the INGOs there, which was also reported by BBC which was focusing among returned commercial sex workers in Kathmandu. The virus is spreading through the men to their spouses and others in many parts of the country. The situation is serious, but since it seems Nepal still is focused on the political priorities of forming a Constituent Assembly and focusing on developing a new Constitution. Health and AIDS have been necessarily neglected.
Currently there are nearly 80 national and international NGOs working in Nepal in the field of HIV/AIDS impact mitigation, while more than 170 orphanages claim to cater to AIDS orphans. But the fact is despite Nepal receiving ample assistance for the past fifteen years in the prevention and control of HIV/AIDS, it has been facing a lot of difficulties in institutionalizing a proper government policy that caters to the true needs of those infected and affected by the virus. Some state, if there was less interference from the donors, the Nepal Government might be able to set its priorities straight, but the Nepal Government appears not being able to take leadership on its own. In the past half decade various AIDS activist groups have been demanding a more pro-active national policy that sensitizes the Nepali population to their status, but with the lenient workings of the NCASC, and the absence of an effective national communications strategy, it is hard to imagine a nationwide advocacy drive that will help Nepal get out of this health rout. Thus, where coordination is strictly desired, there is more confusion in tackling Nepal´s AIDS crises.
In fact it was estimated by the UN and various international organizations working in Nepal in 2005, the number of infections was likely to rise to 150,000 -- about 1.5 percent of adults --. The same sources warned that AIDS would be the main cause of death for the 15-49 age bracket within 10 years of the epidemic, if steps were not taken to bring it under control through proper behavior change communications, putting in place an effective national communications strategy that supports a proper government based national HIV/AIDs control plan, and the proper distribution of condoms and clean needles for Nepal´s rising drug users. So far, various donors pledges have shown in their reports that they believe the strategies, plans and logistics appear well placed, but not everything is being implemented as planned due to coordination difficulties among the donors and the low skills and logistic resource mobilization ability of the Nepal Government. The actual truth expressed by Nepal´s prominent AIDs activists point is there is massive diversion of attention of health resources to focus on lesser priorities which have added injury to insult among Nepal´s AIDS sufferers.
What are the real figures? According to the recent Nepal Government figures, of the total estimated 69,790 cases; 64,585 consisted of adults between the age 15 and 49 years (with 16,387 of them women), likewise, 1857 were children below 14 years of age and 3348 were adults above 50 years of age. The Director of the NCASC Padam Bahadur Chand states, "The number appears stable probably due to better technique of estimation used this time." However most donors believe there is still no visible coordination in efforts from the Nepal Government in curtailing HIV/AIDS or in coming up with periodic survey which contradict national operational goals. Thus, AIDS cases have been rising dis-proportionately with an increment in Nepal´s migrant worker population, younger age clients of sex workers, and, higher number of sex workers. On many highway routes, truck drivers serve as the spring board of transmission.
The Nepal Government might have a good reason to come up with such estimate, since it had received last year US$ 76.5 million from the UN Global Fund and the money needs to be used to maximize reporting feedback inputs which the UN desires. The amount is Nepal´s first major international assistance received in the field of HIV/AIDs in addition to regular and valuable funds being received through USAID, UN agencies and several INGOs who run substantive program interventions in HIV/AIDS prevention and control, which however focus on their individual program bent.
Nepal went through a major civil conflict between 1996-2006 and the country successfully conducted a national constituent assembly poll on April 10 to chart out a democratic and more inclusive future for all Nepalis. The 10 year civil conflict killed 13,600 Nepalis and displaced 400,000 children and 900,000 adults, of which nearly 60% were from the Far Western hilly regions. However, every year due to AIDS more than 15,000 Nepalis are dying. This is a matter of national concern. In many parts of Western Nepal, AIDS is known as the ´Mumbai´ disease since Nepali migrant workers working in India bring it back with them when visiting their families, particularly infecting their spouses, thus infecting a larger number of Nepali women in the rural regions. If one visits districts, such as Dhading, Nuwakot or Achaam, the rates are not only astonishing, they show an epidemic which is quickly migrating into the urban peripheral regions. Besides, the feminization of Nepali AIDS cases is on the rise, but due to the unstable security situation, neither donors nor local INGOs have ventured to go to these pockets of HIV/AIDS earlier. They hopefully will do so now on a regular basis.
International organizations are optimistic about Nepal´s new democratic future after the peaceful CA Poll but worry a lot more about the pessimistic conditions in the general country side where the estimate of true AIDS cases is known to be at least three times what the government quotes and chew into national development efforts. The Nepal Government needs to be more serious about two major issues, health and education. The lack of proper health and education programs fuel in the infections. Recently Prime Minister Girija Prasad Koirala stated that if these two issues were taken more seriously, Nepal could make immense gains in the road to national prosperity, he considered them the two major priorities of any future government. Also, due to this widespread illiteracy and ignorance of the disease in the isolated parts of the country, less than 27.5 percent of Nepal's inhabitants can read, and a recent government survey conducted in the nation's 75 districts revealed that 71.7 percent of males and 49.6 percent of females had never heard of AIDS. There is little doubt that those who have the highest figures are needle-sharing drug addicts in urban locations, migrant workers who work in India, female commercial sex worker who are highly mobile these days, and their clients who appear to be younger and have more money to spend. In urban Kathmandu, Pokhara, and Biratnagar, the cash credit card and car symbol has caught the mood of the younger generation who like to experiment a little with everything in life, including the availability of alternative entertainment. Drug use is on the rise in Nepal, particularly among the youth, needle sharing is common which sparks AIDS infections.
While the Nepal Government's attention appears focused on preventing the spread of AIDS among migrant laborers, intravenous drug users and sex workers, housewives have become one of the most vulnerable groups in the country with the rate of infection rising by more than 100 percent. In 2006, , the NCASC of the Nepal Government reported 1,883 housewives were infected with AIDS. Private hospitals in Nepal have recorded even higher numbers. There is wide spread stigma and discrimination attached in coming up with truthful disclosure on one´s status. This cannot go on for long, before the number of deaths from AIDS triples in the next half decade from 15,000 to 30,000 deaths per year. This is in truth is the reality of AIDS in Nepal in 2008.
Consider this, in the past two years, the figures might have gone up by quite a few percentage points. The growing labor migration to India and other destinations in East and West Asia is another cause of concern, since many of the women also are engaged in commercial sex in Mumbai, Delhi Madras, Kolkata and Bangalore. Nearly 250,000 Nepali female sex workers are involved in India´s sex trade working in Nepali brothels in the inner cities and vice dens. Some of Nepal´s donors have already expressed concern that the rising number of orphans in the Nepalese rural regions particularly in Western and Far Western region have resulted in 13,000 to 15,000 orphans being left out in the open. But who is going to take care of them in future?
The new Nepal Government must take a serious introspection on this issue. The joint report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) the United Nations Children's Fund (UNICEF) and serious donors such as the United States Agency for International Development (USAID), have stated in the past that social stigma has increased with the number of cases globally, including in Nepal. The Nepali AIDS infected children face discrimination both at the hands of adults and other children in both their villages and schools.
UNAIDS India estimates at least 10 percent of the 2-3 million Nepalese migrants working in India are HIV positive, but the figures could be anywhere between 30-40% based on an independent study done by some of the INGOs there, which was also reported by BBC which was focusing among returned commercial sex workers in Kathmandu. The virus is spreading through the men to their spouses and others in many parts of the country. The situation is serious, but since it seems Nepal still is focused on the political priorities of forming a Constituent Assembly and focusing on developing a new Constitution. Health and AIDS have been necessarily neglected.
Currently there are nearly 80 national and international NGOs working in Nepal in the field of HIV/AIDS impact mitigation, while more than 170 orphanages claim to cater to AIDS orphans. But the fact is despite Nepal receiving ample assistance for the past fifteen years in the prevention and control of HIV/AIDS, it has been facing a lot of difficulties in institutionalizing a proper government policy that caters to the true needs of those infected and affected by the virus. Some state, if there was less interference from the donors, the Nepal Government might be able to set its priorities straight, but the Nepal Government appears not being able to take leadership on its own. In the past half decade various AIDS activist groups have been demanding a more pro-active national policy that sensitizes the Nepali population to their status, but with the lenient workings of the NCASC, and the absence of an effective national communications strategy, it is hard to imagine a nationwide advocacy drive that will help Nepal get out of this health rout. Thus, where coordination is strictly desired, there is more confusion in tackling Nepal´s AIDS crises.
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