 |
 |
|
 |
 |
 |
 |
|
Since the time of the first officially reported case of AIDS in Nepal in 1988, resources costing millions of rupees has been poured into this area in the name of awareness raising, prevention, and care and support. Despite all the efforts made by Government, NGOs and the international donor sector, Nepal is still one of the most vulnerable countries facing HIV and AIDS. The issues related to HIV and AIDS in Nepal are still in the stage of denial because of socio-cultural norms, stigma, discrimination and the lack of a strong commitment from the Government. Similarly the Government is having to deal with other challenges such as the Maoist conflict and political instability, which has sidelined the issues of HIV and AIDS. Many development activities including efforts to control the HIV and AIDS epidemic have been sidelined with security taking up the Government's priority. Other challenges faced by the Government in this area is the lack of committed leadership and capacity to coordinate on a sector-wide level. As we have learnt from the experiences of countries such as Uganda , a strong and committed leadership in the Government sector is essential to fight against HIV and AIDS epidemic. Despite regular denial and ignorance from authorities and the general public about its seriousness, it has become an open fact that HIV and AIDS is rapidly emerging as a major public health and social problem and is likely to be a leading cause of death in Nepal in the coming years. Factors like poverty, low levels of education, denial, gender inequality, stigma, and discrimination have intensified Nepal 's vulnerability to HIV and AIDS. The ongoing conflict due to Maoist insurgency, political instability and the lack of education and awareness about HIV and AIDS are all factors that have fuelled the spread of the HIV and AIDS epidemic in Nepal . The lack of existing economic opportunities and the risk of being forced to enlisted into Maoist army has caused mass migration into Indian border towns and internal migration into urban cities. Due to the lack of awareness and separation from the family for an extended period, the migratory population are at great risk of being infected with HIV and AIDS by being involved in different risk behaviour. Recent data suggests a generalised epidemic among the large numbers migratory workers that cross the border with India and a high prevalence rates of HIV infection in the wife's of infected migratory workers. Recent behavioural data indicate the increasing vulnerability of young people to HIV/AIDS due to the generational and cultural gap between newly emerging values, norms, knowledge and independence on the side of adolescents and their parents, and an associated number of young people injecting drugs. The latest Government data at August 2004 shows that 4164 people are HIV positive and out of that 808 people have reached on the stage of AIDS (NCASC Report, June 2004). Contrary to this Government report, UNAIDS reports shows that more than 60,000 people are currently living with HIV and AIDS in Nepal (UNAIDS report 2004). The difference between these two data demonstrates the seriousness of the problem. UNAIDS estimates that, in Nepal , 3000 deaths occurred in 2000 due to HIV and AIDS, while cumulative number of deaths till 1999 was 8325. Though the national prevalence of HIV amongst the adult population ( ages 15-49) is low at 0.5% (UNAIDS report 2002), a response study on HIV and AIDS carried out by the National Centre for STD and AIDS (NCASC) in 2001 indicates that the country has already passed from the stage of "low-level epidemic" to that of a "concentrated epidemic" amongst high risk groups (female sex workers, clients of female sex workers, injecting drug users and men who have sex with men). The magnitude of challenges faced in HIV and AIDS differ between men and women. Women are particularly vulnerable to infection due to their traditionally lower social status in Nepal , despite some knowledge of HIV/AIDS and STD, women have no access to means of protection, making them particularly vulnerable to infection. Due to different socio-cultural factors, women face even more stigma and discrimination as compared to men. These factors include Nepali society's traditional expectations towards women's behaviour, unequal rights to property, women's status in the society and in particular their power in decisions related to sex and reproduction. Prerana therefore attempts to enable women PLWHAs to assert their rights and have clear strategies that adequately address these gender-related issues. With the continued increase in the prevalence rate, the Government has now prioritised HIV and AIDS as one of its main development concern and has demonstrated an increased interest to fight against this epidemic. However, the Government is having to deal with other serious challenges such as the Maoist insurgency and political instability in Nepal , thereby sidelining issues such as HIV and AIDS, and poverty. Other challenges faced by the Government in this area is the lack of committed leadership and capacity to coordinate on a sector-wide level. To make the Government more committed in achieving the national goals of HIV and AIDS prevention, strong and collective public pressure is needed. Nothing could be achieved with out public participation and support. To increase public pressure there is a real need of strong civil society movement to fight against the epidemic. The lack of involvement of PLWHAs in the design of services intended has lead to services that have not adequately addressed the needs of PLWHAs. Prerana believes it can respond more effectively to the needs of PLWHAs as it's management structure is composed predominately of positive people. Due to the increasing number of people living with HIV/AIDS in Nepal , the importance of care, support and treatment services for those infected and affected is rising. Home and community based care and support services are virtually non–existent in Nepal and must become established in the absence of adequate public or private sector health services towards PLWHAs. Nepal also has a significant lack of accurate information services in Nepal to provide information about HIV/AIDS and a limited number of voluntary counselling and testing services across Nepal . However, due to the stigma and discrimination related to HIV/AIDS, PLWHAs are discouraged from accessing what little services are available. Besides being a health issue, different social factors, such as stigma, discrimination, inclusion, empowerment have also factored in the increase of HIV and AIDS infection. Contents which help to raise awareness about HIV and AIDS is not widely included in the school/college curriculum. Majority of the policies that are in place to protect the rights of the people do not sufficiently address the needs of the PLWHAs as HIV and AIDS is relatively a new issue. To aggravate the matter further, what policies are in place that protect PLWHAs rights do not constitute any system and mechanisms to enforce them. Thus due to all these factors, PLWHAs are one of the most disadvantaged group in Nepal . A significant barrier to Nepal addressing the issues surrounding PLWHAs is a deeply rooted traditional belief system that regards the discussion of HIV/AIDS as being taboo. PLWHAs are a particularly marginalized group in Nepal who receive much discrimination and stigma for being positive. Summary of the issues affecting PLWHAs in Nepal • Lack of public awareness about the pandemic • Increased social discrimination/exclusion of HIV and AIDS affected/infected people • High level of stigma and discrimination towards PLWHAs • Lack of appropriate policies and mechanism to assert and protect PLWHAs rights • Access to the services available to PLWHAs are limited and not user-friendly • Lack of public pressure and commitment from the leaders |
