Increased access to HIV services in Nepal

Most of the estimated 65,000 Nepalis living with the human immunodeficiency virus(HIV) are labour migrants, injecting drug users, female sex workers, men who have sex with men or clients of sex workers. Until now infection has been transmitted mostly by unprotected sex amongst these and other at-risk groups and via injecting drug use. Infection is, however, becoming more common amongst the wives of men in the high risk categories.

The DFID and GFATM programmes have made a large contribution to reducing the spread of HIV and AIDS, caring for infected people and helping gear up the national response to HIV in line with the National HIV/AIDS Action Plan (2008-2011) and the National HIV/AIDS Strategy, 2006-2011.

o    The GFATM grants have been instrumental in equipping Nepal’s public health service with the infrastructure, personnel and supplies to respond to HIV and AIDS in Nepal.

o    The DFID support can take much of the credit for the greatly reduced prevalence of HIV amongst injecting drug users and the stabilisation of prevalence rates amongst male sex workers and men who have sex with men. The 2006 to 2010 period has also seen a large reduction in infections amongst the wives of migrant workers.

The 5 million provided by GFATM have greatly improved access to HIV testing, antiretroviral therapy (ART) and the treatment of sexually transmitted infections (STI) and opportunistic infections across 64 of Nepal’s 75 districts.

The establishment of 30 new HIV testing centres, the training of 237 health staff on HIV testing, counselling and laboratory work and the procurement of their HIV test kits and consumables led to an almost doubling in the number of HIV tests (VCT only) carried out in 2010 compared to 2009 in government-run VCT centres. The programme also supplied all Nepal’s hospitals with HIV testing supplies to test all pregnant women attending their ante-natal clinics for HIV.

The programme greatly increased access to antiretrovial treatment (ART) and improved the quality of ART services by establishing 12 new ART centres and sub-centres and by supporting the functioning of all Nepal’s 36 ART centres and sub-centres. It supplied these centres with all their antiretroviral drugs and drugs for treating STIs and opportunistic infections, by training 146 of their staff on managing and monitoring ART and by supporting the monitoring and technical supervision of these centres. This support led to the number of PLHIV on ART more than doubling during the GFATM 7.1 period.

It has also led to a doubling in the number of PLHIV treated for the opportunistic infections that afflict PLHIV to thus greatly improve the quality of life of many PLHIV. The establishment of the 10 sub-centres has extended access to ART for many PLHIV as Nepal’s difficult terrain, limited transportation facilities and strikes and shutdowns make it problematical for them to make their monthly visits to ART centres.

A total of 1,350 health and other staff were trained for the health and mulitisectoral response to HIV and $3.3 million was spent on procuring medical and harm reduction supplies for the three Principal Recipients of this grant (UNDP, Family Planning Association of Nepal and Save the Children US). This included $1.96 million worth of drugs for treating HIV, STIs and opportunistic infections and 3.6 million condoms. Work was also supported to establish and update national standards for HIV testing, treatment and care and to strengthen the national HIV strategic information system.