Missing The Target
Nepal is likely to miss its MDG target about reversing the trend of HIV infection by 2015
By SANJAYA DHAKAL
In all likelihood, Nepal could miss the important target of the UN Millennium Development Goals (MDGs) regarding reversing the trend of HIV/AIDS infection by 2015.
This year’s 19 th World AIDS Day was observed with regular and ritualistic fanfare. A lot of programs were held to promote the awareness about this disease.
However, there was a stark reality lurking behind all these happenings. Lets face it, Nepal is slowly but surely finding itself under AIDS trap. Out of the eight MDGs, the sixth goal of halting and reversing the spread of HIV/AIDS, Malaria and other major diseases is going to become a tall order for Nepal . The incident of HIV prevalence has, instead, been growing from 0.29 percent of total population in 2000 to 0.5 percent now.
The country already suffers from a concentrated HIV epidemic, “with prevalence estimated as high as 50 per cent among certain most-at-risk populations” according to the UNAIDS office in Kathmandu . Injecting drug users, sex workers, men who have sex with men and migrants have the highest risk of exposure in this context, although prevalence in the general population is currently estimated at 0.5 percent.
According to the office, the largest number of cases in the last 18 months was reported among the 30-39 and 15-24 years old. Recent estimates show that 46% of HIV cases are among seasonal labor migrants, 19% clients of sex workers and 20% are wives of partners of HIV positive men. Young people are particularly vulnerable to HIV and form the largest proportion of most-at-risk populations.
“The vulnerability is further exacerbated by poverty, migration, gender inequality, ethnic or caste discrimination, political instability and civil conflict in Nepal .”
In order to meet these challenges posed by the disease, various national responses have been made ranging from an initial focus on prevention concentrating on the coverage of key target groups, to treatment, care and support including STI treatment, voluntary counseling and testing (VCT). “By now, VCT services have been expanded to 65 points in the country from 9 points in 2004. The Antiretroviral Therapy (ART) that was introduced in 2005 has been scaled up to 7 sites by providing ART to about 500 people.”
Despite these efforts the country is still not able to check the spread of the disease. “I cannot claim that the spread of the disease has been checked. Like other developing countries, we are also suffering from its spread,” said Rajendra Panta, chief of the National HIV/AIDS and STD Control Center .
Furthermore, the social stigma that the disease carries has stopped a majority of people living with HIV from disclosing their status leading to a complicated situation.
In the year of 2006 alone, 4.3 million people were infected with the disease and 2.9 million died of it. “The latest global AIDS figures give us reason for concern and for some hope. Multi-drug and extremely drug resistant tuberculosis highlight new challenges in our collective response. The issue of women and girls within the AIDS epidemic needs continued and increased attention. At the same time there is evidence of positive trends in young people's sexual behaviours—increased use of condoms, delay of sexual debut, and fewer sexual partners,” says Dr Peter Piot, Executive Director of UNAIDS, in a statement issued on the World AIDS Day.
Likewise, UN Secretary general Kofi Annan has also called on all world leaders to decide and declare that “AIDS stops with me.”
“The challenge now is to deliver on all the promises that have been made -- including the Millennium Development Goal, agreed by all the world’s Governments, of halting and beginning to reverse the sspread of HIV by 2015. Leaders at every level must recognize that halting the spread of AIDS is also a prerequisite for reaching most of the other Goals, which together form the international community’s agreed blueprint for building a better world in the 21st century. Leaders must hold themselves accountable -- and be held accountable by all of us,” Annan states in a statement.
“Annual investments in the response to AIDS in low-and middle-income countries now stand at more than eight billion dollars. Of course, much more is needed; by 2010 total needs for a comprehensive AIDS response will exceed 20 billion dollars a year,” Annan states.
Estimates say there are at least 75,000 HIV/AIDS patients in Nepal . The country needs both political will and resources to overcome this challenge – especially at a time when indications are strong that India could become one of the epicenters of the disease in the coming years. Since Nepal has open border and there is huge people-to-people interactions with India , the country will face the double challenge of protecting its citizen from the disease – which has emerged as not only a challenge of health but also that of socio-economics.
