Prevention And Control Of HIV/AIDS
An Urgent Need

By Jhabindra Bhandari

THE increasing trend of HIV/AIDS is definitely an emerging social problem of human life. Apart from the global challenge of poverty alleviation, the socio-economic impact of this alarming spread of the epidemic is a matter of serious concern worldwide. If the trend still continues, there is no doubt that the scenario of the problem will become even worse particularly in the poor developing countries.

Since its discovery in the early 1980s, HIV/AIDS has rapidly grown into a worldwide epidemic. If we look at the trend of its spread particularly in the poor developing countries, it will be the greatest threat to sustainable human development. Much more worrying point is that a huge amount of resources will have to be spent in the prevention and care in the years to come.

Even though the National Centre for AIDS and STD Control reports that the HIV/AIDS situation in Nepal is a little more than 1800, the reality is far worse than expected. It is estimated that the cases of HIV/AIDS have reached at least 35000. Despite the efforts of prevention and control, the problem is unfortunately on the rise.

The attempts of national and international community to fight against this social tragedy have drawn serious attention for the urgent need of multi-sectoral response. Understanding the nature of risk behaviour, it is clear that youths are specially at risk. And there is therefore a growing need to concentrate on the young people as a primary target.

Actually, the issue of HIV/AIDS is not perceived as a serious problem of socio-economic development. Furthermore it is equally important to note that the increasing social stigma associated with HIV/AIDS is adding fuel to the spread of the epidemic in most societies.

The most worrying part in most of the societies—the adolescents are poorly and inadequately informed about sexual matters and high risk behaviours. The youths who migrate for jobs and economic opportunities in the country is one of the important social factors contributing to high vulnerability of the problem. Thus, high mobility and migration, not only from rural to urban areas and vice versa, but also between different countries, has allowed the virus to spread more quickly.

One of the significant problems contributing to the spread of the epidemic is the growing problem of drug addiction among youths. The mode of HIV transmission through sharing of syringe among a number of the addicts is still increasing. Even though attempts of behaviour change interventions are taking place, there has been limited input and resources to reach the high risk groups for appropriate behavioural change.

It is important to note that the drug culture in many Asian regions reveals that youths are more addicted to injecting drugs. Injecting drug use is now common amongst young people, with users often sharing needles with others. And they are very mobile at the same time—thereby increasing the vulnerability of the infection.

Every year, thousands of women have been trafficked to different parts of India and other regions. After they contract the killer disease, they are compelled to return to their homes. There are terrible stories of trafficked women who have been infected with HIV/AIDS and diseases. At the same time, there is poor acceptance of the people living with HIV/AIDS in families and communities so that they have to lead a worse life.

Until recently, the impact of the growing problem of HIV/AIDS on infants and young children has been largely a neglected issue. This is primarily because at the beginning of the AIDS epidemic, children were not considered to be at risk of HIV infection. Later it was very clear that the virus could be transmitted from an infected mother to her baby during pregnancy, birth or breast feeding.

This is true that Sexually Transmitted Diseases (STDs) and reproductive tract infections increase the risk of HIV transmission. In a society like ours where interpersonal communication about sexuality and family planning is very rare, there is clearly delay in seeking health care for STDs in the health facilities.

On the other side, it is true that reproductive health services providing counselling, education on sexual health and better detection and treatment of STDS are still lacking particularly in rural areas. Therefore, community based interventions like condom promotion should be a matter of priority for behaviour change.

This is particularly encouraging to note that awareness raising efforts of NGOs in the field of HIV/AIDs have been very effective. Behaviour change intervention has been a core strategy in the fight against the problem. Still the important issue is that awareness raising programmes have not reached the very remote parts of the country effectively.

There are important strategies to address the problem of spread of HIV/AIDS and its socio-economic impact on individuals, families and communities. The District AIDS Coordination Committees (DDCs) need to play a key role in participatory planning and management of HIV/AIDS at district, village and community level. Advocacy to local elected representatives and policy makers help a lot to localise the national response.

Recognising AIDS as a threat to development emerging issues of HIV/AIDS should be a matter of priority agenda. There needs to be participatory operational research on issues related to migration, health seeking behaviour, human trafficking and harm reduction initiatives for effective planning and implementation of prevention and control programmes.

Promoting partnership with local NGOs and private sectors is another part of intervention that help initiate collective action against the epidemic. Therefore, capacity building of the DDCs, VDCs and local NGOs in planning, implementation and monitoring and evaluation of HIV/AIDS programmes is crucial. Past experience shows that social mobilisation is a landmark in prevention and care.

Networking with community based organisations and NGOs is essential for joint action to maximise the impact. Youth mobilisation for prevention and control of HIV/AIDS is extremely essential so
that the rate of increase of the infection will decrease. As there is a big challenge of care and support programmes to people living with HIV/AIDS, the joint efforts of government, NGOs and private sectors can only tackle the problem significantly. To accomplish this, strong political will and commitment is an urgent need for global action in the fight against the epidemic.

What Control On Alcohol Means

By Mohan K.C.

WHAT was on the anvil has recently come to make headline news. The government in an understanding with the All Nepal Women’s Association (Revolutionary) has agreed to implement a set of "revolutionary" measures to curb the sale, distribution and consumption of alcoholic drinks. It seems to be the first time that a problem that had been identified long back is going to receive some serious attention.

According to the agreement, four days a month are to be alcohol free days including the first two days of the month and the final two Saturdays. This might mean much to a family where the earning member has the tendency to throw away all the money on drinks. And the average income of a Nepali is not so high that he can meet both the ends meet i.e. household expenses, education for the children, medical requirements and consuming alcohol as if it was free.

In this context, the new provisions must be fruitful. But the main question arises that will this be enough to check the sale and consumption of alcohol on other days. Like a paper had a cartoon the other day with a man holding on to a number of bottles with presumably alcohol to tide over the alcohol free days. It is not to say that it was intended for making a mockery of the new measures. It seems to convey that unless the sale and distribution of alcoholic drinks are curbed on other days the free days will not come to anything. Most probably, the people who are going to formulate the related rules and regulations will be burning their midnight lamps in arriving at the right mixture.

The first two days of the month definitely mean the time when a wage earner receives his pay packet. Stop him from spending a chunk of it and it would be doing much good not only for him but his whole family. The recent revelation that about 25,000 people in Russia die of over consumption of alcohol must set everyone’s mind as to what the consequences will be if alcoholic beverages are easily accessible.

Of course, the figures for alcohol related deaths are not available for Nepal but it must be certainly high. Not only a host of diseases can make their presence felt but the number of work days lost as a result of excessive consumption can be quite high. For this the agreement must be welcomed from all quarters. For the addict, it might mean some inconvenience but it is all for his own welfare. The nation too benefits. But, how much? There is no answer to it except that the industries are set to lose much when so much investment has been made in distilleries and the network of sales and distribution.

The provision for opening up limited sales outlet in wards too must come as worthy of notice. Once the measures are taken, it would mean that alcohol would not be sold from grocery shops or cold stores as it is at present. At present almost every shop seems to be selling them. And even a six-year old kid is sent by his father or uncle to fetch a bottle of drink. That will not be the case now. It means a change in the mentality of even those who cannot start or end their day with a double or triple measure of the hard drink.

It is true that many brawls and fatal incidents including traffic accidents result from the consumption of alcohol over and above the quota that cheers the heart. Limited outlets means much when it comes to the implementation stage. At present, only conjectures can be made.

The timing of alcohol sale from 2 p.m. to 6 p.m. is somewhat odd. Why not make it 4 to 6 or 5 to 6 so that there’s very little time for those with an attachment for the ‘fire water’ to get down to being really drunk. Why open it at 2 in the afternoon, as that’s no time to indulge in trying to become drunk.

Alcohol can be sold by any person of the age of 21 or over but when it comes to actually drinking a person should have reached the age of 24. This does not sound quite reasonable. Make it either 21 or 24 for both jobs. Anyway, I-cards will be vogue now that it has to be produced by everyone when asking for a sip off the glass.

As everything else, there are pluses and minuses. All efforts must be to capitalise on the positive aspects and try to make the most out of it. There are losers as well as winners. So is the case here.

Glimmer Of Hope

By Prakash C. Poudel

ON my way back to Nepal via Hong Kong in Dragon Air I had an opportunity to acquaint myself with three young Nepali businessmen, who were also on their way home after attending couple of business meetings in South Korea and China. When they learned that my last name is ‘Poudel’ and that I also came from Tanahu their whole attitude towards me changed. That in a way baffled me and I felt rather awkward. In a while, the one who looked smarter of the three could not resist his burning curiosity, "Are you, in anyway, related to Deputy Prime Minister Ram Chandra Poudel?" My negative answer disappointed him beyond his and my own imagination. Before I could think what would come next the gentleman headed back to his friends who were enjoying a bit too excessively. For the rest of the journey, I kept wondering about the changes that must have occurred in my country since I left about 10 years ago. However, as I arrived at the Trivhuwan International Airport, I had to face, to my astonishment, the same question whether I was related to Mr Ramchandra Poudel. But before I could make the situation clear he exhaled bitterly, "Bhitra pani tapain haru bahira pani thapain haru nai." Slowly the clouds of doubt were fading away.

Both of these remarks I mentioned above, however, helped me to draw the picture of my country until I saw it with my own eyes. Also, they assisted me to unveil the corruption and nepotism that prevailed before the restoration of democracy. Personally, it hurt me very deeply as I had participated in the democratic movement as a young student. After many years overseas, I returned with a glimmer of hope to join the mainstream and have a better life. Hopes however are fading every passing day. The truth was more fearful and terrorising. Even taxi drivers would not take you to most of the places late in the evening and after stores were shut down. Deep within, I wondered if I did the right thing by coming back!

At present, somehow, the ceasefire between the government and the Maoist rebels has raised the hope for the peace and security. But many still fear there may come numerous obstacles. Thus, it is high time that both the parties be more careful not to fall back in their endeavour of sustaining peace and harmony through mutual dialogues. There always is a possibility for peace through each others understanding, especially among the people of the same nation, who are raised within the same social and geographical context. If Maoists could be brought into the mainstream and work together for the betterment of the whole nation it won’t take long for us to change the face of the nation. The request for ceasefire by Prime Minister Sher Bahadur Deuba and positive response by Comrade Prachanda has been welcomed by every household, including many international communities. Even Maoists seem to have pinned their hopes on Deuba. Accordingly, Mr Deuba, at present, has emerged as a possible torch bearer who can spread this message of peace if every thing goes well. And the peace in this Himalayan Kingdom is possible to sustain only through mutual understanding and cooperation. We are, as the citizen, ready to march along with Deuba and Prachanda and every other parties concerned in this process. Neplease people are looking forward for the day to hear the news
that the war among ourselves has been put to rest forever. ‘Shanti’, ‘Shanti’, ‘Shanti!’