AIDS Epidemic
Major Problem In Nepal

By Chiranjibi Paudyal

THE epidemic of HIV/AIDS, which has been the major concern of most of the developing countries has reached to an alarming proportion creating a serious social and economic problem. The epidemic which first appeared in the African countries in the 1970s has become the most serious health problem in many countries of the world, specially the third world countries of Africa and the Asia Pacific region.

More than 36 million people of the world, most of them from Africa and the Asia Pacific region, where about 90 per cent of the world’s total HIV /AIDS patients live, have been the serious victim of the epidemic. The African continent has an alarming proportion of the AIDS with more than 70 per cent of the world’s total victims followed by the Asia Pacific region about 18 per cent, Latin America and the Caribbean five per cent, industrialised nations about four per cent, Europe and CIS two per cent and the lowest is the Arab states with only around one per cent. About 1.5 million children below the age of 15 and about 1.6 million women have also become the victims of the killer disease. The HIV/AIDS epidemic has seriously affected the economic condition of the developing countries where it has grown up at an alarming speed forcing the concerned governments to mobilise all the available resources to the rehabilitation of the AIDS victims. According to an estimate of the United Nations Development Programme (UNDP), the life expectancy is expected to drop by as much as 25 years and economies are contracting by 20 per cent or more in the HIV/AIDS hardest hit countries of the world. This has added an additional burden to the countries where fulfilling the basic needs of the poverty stricken population is like taming a wild elephant by an ant. If the HIV/AIDS still increases in the present trend, there will be full stop to the development activities, the government will not be able to provide any resources for the development of education and health care system and the nation will plunge into the mire of poverty.

The epidemic has started to ring an alarming bell in the case of Nepal where officially the figure is put at 2,080 persons suffering from HIV/AIDS but in reality it is estimated to be 30 fold higher than the estimate. According to an estimate, there are about 70,000 persons suffering form the HIV/AIDS in Nepal. The actual victims of the AIDS are estimated at around 550 persons. The first case of the killer disease was seen in 1988 and has increased dramatically within a very short span of time. The experts and the government officials warn if the disease could not be controlled soon, it can be one of the major killer diseases in Nepal. A total of 149 persons have so far died of HIV / AIDS as the actual figure could be more as many people do not want to reveal that they have suffered from the disease which is mainly transmitted from sexual contacts.

According to the information of the National Centre for AIDS and STD Control, most of the people who have contacted the epidemic are sex workers and their clients. Altogether 416 sex workers, 1,278 clients of the sex workers, 235 from injecting drug use, 127 housewives, 21 prenatal transmission and three from blood transfusion have suffered from the epidemic. People of all ages including those of under the age of five and above 50 years have also suffered from AIDS. Most of the people who have suffered from the epidemic are at the 20-29 year age group and their number is 1,156.

The number of HIV victims is increasing in South Asia too and there is the need of concerted efforts from all the countries of the region to tackle the issue. There are around 50,000 drug users in Nepal and there is high risk of HIV/AIDS infections to these uses. Injecting drug is a major mode of HIV transmission. Of all the different ways that the virus can be passed on, injecting directly a substance contaminated with HIV into the bloodstream is by far the most easiect much more than through sexual intercourse. Transmission of HIV among intravenous drug users is almost 13 per cent so there is also the need to concentrate the effort in preventing drug addiction rather than trying to cure.

Poverty and ignorance is rampant in Nepal as a result the battle against AIDS is an uphill task. The open border with India has aggravated the situation. Every day, hundreds of thousands of people cross the border freely, bringing in the deadly disease with them. There is no concrete policy and programmes from any organisations and institutions to tackle the problem very seriously. United States Agency for International Development (USAID) is the lead HIV/AIDS and STI prevention-programme donor in Nepal. According to the agency, its activities have highlighted the importance of HIV/AIDS prevention, which has encouraged other donors, including Britain, Australia, UNDP and UNAIDS, to participate in Nepal’s "initiative to prevent the spread of HIV/AIDS." The programme, seeking to reduce the spread of HIV/AIDS and provide care and support to those already infected, targets those at greatest risk: commercial sex workers and their clients, intravenous drug users and migrant workers. It includes communications programmes targeting behavioural change, harm reduction activities, condom promotion and prompt treatment of sexually transmitted infections.

The United Nations during the world summit last year had urged the world leaders to make concerted efforts to bring the people out of the HIV/AIDS. If attention is not paid in time, it will make hampet all the development initiatives of the government and create a very serious problem in the society. Nepal is a traditional society based on religious, social and cultural values, which discourage the sexual relations with other people except the husband and wife. The national efforts of Nepal should be based on the promotion of our values and culture, which automatically try to stop such anomalies and help control the disease. Most of the people living in Nepal are illiterate and there is the lack of knowledge about the result of such disease therefore there should be strong media campaign against the disease. Once the people become aware, the disease will not be so serious. There is the need to control the killer disease in time otherwise it will create a serious problem in the society. The government, non-governmental organisations, policy makers and the media people should think of the seriousness of the disease in time and work to control it. The words of UN Secretary General Kofi A. Annan reflect the gravity of the problem, "the battle against HIV/AIDS is far more important than any one institution or project. Our success will not be measured by resolutions passed, appointments made, or even funds raised. It will be measured in the lives of succeeding generations."

Targetting Leprosy

By Mohan K.C.

THE 49th World Leprosy Day was marked with a number of programmes to generate awareness among the people that the leprosy like other diseases can be cured if the doctor’s advice and medication is followed. Despite the growing awareness among the people the disease has not yet been eradicated. What was once and, to some extent, is still considered a curse by the people must be removed if the country is to achieve success in the fight against the disease.

The government has already made its commitment to rid the country of leprosy by the year 2003. This is an encouraging sign that the government is aware of the situation and is effortful of providing all the health services to every part of the country. In the effort to eradicate leprosy, lessons must be learnt from the model followed for polio immunisation or tuberculosis control.

TB, a dreaded disease, leads to the death of thousands of people every year in the country. Once it seemed to have been checked but in recent times TB cases have soared. The reason is not difficult to understand. TB patients seem to be somewhat negligent in taking the prescribed medicines. Once they feel an improvement in their health conditions they tend to stop taking the medicines which must be taken for a specified period of time. Before a patient is totally cured, if he/she stops taking medicines the germs become resistant to that particular medication and complications result thereby making it more difficult to cure.

The increasing prevalence of AIDS has added to the woes. Despite the publicity by the government that TB can be cured and the medicines is distributed free of cost, the disease has not disappeared from the country. Malnutrition and unhealthy living are considered to be the cause of TB remaining a main scourge in the country. it is true that modern medicines can completely a patient so the government has adopted the DOTS system wherein the patient is made to take the required medicines in front of health workers. This system has proved quite useful in that more patients are taking medicines and in the specified doses.

For leprosy too medicines are distributed free of cost. But the main hurdle is the belief of the people. Anyone who contracts the disease is treated as an outcaste by the community. There is no contact with such people. The patients lead a vagabound life moving from one place to another making a living by begging. This loss of human dignity creates a big problem in that they often do not avail treatment. At the same time the disease has a devastating effect on their body with the fingers or face being disfigured.

Treatment for leprosy is so effective that if done in the initial stage the patient is completely cured with no visible physical effects. Physiotherapy can restore the person’s movement of fingers and muscles as before. But the greatest problem is that leprosy patients do not visit the health service centres on their own. The need then arises to identify such patients and give them the necessary treatment. In this task the health workers alone cannot do everything, the people in general have to help in bringing the patients to the hospitals for treatment.

The multi-drug therapy now being followed is a result of the great strides taken in medical science. The same system is followed in the country. As a result, if there were 70 leprosy patients per ten thousand people 20 years ago the number has dropped to six. This is an important achievement despite the fact that manpower and resources are not adequate in the country.

According to available statistics, 90,000 patients have been cured with treatment based on the multi-drug therapy. At present about 16,000 patients are undergoing treatment. This, however, does not mean that every person afflicted by leprosy is availing the health service facilities. The main reason for the symptoms of leprosy to be ignored is that they do not look alarming. The people tend to consider them as simple. The people have to be taught to identify the symptoms then the cases of leprosy could be referred to the health centre or hospital for further diagnosis. If the case is confirmed then necessary treatment can be initiated and the patient can recover.

The free treatment including the drugs agrees well with the patients because most of the people cannot afford treatment on their own. Besides, an atmosphere has to be created wherein every person suffering from leprosy feel it their duty to come forward for treatment.

Development Of Private Airlines In Nepal

By Umesh Panthi

WE can read about the flying objects built for carrying the people from one place to another through the air in VEDAS, MAHABHARAT and RAMAYAN. In 1993 A.D. the Wright brothers invented aircraft. In fact, the aviation history has been nearly a century old.

Yet, Nepal saw the first aircraft in 1949 A.D. when a single engine 4 seater Vintage Beech Craft landed at Gaucheran, Kathmandu in the month of April. The first scheduled air service provider in Nepal was Himalayan Aviation Company of India and was replaced by Indian Airlines Associates in 1954. The Department of Civil Aviation was formally established in the year 1957 as separate entity, whereas Royal Nepal Airlines Corporation (RNAC), the only national flag carrier of the country, came into existence as a public sector undertaking in 1958. It remained the only service provider in the country until early 1992.

There were army flights in the domestic sector. They were, however, being operated for only army and rescue purposes and at the time of national disasters and calamities. Thus RNAC enjoyed monopoly in domestic flights for nearly 34 years.

In a land-locked and mountainous country like Nepal, almost seventy per cent of the total territory commprises of mountains and hills. Waterway transportation is non existent and railway transportation is limited to just a few kilometres in the southern strip of the Terai. Still there are as many as 10 districts not yet connected by the road network. Due to the rugged terrain, road construction is not only extremely costly but also environmentally damaging. Thus air transportation is the only means for the easy and fast movement of the people and commodities from one place to another in the country.

The role of air transportation in socio-economic development of the country is obvious. Besides, air transportation plays a vital role in integrating people from different walks of life, from different regions of the country, with different religions and different cultures by bringing them together in a stream of national unity. Air transportation can only boost the country’s tourism sector by the adequate exploration, exploitation and enrichment of the remote and unexplored areas of the country.

In 1993, National Civil Aviation Policy was promulgated introducing liberal sky policy formally. In the policy it is accepted that the expected development of the tourism industry considered as the primary medium for the socio-economic development of the country is not possible without development of a competent, strong and affordable air transportation system. The civil aviation policy has been prepared after review of prevailing domestic and international air transport services and duly considering the privatisation policy pursued by His Majesty’s Government of Nepal as well as the resources constaint of the government. Its objectives will be to provide necessary contribution to the promotion of development of tourism in accordance with tourism policy of His Majesty’s Government, to develop, expand, promote and protect the only national flag carrier through the involvement of local or foreign joint venture investor for the expansion of international air transportation services, to develop healthy and competitive air transportation through encouragement to the private sectors as well, to develop and expand airports in remote areas, to make the air transportation reliable and safe through the development of modern equipment and faclities at airports and to duly encourage recreational, adventurous and research oriented air services activities.

This policy attracted many investors in the private airlines business. Till now, as many as 2 dozen private airlines have been registered and half a dozen are now in operation in the country. Besides these, as many as half a dozen international airlines are also operating their scheduled flight services. But sadly, the dramatic increase in the air accidents at the same time have posed serious threats to it’s future growth and sustainability.

The increase of air traffic especially in the domestic sector within this short span of time is very much encouraging as far as investment is concerned. However the growth trend is not smooth. During this period some private airlines showed up and went off. Some are still struggling for their survival while few others are doing well in terms of growth and profitability. This trend in private airlines clearly indicates the need for careful analysis so as to assure the future of the existing organisations and the others which are still on the pipeline to come up, for the long term sustainability and guaranteed future of aviation industry.