NATIONAL 5 (Spotlight Weekly)]

Race Against Time

The road to a general AIDS epidemic in Nepal appears very short. But there is still hope.

By SANJAYA DHAKAL

Time is running out, says Michael Hahn, the country program adviser of UNAIDS for Nepal. As there are already signs of "concentrated epidemic" -- meaning over five percent infection -- among high-risk groups like sex workers and intravenous drug users in the country, the situation is dangerous.

Experts say that if things are not kept under control, the situation could easily spiral out from a concentrated epidemic to an epidemic among the general population. "The stage is all set for a major epidemic. All it needs now is the initial ignition," says Hahn.

Agrees Dr. T.N. Jha, director of the National Center for AIDS and STD Control. "The present situation needs to be defused quickly. We cannot afford to wait until we become another Africa," he says.

The World Health Organization and UNAIDS estimate that 34,000 people are living with HIV/AIDS in Nepal, and that around 2,500 people died of AIDS last year. HIV prevalence among sex workers in Kathmandu increased from 2.7% in 1996 to 17.3% in 1999. Among intravenous drug users, it increased from 1% in 1993 to around 50% in 1999.

Lack of awareness, labor migration, unsafe drug use, unsafe sex are the main reasons for the occurrence of AIDS in the country. The general population of Nepal is said to be highly vulnerable to a fast spread of the epidemic.

"We have to scale up the intervention among the most vulnerable groups to prevent an escalation," says Hahn. "Intervention here means bringing about a change in behavior through raising awareness and providing means and access to safe behavior."

"Men Make A Difference" is the global slogan for this year's World AIDS Day (December 1). The slogan is all the more relevant for a conservative society like in Nepal where men rule the roost.

As it is the men who decide on the wheres, whens and hows of sex, it is essential to change their behavior to control AIDS. In a society like Nepal, even if a woman knows the importance of safe sex, she will find it difficult -- even impossible -- to ask her partner for safe sex. Moreover, taboos and stigmatization do not allow her access to protective means like condoms.

"We need to orient men towards healthy behavior. This could be the best option to fight the disease," says Jha.

Providing sex education to adolescents could be another way to prevent the disease from infecting the young population.

But merely providing awareness is not enough. Means of healthy behaviors, too, should be in place. For example, 80% of intravenous drug users know that sharing of needles and syringes puts them at risk of getting infected with HIV, but they cannot access clean needles and syringes.

According to UNAIDS, the present situation, if allowed to persist, could lead to a point, in which AIDS becomes the leading cause of death in the age group of 15-49 years in Nepal in the next decade.

UNAIDS has been mobilizing donor support for resources to fight the disease in the country. The National Center for AIDS and STD Control coordinates these efforts. "We have six monitoring stations spread across the country to observe the prevalence and spread of AIDS and STD," says Jha.

Dr. Hahn calls the existing mechanisms to fight the disease "definitely insufficient". "Nepal is not prepared for what is coming. But there is still time to act," he says.

As South Asia has already been termed as a high-risk zone with India already commanding the second highest number of people living with HIV/AIDS in the world, Nepal definitely needs to clean up its act now. Its now or never.