In Nepal HIV/AIDS cases increased tremendously, in spite of the involvement of many national and international organization for controlling and preventing of infection. Millions of rupees have been spent every year to control, prevent, treate, or care of the problem of HIV/AIDS. We know the first HIV/AIDS cases were reportd in Nepal in 1988. Where as in other part of the world first AIDS case was identified in 1980.

In the milestone of HIV/AIDS cases "National centre for AIDS and STDs control established in 1993, as an institution permanently under the organization of Ministry of Health. The then, His Majesty's Government realized the seriousness of the problem of HIV/AIDS and formulated the HIV/AIDS and STD policy in 1995. HIV/AIDS control activity was included in National Planning and allocated the budget by HMG besides the financial support from international organization to implement the activity for prevention and control for HIV/AIDS and STD. In the beginning, many non governmental organization had focused their activity on "Awareness" of secrete problem but couldn't succeed. "Stigma" still persists at all level. Though policy mentioned by the government is clearly absent the non-discrimination of HIV/AIDS in all places.

For the prevention and control of HIV/AIDS activity was carried out by multisectoral approach on the basis of decentralization from centre to district level. During that time "National Coordination Committee" from at higher level and "District Coordination Committee" at the district level to implement monitoring and supervision of HIV/AIDS and STD (S.T.I.) prevention and control activity with the coordination of GO, NGO and INGO's for the process of policy regulation and reporting of HIV/AIDS National centre for AIDS and STD (NCASC) was focal point. NCASC leadership became unstable due to frequent changes couldn't be implemented HIV/AIDS control programme according to the strategic plan. Due to ignorance there was difficulty to understand the seriousness of the problem of HIV/AIDS.

The International organization supporting the NGO to carry their activity against HIV/AIDS continued. Their activity was limited and couldn't fulfill the need of the people living with HIV/AIDS (PLWHA). Policy regulation and strategic plan to control HIV/AIDS failed due to lack of commitment by leaders at the centre. The centre couldn't visualized the ultimate affect of HIV/AIDS. So implementation of HIV/AIDS control activity became weak. The UN system developed the fund i.e. "Global Fund" to support the HIV/AIDS control activity. The global fund was not under control of HMG. The budget of that fund misutilised and spent according to the interest of UN agency. The transmission of HIV infection couldn't be controlled. The epidemicity of HIV/AIDS became threat to the country.

As the case reported at the National Centre for AIDS and STD Control, Teku up to Sept., 2006.
Among the cumulative HIV/AIDS situations

HIV positive cases
Male            -       5574
Female        -       2320

AIDS cases
Male              -              850
Female          -              321
Total                           1171
According to NCASC report approximately 100 cases are reported every month. The surveillance report  also suggests that HIV/AIDS cases are increasing. The project cases on HIV/AIDS are around 60-70 thousand in Nepal.

The cumulative HIV infection
Among Sex worker
Female                           -     638

Among Sex STDs
Male                               -   3753
Female                           -    103
Total                                  3856
Among IDU's                
Male                               -   1608
Female                           -   26
Total                                 1634    
Housewife                     -   1435
Children
Male                             -      193
Female                         -      113
Total                                  306    

The major mode of transmission for HIV/ADIS is heterosexual through unsafe sexual behavior, in some extent transmitted through IDU's either by sharing the needles or by sexual contact. They are more harmful to the society. Mostly the youngsters are involved in IDU's.

As a whole in reported cases 20-40 years of age groups are infected with HIV/AIDS. They are sexually active so dangerous for transmission of HIV infection. Moreover they are most productive age group for the society, if affected with HIV/ADS to create the serious problem for the development of the country.

The temporary migrations are also playing the role to increase the HIV infection because the migrant workers are vulnerable for HIV/AIDS. The study shows about 50% workers knowingly or unknowingly indulge in sex industry or keep sexual relation during that period. In western part of the country, youngsters are going to India for their livelihood. The conflict situation of the country youngsters are going outside the country. More than million of workers are only going to Middle East or other foreign country's in search of job.

No doubt the girl trafficking are also the predisposing factor for HIV/AIDS in Nepal. There are problem for rehabilitation when they come back.

Now this is high time to think seriously by the government of Nepal most and show the commitment on HIV/AIDS and STDs prevention and control. There are example of Zimbabwe and Bosnia where HIV/AIDS are creating problems as a whole in the development of the country. Therefore,  Ministry of Health there are challenge to control and prevention of HIV AIDS in coordination with NGO and INGO with multi sectoral approach.

There is still challenge to the country about the need of the "People living with HIV/AIDS (PLWHA)" and implement the according focused towards them early as possible for prevention, treatment care and support services. Then only we are able to control HIV/AIDS and fulfill the UN message on the occasion of World's AIDS Day "Stop Aids" "Keep Promises".


Dr.Prakash Aryal
Ex-Director & Senior Health Administrator
Ministry of Health