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HEALTH-NEPAL: Meeting MDG on HIV/AIDS – A Dream?

Renu Kshetry

KATHMANDU, Oct 28 2008 (IPS) - Shibu Giri, programme officer at the National Association of People Living with HIV/AIDS in Nepal, who tested positive in 2000, believed he was fit and fine as his CD-4 count stayed normal.

But when he began falling sick frequently and developed candida in his mouth he began to have doubts. "I decided to go for an HIV viral load test," Giri said referring to the relatively expensive test which calls for blood samples to be send to Thailand because Nepal does not have the facilities.

The results sent alarm bells ringing as the count was 500,000 copies per ml, which is far higher than the recommended viral load of 50,000 copies per ml or less.

"If I had relied on CD-4 (immune monitoring indicator) count alone, then my life would have shortened for sure," said Giri, who was started on anti-retroviral therapy (ART) recently.

Giri believes that his life was saved because of his awareness of the system. Not everyone is as lucky, and some of Giri’s friends succumbed to the disease long before they could be started on ART.

While ART came to Nepal in 2004 and CD-4 count tests in 2005, this impoverished country still does not have the capacity to carry out HIV viral load tests that measures the amount of HIV genetic material (RNA or DNA) in the blood.

There are 25 ART sites in 25 of Nepal’s 75 districts. So far only 1,920 people have availed of this facility whereas the number of people living with HIV/AIDS in Nepal is estimated at 70,000, according to National Centre for AIDS and STD Control (NCASC).

The Global Fund to fight AIDS, Tuberculosis and Malaria has approved 36 million US dollars of the ‘Round Seven’ fund to fight HIV/AIDS. But the huge assistance coming from abroad has not been enough.

"For the effective implementation of ARV drugs, viral load testing is very important along with introducing provider initiative counseling testing for effective result rather than voluntary counseling testing," said Rajiv Kafle, vice chairperson of Country Coordination Mechanism for HIV/AIDs.

"Due to the low number of testing facilities, most of the HIV infected people are unaware of it. There is a need for massive testing campaigning. Even though there is treatment availability, due to lack of testing, majority of HIV infected people are dying," said Kafle.

Insufficient coverage of targeted prevention for populations at highest risk is a particular challenge compounded by the huge gap between reported and estimated cases.

National estimates indicate that 92 per cent of cases of infections are in the 15-49 age group. Estimates for 2007 show that 42 percent of all HIV infections in Nepal are among seasonal labour migrants, 15 percent among clients of sex workers and 21 percent are wives or partners of HIV positive men.

As a medical rule also, the viral load should go down (50 copies/ ml) and CD-4 Count should go up after 3 months of taking ARV drugs. But here in Nepal, there are many patients who have been taking ARV drugs for years without knowing whether it was of any use or not.

Though there are an estimated 70,000 HIV-infected people in Nepal, only about 10,000 have revealed their status. Therefore, Nepal achieving Millennium Development Goals (MDGs) by halting and reversing the spread of HIV/AIDS by 2015 remains a far-fetched dream.

Dr. Dirgha Singh Bam, secretary at Nepal’s ministry of health and population, told IPS: "We are working on introducing various new strategies and technologies to achieve the MDGs on HIV/AIDS. It needs collective efforts and more preventive programme which the government is working on.’’ The ministry has now allocated a budget for viral load test machine procurement.

The United Nations’ MDG on HIV/AIDS calls for halting and reversing the spread of HIV by 2015 mainly by providing universal access to comprehensive prevention, treatment and care.

Jeffrey Scot Morey, portfolio manager of the Global Fund, who was here recently for grant negotiations, told IPS that with public and private partnerships among stakeholders, and with the support of the Nepali people, it is possible to achieve the MDGs.

"The national strategy is to increase the availability of voluntary testing and treatment," he said. "As effective programmes are implemented and proposed and ongoing research is continued, more precise information will be available."

"Reducing transmission among groups driving the HIV epidemic through high-risk behaviour is crucial and needs to remain a focus of the response," he further said, adding that the number of people living with HIV/AIDS continues to rise in Nepal as also those in need of care.

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