On the eve of World AIDS Day (December 1), and continuing its commitment to the health sector and the issue of HIV/AIDS in Nepal, USAID/Nepal, on has recently awarded up to $25 million to two new health programs for use over the next three years. USAID/Nepal, on behalf of the American people and government, has been providing support for HIV/AIDS interventions in Nepal since 1993; total funding in this period has reached more than $50 million, not including this new funding.
Nepal has a "concentrated epidemic," driven by injecting drug use, high risk sexual activity and labor migration, all of which are risk factors that lead to substantial rates of HIV infection among female sex workers, their clients, men who have sex with men, injecting drug users and labor migrants. Most of the estimated 70,000 people living with HIV/AIDS do not know they are infected, and HIV/AIDS related stigma and discrimination prevent them and others from seeking HIV counseling and testing, prevention, care and treatment services.
USAID/Nepal, part of the U.S. Mission to Nepal, has developed and supported partnerships with the Government of Nepal and more than 50 international and local non-governmental organizations, community based organizations, groups and networks of people living with and affected by HIV/AIDS, research organizations, private companies, management agencies and faith-based organizations. The current program provides prevention to care services.
Advancing Surveillance, Policies, Prevention, Care and Support to Fight HIV/AIDS (ASHA): This program, implemented under the President’s Emergency Plan, directly contributes to Nepal’s National HIV/AIDS Strategy and National HIV/AIDS Operating Plan. In this phase of the HIV/AIDS program in Nepal, USAID/Nepal plans to sustain the successes of the program to date including: promoting strong local ownership and building capacity in the public sector to oversee HIV/AIDS services; implementing targeted behavior change activities in close collaboration with all partners; encouraging and supporting more public-private partnerships; and optimizing coordination of all activities including surveillance, and monitoring and evaluation to track progress and monitor trends.
Nepal Social Marketing and Franchise Project (N-MARC): Achieving adequate coverage of vital health products and services requires both public and private sector involvement in Nepal. Building on past successes and learning, USAID/Nepal is supporting social marketing/franchising of key family planning, maternal and child health and HIV commodities through the N-MARC project. The goal is to increase access to key health products for a large segment of the population by providing an affordable and accessible alternative to free government products and services. This project will continue to target HIV/AIDS prevention, reproductive health and child survival. Products marketed through the program include clean delivery kits, disinfectant, oral rehydration salts, condoms and a full range of contraceptives for family planning.
- Recent studies of HIV rates in high risk populations such as female sex workers and injecting drug users show that the HIV rates have stabilized at a low prevalence in female sex workers (1.5%) and have significantly decreased among injecting drug users in Kathmandu from 68% in 2003 to 51.6% in 2005. Rates in other high risk populations have also decreased.
- USAID/Nepal has been helping the Government of Nepal to enhance its leadership and management capacity for HIV/AIDS programming. Technical assistance from USAID/Nepal has helped to develop national strategies, guidelines and training curricula on HIV/AIDS prevention-to-care services including Nepal’s national HIV/AIDS supply chain management system.
- USAID/Nepal support has strengthened Nepal’s surveillance system to monitor HIV, STI and risk behaviors with most-at-risk population groups. Data from these surveys have helped not only in planning and modifying HIV/AIDS programs but also to generate political commitment and resources for program activities.
- USAID/Nepal support for targeted and high quality sexually-transmitted infections (STI) services has resulted in increased access to and demand for these services among most-at-risk groups. The prevalence of syphilis has decreased significantly in USAID-supported program areas. A 2003 study in 16 districts along the highways similar to one conducted in 1999, showed that syphilis prevalence was halved among female sex workers and dropped by 20% among truckers. A 2006 study demonstrates that syphilis infection rates have remained low with small pockets of outbreaks.
- To develop local capacity to establish and expand Voluntary Counseling and Testing programs, USAID/Nepal has provided ongoing technical assistance to develop national policies, guidelines, training curricula and quality control mechanisms as well as trained human resources. In addition, these services are linked with other prevention and care programs.
- USAID/Nepal has helped community programs to provide care and support for those affected by HIV/AIDS. Nepal now has an essential package of care services to prevent and manage infections as well as the capacity to provide community and home based care for people with HIV/AIDS.
Some Results to Date
The U.S. Government, through USAID, extends assistance from the American people to peoples of other countries struggling to build better lives. This support ranges from helping to recover from a natural disaster to working to create a free and democratic nation. For 55 years, USAID/Nepal has provided assistance to the people of Nepal in the areas of conflict mitigation and peace building, democracy and governance, health and family planning, economic growth, and disaster and humanitarian aid.