As Nepal celebrates World AIDS Day, Dr. Maria Elena G. Filio-Borromeo UNAIDS Country Coordinator  Nepal spoke to NEW SPOTLIGHT about HIV/AIDS and in Nepal and the steps taken by various stake holders. Excerpts:

How do you see general trends of HIV/AIDS in Nepal?
The 2010 UNAIDS Report on Global AIDS Epidemic released last week, gives Nepal an encouraging scorecard on some key indicators in the past few years such as an increase in condom use, rise in the number of people accessing anti-retroviral drugs, and a greater awareness among general population about HIV/AIDS. Last week, the National Center for AIDS and STD Control (NCASC) the implementation arm of the Ministry of Health and Population (MOHP) released its new fact sheets- which among others, reported that the HIV prevalence is now 0.39%, down from 0.49% in 2007. So based on available data, the trend (HIV prevalence) is decreasing.

Who do you see the data?
But we all know the limitations of these data. So to me, while it is good to refer to these evidences/data for program planning and prioritization, policy formulation and advocacy, let’s continue to focus on HIV risk and vulnerability reduction. AIDS is a behavior-driven disease and human behavior is very complex- it is shaped and affected by multiple, multi-dimensional factors. These factors form an enabling or hindering environment in intensifying HIV prevention, treatment, care and support services.

As there are rampant violation basic human rights of people living with HIV/AIDS, what Nepal needs to do?
Indeed, there are anecdotal reports of human rights violation in the context of HIV/AIDS. This includes harassment of most-at-risk groups or key affected population.  Little documentation has been done on this and I’m not too sure if a formal complaint had ever been filed.

Nepal has made international commitments and had also put in place, appropriate laws and policies to protect the rights of every Nepali. Some of the daunting challenge I see, includes among others- the execution of these laws and policies, documenting and reporting cases of human rights violation and setting up a mechanism to address these reports.

How do you look at the efforts made by the government of Nepal?Amidst the socio-political, economic and geographical challenges, the Government of Nepal is trying its very best to effectively respond to the changing needs and realities of the epidemic. With limited domestic resources, the government continue to mobilize external resources in order not to disrupt the services of those who needs it most. Certainly, there is a long list of to-do:  to implement, to monitor, to put systems in place from the district, regional to the central level, to continue to build its capacities, etc.  But overall, the government’s current focus on prevention while providing treatment to people in need is laudable- and investment is paying off as reflected in the Global AIDS epidemic report. Providing space to civil society including people living with HIV to help in accessing services is another good and remarkable practice in Nepal.  However, if we want to seriously seize the opportunity now while the HIV prevalence (among adult population) is still relatively low and stay ahead of the epidemic, we need to engage other development sectors as well. This will sustain the government’s efforts.

As a leading agency working in Nepal, how UNAIDS has been supporting Nepal?
UNAIDS is s cosponsored program on HIV/AIDS composed of 11 entities:  10 Cosponsors and 1 Secretariat. In Nepal, there are 2 more UN agencies who are members of the UN Theme Group on HIV/AIDS.

UNAIDS support Nepal’s response on HIV/AIDS by providing technical assistance in various areas, like in scaling up interventions on prevention, treatment, care and support, strategic planning, knowledge sharing, strategic information and monitoring and evaluation. This support is aligned to Nepal’s National Strategy Plan on HIV/AIDS 2006-2011. Where there are clear gaps, we also support the country mobilize additional resources.

What other steps UN will take?
Now this year, the UN had embarked on the first-ever mapping of UN HIV-related work, which includes both program areas and funding resources/commitment. This gives us a clear understanding of the UN’s collective contribution and support to the country’s response on HIV/AIDS. This also provides us a strategic direction where to focus in the next years to come, in order to help the country close the gaps on its HIV/AIDS response.

As several steps have been made to end the discriminations against people living with HIV/ AIDS, how do you view general status of people living with HIV/AIDS?
I think this question would be best answered by Nepalis living with HIV themselves. But overall, educating people about rights and responsibilities, about reducing if not eliminating stigma and discrimination, about respecting personal preferences, is a continued process.

Based on my personal observation, the overall attitude of people towards PLWHAs is gradually becoming positive and supportive. I have seen for example in some villages in Doti and Accham, where men and women living with HIV are accepted and support by the community. Of course this might be an exception, but generally there had been good progress compared to 10 or 15 years ago.  

Thanks to initiative taken by the government and support given by UNAIDS and other donor countries, Nepal is able to control infection level, how vulnerable Nepal is?
As I mentioned earlier, Nepal is one of the countries in the world where new HIV infection is declining. But this hard-earned achievement should not make us complacent and relax. For these gains could be very fragile. Nepal still saw an estimated 4,800 new infections last year almost 500 of which were children 0-14 years old. Everyday, an estimated 13 Nepalis are getting infected with HIV. This is indeed alarming, particularly in a small country like Nepal. And factors that fuel the epidemic like poverty and gender inequity is real. So the country, given its current situation, remains to be very vulnerable.

With UNAIDS vision of zero infections, zero discrimination, and zero AIDS-related death-- there is much more that needs to be done.

How do you see the state of Sex Workers? How much vulnerable are they from infections?
If you look at the newly released Fact Sheets on HIV/AIDS by the National Center on AIDS and STD Control (NCASC) of MOHP, female sex workers account to only 1% of the total estimated HIV infections in 2009 (605 of the 59,984 total infections). So to me, while attention is on sex workers because of the very nature of their work, the more strategic focus is on the behavior and practices that puts people at risk of HIV. And in the context of HIV/AIDS, this includes multiple sexual partners, unprotected sex and sharing of unclean needles. Whether one is a sex worker or not, if she/he is indulge in behaviors and practices where there are direct exchange of body fluids- then he/she is at risk of spreading or acquiring HIV infection. Remember, it is not who you are but what you do that puts you at risk of HIV.

How do you see the current strategies in Nepal to fight AIDS?
The country is reaching the tail-end of its current strategy (2008-2011) and is now developing the new one for the next 5 years (2011-2016). Consultations are ongoing and we have yet to see it.  Nepal has rich experience in HIV prevention, treatment, care and support services- and I’m confident that the next strategy will draw upon past experiences, build its momentum, and be more forward-looking so that it will truly be responsive to changing needs of the HIV epidemic in the country.