Prevention against HIV/AIDS in Nepal

ABSTRACT

This dissertation demonstrates some of the key challenges and issues of HIV/AIDS and prevention provided by government in Nepal. HIV/AIDS treatment services provided in Nepal is allied with various challenges and issues, which are created mainly on managerial or cultural issues from law basis to policy level. Although the Nepal is less pervasiveness to such problem, but in near future the possibility of HIV epidemic may increase. Over the nation’s poor political or legal system, social stigma, lack of education, poverty, discrimination and lack of services are delivered for those elevated groups to make assessment on time and admittance the services that impact their lives and health.
The main aim of this study is to reduce the infection of new HIV in general population by lessening the probable challenges. In this research the investigator has applied Quantitative methodology.
The data’s were gathered through questionnaire. After collecting these data they were analyzed in a systematic way. Findings coupled with the objectives of research endeavored to propagate to the Governmental bodies, related organizations and targeted population. The following investigation will try to demonstrate the main concerning regions for HIV anticipation and will converse Government efforts on prevention strategy on HIV/AIDS. Moreover, the paper will discover the current challenges plus issues for their treatment or prevention that create impact on the heath of Nepal’s entire population.

1 – INTRODUCTION

1.1 Background of the study

For about two decades, the AIDS (Acquired Immune Deficiency Syndrome) along with HIV (Human Immunodeficiency Virus) is increasing rapidly as a challenging issue at global level. According to the World Health Organization 2006, HIV/AIDS is documented as a worldwide emergency demanding the concentration on the global health agenda and one of the main essential public health problems. The infection of HIV/AIDS has arrived at an endemic from within a short duration of time. Around 34 million of population is anticipated to be surviving with HIV across the world. Moreover, 2 million individuals lost their life due to virus of AIDS and 2.7 million inhabitants are infected also (ADVERT 2011). On the globe each day 6800 people and more become infected through HIV and 5700 and more individuals die (UNAIDS 2008) due to the reason of not having proper access to HIV treatment, care as well as prevention services. HIV is incorporated by the United Nations in its sixth millennium improvement goals that described in reversing together with combating the spread of HIV/AIDS by the year 2015. This plan has attained universal access in 2010 successfully (Basic Information about HIV and AIDS, 2012).

AIDS is a disease, which is caused by HIV virus. The immune system is alters by this illness, making people more venerable to diseases and infections. This vulnerability deteriorates as the syndrome progresses. The virus of HIV found in infected person body fluids, such as blood and breast milk, semen plus vaginal fluids. It passes from one person to another by blood-to-blood as well as sexual contact. Besides this, the virus could be passed to babies of infected women, at the time of pregnancy, during childbirth and breast feeding. The infection could not reproduce outside the body of human and it is also not spread through:

• Insects as well as mosquitoes;
• Water or air;
• Casual contacts, such as sharing dishes or shaking hands;
• Tears, sweat or saliva.

There are two main types of HIV (HIV-1 and HIV-2) which are known to spread around the world. Both damages the body of the person by way of obliterating particular blood cells, called CD4 + T cells that are essential to supporting body, in order to fight with diseases (The HIV Life Cycle, 2008). The last stage of HIV infection is AIDS, when an immune system of individual’s body is ruthlessly damaged and has complicatedness in fighting certain cancers and diseases (HIV/AIDS and Human Rights, 2013). Presently, individual be able to live much longer, even for decades with HIV before they start developing into AIDS. It is due to advance active medications combinations, which were commenced in the mid of 1990s. However, despite of many advances in treating and diagnosing the infection of HIV, 35,962 AIDS cases were detected in the year 2007. Moreover, in United States among people living with HIV, 14,110 were reported deaths. Hence, it can be said that, the disease is increasing rapidly throughout the globe (Communicable Diseases HEAT Module, n.d).

In the year 1988, Nepal has accounted its first case of AIDS. since then, the infection has rapidly grown and reached to 27 million people of. In addition,, more than 950 cases of AIDS and around 5800 cases of HIV infection were formally reported by the end of 2005. These reported cases have identified that men are infected three times more than women. Though, given the restrictions of public health inspection system of Nepal, the exact infections number is assumed to be much higher (Seddon, 1995).

It is measured to have a determined endemic in populations with more risk behaviors by IDUs having the maximum rates of HIV infection. It is also derived by scientists that a chimpanzee type in West Africa is the source of humans HIV infection. They consider that the simian immunodeficiency virus, which is called as chimpanzee version of the immunodeficiency illness, mostly was spread to humans. Moreover, they transformed into HIV disease when these chimpanzees hunted by human beings for meat and came into contact by their fouled blood. Over decades, this infection slowly extends across whole Africa and after this also came to the several parts of world, including Nepal (A cultural approach to HIV/AIDS UNAIDS prevention and care, 2001).

Under the Ministry of Health and Population in Nepal, the main agency of government, which is responsible for STD and HIV/AIDS, is the NACSC (National Center for AIDS and STD Control). The agency has created a National Strategy on HIV/AIDS that recognizes actions to react to the rising issue of HIV/AIDS. This strategy found effective to some extent in diagnosing the available infections and reducing the number of new infections in Nepal (Nepal Country Progress Report 2012, n.d).

In the collaborative workshop of UNAIDS, Nepal has recognized specific needs for reducing HIV/AIDS in a country by providing adequate nutrition to population, which are as follows:

• Workshop of National stakeholder together with UN theme group and technical group of UN plus several other probable organizations to create consent on whether nourishment is priority or not.
• To put involvements in the National Stratagem Plan.
• Development of navigation committee encompassed of nutrition and technical working members of HIV to discover precedence areas of work and organize a plan of action as well as to
• Search the possibilities of support from outsiders and insiders inculcating financial and technical (Nutrition activities in care, support and treatment of HIV/AIDS, n.d).

Various steps in relation to above facet of including nutrition into the programs and policies of HIV/AIDS have been introduced by Nepal in the following manner:

• The country has developed for 2006-2011, the national policy on HIV/AIDS epidemics, which lays emphasis on significance of sustenance for HIV/AIDS issues. The 2006-2008 National Action Plan declares nutrition assistance in two major areas: Under impact alleviation, it incorporates, supplements of nutrition program for inhabitants under ART, as 50 percent of all population are on ART. Moreover, the scheme provides nutrition support to schools as well as children who are infected with such virus including disadvantaged communities and affected families. Besides this, under home based care and communities, the program declares nutritional, social help and palliative care to PLHA through community support grouping (Country Health System Profile Nepal, 2007).
• A training manual on home based care and community has been developed that comprises sessions on HIV/AIDS and nutrition.
• In the year 2004, the nation was developed a policy for National Nutrition. One of the objectives of this program is to address transmission of HIV by way of breastfeeding and describes – decrease the danger of malnutrition and death by HIV transmission during breastfeeding of infant by way of following mentioned actions:

• Develop guidelines on Breastfeeding and HIV – The strategy states that health professionals or health service provider should create awareness in mothers regarding transmission of HIV through breastfeeding. Mainly female belonging to rural areas are less educated and unaware regarding HIV and its ways of transmission, so they should be provided adequate knowledge on such epidemic by state government.
• Enhance awareness – Generally people feel that HIV transfers through injection, sex and blood transfusion, but they are not aware with other transmission methods, such as breastfeeding. Thus, as per the National Nutrition policy, government of country and health care units should attempt to provide guidelines regarding HIV/AIDS transmission to common population and specifically to pregnant women in the society.
• Develop nutritional condition of positive infants – According to this statement, if doctors found HIV symptoms in infant then should give effective treatment and medicine to eliminate such epidemic at early stage.
• Improve percentage of positive mothers with admittance to counseling – As per this policy, health care units or government should ensure that more and more HIV infected mothers are getting proper counseling for their infection. Moreover, they should be provided with knowledge on taking precautions at the time of delivery and breastfeeding.
• Decrease percentage of infected infant through breastfeeding – The main aim of National Nutrition policy 2004 is to lessen the figure of HIV positive infants. Thus, government should put efforts in giving proper nutrition and counseling to women for securing their infant from getting infected by HIV (Nepal Country Progress Report 2012, n.d).

Though, some of the challenges to put into operations, the proceedings for including nutrition into HIV/AIDS are that adequate guidelines for HIV as well as nutrition have not been created, however support actions are continuing, in both kind and cash. The infected plus affected population from HIV faces financial limitations and this need of the population is not properly meet by National Action Plan. The requirements predictable to defeat those challenges for operationalizing the recognized actions comprise development of operational/technical guidelines (HIV/AIDS AND GENDER ISSUES, 2006).
Many opportunities are faces by Nepal for operationalizing determined actions to include nourishment into HIV/AIDS. Various voluntary and private organizations together with network of positive people’s adopt HIV/AIDS actions funded by donors. At present there are around 100 NGOs are working in the HIV/AIDS area. Nepal NGOs consortium, NANGAN is working to share and coordinate education, information, experiences, and draw some lessons learned from pervious experiences.

The tactics to operationlize the acknowledged actions involve technical working association formation along with members from several sectors (such as UN partners, NCASC – MOHP, INGOs, Child Health Division /Nutrition, Civil societies and NGOs) and enlargement of detailed action plan including training materials and technical guidelines. The Nepal’s Family Health International has done an analysis of nutrition specific needs along with its four main Kathmandu partners to incorporate nutrition as an essential part of HIV/AIDS. Some work has been accomplished in terms of development of resource for PLHIV on particular indicator management, basic food security and food hygiene (Bertozzi and et.al. n.d).
The societal and cultural impact of the infection and disease can result in a general collapse of energy and hope for fighting the virus. The taboo itself and the widely spread rule of silence are just a few of the disastrous cultural effects of the revelation of the disease by the infected person or his/her family. Stigmatization and rejection have been observed in many instances, especially in rural zones and among the poorest populations. In some countries, at least in the first phase of epidemic, numerous cases of hesitation or denial were recorded in respect to the recognition of scope of disease and the seriousness of challenge it posed for the country.

The pressing character of this situation clearly requires urgent action, but different approaches. This has to be done with the necessary respect for the populations’ societal cultural norms and basic human rights, especially if breaking the silence is imperative. Moreover, there may be significant misunderstanding on the issue of sexuality arising from semantics and language. This may lead external prevention and care agents to erroneously consider that women are frequently ignorant of their physiological functions. Hence, country’s government should involve in the treatment program of this virus and conduct some learning sessions for uneducated or rural women, in order to guide them about causes of this disease as well as its early syndrome. This is because if they aware about the infection at initial stage then could be able to cure it with the help of medicines (HIV/AIDS AND GENDER ISSUES, 2006).

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Two main reasons of why HIV/AIDS in Nepal is increasing are:

• Sex trafficking – At present girls are trafficked to several destinations including India are kidnapped by traffickers. These girls are selling by their own husband, parents, relatives and friends etc. The main reason of this is to come out with the poverty and it is now become the source of income for many poor families. Parents sell their beautiful daughters for earning little amount of money from agents. These agents pay $1,700 USD for Nepalese women. In Nepal sex work has become main source of earnings, which is subsequently increasing issues of HIV/AIDS in the country. This is also identified that poverty is the basic root that pressures uneducated women to involve in the sex work. Also the number of commercial male sex workers has increased in Nepal (Bertozzi and et.al. 2006).
• Migration – Nepal is the least developed country of South Asia. It has 85% of its population working on the agriculture. Unemployment, poverty, political disorder and reducing natural resources are the main reason for short as well as long term labor migration, which has turn into source of incomes. Many Nepalese people, travel to India to search for jobs every year. These people include men, women and children. These migrant workers includes large majority of uneducated individuals, whom are trapped so that if they don’t get paid work then they often get engaged in sex work to provide food and shelter for their families. This situation increases chances of escalating the HIV/AIDS problems in Nepal and other countries (Huba and et.al. 2001).

Treatment of AIDS/HIV – For AIDS no cure is available. Though, several treatments are presented that could provide help in keeping symptoms under control and develop the length as well as quality of life for those individuals who have already infected by such virus. Antiretroviral rehabilitation restrains the replication of HIV infection in the human body. Several antiretroviral drugs combination, called HAART (Highly active antiretroviral therapy), has been very effectual in lessening the number of HIV elements in bloodstream. It is considered by viral load, such as how greatly free virus is originated in the blood. The prevention of illness from replicating could progress T-cell counts and support the immune system from HIV disease (Dam and Hutchinson, 2002).

HIV could not be cured by HAART, however from past 12 years; it has been seen very successful. Human beings on HAART with censored HIV levels could still pass on the virus to others by sharing needles or sex. There is best evidence that if HIV levels remain suppressed and count of CD4 keeps high, i.e. more than 200 cells/mm3, then life could be significantly improved and prolonged. Though, virus of HIV may grow to be challenging to one permutation of HAART, particularly in those patients who every day do not take their medications on proper schedule. Generic tests are now presented to find out whether on HIV injure is opposing to a specific drug. The information might be utilize in deciding the combination of best drug for each individual, as well as adjusting the treatment of drug, when it begins to fail, and before the period of starting therapy (American Psychiatric Association, 2000).

At the time of HIV happens to defiant to HAART, the combinations of other drugs should be utilized to try to defiant the HIV resistance injure. Recently, many new drugs are available into the market for better treatment of HIV drug-resistant. This medication not only lessens the infection but also in some cases cure disease effectively. Moreover, through these drugs, spread of virus could be controlled. Treatment by HAART has various complications too. It is the collection of several types of different medications, each containing its own consequences (Ensuring early diagnosis and access to treatment for HIV/AIDS, n.d).

When these drugs are used by an individual for long duration then it can leads to increase in the heart attack risk, perhaps through extending glucose (sugar) and cholesterol level in the blood. Thus, doctors should take care while prescribing medication of HAART to any patient by testing its all side effects to the particular body. Moreover, HIV viral load and blood tests measuring CD4 counts must be taken in every three months. The goal of this regular diagnosis is to get the CD4 count as nearest to standard as possible, and also to repress the HIV amount in blood to a stage where it cannot be discovered (Huba and et.al. 2001).

Several other antiviral medications are being explored. Besides this, factors of growth that encourage escalation of cell, such as filgrastim (G-CSF or Neupogen) and erthythropoetin (Epogen, Recomon and Procrit) are for a times used to treat low white blood cell counts and anemia, which is associated by AIDS. For the prevention of opportunistic infections, such as Pneumocystis jiroveci pneumonia medications are also used, in those cases where CD4 count is short enough. This remains body of AIDS patients healthy for long duration of time. The treatment of Opportunistic virus is done at what time they happen (Kane and Triggle, 2011).
For the purpose of understanding the spread of HIV/AIDS it is essential to address the cultural and social issues that influence HIV spread in community. Socio cultural factors and its constituents like demographics, education, occupation and survival connect the phenomenon of multiplying cases of HIV. Such social norms stop both males and females from acquiring vital information regarding sex, sexuality and sexually transmitted diseases. For example, Nepalese are bordered by the tradition of maintaining silence on sexual issues (HIV/AIDS Strategy and Work plan, 2005). Cultural values like shyness restricts open discussions and education on reproduction as well as sexuality. This leaves adolescents to refer to their friends and peer groups for information. Sometimes adolescent friends are not having adequate knowledge regarding HIV/AIDS and thereby they may provide wrong information to affected person. People experience discomfort and awkwardness on listening and discussing such matters in front of family members. Gender inequality also prevails in most rural Nepalese families and they give preference to a boy child. Even the ways of nurturing boy and girl child is different wherein girls are not given adequate opportunity to get educated. Women have less accessibility to health care facilities. They are pressurized to give birth to a male child and if they fail then the chances of their husbands going to other women increase.

Nepal is a monogamous country. Here extramarital sex is stringently prohibited and considered against values and norms. However, these customs are not applicable to males and females equally (Acton, 2012). When Nepalese men indulge in pleasure it is considered as normal but if a woman does that then she is conferred the tag of a social outcast. HIV/AIDS has been concerned with promiscuity and linked to prostitution. Using drugs and prostitution are regarded as against traditional morals and customs. Thus, HIV/AIDS is termed as social taboo. Fear of discrimination and stigmatization stops people from getting themselves tested and treated thereby exposing them to HIV infection. The hostility and personal stigma in individuals having this infection prevents them from revealing their status. They do not seek out medical help or counsel and remain in the dark, transmitting this infection to other people. Migrating for the purpose of seeking employment opportunities is a very prominent feature of Nepal’s society (Huba and et.al. 2001). Men employed overseas especially in Indian or British army have been a potential source of STDs in Nepal. Not only migrants, truck drivers, smugglers functioning across national boundaries, officials coming for formal visits, traders and merchants travelling for business purposes and seasonal labourers etc. are also increasingly contributing to the spread of this virus in Nepal (American Psychiatric Association, 2000).
This dissertation explains the government’s efforts on programme management of AIDS/HIV and discovers various key challenges plus issues of such infection treatment as well as prevention program in Nepal. Its influence is necessarily higher, rather than just medical and comprises managerial plus cultural considerations that govern progress in medical involvements.