"AIDS could be Prevented"

Dr. María Elena Filio-Borromeo

The UNAIDS  Country Coordinator for Nepal and Buthan, Dr. MARIA ELENA FILIO-BORROMEO spoke to ALVARO CASTRILLO on the situation of HIV/AIDS in Nepal and its implications. Excerpts:

What is the statement of AIDS in Nepal?

Nepal is currently experiencing a dual type of epidemic. In one hand, it stands “low” at 0.49% among adult population, and on the other hand it is characterized as “concentrated” among certain subset of the population. As of 2007, the estimated number of Nepalis living with HIV was about 70,000. However, the reported cases at the Ministry of Health and Population, National Center for AIDS and STD Control is over 14,000 as of end of December 2009.

Nepal’s epidemic is mainly driven by unprotected sex and sharing of unclean needles and syringes.

The Joint United Nations Program on HIV and AIDS or shortly called UNAIDS, is here in Nepal to support accelerate an effective multisectoral response on AIDS before it could be overtaken by the toll of this devastating epidemic.

What are the main strategies to  fight AIDS in Nepal?

Nepal has a National Strategy on HIV/AIDS 2006-2011 that provides the priority strategies and direction to mount a multisectoral response on HIV and AIDS. From this strategy, national action plans have been developed. The UN and other external development partners collectively provide technical and financial resources to assist the country in carrying out the strategies.    

The current National Action Plan 2008-2011 is one that is costed. It is clear how much the country needs to provide a comprehensive prevention, treatment, care and support services. Certainly, as Nepal is experiencing a concentrated epidemic, the major strategy is on targeted intervention for those identified to be practicing high-risk behaviours like sex workers, injecting drug users, men having sex with men, and the clients and sexual partners of these groups. A subset of migrant workers particularly those who avail of the services of sex workers, are also now emerging. Likewise, a core strategy is to provide continued, effective treatment, care and support services to those already infected with HIV.

What is the place of condoms in these programs?

Correct and consistent use of condom is key in preventing HIV and other sexually transmitted infections. Hence this is being continuously promoted particularly among those perceived to be practicing high-risk behaviours.

And is it accepted by people?

In Nepal it is accepted.  Condom is part of the commodities being promoted by the Family Planning program for so long now, so Nepalis have been sensitized to it already. Its dual protection- as an infection-prevention device, and as a pregnancy-prevention commodity is widely promoted.

Do you think SW in Nepal are more vulnerables to STDs due to migration from Nepal to India?

Migration for better economic opportunities, is a reality in Nepal particularly in the Far and Mid West. The situation makes young Nepalis working in adjoining border areas vulnerable to HIV infection. This is further compounded by the fact that most of them lacks education and are in dire poverty.

One of the places that continue to attract young Nepali men, is Mumbai India. And as it is a metropolitan place, Nepalis could easily got attracted to its lights and glitters. However I would like to emphasize that in the context of HIV, it is the behaviour that puts people at risk, not the places where they work or go to.

But certainly because they are away from home, works in places like Mumbai which has high rates of STIs including HIV, has some excess money to buy sex, then they become vulnerable.

.Those who have been exposed and have been infected when they return to their homes have high chances of infecting his spouse or wife.

What is the relationship betwen AIDS and poverty?

It is a double edged-blade. Because of poverty you are pushed into vulnerable situations including selling sex, but also, and this is the other blade,  when you are poor and you are infected with HIV and progressed into AIDS, it will push you more to poverty  because you need to buy expensive medicine to prolong your life and pay laboratory services to monitor your HIV status. All the theses call for huge amount of money. Plus of course, when one is already on the terminal stage, he or she can’t work anymore. And somebody in the family might also stop working to provide the day-to-day care and support.

What is your plans for the next 5 years for fighting AIDS in Nepal?

Well, we hope the target set by Nepal towards universal access to prevention, treatment, care and support could be achieved- that is what we are all working for. This will be midway in achieving MDG 6 target 7 for Nepal. We must understand that AIDS is a preventable disease. Unlike in the past, now it could be treated. Although until now there is still no vaccine or a total cure, but with the advent of effective antiretroviral drug, it could be treated already prolonging and improving the quality of lives of men, women and children infected with HIV.  So to me, it is increasingly becoming unacceptable to see a baby born with HIV. We all should aim towards having a zero- child being born off HIV in the future for Nepal. Then we will have a healthy Nepali comunity and a healthy society free from HIV.

That is possible?

Yes, it is possible. It is being done in others countries and it can be done here. But a lot of commitment and leadership actions have to be done, at the national, regional and community level. This is where we are supporting Nepal speed up its action, while there is still a golden window of opportunity to act- so  we will not be overtaken by the epidemic.

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