HIV/AIDS in Nepal - Prevalence

Prevalence

As of December 2007, the Government of Nepal reported 1,610 cases of AIDS and 10,546 HIV infections, which has grown to 13,000 infections by World AIDS Day 2008. UNAIDS estimates from 2007 indicate that approximately 75,000 people in Nepal are HIV-positive, including all age groups. The Government of Nepal's National Center for AIDS & STD Control (NCASC) estimated that number to be closer to 70,000 in December 2007.

The epidemic in Nepal is driven by IDUs, migrants, sex workers and their clients, and MSM. Results from the 2007 Integrated Bio-Behavioral Surveillance Study (IBBS) among IDUs in Kathmandu, Pokhara, and East and West Terai indicate that the highest prevalence rates have been found among urban IDUs, 6.8 percent to 34.7 percent of whom are HIV-positive, depending on location. However, in terms of absolute numbers, Nepal's 1.5 million to 2 million labor migrants account for the majority of Nepal’s HIV-positive population. In one subgroup, 2.8 percent of migrants returning from Mumbai, India, were infected with HIV, according to the 2006 IBBS among migrants. As of 2007, HIV prevalence among FSWs and their clients was less than 2 percent and 1 percent, respectively, and 3.3 percent among urban-based MSM. HIV and AIDS case reporting by the NCASC reports HIV infections to be more common among men than women, as well as in urban areas and the far western region of the country, where migrant labor is more common. According to Nepal's 2007 United Nations General Assembly Special Session (UNGASS) report, labor migrants make up 41 percent of the total known HIV infections in the country, followed by clients of sex workers (15.5 percent) and IDUs (10.2 percent).

Migrants have become so vulnerable to infection due to uncertainty about their immigration status. While India and Nepal have an open borders policy, whereby Nepalese citizens have the same rights as Indians to live and work in India and vice versa. However, there is low awareness of this agreement and as a result many migrants avoid any contact with the state, including health services. There are also many cases of human trafficking for the sex trade. Not only are all sex-workers at risk, but Nepalese sex workers are often isolated from peers due to language barriers. Those peer network are important for providing information about prevention.

While the most recent data demonstrate a stabilizing of the epidemic and a downward trend in seroprevalence among several of the key high-risk groups, a number of issues pose continued challenges for Nepal. Many sex workers are also IDUs, migrants, or both, increasing the spread of HIV among at-risk groups. A large portion of men who purchase sex are also married, making them potential conduits for HIV to bridge to the general population. Poverty, low levels of education, illiteracy, gender inequalities, marginalization of at-risk groups, and stigma and discrimination compound the epidemic's effects. Unsafe sex and drug injection practices, civil conflict, internal and external mobility, and limited adequate health care delivery multiply the difficulties of addressing HIV/AIDS. Moreover, existing care and support services are already overwhelmed as increasing numbers of HIV-infected individuals become sick with AIDS.

Street children are also one of the most vulnerable groups. The UNICEF report, "Increasing Vulnerability of Children in Nepal", estimates the number of children orphaned by HIV/AIDS to be more than 13,000. The national estimate of children 0 to 14 years of age infected by HIV is 2,500 (2007).

Nepal has a high tuberculosis (TB) burden, with 81 new cases per 100,000 people in 2005, according to the World Health Organization. HIV infects 3.1 percent of adult TB patients, and HIV-TB co-infections complicate treatment and care for both diseases.