HISTORY OF HIV AIDS IN NEPAL AS WELL AS ITS SITUATION

In 1988, HMG/Nepal launched the first National AIDS Prevention and Control Programme. This programme, known as the Short-Term Plan for AIDS Prevention and Control, formed the basis for the First Medium Term Plan 1990-92. This programme was externally reviewed in December 1992 and on the basis of the recommendations made during the review, the Second Medium Term Plan for AIDS Prevention and Control in Nepal was formulated covering the years 1993-97.

In 1993, HMG/Nepal accepted the need for multi-sectoral involvement for AIDS and STD control and different focal points were appointed in various sectoral ministries.HMG/Nepal adopted a national policy for AIDS prevention, with 12 key policy statements, in 1995. However, due to frequent political changes neither the National AIDS Coordination Committee, nor the multisectoral coordination and cooperation was fully functional.

Based on the National Policy, a "Strategic Plan for HIV and AIDS in Nepal", covering 1997 to 2001 was developed and adopted. It tried to operationalize the national policy and to define key activities for each policy objective. Although the strategic plan contained a number of activities aimed at prevention of a fast spread of the epidemic, only few of them were actually implemented. The strategic plan sought to broaden the response to other sectors beyond the health ministry and to integrate HIV/AIDS concerns within these sectors. Factors relating to mobility of populations, urbanization, heavy labour migration to areas where huge infrastructure programmes are being undertaken, the open border between Nepal and India and poverty have been recognized as casual factors for the spread of the infection in the country.

Recently Nepal established a "National AIDS Council" chaired by the Prime Minister. The Council with representation from government, non-governmental organisations, private sector and civil society will take the lead in policy making and will advocate for multi-sectoral participation in the fight against HIV/AIDS in Nepal.

HOW CAN HIV BE PREVENTED?

There is no vaccine or medicine to protect people against getting infected with HIV and there is no cure available. The only certain way to avoid HIV/AIDS is to prevent getting infected with HIV.
• Sex without penetration (involving stimulation and pleasure through caressing, hugging, kissing, and massaging different parts of the body) can decrease the risk of getting infected with HIV.
• Having a sexually transmitted infection (STI) can increase a person's chance of getting HIV through sexual contact. So, it is necessary to treat STIs as soon as an infection is suspected
• By always using a good quality latex condom correctly during sex that involves penetration, people can protect themselves from HIV. Whenever necessary only water-based lubricants should be used. People allergic to latex can use polyurethane condoms.
• If one or both of the couple know that they are HIV positive, they should seek advice and counseling before they plan a pregnancy to discuss the risks of their baby becoming infected with HIV, and get advice on breast feeding.
• Blood that has been donated should be tested for HIV infection and only non-infected blood used for transfusion.
• Sterile, never-used needles and syringes should always be used, and used only once.
• The safest of all is either abstain from having sex or to be in a stable relationship where both partners are free of HIV and neither has other sex partners or uses IV drugs

HOW IS HIV TRANSMITTED?

HIV is found in body fluids such as blood, semen, vaginal fluids and breastmilk. It is passed from one person to another only in very specific ways. These are:

• Infected Blood: If blood from a person infected by HIV gets into the blood stream of another person, it will also infect the other person. Infection may occur during blood transfusions after an accident, duringa surgery, after childbirth, or other medical treatments
• Mother To Child: If an HIV positive woman becomes pregnant, the HIV virus can pass from her blood (through the placenta) into the growing baby during pregnancy or during birth. Breast milk can also transmit HIV.
• Unprotected Sex: A person can get infected with HIV through unprotected sexual intercourse (means both vaginal and anal) with an infected person. The virus can be present either in an infected person's blood, semen or vaginal secretions and enters the body of the sexual partner through the thin skin of their sex organs, mouth or anus, or through sores or cuts on their mouth, hands or body.
• Sharing Of Needles: If a person uses the needle or syringe used by an HIV infected person, for injecting drugs or medicines, for drawing blood or for piercing, he/she can get infected. Contaminated instruments used for piercing the skin such as tattooing and acupuncture also carry a risk of infection.
• Unsterile Equipment: Surgical instruments like syringes and scalpels used on an HIV infected person can transmit the infection if used again without proper sterilization.

It is not possible to become infected with HIV through:

• sharing crockery and cutlery
• insect / animal bites
• touching, hugging or shaking hands
• eating food prepared by someone with HIV
• toilet seats

HOW CAN HIV BE TESTED?

An HIV antibody blood test can determine whether a person is HIV positive. The most commonly used test is Elisa. These tests should be conducted in a recognized institution or by a qualified health professional. Remember:

• The test should be completely confidential.
• Counseling beforehand is important to help weigh the advantages and disadvantages of the test.
• Post test counseling is important to help cope if results show HIV positive.