Hydrology and Climate Change

Introduction:
Nepal is facing increasing numbers of HIV infected dominance among most at risk populations (MARPs) such as sex workers, injecting drug users (IDUs), and migrants. Effective prevention programs from government level are to be addressed such as awareness program, searching program, controlling program and reduction program among whole DVC levels. The prevention programs are to be implemented specialy among IDUs, sex workers and migrants. Poverty, political instability and gender inequality, combined with low levels of education and literacy make the task more challenging in Nepal. AIDS in Nepal was reported in 1988. But it spreads in such a way that by the middle of 2008, more than 1750 cases of AIDS and over 11,000 cases of HIV infection were officially reported. Nepal has limitation of budget allocation in health sector and the limitations of public health surveillance system, the actual number of infections is thought to be much higher. It is in increasing trend and the number of the HIV infected person till now may cross 80,000. The HIV/ AIDS epidemic in Nepal has changed from a "low level epidemic" to a concentrated epidemic. The majority of the infected represented adults (aged 15- 49 years) in which the dominance was calculated to be 0.29% (WHO/UNAIDS).

Methods:

The National Center for AIDS and STD control (NCASC), was established in 1995 under the Department of Health Services / Ministry of Health. This department of health is responsible for working against the epidemic of HIV/AIDS. As a result, the national AIDS program has been institutionalized within the government system. Recently, a high level commission under the chair of the Prime Minister has been formed to ensure political commitment and to ensure multisectoral participation. But, due to the unstable political situation, all leaders are ingage only in the benefit of their party and inter-party groups. They are batgaining each other only for their benefit. No public awareness programs are carried out till now. The epidemic of HIV / AIDS in Nepal is still in the form of a concentrated epidemic within specific sub-groups of sex workers and injecting drug users. If effective measures are not taken immediately, this epidemic will be a major public health problem in coming days. A strong commitment of the government and parliament members is necessary of the hour. HIV/AIDS is no longer a health issue, it is rather a development issue; therefore, a multi-sectoral response with strong coordination and cooperation from all sectors is required. We have to focus priorities and sustained intervention strategies with adequate program coverage and effective monitoring and evaluation. Nepal’s HIV epidemic is largely concentrated in MARPs, especially female sex workers (FSW), IDUs, transgender and migrants. Another important factor is the high number of sex workers who migrate or are trafficked to Mumbai, India to work, thereby increasing HIV in Nepal. Nepal’s epidemic will continue to grow if immediate and effective action is not taken in time.

Continued Spread among Injecting Drug Users:

Nepal was the first developing country to establish a reduction of drug users program with needle exchange for IDUs. However, due to limited coverage, the impact on HIV transmission was also limited. In Nepal the drug users inject drugs along with brown sugar is common. Poly drug use appears to be the norm. An estimated 6,557 IDUs are living with HIV or AIDS (about 10 percent of the total AIDS cases). The burden of HIV among IDUs is heavy in the Highway Districts and Kathmandu Valley. HIV dominance among IDUs in 2007 was 34.7 %, and it is 51 % in 2003. This decline in prevalence is, to some extent, supported by improving behavior.

Female Sex Workers:
There are about 20,000 female sex workers in Nepal with an estimated HIV prevalence of 1.6%. Due to their highly marginalized status, FSWs in Nepal have limited access to information about safe sex practices. Almost 60% of their clients are transport workers, members of the police or military, and migrant workers. Nationally, clients of FSWs have an estimated HIV prevalence of 2%. A major challenge to HIV control is the trafficking of Nepalese girls and women into commercial sex work in India. About 100,000 Nepalese women continue to work there. It is estimated that 50 percent of Nepalese sex workers in Mumbai brothels are HIV positive (FHI 2004).

Migration and Mobility:
It is estimated of internal and external migration for seasonal and long-term labor range from 1.5 to 2 million people. It is necessary for the economic survival of many households in both rural and urban areas. It is suggested that HIV prevalence is nearly 10 % in migrants returning from Mumbai.