Nepal to offer Free AIDS Drugs

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As Toll Rises, Nepal Doles Out Free AIDS Drugs

Keshab Poudel, OneWorld South Asia, 26 February 2004

KATHMANDU, Feb 26 (OneWorld) - With AIDS threatening to become the No:1 killer

in the 15-49 age group, Nepal has started an ambitious program to provide free

AIDS treatment to poor patients in the Himalayan kingdom.

AIDS treatment - which requires anti-retroviral (ARV) drugs and highly active

anti-retroviral therapy (HAART) - costs about US $600 per person a year, and in

a country where the per capita annual income is US $220, medical care without

government assistance is virtually impossible.

The freebie isn't a populist measure - it's a desperate one. In the absence of

effective intervention, including ARV treatment, the HIV-positive population has

crossed the 62,000 mark with nearly 3,000 AIDS deaths.

Nepal's National HIV/AIDS Strategy (2002-2006) estimates that between 100,000

and 200,000 young adults will soon become infected, with an annual toll of up to

15,000 AIDS cases and deaths.

Declares the director of the National Center for AIDS and Sexually Transmitted

Disease Control (NCASC), Dr R.P. Shrestha, " The government cannot subsidize such

a huge amount for long. We need donor support to extend the service and to

protect human rights of People Living With HIV/AIDS (PLWHA). "

According to the NCASC, 3,388 HIV-positive patients and 708 with full-blown

AIDS, have already registered with the center till the end of January, 2004. The

first case of HIV was reported in 1988 in Nepal.

Given the existing medical and public health infrastructure in Nepal and the

lack of continuity in the national HIV/AIDS surveillance system, the actual

number of cases could be many times higher.

As per UNAIDS/WHO estimates, there are around 62,000 people living with HIV/AIDS

in Nepal. Till last year, the country recorded 2,958 AIDS-related deaths.

" This is just a beginning and the government will expand services and facilities

throughout the country in a phased manner. Our aim is to increase the access of

ARVs to HIV patients as their fundamental right, " says Minister of Health Kamal

Thapa. " We will evaluate the present program within six months and expand the

service in the far-western region. "

This is the first time a large number of HIV-positive people are being given

ARVs free of cost. Pregnant HIV-positive women were the first to receive free

ARVs.

To prevent transmission of the virus from mother to child, the government has

been distributing this service to HIV-positive pregnant women through maternity

hospitals in Kathmandu since December. Five pregnant women with HIV are

currently taking ARVs.

Apart from the Kathmandu Valley, there are HIV/AIDS patients in the mid-western

and far-western region too who are yet to receive treatment. " This is a good

beginning and the donor community is firmly committed to provide necessary

support to the government to expand the service, " says the resident

representative of UNAIDS, Dr Hahn.

ARV treatment is the only available treatment to lengthen the life of PLWHA.

Anti-retroviral therapy, community-based care and support services are virtually

non-existent in Nepal and many PLWHA living in rural Nepal lack options for

treatment, counseling or care.

Maiti Nepal, a nongovermental organization working against girl trafficking, has

been providing ARVs to HIV-infected girls taking shelter at its center in

Kathmandu.

" We have been providing ARVs to 25 HIV-positive people since September, " says

the general secretary of Maiti Nepal, Bishworam Khadka. " We are happy that the

government has also initiated a free ARV program. "

Maiti is providing the service through individual contributions received from

individual foreigners and other agencies.

The WHO estimates that ten percent of HIV infected persons require ARV

treatment. According to government estimates there are 300 patients who require

the treatment, indicating there is a huge gap between demand and supply.

" It is the right of all HIV-positive people to have access to ARV, " says Sharan

Chettri, who carries the deadly virus. " Among others, the right to life,

freedom, health, work and shelter must be guaranteed to those who are infected

and affected. "

With few exceptions, a large number of PLWHA have no access to services and

doctors sometimes refuse to treat them. Recently, doctors at the B.P. Koirala

Medical Sciences Hospital in Dharan, 500 miles west of the capital Kathmandu,

refused to treat an HIV-positive patient.

Another patient in Nepalgunj Hospital was thrown out of the hospital following

the revelation that he was HIV-positive.

" The challenge before Nepal right now is to train the medical staff, extend

laboratory services, increase care and support system as well as provide

voluntary counseling and testing services, " says Dr Shrestha. " Although

prevalence of the disease is still low in the general population, it is

increasing in several groups. "

For instance, among the 30,000 injecting drug users in Nepal, nearly 40 percent

are HIV-positive. The figure for female sex workers is over 17 percent. There is

0.2 percent infection at Ante Natal Care (ANC).

It is estimated that as many as 70 percent of sex workers returning from India

are HIV-positive. There are over a million Nepali men working in India and some

of them bring back HIV/AIDS on their home visits.

Most of the returning workers are from the far-western and mid-western region.

" We will extend our program at least in two centers of these regions, " says Dr

Shrestha.

The studies have shown that the central region including the Kathmandu valley

has the highest prevalence of HIV/AIDS. HIV infection is concentrated in

urbanized areas and districts in the mid-west and far-west where there is high

labor migration.

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