Nepal moves on free AIDS drugs

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 Michael 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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