Stronger HIV/AIDS awareness urgently needed

Talking to locals in the back streets of Kathmandu's bustling Thamel district, a touristic honeycomb packed with hippies and would-be mountaineers, opinions can vary greatly on the causes and effects of HIV/AIDS. "AIDS affects all segments of society," Khem Bahadur Budhathoki said with an air of confidence from his stall of pirated CDs in the street. "It's transferred by blood or sexual contact," the 22-year-old explained, wrapping up yet another quick sale. But his friend Krishma Thakuri, the same age, had a less than enlightened understanding - and a particularly dangerous one at that. "People get AIDS from drugs. I'm not at risk," he asserted. Such a divergence of awareness is not unusual in Nepal's largest city, home to over 2.5 million, but it underscores what health experts have been warning all along: awareness levels remain low in the Himalayan kingdom. "Although there is a high level of knowledge about HIV/AIDS and how it is transmitted, that knowledge is not always translated into real protective behaviour," Aurorita Mendoza, UN AIDS coordinator for the country, told IRIN in the Nepalese capital. That could prove dangerous in the mountain nation, where an estimated 70,000 people between the ages of 15 and 49 currently live with the virus - with most people not even knowing if they are infected. Nepal's HIV/AIDS epidemic is considered to be "concentrated" in nature, meaning a prevalence rate of less than 1 percent, concentrated among specific vulnerable groups such as injecting drug users, commercial sex workers (CSW) and their clients, as well as men who have sex with men (MSM). "But now we are seeing that it might be spreading to a larger group which is labour migrants," Mendoza warned – a fact which could have serious implications on the spread of the disease. According to UNAIDS, migrants and their families constitute a highly vulnerable population, and yet little is known about their HIV prevalence. Information is urgently needed about this community, including what resources are available to them for testing, care and support. "There are new groups where high-risk behaviour is being seen," Mendoza said, referring to the country's burgeoning labour migrant population, as well as women or girls who have been trafficked, and street children. "We don't know exactly how big the problem is," she said, noting that tracking the disease's spread has proven difficult, with surveillance methods not very well developed. According to the 2005 United Nations General Assembly (UNGASS) national report for Nepal, the country's vulnerability to HIV and AIDS is further exacerbated by its geographic and ethnic diversity; its landlocked position between India and China; its poverty, inequality and underdevelopment; as well as the ongoing Maoist insurgency to overthrow the state, which has already taken the lives of 13,000 people over the last decade. Additionally, there are varying levels of knowledge about HIV transmission among most-at-risk groups and young people, as well as insufficient risk reduction behaviour being seen among most-at-risk groups and young people, the report said. Such factors, as well as the limited coverage and utilisation of HIV-related health services, make projecting the disease's course and impact particularly difficult. "Indications are that the epidemic will increase without effective interventions," the report warned, adding that the country’s Millennium Development Goal of halting and beginning to reverse the spread of HIV/AIDS by 2015 would not be achieved. Indeed, it is precisely that fact that makes the need for expanding awareness so vital. Although there is a high level of awareness among certain groups, particularly among young educated people and those living in urban areas - many of the country’s 27 million inhabitants still lack the information they need. "We need more awareness – especially amongst the migrant labour population," Mendoza stressed. "They come from the rural areas and we know that these areas still have very low levels of awareness." To address that, a two-pronged approach was needed, she said, including maintaining prevention and information dissemination among the concentrated epidemics – giving them full prevention, treatment, care and support services, but also expanding public education to the general population – especially in rural areas. Meanwhile, the impact of the conflict and insecurity in rural areas of Nepal makes it increasingly difficult to discern how the HIV situation in the country will develop – making the issue of awareness all the more important. A decade of conflict between Maoist insurgents and security forces in the country's remote hill districts has killed an estimated 12,000 people. "This could really be the 'tipping' factor in the course of the epidemic," the UN official warned, describing conflict as a driving factor behind migration and mobility – both of which could influence the disease's spread to the general population. "We cannot say we are not a risk or are not threatened by this epidemic," Mendoza repeated. But back in Thamel, there are many who might think otherwise. "I don't know too much about HIV/AIDS because I don't use drugs," Shamu Shahi, another street vender remarked casually. "People get it [HIV/AIDS] by using drugs and visiting the 'wrong' women," referring to the city's now thriving CSW scene. "I have no interest in these women – there are enough tourist ladies around for that," the 30-year-old laughed.