On the brink - is Nepal facing an AIDS crisis?

Nepal is one of the poorest nations in the world. It has poor health and development indicators and would be devastated by an extensive AIDS epidemic. But what is known about HIV rates and sexual behaviour in Nepal? Researchers from the UK Nuffield Institute for Health conducted a systematic review of current knowledge.

The first case of HIV infection in Nepal was identified in 1988. Current HIV/AIDS control focuses on risk reduction within high-risk groups: injecting drug users (IDUs) and female commercial sex workers (CSWs).

Looking at current disease rates, the research found that:

• HIV rates are low in the general population (0.29 percent in 15-49 year olds) but are rising rapidly in association with high-risk behaviours.
• HIV prevalence is currently 40 percent among IDUs and approaching 20 percent among Kathmandu's female CSWs.
• Rates of sexually transmitted infections also appear to be low, with less than two percent of pregnant women testing positive for syphilis.
• The extent of high-risk behaviour amongst Kathmandu's IDUs is reflected by the reported hepatitis C prevalence of 94 percent compared with 0.6 percent in the general population.
• Available data on HIV prevalence may be unreliable, so estimates should be treated with caution.

One study estimates that infection rates will double between 1999 and 2005, which would make AIDS the leading cause of death in Nepal by 2010. However, the extent of the AIDS epidemic in Nepal will depend upon the largely unknown issues of:

• the sexual partner exchange rates of female CSWs and the men who regularly visit them
• the proportion of the general population who have multiple and concurrent sexual partners.

There are extensive migration patterns both within the country and internationally which provide the potential for considerable sexual networking. An estimated four to six percent of Nepalese men migrate annually. However, studies of sexual behaviour have focused on CSWs and the extent of sexual networks within the general population is largely unknown.

Female CSWs are often mobile and not brothel-based and, in rural areas especially, may be hard to identify. The number of Nepalese CSWs in India, and the high HIV prevalence in Mumbai in particular, could mean that there are as many Nepalese women living with HIV/AIDS in India as in Nepal. Should these women be deported or choose to return home in large numbers, Nepal's HIV prevalence might rise steeply.

The researchers conclude that there is a need for good quality research on sexual networking and HIV prevalence in Nepal. They also call for formal co-ordination and dissemination of information relating to HIV epidemiology in Nepal. There is no central point of reference for such material. Given the number of agencies involved, better co-ordination in the collection of HIV-related epidemiological data will help HIV intervention programmes to avert the possible crisis.

Source(s):
'A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal', Tropical Medicine and International Health 7 (2): 140-148, by A. Furber, J. Newell and M. Lubben, 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Department for International Development (in part)

id21 Research Highlight: 14 May 2002

Further Information:
James Newell
Nuffield Institute for Health
71-75 Clarendon Road
Leeds
LS2 9PL
UK

Tel: +44 (0)113 343 6950
Fax: +44 (0)113 343 6997
Contact the contributor: j.n.newell@leeds.ac.uk

Nuffield Institute for Health, University of Leeds, UK

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