There are significant challenges in effectively implementing the national HIV strategy in the federal context. These basically include political instability, inadequate trained human resources for health, limited capacity of local governments, poor monitoring and evaluation systems, and lack of preparedness
Forty years since the first cases of AIDS were identified, the epidemic is increasingly considered as one the significant challenges to sustainable human development. Despite remarkable progress, HIV/ AIDS remains an urgent global crisis. Unfortunately, the progress against HIV remains gloomy in many developing countries. The social, cultural, economic and legal inequalities have profound impacts on the lives of key and vulnerable populations in terms of their easy access to prevention, treatment and care services.
More importantly, the intersecting inequalities are preventing progress in ending the HIV epidemic worldwide. During the COVID-19 pandemic, progress against HIV response was halted, and resources were shrunk to a large extent.
As a result, many more vulnerable populations were at risk of being HIV infected.
Therefore, ensuring access to HIV prevention, treatment and care services for all key and vulnerable populations should be a high priority in national HIV policy and strategic interventions.
Again, existing social, cultural, economic and legal barriers need to be tackled in a comprehensive approach to ensure that vulnerable populations have easy access to life-saving HIV services. The strategic interventions have not adequately addressed the social and structural determinants that increase HIV vulnerability among key populations.
Therefore, the Global AIDS Strategy (2021-2026) has explicitly articulated the needs for a people-centred approach in HIV response in order to empower key populations with the resources they need to exercise their rights, protect themselves and thrive in the face of HIV.
In many developing countries, community-led response is a new priority to end AIDS as a public threat by 2030. Over the years, communities have led innovative efforts to identify and address the inequalities that hinder their access to prevention, treatment and care services in the communities. Their meaningful engagement in capacity building, advocacy, participatory research and networking is crucial to promote and protect their rights to health and sustained livelihoods.
In Nepal, there has been significant progress in reducing HIV prevalence to 0.13per cent in 2021. Moreover, the national HIV Stra-tegic Plan (2021-2026) has focused on priority actions to identify and reach vulnerable populations and ensure a combination of differentiated services in the communities. It has also urged the critical needs of investments to scale up innovative interventions, which are primarily targeted at vulnerable populations in the communities.However, there are significant challenges for effective implementation of the strategy in the federal context. These basically include political instability, inadequate trained human resources for health, limited capacity of local governments, poor monitoring and evaluation systems, and lack of preparedness and response plans during natural disasters or a pandemic like COVID-19.
Where HIV service cover-age is still low, more focused community-led prevention interventions are crucial to reduce the risk and vulnerability to HIV infections among adolescents and youth in particular.
In the federal context, capacity building of provincial and local governments is necessary in strengthening integrated HIV services in the health system at all levels. Moreemphasis is needed to ensure quality of HIV services through community-led monitoring and evaluations.
On the other hand, gender-based violence is another global challenge, regardless of the age, race or socio-economic status of girls and women. This kind of violence is rooted in systemic gender inequality and can be physical, sexual, economic or psychological.
The evidence suggeststhat gender inequality, underpinned by harmful gender norms, restricts women's access to HIV and sexual and reproductive health services. Achieving gender equality and ending AIDS are among the objectives of the Sustainable Development Goals (SDGs) that need urgent attention for multi-sector response.
More importantly, national policies and strategic measures should harness the opportunities for promoting gender equality as well as investing in women's economic empowerment.
Apart from the epidemiological and prevention science, the increasing role of social and behavioural science is gaining momentum not only in contextualising prevention and care research, but also in assessing trends in social and behavioural research on HIV.
The anthropological perspectives on HIV response will help better understand the risk behaviours of key populations, their willingness or motivation to access HIV care, sex culture, technology and society at large.
The risk of HIV transmission among key populations and their sexual partners is the major contributor to new HIV infections globally. HIV prevention efforts have also yet to fully engage the broader health sector as well as non-health sectors to address underlying inequalities and structural factors that contribute to HIV vulnerability.
In order to reduce the existing barriers that undermine access to equitable HIV services, more concerted efforts are needed to address human rights issues in the context of HIV, promote gender equality, and eliminate stigma and discrimination against people living with HIV. On the other hand, reducing inequalities also requires improved data disaggregation by age, gender, disability status, socioeconomic status and many more.
More importantly, there needs strong political will and commitment to reducing a wide range of inequalities in HIV response. Advancing a bold multi-sector response from governments, civil society, development partners, UN agencies, media, private sector, key and vulnerable populations will make a difference in confronting the inequalities to yield positive impacts on the lives of people living with HIV and their communities.
Therefore, there are urgent needs of identifying priorities to enhance relevant laws and policies to reduce HIV-related inequalities.
A version of this article appears in the print on December 2, 2022, of The Himalayan Times.
