The health sector response is inadequate to address the treatment and care issues of people living with HIV and AIDS across the country. In most of the remote districts access to HIV services is very limited

Many developing countries around the world are still facing huge burden of poverty, illiteracy, forced migration, unemployment and poor health systems. While population growth in these counties is still on the rise, it has profound impacts on social, demographic, economic and public health.

In recent years, HIV/AIDS is largely considered as a development issue and a multi-sector approach is required to address the epidemic. This year’s World AIDS Day has been campaigning hands up for HIV prevention to raise public awareness about HIV and its creeping impacts on individuals and families. Moreover, this opportunity calls for urgent actions to strengthen prevention efforts by breaking the silence on HIV globally.

It is interesting to note that the first HIV case in Nepal was detected in 1989. After this, the number of HIV cases started to increase gradually. In this context, National Centre for AIDS and STD Control (NCASC) of Ministry of Health has the key responsibility of planning and managing national HIV/AIDS programmes in the country. In this process, many partners such as UN agencies, USAID, DFID and others have been providing technical assistance to NCASC to further enhance its institutional capacity for effective implementation of HIV/AIDS programmes across the country.

The first national HIV/AIDS and STD control policy was formulated in 1995 which outlined the need for multi-sector approach to tackle the problem of HIV/AIDS. Reducing stigma and discrimination was one of the key strategic approaches of this policy which highlighted the need for special focus on high risk behaviour populations such as labour migrants, female sex workers and clients and drug users.

Considering the changing context and dynamics of HIV epidemic, National Policy on HIV and STD, 2011 was formulated to widen the scope of national response with specific guiding principles. Over the years, attempts have been made to prioritise HIV/AIDS in national development issues and mainstream HIV across national, regional and district level planning processes. However, there is slow progress in effective implementation of the policy and strategic framework.

One of the key objectives of this new policy is to protect and promote human rights of the affected and high-risk populations by reducing stigma and discrimination. In order to achieve the objectives of the new policy, strategic plans for HIV/AIDS have been a major landmark in prioritising the cost effective interventions targeting key affected populations. However, due to limited capacity and resources, the outcome of these initiatives is still minimal.

Clearly, there is still a lack of an enabling environment for meaningful engagement of key affected populations, civil society and development partners in national response. More efforts are needed to ensure multi-sector coordination, partnership and networking among key stakeholders in participatory planning, implementation, monitoring and evaluation of national HIV and AIDS programme. In addition, there is criticism for the lack of coordination and transparency in resource mobilisation of externally funded HIV prevention projects. The health sector response is inadequate to address the treatment and care issues of people living with HIV/AIDS across the country. In most of the remote districts, access to HIV services is very limited.  NCASC and other partners need to expand the HIV prevention interventions and services in the remote areas. Capacity enhancement of health workers in implementation of national guidelines for HIV services should be the first and foremost priority in a health sector response.

The role of NCASC is very important in terms of planning and managing HIV/AIDS programme at national, regional and district levels. Mobilising female community health volunteers and health workers of local health facilities have been effective to raise community awareness about the prevention, treatment and care services. However, the health system strengthening is still an unfinished agenda in terms of providing quality HIV services such as counselling, testing, and referrals for treatment. Access to Anti-retroviral Therapy (ART) is still limited in remote district health facilities. Decentralisation of HIV/AIDS programmes is indeed an exciting opportunity in order to expand coverage of HIV services across the country. At national level, the National AIDS Council (NAC) and National AIDS Coordination Committee (NACC) have been formed. Unfortunately, these are not actively functional as very few meetings of NAC and NACC are  held to discuss issues around multi-sector response, resource mobilisation and strategic approach to tackle the burden of an HIV epidemic.

The civil society organisations, including networks of people living with HIV/AIDS, need to strengthen their efforts to protect and promote their rights to health and education. Furthermore, an enabling environment is urgently needed to ensure meaningful engagement of the key affected populations in a national response. Scaling up of HIV services is definitely a new challenge for wider coverage. Innovative and cost-effective interventions for behaviour change will significantly contribute to reduce the incidence of HIV among vulnerable populations across the country.

Bhandari is a PhD candidate in public health at Chulalongkorn University, Thailand