In the social history of HIV and AIDS, it is a persistent challenge for human health and sustainable development. UNAIDS estimates that nine million people living with HIV were not on treatment at the end of 2024. About 11 million people living with HIV still have unsuppressed viral loads. At the end of 2024, there were 1.3 million new infections globally. More worryingly, there were 570 new HIV infections among adolescent girls and young women globally per day in 2024.
This evidence clearly reveals that HIV epidemic is not over and the progress we have made so far is not adequate. In the context of declining international funding for HIV response in 2025, the progress is rather at risk. Such immediate disruptions in funding have adverse impacts on continuity and sustainability of community-led HIV responses in low-and middle- income countries. In many countries, HIV response is largely relying on international funding and there is always limited domestic financing for HIV and health services.
In Nepal, HIV is considered as a concentrated epidemic. The risk is high among key populations who are mostly living in urban areas. Evidence suggests that people who use drugs, sex workers, male who have sex with male, transgenders and migrants are more vulnerable to HIV infections.
The National Centre for AIDS and STD Control (NCASC) estimates that there were 34 thousands and 337 people infected with HIV by the end of 2024. Of these, only 77 per cent are accessing treatment. The 569 people with HIV died in the same year. The deaths are declined by 86 % compared to the data in 2010. Health system response is vital for HIV treatment. Across 64 districts, there are 96 Antiretroviral Treatment Centers (ART) providing treatment services free of charge.
Nepal's HIV Strategic Plan (2021-2026) has particularly focused on health system strengthening as an important strategic priority to ensure prevention, testing, treatment and other essential health services are available for all key populations including people living with HIV. On the other side, there is critical need to strengthen community systems in order to empower key populations who are poor, socio-culturally marginalized and living in the remote areas for their easy access to prevention, testing, treatment, care and support in the families.
Nepal has started community-led interventions in partnership with national networks of people living with HIV and key populations in some districts with the support from development partners. This is a very important initiative to be scaled up across the districts, but recent funding cuts will profoundly impact on its continuity and sustainability. Therefore, scenario of HIV programs are at a time of great vulnerability and risk when people living with, at risk of or affected by HIV are losing access to lifesaving services.
Now, we need to urgently think of developing sustainability roadmap with concrete priorities and resources. The issues of universal access to HIV prevention, human rights, gender, inclusion, and equity need to be high priority agenda in the policy, strategic plan and community-based interventions. Strengthening institutional capacity of NCASC should be a priority in coordinating, facilitating and managing national HIV programs at all levels.
However, this should not be limited within health sector alone, but other social sectors such as education, urban development, social protection, women and children must be engaged for effective and sustained multi-sectoral response. The social inequalities in HIV and other structural barriers need to be addressed in HIV response. The stigma and discrimination are also barriers in HIV prevention. Most often, these are sidelined and hence not receiving sufficient attention for coordinated actions at all levels.
Last year, the NCASC together with UNAIDS, civil society and other partners convened national level sustainability dialogue to discuss the current gaps in HIV response and identify the priorities from sustainability perspective. But the process has not fully progressed yet.
More importantly, considering the declining international funding landscape in HIV response, there is an emerging need to discuss with a range of stakeholders and convene a series of meetings to develop sustainability plan as early as possible. We need to critically review and identify gaps around political leadership, enabling laws and policies, sustainable and equitable financing, services and solutions, and systems.
Above all, closing the funding gaps is more critical. Because it is more likely to undermine the efforts that address the HIV-related needs of people from key and vulnerable populations. Despite considerable limitations to fiscal space, there is an urgent need to renew and strengthen political commitment to closing HIV financial gaps and investing in long-term sustainability.
The integration of social, financial, human resources and infrastructural systems can further synergize the outcomes of HIV response. The other priority areas include reducing HIV/TB co-infections, mental health, nutrition and other social protection services for marginalized populations. In all aspects of HIV programming, rights-based and people-centric approach are critical for delivering comprehensive services.
Cultivating and optimizing partnerships for sustained HIV response must be the high priority of the NCASC. An enabling environment for facilitating community-led responses is crucial as they play unique role in community mobilization as well as societal enablers for effective prevention response. In order to transform AIDS response, efforts must be prioritized to support capacity-strengthening, resilience and preparedness of community-led organizations. Without community system strengthening, we can not achieve the ambitious target of ending AIDS as public threat by 2030.
Bhandari is a health policy analyst
