Since AIDS is linked to taboos like sex, alcohol, drugs and crime, even medical doctors, professionals and political leaders hesitate to publicly talk about it. Campaigns which aim to sensitise people on AIDS automatically refer to sexual intercourse as unethical. None of us would exist without sex, yet we unnecessarily stigmatise sex, drugs and HIV/AIDS.
A few years ago when politician Gagan Thapa posed alongside an HIV positive person for a poster aimed at reducing the stigma attached to AIDS, he was inundated with questions and rather unpleasant comments by curious reporters and colleagues. What relation did he have with those living with AIDS? Why was he sympathetic towards them?
All Gagan wanted to do was to promote greater acceptance and hoped people living with AIDS would not be ostracised any longer. But after being hounded by the media for months and after giving hundreds of clarifications, he told me in a rather tired and defeated voice that he would do anything to fight AIDS related stigma in the future, but under one condition: I would not ask him to pose for another poster.
I respected Gagan's feelings and have not asked him to be on another campaign poster. But his experience confirms how far we in Nepal still are from normalising AIDS in our discourse.
HIV in Nepal is technically a 'concentrated' epidemic. More than four out of every five HIV infections are transmitted through heterosexual transmission. People who inject drugs, men who have sex with other men and female sex workers are the key high-risk groups driving the epidemic.
Male labour migrants (particularly from India where they visit female sex workers) and clients of female sex workers in Nepal serve as the bridging population groups transferring infections from high risk groups to a low risk general population. As the epidemic matures 23 years after the first reported case of HIV in 1988, more and more infections are being recorded among the general populations.
Officially, 55,626 Nepalis were HIV positive in 2010 out of which slightly more than half (58 per cent) were men and 28 per cent women of reproductive age group. Children under 15 made up eight per cent of infections.
In the past year, Nepal has made progress in reducing HIV prevalence among injecting drug users and sex workers. We have also succeeded in dramatically reducing AIDS related deaths through the use of life prolonging antiretroviral (ARV) treatment. More than 6,000 HIV positive Nepalis are now living healthier and longer lives. The transmission of HIV among those undergoing ARV treatment was reduced by 96 per cent, and ARV might help prevent the spread of new infections in the future.
As Nepal gears up for a new National AIDS Strategy for the next five years, donors have pledged over $100 million to achieve its goals. We have gained valuable experience in managing programs for hard-to-reach populations in the past 20 years, and we must put this to good use for efficient and effective AIDS response.
We also have young Nepali scientists and researchers, expert clinicians, health care providers and most importantly groups of people living with AIDS who have dared to overcome the stigma and are living openly with HIV in almost 65 out of 75 districts. They are the second generation leaders who will power the future of our AIDS response.
This means those of us who have been the pioneers of the AIDS movement in Nepal need to back up and make space for the next generation. It's time we proudly pass on the baton to the bigger, better and stronger wave of activists and troopers.
An epidemic of stigma and discrimination, BHRIKUTI RAI
Fewer Nepalis are being infected with HIV/AIDS, but ostracisation within families, in schools and workplaces is still a major barrier