Academic journal article Health Sociology Review

Strategies for Reinventing and Reinforcing the Disrupted Biography of People with HIV in Nepal

Academic journal article Health Sociology Review

Strategies for Reinventing and Reinforcing the Disrupted Biography of People with HIV in Nepal

Article excerpt


The World Health Organisation (WHO) and United Nations Program on HIV/AIDS (UNAIDS) actively advocate for the provision of antiretroviral treatment for people with HIV by highlighting health as a fundamental human right (WHO & UNAIDS, 2004). However, the achievement of this goal appears to be overly ambitious. In 2008, out of nine million people, only 42% of people with HIV worldwide received anti retro viral (ARV) treatments who urgently required it. ARV was introduced in 1996, and has improved the quality of life for people with HIV by prolonging their lifespan. Typically, ARV needs to be taken for several years so the financial impact of this treatment can be significant over time (UNAIDS/WHO, 2009).

Importantly, besides increasing life expec- tancy, ARV is also considered a tool for the prevention of HIV transmission. For instance, its use has been demonstrated as reducing peri- natal HIV transmission significantly (Granich et al., 2010). As yet, convincing research as to how ARV decreases HIV transmission via sexual activity is illusive, a meta-analysis of 11 cohort studies indicated that the sexual transmission of HIV-1 virus was calculated as almost nil upon the initiation of ARV (Attia, Egger, Muller, Zwahlen, & Low, 2009).

The recommended time to commence ARV somehow remains a subject of considerable debate. In poorer countries, ARV usage is recom- mended if cd4 counts is less than 200/μL. Other studies have demonstrated that ARV has helped to increase life expectancy of people with HIV at varying scales, based on the timing of com- mencement of ARV (Johansson, Robberstad, & Norheim, 2010).


Accurate data about HIV and AIDS epidemi- ology is problematic and under-reporting is likely. As of 15 December 2009, the total num- ber of people with HIV in Nepal was reported to be 17,058 (NCASC, 2010), and those with AIDS were 2,729 (NCASC, 2009). UNAIDS however, predicted that at least 70,000 people were living with HIV in Nepal by August 2008. As of 14 June 2009, the total number of deaths due to AIDS was reported to be 533 (NCASC, 2009). Discrepancies exist in reported and esti- mated figures, especially due to the fact that many people do not know their HIV diagno- sis although they admit to having engaged in high-risk behaviors. Typically, it is only when they start to experience symptoms or signs of illness, that they seek health care. In the early stage of the evolution of HIV, the transmission was propagated through injecting drug users and female sex workers. By the end of 2007, HIV transmission was reported to be 42% amongst migrant workers relocating from or to, neigh- boring countries. Nearly half of all HIV infected people reside in Nepal's southern plains region, which connects with India through more than 20 open borders (UNAIDS, 2008).


ARV treatment was started in 2004 in Nepal (NCASC, 2004). In recent years, the focus of treatment has been on providing quality medi- cal care, ARV and voluntary counseling and HIV testing (VCT) services, including home and community-based care and supports in Nepal (MOH/NCASC, 2003, p. 10; Steinberg, Gilligan, Rijal, & Pokharel, 2003, p. 14). In light of these services, the government has developed comprehensive guidelines to provide ARV and VCT through the larger health facili- ties in more populous centers (MOH/NCASC, 2003, p. 7; 2004, p. 2). These facilities are lim- ited to the major government hospitals and some non-governmental organizations (NGOs) (MEH & REGHED, 2000, p. 7).

Expenditures on ARV treatment is a key concern in Nepal. ARV treatment was provided to 1,100 people with HIV during 2006-2007 through 17 service cen- ters, up from 160 people with HIV receiv- ing ARV treatment during 2004-2005. The Government of Nepal estimated ARV costs at USD$3,883,880, which is 6% of the total HIV/AIDS related expenditures or USD$64,110,287 for the period of 2006- 2008. …

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