HIV/AIDS/STDs Prevention, Care and Support Program - Nepal

In an effort to reach out to migrant workers and their wives, potential migrants, and female CSWs and their clients, organisers developed community-based behaviour change interventions that shared the following strategies:

• Partnership with local NGOs
• Social mobilisation - approaching different groups such as women's groups, migrants wives groups, Junior Red Cross Circle (JRC)
• Peer education
• Rights-based approaches.

The idea was to increase motivation and skills among NGO staff, which hopefully would lead to more interactions and acceptance at community levels. Through awareness-raising, it was hoped that migrant worker populations and CSWs would feel more free to share their concerns with outreach teams and peer educators. Migrant wives' groups, it was thought, should be at the forefront of disseminating messages to family members and the community.

Specifically, face-to-face training and activities were implemented to raise awareness and change behaviour at the community level. A total of 2065 individuals attended a one-day HIV/AIDS orientation. These individuals included Village Defence Committee leaders and key persons, schoolteachers, non-formal education members, students, active male migrants, shopkeepers, and CSWs. Awareness-raising sessions focussed on various aspects of HIV/AIDS such as modes of transmission and methods of prevention. In addition, cultural programmes were held (which were attended by nearly 27,000) people to disseminate information about HIV/AIDS via a song competition, street drama, and other entertainment-based activities. Printed materials focussing on various aspects of HIV/AIDS and STDs were distributed. In addition, citizens were educated about proper condom use through 807 condom demonstration events (at which 12,234 condoms were distributed).

Staff of the three local NGO partners were also provided with information and skills training conducive to better care. For instance, 23 staff members participated in a 5-day HIV/AIDS training of trainer (TOT) workshop. Health care providers (government and NGO) from the project area underwent a 5-day orientation on STDs and case management strategies. Peer educators also received basic orientation training and, later, refresher training.

HIV/AIDS, STDs.

According to CARE Nepal, HIV/AIDS has been increasing since the first case was detected in 1988 in Nepal. Heterosexual transmission is the primary mode of HIV transmission. The national data as of January 31 2003 indicates that 2665 individuals have HIV; 626 of them have developed AIDS. Of the total AIDS cases, 153 people have died. HIV transmission is increasing in the population of the 14- to 49-year age group, especially among housewives. It is thought that HIV is being passed to them by their husbands after visiting CSWs. Given the high rate of HIV among populations with high-risk behaviours, Nepal ranks among 'concentrated epidemic' countries.

Seasonal migration to India from Far-Western Nepal, organisers say, has been widespread over the past several decades. Migration from Bajhang and Doti districts is common: at least one member among 40% to 90% of households migrates to India.

A baseline study conducted by CARE in Bajhang revealed that 5% of married women had heard of HIV/AIDS; 3% of them knew that HIV transmission could be prevented and 1% were aware that appropriate condom use could protect them from contracting HIV. This study also found that only 2 migrants out of 32 uses condoms; reasons cited for failure to use were 'maja audiena' (unpleasurable sex) and unnecessary complications. When they have STD symptoms, many migrant workers not visit health clinics for treatment due to lack of medicines or absent health workers. Anecdotal reports indicate low levels of awareness about HIV/AIDS and low levels of safer sex practices among migrants.