At a glance: HIV in Nepal

• 30,000 people with HIV
• 0.1% adult HIV prevalence
• <1,000 new HIV infections
• <1,000 AIDS-related deaths
• 22,000 people on antiretroviral treatment

The current targets for HIV testing and treatment are called the 95-95-95 targets and must be reached by 2025 in order to end AIDS by 2030.

In 2021 in Nepal:

Did you know?

Community and home-based care programmes run by and for people with HIV are playing a key role in addressing access to treatment, and have been very effective at keeping people in care.

Preventing HIV in Nepal focuses on:

• prevention of mother-to-child transmission (PMTCT)
• harm reduction (needle and syringe programmes and opioid agonist therapy)
• comprehensive sexuality education in secondary schools
• condom distribution
• PrEP (small-scale pilot)
• behaviour change communication.

Did you know?

Nepal has scaled up PMTCT services in recent years. In 2021, around 70% of pregnant women were offered an HIV test, and only 83% of pregnant women diagnosed with HIV were on treatment.

Testing for HIV is:

• available in HIV testing clinics, HIV care clinics, mobile facilities, antenatal care and labour rooms, opioid agonist therapy sites, tuberculosis clinics and private clinics
• encouraged for the partners and children of people newly diagnosed with HIV (called index testing)
• can be carried out by trained peer providers in community settings
• linked to HIV prevention services (for people who test negative)
• linked to HIV treatment services, with immediate treatment is available.

Did you know?

Nepal focuses its testing programme on communities most affected by HIV. As part of this, mobile testing units staffed by healthcare workers and peers go to nightclubs and bars, neighbourhoods where people sell sex, remote birthing sites, injecting dens, and areas where high numbers of male labour migrants and their partners live and work.

Treatment for HIV is:

• free
• available immediately after diagnosis
• provided as part of a ‘one-stop shop’ approach, alongside services for sexually transmitted infections and tuberculosis
• monitored by viral load testing, although this is not available everywhere
• available in most health facilities
• includes home-based or community-based adherence support for individuals, or as part of an adherence support group.

Did you know?

AIDS-related deaths are declining fast in Nepal, falling by 65% since 2010.

Nepal’s HV epidemic used to be driven by injecting drug use, but now the main way HIV spreads is through sex. But people who inject drugs are still one of the population groups most affected by HIV in Nepal. The other groups most at risk are migrant workers, transgender people, sex workers, prisoners, young people, men who have sex with men and military personnel. Half of all HIV infections occur among sex workers (4.8%), their clients (36.7%) and migrant workers (7.2%).

Men are disproportionately affected: 60% of people with HIV in Nepal are male. This is due to high HIV prevalence rates among the male clients of sex workers, people who inject drugs and migrant labourers. Men are also more likely to die from an AIDS-related illness than women.

HIV prevalence varies across the country. The Kathmandu Valley, the highway districts and the far-western development region are home to the greatest number of people with HIV. These areas are highly populated and home to large migrant populations. Community-based organisations and networks led by people with HIV can be found across the country and are involved in supporting HIV treatment and care, as well as overall wellbeing, for almost 17,000 people.

Late diagnosis is a problem in Nepal – around one third of people are diagnosed with HIV after it has already progressed to AIDS.

HIV-related stigma is also an issue. The most recent data (2016) suggests around one-third of Nepalese people hold discriminatory attitudes towards people with HIV. In recent years, Nepal has made reducing stigma and discrimination against people with HIV a priority of its HIV response.

Nepal was the first Asian country to identify the existence of ‘gender and sexual minorities’ in its constitution. Same-sex acts are legal. Abortion is legal, but it must be carried out in the first 12 weeks of pregnancy.

Nepal has a national strategy to address gender-based violence and violence against women, including women with HIV. The country also provides HIV and sexuality education in secondary schools. And it has recently changed laws and policies so that adolescents can access HIV testing and other HIV services more easily. All of these factors have aided the response to the HIV epidemic in the country.

Nepal’s National HIV Strategic Plan 2016-2021 aimed to reach UNAIDS’ targets through a rights-based and decentralised HIV programme. Every year, around three-quarters of funding for its HIV response goes towards reaching key populations with HIV prevention; targeted HIV testing to find people with HIV who are not diagnosed, and ensuring people are linked to testing and treatment.

Nepal’s HIV programme remains heavily dependent on international assistance – donors provide seven times more investment in the country’s HIV response than the Nepalese Government.