Situation Analysis: Although the HIV/AIDS epidemic is relatively new in Nepal, yet though it is transforming from 'low' to 'concentrated' epidemic. The first case was identified in Nepal in 1988 (NCASC, 2002).

As of 31st March, 2004 a total of 3,529 HIV infection cases were reported in government facilities. Of this number 715 were infected by AIDS of which 191 had already died (NCASC, 2004).

Actual HIV/AIDS infection in Nepal is feared to be many times higher than the recorded cases. The number of the adults and children living with HIV/AIDS until December 2002 was 60,000 (estimated) and AIDS related deaths were 2958 (UNAIDS, 2002). Current estimated HIV infection rate of 0.5 percent pervades on the adult population between the age cohorts of 15-49.

Of the total reported HIV/AIDS infections, males comprise 73 percent and females only 27 percent (NCASC, 2003). Young people (20-29 aged) make the highest suffering group from HIV/AIDS.

Sexually transmitted infections are proven co-factors increasing the risk of HIV transmission. Their appropriate diagnosis and treatment are critical. It is estimated that about 200,000 new STI episodes take place in Nepal in every year. STI prevalence rate among women is estimated at 4.7 percent (MoH, 2002).

The migrant people are one of the most vulnerable groups of people to STI/HIV infection in Nepal. Independent estimates reveal that the number of periodic migrants is higher than it is recorded in official statistics. About 800,000 people cross the southern boarder as seasonal migrant labourers to India every year and approximately 350,000 labourers migrate from one part of the country to another for wage earning (MEH and REGHED, 2000). Most of these migrants do not have access to information, condoms, supportive services which enable them to have safer sex. They are likely to take the virus back to their wives who could transmit it to their babies and at the same time work as HIV/AIDS breeding populations. Moreover, female sex workers (FSWs) and their clients are also vulnerable group for HIV infection in Nepal. It is estimated that about 5000-7000 rural women, mostly girls are trafficked to India across the open boarder. Altogether, there are more than 200,000 Nepalese women currently engaged in flesh trade in India (CWIN, 2002).

Injecting/intravenous drug users (IDUs) with their high-risk behaviour are most vulnerable to HIV/AIDS epidemic in Nepal. There are about 200,000 drug addicts in Nepal (CWIN, 2002), of whom 30,000 are injecting drug users, of whom, again approximately 40 percent are HIV infected (MoH, 2002).

Mobile transport workers are another vulnerable groups of people for HIV infections in Nepal. Altogether, there are 135,000 transport workers, 130,000 male and 5,000 female, in Nepal (CBS, 1999). Strategic Direction Reduce HIV incidence by strengthening STI services and improving sexual and reproductive health in FPAN operational areas

Goal: Contribute to reduce the incidence of HIV/AIDS in FPAN operational areas

Objectives:

• To increase access of gender sensitive STI services and STI/HIV/AIDS education to vulnerable population
• To reduce stigma and discrimination on HIV/AIDS at all level

Activities to Achieve Objective 1:To increase access of gender sensitive STI services and STI/HIV/AIDS education to vulnerable population

• Conduct surveys/studies on STI/HIV/AIDS among vulnerable population
• Develop IEC/BCC materials for vulnerable population
• Develop training curriculum and service delivery guidelines
• Build capacity of service providers to provide STI services and proper knowledge to deal with the stigma and discrimination relating to HIV/AIDS
• Provide STI diagnosis and treatment services through selected FPAN's clinics
• Provide care and support services to HIV infected and affected people (on pilot basis in selected area)
• Establish referral linkages in government and NGO facilities at appropriate levels for STI services, confirmatory HIV test and care and support services to people living with HIV/AIDS (PLWHA)
• Document the processes of implementation and success stories

Activities to Achieve Objective 2 :

• To reduce stigma and discrimination on HIV/AIDS at all level
• Review and update existing service delivery guidelines
• Conduct workshop/seminars among health planners, policy makers, implementers and media persons to advocate them about the non-discriminatory policy & it's implementation to protect the right of HIV infected and affected people.

Outcomes and Indicators: