Since the first case of AIDS was reported in 1988, HIV in the country has evolved from “low” to “concentrated” epidemic. According to 2010 UNAIDS Report on the Global AIDS Epidemic, by the end of 2009, an estimated 64,000 adults and children (up from 60,000 in 2001) were living with HIV, of which 20,000 were women aged 15 years and older. In addition, there were an estimated 4,800 people newly infected with HIV and 4,700 deaths due to AIDS in 2009, up from 4,000 in 2001 [1]. A total of 17,058 cases of HIV had been reported by 15 December 2010 to the National Centre for AIDS and STD Control (NCASC) [2]. The sex ratio among people living with HIV and AIDS was nearly 3:1 (male: female) [3]. Almost 50% of the total HIV infections were recorded along the highway districts across the country [3].  

The 2002-2010 Integrated Biological and Behavioural Surveillance (IBBS) found that commercial sex and the sharing of unclean needles by injecting drug users were the major drivers of the HIV epidemic in the highways and major towns, while migration of people to India and other countries was the primary risk factor in selected hill districts. According to the NCASC, as of 2009, an estimated 29.4% of all HIV infections occurred in labour migrants, followed by 6.2% in men who have sex with men (MSM), and 5% in clients of female sex workers (FSWs). In addition, ‘low-risk’ male and female populations accounted for 26.2% and 28% of HIV infections, respectively, due to their disproportionately larger population sizes [4]. Among FSWs, HIV prevalence had been fluctuating over the past decade but remained low - 2.3% in Terai Highway Districts as of 2009, and 2.2% in Kathmandu and 3% in Pokhara as of 2008 [5].  In 2009, HIV prevalence among male sex workers (MSW) was 5.2% (up from 2.9% in 2007) [6].  

Nepal is confronted with vulnerability and risk factors as follows [7]: High rates of migration and mobility due to poverty and lack of livelihood opportunities; stigma and discrimination against people living with HIV & AIDS; trafficking of women and girls; low status of women, particularly those living in  rural areas; political instability and large number of Internally Displaced Persons; very difficult to reach FSWs due to their remote geographical location or tenuous links with existing networks [8];  and the limited screening for HIV of blood unites (only 38%) in a quality-assured manner at a reference laboratory [3].

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic, 2010

[2] National Centre for AIDS and STD Control (NCASC) "http://www.ncasc.gov.np” 23rd May 2011

[3] NCASC, UNGASS Country Progress Report: Nepal (January 2008-December 2009), 30 January 2010

[4] NCASC, National Estimates of HIV Infection 2009 Nepal, August 2010

[5] IBBS FSWs, Kathmandu Valley and Pokhara Valley, Round I to Round III (2006, 2004, 2008); Round I to Round IV in 22 Highway Districts (1999, 2003,2006, 2009)

[6] IBBS 2009 MSM

[7] The World Bank in South Asia, HIV/AIDS in Nepal, August 2008

[8] NCASC, UNGASS Country Progress Report: Nepal (January 2006-December 2007), 30 January 2008