Injecting drug users (IDUs) are the major HIV epidemic drivers in Nepal. Since the country’s HIV epidemic is still concentrated in the most at risk population (MARP) groups, the major programs designed and implemented targeting these groups are the only and most effective way to control it from spreading among the general population. According to the CBS report (2007), 61.4% among the drug users inject drugs, and 29% of them share needles, putting them in a more vulnerable situation.
The HIV/AIDS and Hepatitis C (HCV) epidemics have highlighted the urgent need to involve people who use drugs, as well as the importance of “understand[ing] more about how the injecting drug user community functioned, in order to understand the nature of risk and to plan interventions.” In addition to forming their own organizations, people who use drugs have also been instrumental in establishing the first harm reduction programs in a number of countries, including the very first needle and syringe exchange program, which was set up as a hepatitis B prevention measure by people who use drugs.
The user groups have been agents of social change, who have altered the landscape in relation to every aspect of our perception of injecting drug use in the country.
Harm reduction (HR) program aims to reduce the health, social and economic harms associated with the use of psychoactive substances. It is the alternative solution to address HIV epidemic among the IDUs. However, the HR service coverage in Nepal is alarmingly low. Due to our heavy dependence on the external development partners for HR programs, oftentimes, the sustainability of funding for AIDS and harm reduction is unclear, uncertain and unpredictable. This has led to frequent interruption in the past and present. Discontinuation of these effective, high coverage sites to which people have responded well, will jeopardize our overall health gains of the past decade.
The HIV response in Nepal, which includes critical harm reduction programs and HIV services for people who use drugs, is under threat due to a shortage of resources after July 15, 2011.
Nepal is receiving up to USD 70 million over the next 5 years from the Global Fund and Health SWAP donors led by the World Bank (WB). In spite of the significant financial resources invested, it is disturbing to find that people who use drugs are faced with a drought in services. The fear is compounded while there is no hope seen in the immediate horizon of smooth transition of services as promised by WB, pooled partners and Ministry of Health and Population. There is serious concern regarding the escalating public health crisis in Nepal due to the loss of resources and poor coordination among donors to ensure the smooth transition to a health SWAP approach and Global Fund programs. Prevailing facts like the lack of coordinated efforts among the different stakeholders like Ministry of Home Affairs, UNODC, UNDP, and DFID programs are being implemented in fragments, which directly affects the impact of the programs also needs to be addressed.
The life or death decisions about the concerned target groups are being made without their active involvement. Nepalese drug using communities have played a crucial role in the AIDS response from the earliest stages of the epidemic in Nepal, as envisioned by the international policy mandates, including Treatment 2.0 by UNAIDS and Community Systems Strengthening framework [CSS] by the Global Fund which underpins the importance of supporting communities to play a central role in the overall AIDS response.
Currently, IDUs Advocacy Task Force, NEPAL, has been organizing advocacy at various levels. During a recent advocacy program, the unjustified arrests of user activists who were demanding immediate service, along with mounting human rights violation of people, is unjustifiable. Rather than coming closer to ensuring smooth transition of services for people who use drugs, increasing human rights violation will only keep the country one step behind in achieving the millennium development health goals for the people who use drugs.
There is no doubt that the overall volume of spending on HIV related harm reduction in Nepal is still small and nowhere near proportionate to the need. We encourage the Government of Nepal, external development partners and UN agencies to invest more on evidence-based interventions and make resources available for drug and HIV services for people who use drugs, and make it proportionate to the needs of the country.
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