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  • Most of the estimated infections, around 86%, occurs among economically productive age group only; while the more than 5,000 (10% of total estimated infections) young people are ling with the virus.
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  • Size wise,Populations with higher sexual and injecting behaviorals are also living in similar pattern – terai highway districts, Kathmandu valley,
  • Nepal reduced new HIV infections by 86% in last one decade; whereas 77%.

Transcript

  • 1. Overview of HIV Epidemic Situation in Nepal Deepak Kumar Karki National Centre for AIDS and STD Control Teku, Kathmandu
  • 2. Outline Epidemiology of HIV in Nepal o Epidemic burden (in terms of classical epidemiological parameters) o Drivers of HIV risk Efforts to curve HIV infections New directions www.nepalaids2012.org.np
  • 3. Current situation of HIV in Nepal Estimated HIV infections in 2011: 50,288 www.nepalaids2012.org.np
  • 4. Nepal 2011 HIV Infections Estimates35,00030,000 29,052 Male25,000 Female20,00015,000 14,18610,000 5,000 3,023 2,095 2,444 1,953 1,852 802 0 0-14 years 15-24 years 15-49 years 50+ years www.nepalaids2012.org.np
  • 5. HIV Age Distribution, 2011 Of total infections:  Children (0-14) = 8 %  Female (15-49) = 28 %  Male (15-49) = 58 % www.nepalaids2012.org.np
  • 6. Nepal 2011 HIV Infections Estimates Estimated HIV Proportion Population Groups Infections (15-49 years) (%) People who Inject Drugs (PWIDs) 939 2.2 MSW, TG and Clients 3,099 7.2 Other MSM who do not sell and/or buy sex 6,245 14.4 Female Sex Workers (FSWs) 647 1.5 Clients of FSWs 1,915 4.4 Male Labour Migrants 11,672 27.0 Remaining Male Population 6,914 16.0 Remaining Female Population 11,808 27.3 Total 43,239 100.0 www.nepalaids2012.org.np
  • 7. Distribution of Estimated HIV Infections by Epi-Zones in Nepal16% 18% 50% 16% Source: National Estimates of HIV Infections, 2007 www.nepalaids2012.org.np
  • 8. Distribution of Reported HIV Infections by Epi-Zones in Nepal, 2010-2011 (4,075)10% 8% 63% 19% Source: NCASC:2010 and 2011; Reported HIV infections www.nepalaids2012.org.np
  • 9. Distribution of key populations at higher risk(FSWs, MSM/TG and PWIDs), 2010 HUMLA FSW Sizes by districts HUMLA IDUs Sizes by districts DARCHULA DARCHULA BAJHANG BAJHANG MUGU MUGU BAITADI BAITADI BAJURA BAJURA DADELDHURA DADELDHURA JUMLA JUMLA DOTI DOTI ACHHAM KALIKOT DOLPA ACHHAM KALIKOT DOLPA MUSTANG MUSTANG KANCHANPUR KANCHANPUR DAILEKH DAILEKH JAJARKOT JAJARKOT KAILALI KAILALI RUKUM MANANG RUKUM MANANG SURKHET SURKHET MYAGDI MYAGDI SALYAN SALYAN BARDIYA BA BARDIYA BA GL GORKHA GL GORKHA ROLPA UN KASKI ROLPA UN KASKI G G LAMJUNG LAMJUNG PARBAT RASUWA PARBAT RASUWA N HA AN BANKE UT BANKE TH PY YU I GULMI P HI GULMI CH NC DANG AN SYANGJA SINDHU- DANG HA SYANGJA KH TANAHU TANAHU SINDHU- HA NUWAKOT PALCHOK AK NUWAKOT G GH PALCHOK AR PALPA AR PALPA DHADING KATHM DOLAKHA DHADING DOLAKHA KATHM NAWAL SULUKHUMBU KAPILBASTU RUPANDEHI BHAK NAWAL BHAK SULUKHUMBU PARASI KAPILBASTU RUPANDEHI SANKHUWASABA PARASI TAPLEJUNG SANKHUWASABA TAPLEJUNG CHITWAN MAKAWANPUR LALIT KAVRE RA CHITWAN MAKAWANPUR LALIT KAVRE RA ME ME CH CH H AP H AP OKHALDHUNGA OKHALDHUNGA PARSA M SINDHULI HU PARSA KHOTANG BHOJPUR RAU R M AT SINDHULI HA HU KHOTANG BHOJPUR RH R RAU R T AT DH HA BARA HE TAH TE RH AN A A T NC DH BARA HE TAH TE H KU MAHOTTARAI U UDAYAPUR PA AN SARLAHI NC TT T KU 101-500 MAHOTTARAI A U AT SARLAHI UDAYAPUR PA Upto 100 TT DH T 101-500 A Upto 100 AN DH ILAM HA U US 501- 1000 Over 1000 SIRAHA NU ILAM A 501- 1000 Over 1000 SIRAHA S SA SUNSARI MORANG SAPTARI SUNSARI MORANG SAPTARI JHAPA JHAPA HUMLA MSM Sizes by districts DARCHULA BAJHANG MUGU BAITADI BAJURA DADELDHURA JUMLA DOTI ACHHAM KALIKOT DOLPA MUSTANGKANCHANPUR DAILEKH JAJARKOT KAILALI RUKUM MANANG SURKHET MYAGDI SALYAN BARDIYA BA GL GORKHA ROLPA UN KASKI G LAMJUNG PARBAT RASUWA N HA BANKE UT PY I GULMI CH DANG AN SYANGJA SINDHU- KH TANAHU G HA NUWAKOT PALCHOK AR PALPA DHADING DOLAKHA KATHM Source: Population size RUPANDEHI NAWAL BHAK SULUKHUMBU KAPILBASTU PARASI SANKHUWASABA TAPLEJUNG CHITWAN MAKAWANPUR LALIT KAVRE RA ME CH H AP OKHALDHUNGA estimation of MARPs, 2010 PARSA M SINDHULI HU KHOTANG BHOJPUR RAU R AT HA A T RH T DH BARA HE TE AN AHA NC KU MAHOTTARAI SARLAHI UDAYAPUR PA TT T 101-500 A Upto 100 DH AN ILAM US 501- 1000 Over 1000 SIRAHA A SUNSARI MORANG SAPTARI JHAPA www.nepalaids2012.org.np
  • 10. Estimated Number of HIV Infections and HIVPrevalence among Adults : 1985-201570,000 1 Estimated HIV Infections 0.960,000 Estimated HIV prevalence 0.8 50,28850,000 0.7 0.640,000 0.5 %30,000 0.420,000 0.3 0.210,000 0.1 0 0 1992 2004 1985 1986 1987 1988 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 www.nepalaids2012.org.np
  • 11. HIV Prevalence among Adults (15-49 years) 0.30 % (2011) www.nepalaids2012.org.np
  • 12. Distribution of Adult (15-49) Estimated HIV Infectionsamong Risk Groups: 1980-2015 70,000 Remaining female population Remaining male populationEstimated number of infections 60,000 Male labour migrants Clients of FSWs 50,000 Female sex workers Other MSM 40,000 MSW, TG and their clients 30,000 People who inject drugs 20,000 10,000 0 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013 www.nepalaids2012.org.np
  • 13. Routes of Transmission among ReportedHIV cases, 2011 87.9% N = 2,060 100% 80% 7.7% 60% 0.2% Mother to child 40% 4.2% Blood and blood products 20% Sharing unsafe needles 0% Sexual transmision www.nepalaids2012.org.np
  • 14. Routes of Transmission among ReportedHIV cases, 2010 and 2011201 87.9% 4.2% 0.2% 7.7% 1201 84.9% 6.7% 0.4% 8.0% 0 75% 80% 85% 90% 95% 100% Sexual transmision Sharing unsafe needles Blood and blood products Mother to child www.nepalaids2012.org.np
  • 15. New HIV Infections by Risk Groups www.nepalaids2012.org.np
  • 16. New HIV Infections (15+) <1.1 (2011) www.nepalaids2012.org.np
  • 17. We can END AIDS14,000 AIDS related deaths12,000 New HIV infections10,000 8,000 6,000 4,000 2,000 0 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 www.nepalaids2012.org.np
  • 18. Impact so far of ART and PMTCT16,000 Deaths averted by ART 1349414,000 Infections averted by PMTCT12,000 Life years gained by ART and PMTCT 1036210,000 8,000 7428 6,000 4736 4,000 2776 1872 2,000 1126 68 216 550 0 18 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 www.nepalaids2012.org.np
  • 19. EFFORTS• Prevention – 69% of the total expenditures were on HIV prevention programs• Behavioural change interventions – Peer education (informal/formal setting) – HIV testing and counselling – Diagnosis and treatment of STIs – Harm reduction – NSEP, MMT – PMTCT• Scaling-up of Antiretroviral therapy• Health system strengthening and engaging communities www.nepalaids2012.org.np
  • 20. New Directions Current data/information tell us where epidemic was but not where it is heading; and how it can be changed with better mix of interventions. We are studying key populations at higher risk of HIV (KPHR) and behavirours but not their needs (health + ) Do we really trust point estimates of surveillance surveys?  Or, is it the effect of changing methodologies over the period of time? In-depth evaluation is needed www.nepalaids2012.org.np
  • 21. New Directions• Explore the possibilities to use routine data as a supplemental data source for HIV surveillance• Use of existing SDPs to run cost-effective longitudinal studies – limited data available to establish causality• Individual level factors are well evaluated but lack evidence on effect of contextual/structural factors impact on Key Populations at Higher Risk behaviours  Illegal sex work; cross-border movement of KPHR  Incarceration of PWIDs  Social stigma against male-male sex  Linkage of health and human rights issues of sexual minorities www.nepalaids2012.org.np
  • 22. NEW DIRECTIONS Individual level factors are well evaluated but lack evidence on effect of contextual/structural factors impact on KPHR risk behaviours  Illegal sex work; cross-border movement of KPHR  Incarceration of PWIDs  Social stigma against male-male sex  Linkage of health and human rights issues of sexual minorities www.nepalaids2012.org.np