This document summarizes a health seminar paper on the effectiveness and utilization of HIV testing and counseling (HTC) services in Nepal. It provides background on HIV/AIDS in Nepal, describes the current situation of the epidemic and HTC services. It discusses the objectives, methodology, essential elements and process of HTC services. It analyzes trends in the effectiveness and utilization of HTC, noting challenges like low testing rates, barriers to access, and a lack of coordination between service providers. The paper concludes that collective action is needed from all stakeholders to increase HTC utilization and effectiveness. It recommends integrating HTC with primary health care, improving collaboration, identifying alternative prevention strategies, and addressing stigma.

1. ‘‘Effectiveness and Utilization of HIV Testing and Counseling (HTC) Service
in Nepal’’
A Health Seminar Paper submitted to fulfill the partial requirement of BPH Seventh Semester
[HES 405.1Health Seminar in Special Topics]
Submitted To
Department of Public Health
LA GRANDEE International College
Simalchour, Pokhara
March,2014
Submitted By
SAgun PAudel
Roll No. 22

2. I
ACKNOWLEDGEMENT
I like to express my humbly thanks to all those who have supported and helped for
accomplishing this Seminar paper in the topic ‘‘Effectiveness and Utilization of HIV Testing
and Counseling (HTC) Service in Nepal’’.
First of all i would like to thank my respected BPH Program coordinator Mr. NandrajGahatraj
for giving opportunity to prepare this seminar paper. I am fully indebted to him for expert
guidance, regular supervision, untiring encouragement, inspiration and valuable suggestion and
full support during preparation of term paper. I would like to convey our heartfelt thanks to all
those who were directly or indirectly concerned with this and to all my well-wishers.
This term paper is written in simple language, with every bit of necessary information related to
the topic so that studying independently also would not find any difficulties. i think that this
effort will help every individual to understand about the information of the related topic.
SAgun PAudel
Student of Public Health

3. II
TABLE OF CONTENT
ACKNOWLEDGEMENT......................................................................................................................i
TABLE OF CONTENT ........................................................................................................................2
1. INTRODUCTION...........................................................................................................................1
2. OBJECTIVES .................................................................................................................................2
2.1. General objectives....................................................................................................................2
2.2. Specific objectives ...................................................................................................................2
3. METHODOLOGY..........................................................................................................................3
4. CURRENT SITUATION AND COMPARISON..............................................................................4
4.1. Situation of HIV/AIDS.............................................................................................................4
4.2. HIV Testing and Counseling Center in Nepal ...........................................................................4
4.3. The essential elements of VCT services in Nepal:.....................................................................5
4.4. Process of Voluntary Testing and Counseling...........................................................................6
4.5. Effectiveness and Service Utilization Trend .............................................................................6
5. Conclusion ......................................................................................................................................8
6. Recommendations ...........................................................................................................................9
7. REFERENCES.............................................................................................................................. 10

4. 1
1. INTRODUCTION
HIV counseling is an interaction in which the counselor offers another person the time, attention
and respect necessary to explore, discover, and clarify ways of living more resourcefully.
Counseling is an issue-centered and goal-oriented interaction. Counseling is DIALOGING and
helping to provide options for decision-making and BEHAVIOUR CHANGE. Good counseling
helps another person to be AUTONOMOUS, meaning able to explore options, make decisions,
and take responsibility for his or her own actions.
In 1994, WHO defined counseling as follows: A confidential dialogue between a person and a
care provider aimed at enabling the person to cope with stress and make personal decisions
related to HIV/AIDS. The counseling process includes an evaluation of personal risk of HIV
transmission and facilitation of preventive behaviors and appropriate referrals for care and
support services.
Voluntary Counseling and Testing (VCT) allows individuals to learn their HIV status through
pre- and post-test counseling and HIV test. VCT is client-initiated, as opposed to provider-
initiated testing and counseling (PITC) when health care providers initiate discussion of HIV
testing with clients who are seeking health care for other reasons. VCT can be provided through
stand-alone clinics or offered through community-based approaches, such as mobile or home-
based HIV testing. In addition, counseling for VCT may take place at the individual, couple, or
group level. VCT was originally implemented as an individual-level, clinic-based procedure.1
Voluntary HIV/AIDS counseling, testing and referral (VCT) is a major strategy in HIV/AIDS
prevention and care. Nepal’s National HIV/AIDS Strategy 2002 emphasizes the need to
“establish a non-discriminatory, accessible, voluntary, confidential HIV testing system with pre-
and post-test counseling and urges the MoHP “to develop a policy and quality framework for
government and private institutions including NGOs” as a basis for expansion of services.2
Voluntary Counseling and Testing VCT was used initially to support people diagnosed with
HIV/AIDS in the clinical setting, but has developed over years to become a main entrance point
to wider prevention, care, prophylaxis and treatment of HIV related illness, psycho-emotional
and legal support for people tested positive and negative.
1. Voluntary Counseling and Testing Rigorous Evidence – Usable Results, Research for Prevention, June, 2012
2. NATIONAL GUIDELINES FOR VOLUNTARY HIV/AIDS COUNSELINGAND TESTING, Ministry of Health National Center
for AIDS and STD Control ,Teku, Kathmandu, Nepal, July 2003

5. 2
2. OBJECTIVES
2.1.General objectives
 To study the Effectiveness and Utilization of HIV Testing and Counseling
Service in Nepal.
2.2.Specific objectives
 To study the current situation of HIV/AIDS in Nepal.
 To study the HIV Testing and Counseling Center in Nepal.
 To study the process of HIV testing and Counseling in Nepal.
 To study the essential elements of HTC services in Nepal.

6. 3
3. METHODOLOGY
To prepare this Seminar paper Google was used to retrieve journal and articles. Google Scholar,
EndNote was used to retrieve the articles. The articles related to VCT are downloaded and
studied. To collect the further information advanced Google search was also done and various
books from library were also studied for the Preparation of this paper. This report was prepared
by using various secondary data sources Available on internet, journals, and articles.

7. 4
4. CURRENT SITUATION AND COMPARISON
4.1.Situation of HIV/AIDS
Nepal faces increasing HIV prevalence among most at-risk populations (MARPs) such as sex
workers, injecting drug users (IDUs), men who have sex with men (MSM), and migrants.
Effective prevention interventions need to be scaled up, especially among IDUs. Nepal's poverty,
political instability, and gender inequality, combined with low levels of education and literacy,
make the task challenging, as do the denial, stigma, and discrimination that surround HIV and
AIDS.3
HIV in Nepal is characterized as concentrated epidemic. More than 80 percent HIV infections
spreadthrough heterosexual transmission. People who inject drugs, female sex workers (FSWs)
and menhaving sex with other men (MSM) are the key populations at higher risk spreading the
epidemic.Male labour migrants (particularly to HIV prevalence areas in India, where labour
migrants often visit female sex workers) and clients of female sex workers in Nepal are acting as
bridging populations that transmit infections from higher risk groups to lower risk general
population. As the epidemic ismaturing (after the first HIV case reported in 1988), increased
number of infections are beingrecorded among low risk general men and women. However, the
epidemic has never maintainedthrough heterosexual transmission in the general population in
Nepal, rather driven by theinfections among higher risk populations and their sexual partners.It is
estimated that about 55,626 people are living with HIV in Nepal in2010. Majority of
infectionsare occurred among adult (15‐49) male (58%) women of reproductive age group (28%)
populations,while 8% of infections are occurred among children under 15 years of age. The key
populations athigher risk (IDUs, FSWs, MSM, male labour migrants and clients of FSWs) shared
58% of all adult HIVinfections. Highest number of infections is estimated is in the age group of
25‐49 years who areeconomically productive and sexually active. The younger stratum of
population below the age of 15has lowest number of infections and most are due to mother to
child transmission. The HIV prevalence is moving to a downward trend and it is at 0.33% in
2011.4
4.2.HIV Testing and Counseling Center in Nepal
The growth in the number of testing and counseling service provision sites has been rapid and
overtwo hundred sites now offer HIV counseling and testing nationwide. However, there the
peopleserved by different sites indicating underutilization at some sites due to higher
concentration ofservice sites in some places. There is need for harmonization and coordination in
the HTC sites runby different programs, at the same time integrating into the health system.
Provider initiatedcounseling and testing is being initiated from ANC, STI and TB clinics.
3.HIV/AIDS in Nepal,WORLD BANK(August 2008)www.worldbank.org/np
4.NATIONAL HIV/AIDS STRATEGY 2011-2016, Government of Nepal,Ministry of Health and Population, National Centre for
AIDS and STD Control,Teku, Kathmandu,November 2011

8. 5
A review of the NHSP 2006‐2011 found considerable gaps in reaching migrant workers to India
andtheir spouses, low rates of utilization of VCT services and PMTCT services, policy variations
ininitiation of ART, lack of mainstreaming of HIV into other sectoral plans, lack of coordination
andunclear roles at the highest levels of government as well as the national coordinating bodies
in theHIV response, limitations in civil society capacities, continuing discrimination against
transgenderpersons, and almost complete dependence on external sources of funding for
HIV/AIDS.5
4.3.The essential elements of VCT services in Nepal:
VCT services are an important part of an expanded National HIV/AIDS Prevention and Care
Strategy
In Nepal because they:
 Determining the clients knowledge
 Providing information
 Conducting a personalized risk assessment
 Developing a personalized risk reduction plan
 Demonstrating appropriate condom use
 Counseling about test results
 Counseling about making the decision to take the test
 Assessing the client’s capacity and ability to cope
 Counseling on how to inform partners of results and how to refer partners for testing
 Providing psychological and emotional support and referrals, as appropriate.
5.Nepal Health Sector Programme –II ,2010-2015, Government of Nepal, Ministry of Health and Population.

9. 6
4.4.Process of Voluntary Testing and Counseling
4.5.Effectiveness and Service Utilization Trend
The effectiveness of the current HIV programs must be improved. HIV testing, a key
programelement is not being undertaken on a large enough scale, and in spite of statistics
showing high condom use rates, the STI rates amongst KAP tell another story.the testing rates in
Nepal are far from adequate: 54% test in a year, and even fewer street-based FSW test, as only
45% has ever been tested for HIV. Testing levels among KAP are low; for most, alarmingly low.
Of PWID, in Kathmandu valley, only a low 21% has ever had an HIV test (IBBS 2011).As the
June 2013 review of the Nepal HIV response shows, services are not always delivered in the
most effective and efficient way. There is duplication and fragmentation of services at district
and village levels, and much could be gained by improved cooperation between providers of
services.

10. 7
The cooperation between NGOs working towards preventing HIV in key affected populations is
non-existent or limited. Keythe lack of effective dialogue may be a key barrier for KAP to
test.6
various barriers including socio-cultural issues, geography, the presence of stigma and
discrimination faced by people with HIV/AIDS and a lack of knowledge and awareness were
identified as important factors limiting the utilization of VCT services. Current government
efforts to improve VCT service provision, although promising, require ongoing development.
Systemic barriers included the sustainability of the temporary NGO VCT services, lack of staff
and training, inadequate monitoring and evaluation and limited access to services for people
living in rural areas.7

11. 8
5. Conclusion
Voluntary Counseling and Testing (VCT) is a proven strategy for the prevention and
management of HIV/AIDS especially in developing countries. The utilization of VCT is low in
Nepal. There are various barriers and challenges for VCT services in Nepal. it is important to
understand the barriers and challenges that Nepal is facing in the provision and utilization of
these services. In order to increase the utilization and effectiveness of the VCT services,
collective action from Government, private, NGO/INGOS, and community should be
established.

12. 9
6. Recommendations
The government could intervene in a number of areas such as
 The integration of VCT services with sexual health and primary health care offers the
possibility of more referrals and easier access to services for people with HIV.
 staffing recruitment, retention and training
 Better collaboration between government, service providers, and NGOs.
 Identification of alternative strategies for the prevention and management of HIV/AIDS
apart from the VCT services,
 VCT services access, sustainability and stigma and discrimination in Nepali society.
Cooperation between governments, private, NGO, and community service provider’s needs to be
established and improved urgently to address the Public health Burden of HIV/AIDS and its
consequences.
6.The Nepal HIV Investment Plan 2014-2016, October 2013
7.Mahato et al. VCT services and HIV/AIDS prevention and management in Nepal, South East Asia Journal Of Public
Health,ISSN: 2220-9476

13. 10
7. REFERENCES
1. Voluntary Counseling and Testing Rigorous Evidence – Usable Results, Research for
Prevention, June, 2012
2. NATIONAL GUIDELINES FOR VOLUNTARY HIV/AIDS COUNSELING AND
TESTING, Ministry of Health National Center for AIDS and STD Control ,Teku,
Kathmandu, Nepal, July 2003
3. HIV/AIDS in Nepal,WORLD BANK(August 2008)www.worldbank.org/np
4. NATIONAL HIV/AIDS STRATEGY 2011-2016, Government of Nepal,Ministry of
Health and Population, National Centre for AIDS and STD Control,Teku,
Kathmandu,November 2011
5. Nepal Health Sector Programme –II ,2010-2015, Government of Nepal, Ministry of
Health and Population.
6. The Nepal HIV Investment Plan 2014-2016, October 2013
7. Mahato et al. VCT services and HIV/AIDS prevention and management in Nepal, South
East Asia Journal Of Public Health,ISSN: 2220-9476
[Available at www.slideshare.net/sagunpaudel]
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