National NGOs Network Group Against AIDS – Nepal

NANGAN

“The oldest NGOs networking group against AIDS in Nepal”

E-bulletin: Issue No. 1, March 2006
In this issue:

NANGAN proudly presents the first issue of the E-bulletin. This monthly E-bulletin will be distributed to individuals and organizations that are directly or indirectly the stakeholders of HIV/AIDS.  NANGAN will publish news, investigation reports, features and press releases related to HIV/AIDS in this bulletin. 

The first bulletin focuses on the issues relating to prevention.  Our next edition will look at issues relating to stigma and discrimination.  If you have a story to tell or any information that we can share with our members relating to stigma and discrimination please send us your input by April 5th.

We encourage you to send your comments regarding this bulletin to nangan@wlink.com.np.

Welcome note from National NGOs Network Group Against AIDS - Nepal (NANGAN)

We, the National NGOs Network Group Against AIDS-Nepal (NANGAN), are an autonomous, non-political, non-profit making network organization working on HIV/AIDS in Nepal.  We focus on lobbying among our members, which has increased its enrolment every year.

Our GOAL is to develop and strengthen the capacity of member organizations through collaborative networking, advocacy and information dissemination on HIV/AIDS. 

Our objectives are to coordinate National level I/NGOs working for STIs, HIV/AIDS prevention, control and care; organize periodic networking meetings among member NGOs to assure proper information dissemination and organize regular workshops, seminars, training and interactions for our stakeholders on HIV/AIDS/STIs focusing on behaviour change communication intervention

- On our members  behalf we  have also been active in the following activities:

- Information sharing about HIV/ AIDS and its related issues to the member organizations though newsletter, e-bulletin and electronic media

- Lobbying, advocating, linkage and coordination with government agencies and donor organizations for appropriate resource mobilization

- Organized regional level networking workshops for better coordination among the member organizations and stakeholders within the regions and districts

- Support for UNGASS national report preparation

- Coordinate to organize national events such as National Condom & World AIDS Day 

- orking to reduce stigma and discrimination to people living with HIV/AIDS through member organizations

To know more about NANGAN, please visit our web page
– www.nangan.org 

 Worldwide HIV Statistics 2005

www.avert.org/worldstats.htm

Risky behaviour sustains  AIDS epidemics in Asia.

National HIV infection levels in Asia are low compared with some other continents, notably Africa. However, the populations of many Asian nations are so large that even low national HIV prevalence means large numbers of people are living with HIV. Risky behaviour—often more than one form—continues to sustain serious AIDS epidemics in Asia.

At the heart of many of Asia’s epidemics lies the interplay between injecting drug use and unprotected sex, much of it commercial. Yet prevention strategies still rarely reflect the fact that such combinations of risk-taking exist in virtually every country in the region. As a result, many of the epidemics in Asia are in transition—including in those countries where the spread of HIV to date has been contained.
www.avert.org/statindx.htm

Nepal Statistics February 2006

INTENSIFYING PREVENTION: THE ROAD TO UNIVERSAL ACCESS

Today the total number of people living with HIV stands at 40.3 million, double the number (19.9 million) in 1995. Despite progress made in a small but growing number of countries, the AIDS epidemic continues to outstrip global efforts to contain it.

The inescapable fact is that, as more people become infected with HIV, more people will die of AIDS.  The number of people receiving HIV antiretroviral therapy in low and middle income countries has tripled since the end of 2001. Yet, at best, only one in seven in Asia in need of antiretroviral treatment were receiving it in mid-2005. Efforts to rapidly expand and sustain access to antiretroviral treatment and care will be undermined if the spiraling cycle of new HIV infections is not broken.

To get ahead of the epidemic, there is growing recognition that HIV prevention efforts must be scaled up and intensified (UNAIDS, 2005), as part of a comprehensive response that simultaneously expands access to treatment and care.  Only through these fundamental efforts coupled with increased global and national commitment will the world be able to achieve universal access, and truly begin to get ahead of AIDS.

Nepal’s National HIV/AIDS Strategy 2006-2011

A 3-day strategic planning workshop to discuss the development of the National HIV/AIDS Strategy for 2006-2011 took place from March 9-11 at Hotel L’Annapurna under the chairmanship of the Ministry of Health. 
Representatives from all sectors involved in the field of HIV/AIDS participated in the workshop.  The objectives of the workshop were to review the progress of the current National HIV/AIDS Action Plan, identify the capacity building needs of civil society and provide guidance on strategic planning and goal setting. 

The workshop resulted in the identification of task force groups for strategic planning, action planning and monitoring and evaluation.  The task force groups will review all the documents relating to the previous strategy.  A representative of NANGAN has recommended the incorporation of  the issues and gaps, which had not been addressed in the previouse strategy,  relating to street children, sex workers, disabled and other minority groups.

The EDP and donor community declared their commitment to provide their financial and technical support to Nepal's HIV/AIDS Strategy which was very much appreciated by all the participants.

HIV PREVENTION WORKS—BUT NEEDS INTENSIFYING

The challenges are immense. Worldwide, less than 1 in 5 people at risk of becoming infected with HIV has access to basic prevention services (UNAIDS, 2004).  Of people living with HIV only one in ten has been tested and knows that he or she is infected.

There is ample evidence that HIV does yield to determined and concerted intervention. Sustained efforts in diverse settings have helped bring decreases in HIV incidence among men who have sex with men in many Western countries, among young people in Uganda, among sex workers and their clients in Thailand and Cambodia, and among injecting drug users in Spain and Brazil. Now there is new evidence that prevention programs initiated some time ago are currently helping to bring down HIV prevalence in Kenya and Zimbabwe, as well as in urban Haiti. But too often, prevention strategies are lacking sufficiency of scale, intensity and long-term vision. For prevention interventions to give the results necessary to get ahead of the epidemic, projects with short-term horizons must translate into long-term programmatic strategies.

There is no single AIDS epidemic. Even within a country itself, epidemics can be extremely diverse. Therefore prevention strategies need to address the diversity of epidemics and must be evidence informed, through accurate epidemiological and behavioural information.  However, fundamental to all settings are comprehensive prevention strategies that include scale, intensity, consistency and sustainability as core requirements. All strategies must also recognize that HIV prevention and treatment are interlinked and that both should be simultaneously accelerated.

There are other basic approaches that can be applied to all HIV prevention efforts. First is the need to acknowledge that HIV prevention is a classic “public good” intervention that requires national governments to take the lead (including resource allocation) in building a strong response to the epidemic.  Second is the need to ensure that all HIV prevention strategies take into account the growing linkages between AIDS and factors that put people at greater risk of HIV infection, such as poverty, gender inequality, and social marginalization of specific populations.  Equally important is the development and implementation of new technologies—such as microbicides and the improvement of existing products such as the female condom—that will provide additional options for the response and should become part of comprehensive prevention strategies. Longer-term vaccine development is also necessary.
A broad approach across all prevention strategies also requires that stigma and discrimination is addressed, that those most at risk of HIV infection are effectively reached, and that people living with HIV are engaged more fully in the AIDS response.

PREVENTION AND TREATMENT ARE ESSENTIAL PARTNERS

To ensure a comprehensive response to HIV, treatment and prevention efforts should be accelerated simultaneously. Mathematical modeling comparing a range of scenarios shows that in the scenario in which effective prevention and treatment are scaled up jointly, the benefits both in terms of new HIV infections and deaths averted are greatest (Salomon et al., 2005) The conclusions are clear:

In Sub-Saharan Africa, a comprehensive prevention and treatment package would avert 55% of the new infections that otherwise could be expected to occur until 2020. Evidence and experience show that rapidly increasing the availability of antiretroviral therapy leads to greater uptake of HIV testing. Kenya, for example, has seen a dramatic increase in testing and counseling uptake in 2000–2004, while in Brazil uptake increased more than threefold in 2001–2003 (WHO, “3 by 5” Progress Report, June 2005). Availability of treatment and enhanced community outreach can lead to more openness about AIDS, which can help break down stigma and discrimination. A health survey conducted after the introduction of an antiretroviral programme in South Africa, found higher condom use, willingness to join AIDS clubs, and readiness to be tested for HIV than in any of the seven other sites surveyed (WHO, 2003).

But greater treatment access also brings new challenges. There is evidence of increases in unsafe sexual behaviour coinciding with wide-scale antiretroviral access in several high income countries (U.S. Centers for Disease Control and Prevention, 2002; Stolte et al., 2004). There is a need for stronger operational research to improve our understandings of changing prevention needs, challenges and opportunities

Female condoms: Although shown to be effective in prevention of pregnancy and acceptable to users, the female condom has not achieved its full potential in national programmes because of its relatively high cost. A new version of the Reality® female condom is made of synthetic nitrile, which makes it considerably less expensive. The new device has the potential for wider acceptability and utilization. It is hoped that, if high utilization rates of the new device can be achieved, it will make a substantial contribution to prevention of unwanted pregnancy and sexually transmitted infections, including HIV. In addition to the new female condom, trials are also under way to test the effectiveness of diaphragms and other methods of protecting the cervix for HIV/STI prevention. Results are expected in 2006.

Male circumcision: A recent study in South Africa found that circumcised men were at least 60% less likely to become infected than uncircumcised men. These promising results must be confirmed in ongoing studies in Kenya and Uganda before male circumcision can be promoted as a specific HIV prevention tool. If proven effective, male circumcision may help increase available proven options for HIV prevention, but should not cause the abandonment of existing effective strategies such as correct and consistent condom use, behavioural change and voluntary testing and counseling. Male circumcision does not eliminate the risk of HIV for men and the effects of male circumcision on women’s risk of HIV are not known. It also remains to be demonstrated whether and to what degree circumcision could reduce HIV transmission in cultures where it is not currently practiced.

Microbicides: Microbicides offer the best promise of a prevention tool that women can control. They could have a substantial impact on the epidemic. Currently, the HIV microbicide field has four-candidate microbicides entering or in phase III trials, five in phase II, and six in phase I. They include soaps, acid buffering agents, seaweed derivatives and anti-HIV compounds. Modeling indicates that even a 60%-efficacious microbicide could have considerable impact on HIV spread. If used regularly by just 20% of women in countries with substantial epidemics, hundreds of thousands of new infections could be averted over three years (Rockefeller, 2001).

Involvement of people living with HIV in prevention efforts

People living with HIV are some of the greatest champions for HIV prevention. Since the beginning of the epidemic prevention strategies have been more effective when they have meaningfully involved people living with HIV in their design, implementation and evaluation. The principle of the Greater Involvement of People Living with HIV/AIDS (GIPA) in the AIDS effort was formally recognized at the 1994 Paris AIDS Summit, when 42 countries agreed that ensuring their full involvement at national, regional and global levels will stimulate the creation of supportive political, legal and social environments. HIV prevention strategies have, however, often failed to address the distinct prevention needs of people diagnosed with HIV or to build capacity for their meaningful participation. Their involvement has often been relegated to little more than tokenism. An effective response requires that this should change.

The aim of prevention for people living with HIV is to empower them to avoid acquiring new sexually transmitted infections, delay HIV disease progression and avoid passing HIV to others. Prevention counseling strategies increase knowledge of HIV transmission and improve safer sex negotiation skills. Other HIV prevention strategies also include scaling up, focusing and improving services and commodity delivery; services for serodiscordant couples (one partner HIV +ve); protecting human rights; strengthening community capacity for mobilization; and supporting advocacy, policy change and community awareness (International HIV/AIDS Alliance, 2003). These strategies do not stand alone, but work in combination.

Pre-exposure prophylaxis: Pre-exposure prophylaxis (PrEP) to prevent sexual–and possibly parenteral–transmission of HIV holds promise for serodiscordant couples (one partner HIV +ve), sex workers, men who have sex with men and injecting drug users who may be exposed to HIV despite using precautions. Small-to-medium sized phase II trials are under way in Atlanta and San Francisco, with larger phase II/III studies under way or planned in Botswana, Ghana, and possibly Thailand. Some of these studies have been dogged by controversy. The main issues were the adequacy of pre-trial community consultation and informed consent, linkages to HIV treatment programmes for those found to be infected at baseline or in the course of the study, and – in the case of Thailand – the lack of access to sterile needles in a study designed to examine HIV transmission among injecting drug users. Two PrEP studies were cancelled (Cambodia, Nigeria) and another (Cameroon) postponed.

Vaccines: A vaccine to overcome HIV is the most compelling hope. But developing a vaccine remains an enormous challenge for reasons related to inadequate resources, clinical trial and regulatory capacity concerns, intellectual property issues and scientific challenges. There are now 17 vaccine candidates in phase I trials and four vaccines in phase I/II (including the promising Merck adenovirus vector vaccine now in phase IIb, which may stimulate anti-HIV cell-mediated immunity). There is only one in phase III (the NIH/Department of Defense’s ALVAC vCP 1521 canary pox vector/AIDSVAX prime-boost vaccine trial now under way in Thailand). The Global HIV Vaccine Enterprise has rallied scientists, activists, funders and others worldwide around a Strategic Scientific Plan to rapidly advance progress towards effective HIV vaccines, the world’s best long-term hope for bringing the global HIV epidemic under control.

For more information please visit www.avert.org/hivprevention.htm

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