National HIV/AIDS Strategy: Focus On Multi-sectoral Approach
The Rising Nepal: Editorial
OVER the years, HIV/AIDS has been increasingly considered a development problem in most of the developing countries. Like many other countries, Nepal is also making several attempts to address the diverse issues of HIV/AIDS in its national programme. Mainly, the national strategy is focusing on prevention and care efforts. However, prevention is regarded as the mainstay for an effective national response.
Strategy
If we review the national HIV/AIDS strategy (2002-2006), it has clearly outlined the needs of community-based interventions in prevention, and care and support to appropriately address wider socio-economic consequences of HIV/AIDS on individuals, families and communities.
Undoubtedly, the overall purpose of the strategy is to create an effective national response to HIV/AIDS with the support from government, non-government and private sectors. Public-private partnership and decentralization in health service delivery are the emerging strategies that can effectively become the local response.
More importantly, the increasing role of non-governmental organisations in planning, implementation, and monitoring and evaluation of community-based HIV/AIDS programmes has synergic effects in yielding the desired results. There are very good evidences of programmatic success in reducing the vulnerability of HIV/AIDS among the high-risk populations and communities.
Based on the solid experiences in the last five years, the strategy has to be comprehensively reviewed and analysed in terms of real progress in the fight against the epidemic, and the programmatic and institutional obstacles experienced during the implementation of the strategy.
With the national HIV/AIDS strategy being formulated for the next five years through a participatory approach, the programmatic issues of HIV/AIDS plans and strategies need to be thoroughly reviewed with a diverse set of stakeholders. It is extremely important to ensure the participation of people living with HIV/AIDS and the affected families so that their voices and concerns can be adequately addressed in the strategic plans and actions in the future.
The guiding principles of the strategy should largely include multi-sectoral engagement, broader political commitment, participation of civil society organisations, reducing stigma and discrimination, meaningful participation of people living with HIV/AIDS and the affected families and communities.
Moreover, prevention is the key to fighting HIV/AIDS. Experience has shown that care and support activities are still inadequate in the communities, and there is a lack of supportive environment for the vulnerable families in accessing social and health services.
Health is a fundamental human right. Therefore, the new strategy must address the human rights issues around HIV/AIDS. There is a need for strong human rights approaches, which appropriately address access to health care, information and gender equity. Such approaches are effective in reducing the vulnerability of HIV/AIDS among populations at high risk.
Reviewing the dynamics of the epidemic, the most vulnerable groups are the sex workers and their clients, injecting drug users and mobile populations. In this context, behaviour change interventions such as information, education and communication services are extremely important to empower the people.
The rapid spread of HIV/AIDS is not only a health problem, it is rather a social problem, which has close links with poverty, illiteracy, unemployment and poor access to health services. Therefore, increasing problems of HIV/AIDS will have adverse impacts on socio-economic development.
Despite the wide range of awareness raising activities about HIV/AIDS in the country, stigma is one of the most traumatic and important factors impacting the quality of life of the people living with HIV/AIDS. Consequently, this has enormous impacts on counselling, social support and improved access to health care.
In addition to this, sigma exists in workplaces across the globe. There are several evidences of serious workplace discrimination and violation of people's rights. Therefore, HIV-related stigma and discrimination must be the agenda of urgent action in the fight against the epidemic.
There are increasing demands of community and home-based care which highlights care and support as a strong mechanism for prevention and control of HIV/AIDS. It is encouraging to note that a few non-governmental organisations have already started to work in the area of home-based care in the country.
However, capacity building of the government and non-governmental organisations to plan and implement community and home-based care programmes is extremely crucial. But such efforts are still minimal.
Best practices can be learned from other countries such as Thailand where condom promotion has been very effective to reduce the burden of HIV/AIDS. Side by side, community-based care and support is gradually progressing with tangible results.
Development partners
In recent years, support from external development partners to plan, implement and evaluate the national HIV/AIDS program has been encouraging in terms of achieving success towards joint action against the epidemic. This has also been helpful in strengthening the institutional capacity of the National Centre for AIDS and STD Control in the country.
However, much more still needs to be done in the area of capacity building, effective coordination, research, and monitoring and evaluation of the national HIV/AIDS programme. Moreover, building linkages with the private sector and NGOs, networks of people living with HIV/AIDS, timely sharing of plans and results, and harmonising the multi-sectoral efforts in prevention and control are instrumental in implementing the strategy and achieving the desired success.
(The writer is with the Faculty of Public Health, Mahidol University, Bangkok)
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