Injecting Drug Use and Drug Led HIV in Nepal Bijay Pandey Recovering Nepal

Prevalence Drug Users: 70,000 IDU: 25,000-30,000 HIV prevalence among IDUs: 40%- 70%

Coverage Coverage 8.6% (Nepal Country Report 2005/06) Drug treatment and rehabilitation services: 30 to 35 centers Harm reduction interventions: NSP (supported by DFID, Global Fund, UNODC), Buprenorphine substitution Program Strategy: Single sectored involvement- primarily NGOs Delivery Strategy: community outreach, NSP, DIC centers, Primary Health Care, BCI, STI, VCT etc Pilot Buprenorphine with MOHA/MOH/Youth Vision

Major challenges in scaling-up? Political Instability Lack of national coordination committee Policy and legal barriers No strategic plan Health infrastructure: Service, Attitude of service providers Technical capacity: Long term Planning Resources (Human, Money, Materials): Donor dependent Others: Social Perception, Stigma and discrimination

Vision for future Start & expand OS to cover 15% by by 2008, by end of 2011 achieve 75% coverage NSP: to cover 15% by by 2008, by end of 2011 achieve 75% coverage Scale-up Rehabilitation services for male/female IDUs Provision of condoms/ STI services for drug users & sexual partners Provision of ARV to Drug users

By Whom Multi-sector approach Government Institutions, hospitals, medical colleges NGOs Private sector Need to enhance partnerships and cooperation

Summary 40%-70% HIV prevalence among IDUs Low Coverage Revisiting policies & structures Costed Workplans Improved advocacy Training M&E

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