We have recently completed a project in partnership with Liverpool John Moores University to conduct research on Socio Cultural Impact of HIV/AIDS on Individuals and Households in Nepal. The project is intended to improve welfare of HIV-infected individuals and their families through policy recommendations based on research findings/evidences. For this, the project will get depth insights of the socio-economic burden of HIV/AIDS on affected individuals and households. This project was started from April 2016 for one-year period.
The conclusion of the project is as follow:
People living with HIV (PLHIV) are still facing a number of social and economic problems in Nepal. Although the treatment facilities in Nepal is said ‘free’, these are not completely free. The PLHIV still need to pay themselves for diagnostic tests like – MRI and CT scan and medicines for many opportunistic infections. Some NGOs/INGOs are supporting the poor PLHIV for their diagnostic and treatment services. However, these supports are not available to every poor PLHIV. Costs of transportation due to remoteness was also found a reason for higher treatment costs. Therefore, PLHIV are experiencing economic burden for their treatment. Most of the PLHIV are already poor and middle-class PLHIV also sink below poverty due to loss of productivity, treatment costs and other reasons. There are no proper policy in place to improve economic status of PLHIV and their families as all the organisations working in the field of HIV/AIDS (governmental and non-governmental organisations) mainly focused on prevention and treatment of HIV/AIDS. There are more problems in remote rural areas than cities and more problems faced by females than males. There is still existence of a considerable amount of stigma and discrimination towards PLHIV by their families, societies, teachers, friends, employers and health workers although a number of awareness programmes conducted by different organisations. Self-stigma is also prevalent among PLHIV which hinders to use treatment facilities close to their home, hinders to stay and work in their own village, and hinders to participate in different social gatherings. There was a lack of implementation of discriminatory law from the government side. The coverage and content of awareness programmes were found incomplete and insufficient. There was lack of policy regarding the discrimination of children at school either by teachers, or fellow students or by school administration. There was a lack of policy at the work place regarding the discrimination to PLHIV. Although trainings are provided to health workers, PLHIV are still facing discrimination from the health workers in government or private hospitals or clinics. It was found that PLHIV compelled to pay double charge for their treatment, mostly in private hospitals and in some government hospital too for operation (surgery) cases. The monitoring of projects and programmes conducted by government and non-government organisations were less effective. Availability of limited resources for HIV/AIDS is also hindering availability of services to PLHIV.
Based on the research findings, following recommendations are made to the governmental and non-governmental organisations working for PLHIV in Nepal to improve their socioeconomic status:
- There is an extreme lack of economic support programmes to improve economic status of PLHIV and their families so that they can live a decent life. Therefore, government should prepare a policy to improve economic status of PLHIV and their families. Criteria should be made based on poverty status of PLHIV while selecting for the supports;
- Skill development trainings along with free or low interest loan to the PLHIV or their family members should be provided to utilize their skills to look after themselves and their families;
- Need, interest and feasibility study should be conducted before starting any programmes or activities for their success;
- Microfinance model of economic programme in the village where PLHIV and other people with similar problems (chronic illness) should be implemented by providing support as a seed capital for investment;
- NGOs or other community-based organisations (CBOs) should be supported by government and donors to increase employment generation to the PLHIV or their family members;
- Social support package should be provided to those PLHIV who don’t have anyone to look after and don’t have any property;
- Biometric card system should be implemented so that PLHIV can get necessary services from anywhere in Nepal, which also helps to monitor the services obtained by them;
- Although there are 65 treatment centers in Nepal, there is a lack of comprehensive treatment facilities available to PLHIV in most of the treatment centres. Therefore, there should be decentralized comprehensive treatment services provided to PLHIV in each treatment center;
- Treatment services should be integrated with other social and economic supports to PLHIV as a cross-cutting issue to improve PLHIV’s socio-economic status;
- ‘HIV Bill’ (which is already prepared) should be forwarded for approval so that every person related to HIV/AIDS could manage to protect themselves, get support if necessary and feel safe physically, socially and economically;
- Environment should be made in villages to retain or return the PLHIV to their own village so that they would not need to live in a vulnerable condition in a new place where they have very limited options livelihood;
- Stigma and discrimination has been reduced in the recent years. However, still it is in considerable amount in villages. Therefore, awareness raising activities and programmes should be focused in villages by covering every issues like- how it transmits, how it doesn’t, how to treat (behave with) PLHIV, what is their rights, etc.
- Current non-discriminatory policy should be fully implemented by government;
- There should be separate policy regarding ‘work place and HIV’ to protect PLHIV who are infected with HIV/AIDS;
- There should be separate policy related to ‘school and HIV-affected children’ to reduce education related discrimination to HIV-affected children;
- Ethics in hospitals and health care facilities should be updated and implemented so that treatment costs and discrimination in such places could be reduced;
- Government should build a hospice to keep those PLHIV who are abandoned or who don’t have any family members to look after because they are the most vulnerable people;
- Property rights of women’s should be reviewed so that they should not be deprived of getting share of their property either from their husband or from their family;
- PLHIV’s rights should be clearly written in policy so that they can claim back if deprived of those;
- ‘HIV/AIDS, PLHIV and their rights’ should be included in school curriculum at a certain class so that future generation will be more aware about HIV/AIDS and will not discriminate PLHIV;
- Supportive programmes (as mentioned above) should be implemented to improve economic status of PLHIV to uplift their status in their society so that discrimination towards them is reduced;
Finally, collaboration and cooperation among all stakeholders working in the field of HIV/AIDS are necessary to improve socioeconomic status of PLHIV and their families, to reduce new HIV-infection, to improve care and treatment of PLHIV, to extend life of PLHIV, and to improve their quality of life. Therefore, government of Nepal should play a leading role to fight against HIV, HIV-generated social and economic problems, should lobby with donor agencies for more budget and should increase budget on HIV/AIDS by herself to resolve social and economic problems faced by PLHIV.
For further details of this project, please contact us at firstname.lastname@example.org