Ensuring Dignity, Equality, and Safety: A Rights-Based Approach to HIV Care

Every person deserves dignity, respect, and equitable access to healthcare, including individuals living with HIV. However, stigma, discrimination, and exclusion, particularly in education, employment, and healthcare continue to affect their lives, especially in marginalized communities.

Addressing these issues requires the enforcement of rights-based policies and widespread awareness campaigns. Nepal has made significant strides in combating HIV/AIDS, aligning its efforts with international commitments such as the Sustainable Development Goals (SDG 3.3) and the UNAIDS 95-95-95 targets, which focus on diagnosis, treatment, and viral suppression.

The National HIV Strategic Plan prioritizes free Antiretroviral Therapy (ART) and prevention services, with a focus on high-risk populations, including migrant workers, people who inject drugs, sex workers, etc. The country’s legal framework supports these efforts. The Constitution of Nepal guarantees free essential healthcare for HIV treatment (Article 35), prohibits discrimination against individuals with HIV (Article 18), and ensures social security support (Article 43).

The National AIDS Policy emphasizes awareness, harm reduction, and stigma-free health services, while HIV testing and counseling guidelines promote multiple testing approaches, including hospital-based, community-based, mobile, and self-testing options to protect confidentiality.

The HIV/AIDS Prevention and Treatment Act reinforces anti-discrimination measures in workplaces, schools, and healthcare settings while safeguarding personal medical information. Harm reduction programs, such as needle exchange initiatives and alternative rehabilitation for drug users, further support public health efforts.

Despite these advancements, HIV prevalence remains concentrated within key populations. Approximately 30,500 people live with HIV, with a national adult prevalence rate of 0.14%. Urban centers and border regions see higher infection rates due to migration and socio-economic factors. Free ART services are available nationwide, supplemented by harm reduction programs, condom promotion, and mother-to-child transmission prevention initiatives.

However, specific populations remain at higher risk, including people who inject drugs (2.8% in Kathmandu), men who have sex with men (4.9% in Kathmandu & Pokhara), transgender individuals (8.5% in Kathmandu, 11.5% in Terai), and sex workers (0.3% in Pokhara, 0.7% in Terai, 2.2% in Kathmandu). HIV spreads primarily through unprotected sexual contact, sharing needles, mother-to-child transmission, blood transfusions, and occupational exposure, etc.

Preventive measures such as contraceptives use, avoiding needle sharing, and providing ART to HIV-positive mothers significantly reduce transmission risks. Regular testing and early diagnosis are crucial for reducing new infections. However, misinformation continues to drive stigma and myths, such as, HIV being transmitted through casual contact, insect bites, shared utensils, etc. persist. Public awareness campaigns must focus on debunking these misconceptions to foster a well-informed society.

Despite many efforts, several challenges are hindering progress in responding to HIV/AIDS. Stigma and discrimination remain significant barriers, discouraging individuals from seeking testing and treatment. Gender-based discrimination further restricts healthcare access, particularly for women and marginalized groups.

Limited healthcare access is another critical concern with ART services being inadequate in remote areas and a shortage of skilled healthcare workers affecting service delivery ocio-economic factors, particularly among migrant workers, exacerbate HIV vulnerability due to a lack of awareness and access to healthcare abroad. Financial constraints also threaten the sustainability of HIV programs.

Data gaps and weak surveillance further are hindering effective intervention. Limited realtime data availability is also affecting monitoring and planning, and the integration of HIV-related information into Nepal’s national health system remains insufficient. Although Nepal has a strong policy framework, implementation gaps continue to hinder efforts to achieve the 2030 goal of ending HIV/AIDS as a public health threat. The integration of HIV services into primary healthcare remains insufficient, limiting treatment access for those in need.

Community engagement in program design and execution is also inadequate, reducing intervention effectiveness. Furthermore, limited funding threatens the long-term sustainability of Nepal’s HIV response, making increased investment critical. Ensuring human dignity and safeguarding rights are essential in Nepal’s HIV response, particularly for vulnerable children. Adolescent girls, LGBTIQ+ individuals, sex workers, and people who inject drugs face increased risks of exploitation, abuse, and neglect.

To protect them, healthcare settings must uphold confidentiality to prevent involuntary disclosure and discrimination. Education and employment sectors must adopt non-discriminatory practices to ensure equal opportunities. Community-led initiatives should provide protection from coercion and violence, while accessible and safe reporting mechanisms must be established for individuals facing exclusion or mistreatment. To enhance HIV prevention and care, Nepal should adopt a multi-pronged approach by expanding prevention and awareness.

Targeted awareness campaigns, particularly in high-risk communities, are necessary. Integrating HIV education into school’s curricular and extracurricular activities along with promoting youth engagement plays a crucial role in achieving targets. Through youth engagement and media advocacy, misinformation and stigma can be countered. Access to treatment and care, expanding ART services in rural areas, strengthening community-based support systems and increasing training for healthcare providers & school- teachers are key ingredients for social justice to HIV infected individuals. Reducing deep rooted stigma and discrimination is not easy.

For that, system strengthening by enforcing anti-discrimination laws in workplaces, schools, and healthcare settings are essential. Mass media and public campaigns can promote positive messaging. Peer-led interventions’ support foster inclusion, equity, dignity, equality and safety. To mitigate the data gaps, HIV surveillance should be improved along with improving multisectoral coordination for long term investment and sustainability.

HIV services need to expand in healthcare centers, particularly in underserved areas. By utilizing digital health tools, HIV individuals can be tracked for service delivery. Additionally, regular psychosocial counseling is necessary for both HIV infected and affected people for holistic care and support. In a nutshell, Nepal has made commendable progress in addressing HIV/AIDS, yet significant challenges remain.

A comprehensive strategy centered on policy reform, community engagement, and sustainable investment is essential for achieving national and global HIV targets. Strengthening prevention, treatment, and support mechanisms will be critical to ending the epidemic and ensuring dignity, respect, equity, safety and equal opportunities for all individuals including living with HIV.