The aim of this review was to conduct a meta-analysis to assess the effectiveness of behavioural interventions to reduce HIV-related risk behaviours among key populations: people who inject drugs, female sex workers, men who have sex with men and transgender in Nepal over the last two decades. Using four electronic databases, we performed a systematic search of the literature on HIV interventions implemented in Nepal and published from January 2001 to December 2016. In addition, grey literature was also scrutinised for potential articles. The search focussed specifically on behavioural interventions (peer education and HIV testing services) targeted for key populations. Random-effects models were used to calculate the pooled odds ratio for dichotomous outcomes (condom use in last sex or unsafe injection practices), pooled HIV prevalence and subgroup analyses by age groups and epidemic zones in Nepal. Forty-three studies with 15,642 participants were included (people who inject drugs: 7105; men who have sex with men and transgender: 2637; female sex workers: 5900). Pooled prevalence showed a higher occurrence of HIV among people who inject drugs (12%) followed by men who have sex with men/transgender (5%) and female sex workers (2%) respectively. There was a significant increase in the odds of condom use among female sex workers, men who have sex with men and transgender who received peer education interventions in both informal and formal setting compared to those who did not. Similarly, the odds of condom use among female sex workers, men who have sex with men and transgender improved significantly among those who received HIV counselling and testing services as compared to those who did not use such services. Subgroup analyses also verified the effectiveness of these interventions for both young and adult key populations and across all three epidemic zones. However, none of the included interventions were found to be effective for reducing unsafe injection practices among people who inject drugs. HIV prevention interventions in Nepal have effectively reduced risky behaviours among female sex workers, men who have sex with men and transgender over the last two decades but not among people who inject drugs. This calls for continued implementation of existing efforts as well as for new interventions adapted to the needs of people who inject drugs.The world has committed to ending the HIV epidemic by 2030. Accomplishments such as a decrease in AIDS-related mortality by 45% since its peak in 2005 and increase in people receiving antiretroviral therapy (ART) by one-third in just two years have inspired global confidence that this target is achievable 1 . Several (the capital city of Nepal), 11 were conducted in the Pokhara Valley (one of the major tourist destinations of Nepal), 11 were conducted in Terai highway districts and 5 were conducted in west to far west Terai highway districts. Amongst the included studies, 42 were nationally representative surveys using a cross-sectional design, and one was a cross-section...
BACKGROUND Most low-income settings experiencing concentrated HIV epidemic lack information about key populations (KPs), including people who inject drugs (PWID), men who have sex with men (MSM), male sex workers (MSW), transgender (TG) and female sex workers (FSW) because they are hidden and marginalised in society and frequently undocumented. Out of several approaches to size estimation, mapping and size estimation is particularly useful when local estimates are needed for planning and monitoring of prevention programmes. OBJECTIVE To locate hot spots related to sex work, cruising spots, and injecting drug use, and to estimate the number of sex workers, PWID, MSM, MSW and TG at the district level (adjusting for double-counting, frequency of visiting spots, and low visibility), and at the national level using extrapolation algorithms . METHODS The mapping exercise among MSM, MSW, TG, PWID and FSW was carried out in 44 districts of Nepal between July and November 2016 by collecting relevant information directly from hotspots where KPs members congregate. Districts to be mapped were selected purposively, to both provide data to local programmes in areas with high concentrations of KPs, and inform extrapolation to unmapped districts as part of national estimation procedures. RESULTS Altogether 11056 KPs and 10977 non- KPs informants were interviewed from across the 44 mapped districts to identify the hotspots. District level adjustment factors (mobility adjustment, frequency adjustment and invisibility adjustment) were sequentially applied. The final estimates used all three adjustment factors. We found that the national estimate of FSW in Nepal ranges between 43,829 to 54,207. The national estimate of MSM/TG lies between 88,009 and 112,150, of which a minimum of 18,704 and maximum 24,216 are TG, and a minimum 53,373 and maximum 67,292 are MSM. And finally the national estimate of PWID ranges between 27,248 to 34,487. Among them, a minimum 24,572 and a maximum 30,561 are men, and minimum 2,676 and maximum 3,926 are women. CONCLUSIONS The size of KPs provided through mapping exercise can be utilised for setting benchmarks and measuring program coverage. The major limitation is that mapping may count the majority of KPs who visit hotspots on a very regular basis, while missing the subset who are not “hotspot based” or who visit hotspots less frequently. However, the strength of mapping is that it reflects hands-on knowledge and experience of people who have access to communities that outside researchers may not have, thereby accounting for people who might otherwise be invisible.
Introduction: HIV epidemic has become the major problems among people with injecting drugs (PWIDs) in Nepal. The study was carried out to assess the prevalence of sexually transmitted diseases including HIV/AIDS among PWIDs. Methods: This descriptive cross-sectional survey was conducted in male PWIDs of age more than 16 years residing in Western to Far West Terai Districts of Nepal who had been injecting drugs for three months prior to the date of the survey" March-April 2017. A two-stage cluster sampling was used to recruit 300 PWIDs from seven Districts. HIV was diagnosed by using standard techniques approved by WHO. Similarly, Syphilis was tested using the "Rapid Plasma Reagin" and Hepatitis C as well as Hepatitis B was tested by using rapid test kits. Demographic data were collected by using structured questionnaire and the data obtained were entered in MS excel was transformed into the SPSS version 21 for the descriptive as well as inferential analysis. Results: Prevalence of HIV, HBV, HCV, and STI among PWIDs were 5.3%, 2.7%, 23.7%, and 2.0% respectively. Majority of the PWIDs were literate (93.7%) and their age was below 35 years. Among the married PWIDs, 32.4% had got married before the age of 19. Similarly, 53.7% of them were living with their female sexual partner, and 95.0% were living with their wife. Ninety six percent of the respondents reported to be ever involved in sexual activity, 77.1% of them initiated the sexual intercourse before the age of 20 years and 41.9% of them had more than one female sexual partner. The survey indicated that 36.3% had been injecting drugs for more than 5 years while 27.7% had been injecting for last 2-5 years and 55.0% of the respondents had injected for the first time at the age of 16-24 years. About one in 10 respondents had started injecting drugs recently. Conclusion: There is high prevalence of HIV, HCV, HBV and active syphilis among the PWIDs. Co-infection of HIV and HCV as well as Hepatitis B and C were also prevalent among PWIDs. Comprehensive education and awareness program is required to reduce the prevalence.
Background HIV is a major public health issue around the world, especially in developing countries.Although the overall prevalence of HIV in Nepal is relatively low and the country itself is considered low risk, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male injection drug users (IDUs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledgebased risk factors need to be assessed. MethodsThe study used a series of 7 cross-sectional survey datasets, collected between 2003 and 2017 (N=2,235) to investigate trends in HIV prevalence among male IDUs by key socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV in the Pokhara valley, Nepal.Results A lower risk of HIV was associated with younger age (≤24 years compared to >24 years, OR = 0.17, 95% CI = 0.10, 0.31), not being married (OR = 0.51, 95% CI = 0.33, 0.80) and shorter duration of drug use (≤4 years compared to >4 years, OR = 0.16, 95% CI = 0.09, 0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75, 4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64, 4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20, 4.11).Conclusion Although knowledge of HIV is high among male IDUs, the prevalence of individuals who possess comprehensive knowledge and the number of individuals who have received treatment for drug addiction has decreased. This may indicate that addiction treatment and HIV education programs need to be strengthened.
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