Addressing the needs of people living with HIV and other key populations
in the 14 hardest earthquake affected districts of Nepal
Kathmandu, 28 May 2015. TO BE UPDATED
Brief on the status of the HIV-related situation and services before the 25th April 2015 earthquake, and following aftershocks, in Nepal
It is estimated that there are currently around 40,000 people living with HIV in Nepal. New HIV infections have been declining since 2005. Yet, a higher prevalence
of HIV remains concentrated among key populations that are sex workers (SW); people who inject drugs (PWID); gay men and other men who have sex with men
(MSM), and transgender people. Seasonal male labour migrants going to high burden states of India are also at a higher risk of HIV, particularly those who migrate
to cities like Mumbai and Delhi. As of July 2014, 25,222 HIV positive cases have been reported by the National Centre for AIDS and STD Control, NCASC, of the
Ministry of Health and Population, out of which 63% were male and 37% female. Furthermore, 7% of total reported cases were children under the age of 15.
The Government of Nepal has started anti-retroviral treatment of PLHIV from 2004. As of December 2014, there are 10,407 PLHIV on anti-retroviral therapy (ART);
5,030 of these are male, 4,558 are female, 36 are transgender people, and 783 are children under the age of 15. HIV-related services such as HIV testing, antiretroviral treatment (ART), elimination of vertical transmission (eVT), opportunistic infections (OIs) control and treatment, including for TB, Sexually transmitted
infections (STI); post-exposure prophylaxis (PEP) services are being provided by both the government and the communities. Most of the treatment related services
are led by government, while the majority of prevention services are offered by community groups and non-governmental organizations.
Situation after the earthquake of 25th May 2015 and the aftershocks
There are an estimated 78,000 key affected people (PLHIV, MSM, TG, SW and PWID) residing in the 14 hardest hit districts in Nepal. Out of the 53 ART sites in the
country, 16 are situated within these 14 districts. As of December 2014, there are 2,940 reported PLHIV (1,854 Male, 1,079 female and 7 transgender people) in
these affected districts, of which 2,463 are receiving ART services from the 16 ART sites. After the earthquake, as per emergency relief response, ART has been
ensured for a period of 2 months through the joint efforts of communities, government and partners. However, other essentials including shelter, food, nutrition,
livelihood support, safe drinking water and hygiene also need to be ensured. There are 223 children, 113 male and 110 female, infected with HIV, residing in these
districts, who are getting cash support though a Global Fund grant.
There are reports that 231 female sex workers with 146 children are living under tents due to partial damage of rented house and many have left Kathmandu, some
due to their fear of aftershocks and rumours of new earthquakes; while for many the houses they were renting are damaged; rent increased beyond their means,
and many have left because their working areas have been devastated, some even have departed to India in search of their livelihood.
From 7,000 prisoners, in 18 prisons in these 14 hard hit districts, 60 are living with HIV and 600 are from other key populations, mainly from a drug using background.
All 18 prisons are badly affected by the earthquake and the aftershocks.
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Status of casualties, damages, status of services, and other earthquake effects, as reported from the networks of PLHIV and other key populations, the
Government of Nepal, OCHA and other partners:
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19 Casualties reported: Affiliated with Blue Diamond Society: 2 community members and 1 staff member and 16 prisoners.
96 Injuries reported: 80 prisoners, 14 PLHIV, and 2 MSM
343 Houses collapsed reported: PLHIV 278 of which 72 are women, 65 of MSM and TG) –estimates are higher at approximately 450.
Service sites: Hospitals with ART in Nuwakot and Sindhupalchowk destroyed, Community care centres in Nuwakot and Sindhupalchowk destroyed; 1
shelter home of children affected by AIDS, and 3 buildings owned by Nav Kiran Plus damaged, 1 office building with care and support site of BDS partially
damaged and 1 satellite Drop-in Center (DIC) operating from rented house is not functioning at present due to the cracks in the rented house.
Female sex workers are reported to have moved from affected districts mostly from Kathmandu, mainly to the Terai districts and India. Unsure if they
access services. Risk of unprotected sex increases.
TG, WLHIV and sex workers report difficulty in renting houses and 4 times increase in the rent by the house owners.
Loss of livelihood for sex workers.
With the Collaborative efforts from Government, implementing partners and CSOs:
 ART services and drugs supply ensured for two months even in the hardest hit districts including Nuwakot and Sindhupalchowk, where the hospitals are
destroyed. Services are provided from temporary medical tents.
 Community care centres in Nuwakot and Sindhupalchowk operational under tents, with the support of National Association of People living with HIV and
Save the Children International.
 Children of NKP are living under tents. BDS office and care and support service has been adjusted to the safe place in the building avoiding the cracked
areas. Satellite DIC service will be resumed after finding a safer place/house to move in.
 Continuations of HIV prevention services including harm reduction and community out-reach have been secured by the two key implementing agencies
Save the Children and FHI360. Beneficiaries accessing these services are likely to be reduced, especially in the monsoon months.
 PLHIV and other KP networks are continuously doing follow up in the districts through their support groups and collecting data to update the information
for planning purposes.
 PLHIV and other KP networks are linking their members with services and commodities, such as dignity kits, tents, foods, blankets, kitchen utensils etc.
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Intermediate needs, with their indicative cost, as highlighted by PLHIV and KP networks, for uninterrupted treatment and care services, with the basic
requirements to survive, for people living with HIV and other key populations:
Note that these needs have been identified through consultations, and are not meant to be additional to the resources that have been and will be mobilised for
relief and recovery. This appeal is meant to, specifically, ensure that the affected HIV-related needs are addressed under the flash appeal, the PDNA and other
processes for relief and recovery in the 14 most-affected districts in Nepal; including the emergency funds made available by the Global Fund through Save the
Children.
Health
 Database of people on ART before and after the earthquake
 Follow up-support to retain people on treatment by community in-reach
 Regularly updated data base of the casualties, injuries and damage caused among the PLHIV and other KP, including the data on women-headed and child
headed households.
 Maintenance of community care centres and community in-reach programmes
 Maintenance of ARV centres and central warehouse and 2 VCT centres
 Uninterrupted supply of drugs, reagents and test kits: ARV, medical equipment, including for eVT, HTC, OI, STI, CD4 counting; other HTC and harm
reduction services including needles and syringes, female condoms; post exposure prophylaxis (PEP) for 4 months, to cover the monsoon season
 Continuation of services in the ART/eVT centres/hospitals, in communities, home-based care house visits, and in the prisons;
 Well-equipped and mobilised community support groups and networks for in-reach in the 14 districts, to facilitate affected PLHIV and other KP accessing
basic services such as food, shelter, nutrition, protection, livelihood, that are available at the local level, for their community members, including
participating in the “Communicating with Affected Communities” working group
 Logistic support (transportation and communication cost, etc.) and additional, temporary service delivery and ART dispensing sites to facilitate accessing
services and drugs by PLHIV and other KP, where the regular service centres are non-functional or at large distances from the community
 Increase mobile drop-in centres (DIC) and hotspots for PWID and sex workers in Kathmandu Valley
Emergency Shelter
 Temporary shelters, tents/zinc plates; raincoats; matrasses; blankets; bed nets for 450 families of PHLIV and other KP
 Solar lanterns for 450 families of PLHIV and other KP
 Repairing of NKP Child care home and Blue Diamond Society head office;
Food
Food for 450 families of PLHIV and other KP, for 4 months.
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Nutrition
Nutritional support, for 4 months, to PLHIV who are on ARV and children living with and affected by HIV, who have no house, and loss of income in 14 districts
possibly provided through Community Care Centres (CCC) and Community and Home based Care (CHBC).
Protection
 Ensuring that basic needs of food, shelter, nutrition, education, etc., of children living with and affected by HIV are met along with their treatment.
 Livelihood support to PLHIV and other KP – immediately for those whose houses have been damaged, have lost their regular income; linking of PLHIV and
other KP with food for work/cash for work programmes, building community skills such as masonry, carpentry, rubble removal, etc.
 Optimising existing human capacity for psychosocial support to the PLHIV and other KP
 Linking women living with HIV, female sex workers, females who inject drugs and transgender females to the GBV programmes at the local level and the
cash transfer programmes
 Advocating for cash transfers to the women living with HIV and Children Affected by AIDS (CABA) through the national social protection mechanism.
 Dignity kits to 500 WLHIV, TG women, Female who injects drugs and Female Sex Workers;
 Early Childhood Development (ECD) kits and recreational kits to 100 CABA;
 Family kits for 450 families whose houses have been destroyed;
Education
 Educational support to 223 CABA, such as uniforms, books;
 (Re)-establishment of community radio programme(s) for the dissemination of information on relief and recovery support to PLHIV and other KP, safer
sex, harm reduction, human rights messages, etc.
Wash
 Sanitation and hygiene in community care centres in 14 districts for 4 months.
 Safe drinking water, including water purification tablets to the PLHIV and other KP living in temporary shelters;
 Biodegradable trash bags for 450 families;
 Latrines for 450 families in 14 districts
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