We believe that the end of AIDS is possible if there is more focus on key populations. Our project in Nepal addresses barriers faced by the PWUD community related to their sexual and reproductive health and rights. Driven by community champions, we work to realize that effective NSP policies are in place; an improved legal context exists for PWUD; and that there is increased access to quality, comprehensive and accessible harm reduction services in Kathmandu Valley.
Prejudice, discrimination and a punitive legal context
In Nepal, prejudice and discriminatory attitudes towards key populations hinder access to health services, especially those seeking STI treatment and ART. PWUD continue to face punitive legal environments and human rights abuses, and the right to health for many PWUD is impaired.
Nepal endorsed the national guidelines on Opioid Substitution Therapy in 2014, which paves the way to scale up and support OST programmes for PWUD (including methadone and buprenorphine). There are an estimated 52,174 PWID, with a HIV prevalence of 6.3%. However, these numbers are contested by civil society and there is little data on female PWID available. On average, there are 36 syringes distributed per PWID per year. Condom usage (estimated at 46,50%) and HIV testing (estimated at 21,40%) are low among PWUD. The current OST programme implemented has problems of low uptake and low retention rates. Female drug users are also common and very vulnerable to sexual violence and poverty in a male-dominated culture. Though HIV prevalence among PWID has remarkably decreased, high prevalence of viral hepatitis has been observed among PWID and in particular among those co-infected with HIV.
PWUD claim a right-based HIV and SRHR response
Bridging the Gaps works with a Theory of Change approach. A Theory of Change is a description of a list of events that is expected to lead to a particular desired outcome. It is a visualization how change is believed to happen. In 2016, representatives of the PWUD community developed a specified Theory of Change that consists of short-,medium, and long term outcomes. The Theory of Change describes how we plan to realize the existence of effective NSP policies; an improved legal context exists for PWUD; and that there is increased access to quality, comprehensive and accessible harm reduction services in Kathmandu Valley.
Through innovation and by building on previous work, we will strengthen civil society organisations’ ability to:
1. We facilitate community development
- Building of national PWUD network;
- Facilitating community development on advocacy.
2. We advocate for the continuously strengthening of services and upholding human rights
- Using evidence from the Human Rights Count (HRC) report on PWUD living with HIV (BtG 1) to build an advocacy campaign, and push for legislative and programmatic changes to ensure that the health and human rights needs of PLHIV drug users are advanced.
3. Deliver inclusive, rights-based and gender sensitive services
- Implementing an efficient and high-quality Needle and Syringe Programme in Kathmandu Valley;
- Conducting size estimation of IDU’s in Kathmandu Valley and conducting effective outreach;
- Training outreach workers on thematic skills and pilot outreach methods in the field.
4. Foster global and in-country processes and partnerships that reinforce results
- Improving partnerships in-country with other NGOs, government, the Health Council, and organisations that can assist in (data) management systems.
Our project builds on the strong advocacy work of our partners Youth Vision, Nap+N and DUNA to put PWUD’s health issues on the political agenda and get them included in national plans. Their work is internationally supported by Mainline, INPUD and GNP+.