HIV/MSM

As a community based organization, the Blue Diamond Society (BDS) exists to improve the sexual health, human rights and well-being of sexual/gender minorities in Nepal. BDS is the first Nepalese organization working with and for sexual/gender minorities on social justice, human rights, sexual health and HIV/AIDS. BDS seeks to encourage and support networks for sexual/gender minorities all over Nepal. To this end BDS has already established networks in more than 30 municipalities/districts in Nepal.

In the last 8 years, despite enormous challenges, BDS has achieved a great deal in terms of improving the lives of sexual and gender minorities in Nepal, including:

1. Mobilized communities throughout Nepal and delivered services for our target group, through 31 prevention intervention centers, 5 regional care & support centers and 5 regional human rights posts.
2. More than 90,000 Transgender, Gay Men, Lesbians and Bisexual People (LGBT) as well as other man having sex with man (MSM) have benefited from outreach work and access to our HIV prevention services.
3. More than 700 MSM/LGBT living with HIV accessed our care, support and treatment services.
4. More than 5,000 MSM/LGBT received legal and social support. 
5. Successfully conducted training on Human Rights, HIV prevention, care, support and treatment, empowerment of LGBT, advocacy for legal and policy change, and skill building programs for marginalized LGBT so that they can make a living.
6. Formed the Federation of Sexual and Gender Minorities, Nepal with 9 founding member organizations.
7. Landmark decision by the Supreme Court of Nepal ordering the Government of Nepal to protect and defend the equal rights of LGBT in Nepal as natural persons and eliminate discriminatory laws.
8. Many political parties have included the LGBT community issues within their manifestos and they are to be included under the constitution.
9. More than 50% of the Constituent Assembly members have been sensitized to the issues of the LGBT community.
10. The government has allocated a budget for an LGBT community center and a site has been purchased by BDS.
11. BDS Care & Support with support from the Danish Embassy has purchased a CD4 Count machine

The HIV/AIDS Epidemic in Nepal
AIDS has killed more than 25 million people worldwide since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite efforts world-wide to tackle the epidemic, the total number of people living with the human immunodeficiency virus (HIV) has reached an estimated 40 million.

Nepal reported its first case of HIV infection in 1988 and in the two decades since, it has witnessed a rapidly evolving epidemic with the UN now estimating the total infection at about 70,000. The epidemic in Nepal has been termed as a ‘concentrated epidemic’, whereby in general, the infection is low in the general community and is seen to be concentrated among certain groups at risk. However, given the fact that there is increasing number of infections reported among housewives through heterosexual transmission, it is possible that Nepal could see an increase in the number of infections including increased infections among the general community.

Response to HIV/AIDS in Nepal
1988                 Launched the first National AIDS Prevention and Control Program (short term)
1990-1992         First Medium Term Plan
1993-1997         Second Medium Term Plan
1993                 National Policy on Blood safety
1995                 National Policy on HIV/AIDS
1997–2001        Strategic Plan for HIV/AIDS Prevention
2000                 Situation and Response Analysis of HIV/AIDS -Nepal -December 2000
2002                 National HIV/AIDS Strategic Plan (2002-2006)
2003                 National HIV/AIDS Operational Plan (2003-2007)
2006                 New National HIV/AIDS Strategic Plan, 2006-2011
2006                 National HIV/AIDS Action Plan (2006-2008)
2009                 National HIV/AIDS Action Plan (2008-2011)
2009                 HIV/AIDS Control Board Forms a Thematic group on MSM/MSW

At least 5-10% of all HIV cases worldwide are due to sexual transmission between men, though this figure varies locally very considerably.  Policy-makers and programme managers sometimes deny that male-to-male sex occurs in their part of the world and this was certainly the case in Nepal’s initial response to the epidemic. Denial is an enormous obstacle to efforts at AIDS prevention and care among MSM.
Despite the international experience in tackling the HIV/AIDS epidemic, it was only in 2002, after persistent lobbying by BDS, that MSM were factored into the National HIV/AIDS strategic plan for Nepal – 14 years after Nepal’s first reported case of the virus.

The government records data on the number of reported HIV infections and releases this information publicly (www.ncasc.gov.np).  These figures are based on the testing reports submitted by VCT centres across the country and recent figures showed 14,320 reported cases (NCASC data for the period up to July 2009/Ashadh 2066). These recorded cases have to be compared to UN estimates showing the total number of HIV infections in Nepal is close to 70,000.

It was only in 2006 that the government acknowledged ‘men having sex with men’ as a vulnerable group by including them in the government data on HIV infection and on this basis, the data is not comparable with the other risk groups reported as these show cumulative data reported from a much earlier date.  There are still significant issues with the method of reporting partly attributable to the shortage of VCT services specifically for MSM/TG.  As long as the stigma and discrimination against this population continues, the reported cases will not accurately reflect the proportion of MSM/TG infections in Nepal.

BDS Response to HIV/AIDS
MSM and transgender people are one of the most vulnerable populations towards HIV transmission. Stigma and discrimination towards them in Nepal has resulted in a "hidden population" trapped by misconceptions, myths and a lack of factual knowledge. As long as they remain hidden they do not hear the essential messages of HIV & AIDS prevention and this lack of knowledge places them at even higher risk.
The MSM/transgender community comprises a diverse group of individuals—including cross-dressers or transvestites, transsexuals, bi-gender persons, drag queens and kings, and (fe) male impersonators who cross or transcend culturally defined categories of gender.  The prevention of HIV among this population is considered critical because: (1) prevalence indicators suggest high levels of HIV infection, (2) behavioral studies identify the highest risk behaviors for HIV - unprotected receptive anal intercourse and (3) transgender people remain a marginalized group with little access to prevention education. Despite the high prevalence of HIV infection among transgender sex workers, their awareness of AIDS was found to be low. Identified risk behaviors include multiple partners, frequent receptive anal sex and irregular condom use.

BDS was first funded for HIV/AIDS prevention programs in 2002.  From April 2002 until April 2006 BDS implemented a Behavior Change Intervention Program for MSM and MSW living in Kathmandu. This program was funded by FHI through USAID. This program was delivered by teaching MSM and MSW ways in which STI including HIV is transmitted, the ways of preventing its spread by taking small precautions like consistent and correct use of condoms with water-based lubricants, maintenance of sexual hygiene and reduction in multiple partners. We devised and successfully implemented this program through a network of outreach educators and peer educators, DIC centers who had been empowered through various training sessions to educate, counsel and refer to other STI clinics for diagnosis and treatment. Different cruising areas were covered in Kathmandu Valley.

BDS have been an implementing partner of UNDP/DFID since 1 February 2006 of the HIV/AIDS prevention project titled “Comprehensive Package for MSM/MSW”.  The project is currently funded up to 31 December 2009.  When the project commenced in 2006 BDS was operating in a significant way in only one city.  There are now 17 city offices, Drop-In-Centers or separately established Community Based Organizations (CBOs) delivering HIV/AIDS and sexual health services to MSM/MSW across Nepal.  In 2009 BDS was selected as a sub recipient of the Global Fund by Family Planning Association of Nepal and is now implementing a second prevention project targeting MSM/MSW with this funding in an additional 11 cities as well as extending services in 3 cities that had previously been under the UNDP/DFID project.  This project commenced in May and is funded up to 15 November 2010, after which a further 3 years of funding may be granted by the Global Fund.  Also in 2009, BDS implemented a pilot prevention project in 3 cities targeting adolescent MSM/MSW funded by UNICEF.