HIV/AIDS has been a well-recognized pandemic throughout the world for nearly over the past two decades. Despite several efforts to address the problem, the trend of HIV spread is still unbroken and it is more apparent in poor resource setting countries such as Nepal. As of January 2004, the Ministry of Health (MoH) has reported 708 cases of AIDS and 3,388 cases of HIV infections in Nepal. Given the poor existing medical and public health infrastructure and the lack of continuity in national HIV/AIDS surveillance systems, it is very likely that the actual number of cases can be many times higher. UNAIDS has estimated that about 60,000 people are living with HIV/AIDS in Nepal.

The Far Western Region of Nepal is considered by many to have one of Asia’s fastest growing AIDS epidemics. The high migration rate (at least one male member from 80-90% of the household) in Far-Western Region has contributed for the rapid spread of HIV/AIDS. About 10% of the migrants returning from Mumbai, India have been tested HIV positive. Many of them may be engaged in unsafe sexual practices. The socio cultural norms and practices, the high level of stigma and discriminations prevent these people and others in the high-risk groups from being open, practice safer sex, seek medical attention and undergo testing.

Given the context, CARE Nepal worked in two remote districts (i.e. Doti and Bajhang) in the Far Western Region of Nepal, from February 2002 to 2004, with funding support from FHI. The objective of the program was to reduce STI/HIV related high-risk behavior among migrants and other vulnerable population. CARE Nepal’s work in these two districts during the last two years has strengthened the institutional capacity of the local NGOs and created higher level of awareness on the STI/HIV among the migrant men, their wives and young population. The program was directed towards creating greater awareness and promoting the use of condom, but the project neither investigated stigma and discrimination nor included components of working with/and or support mechanism for People Living With and Affected by HIV/AIDS (PLWHA).

Background
One of the most difficult challenges for People Living with HIV/AIDS (PLWHA) is to face negative responses towards them by people in their social environment. These responses may range from unconscious gestures, to rejection and mistreatment tinged with harassment and hostility. Negative attitudes and behaviors related to HIV/AIDS that are based on unfound ideas and fears constitute stigma and discrimination (S&D). The S&D often have a profound impact on the lives of PLWHA.

The S&D are one of the most important barriers to fighting the AIDS epidemic. They result in individuals denying they are HIV-positive, shying away from preventive behaviors and being inhibited in seeking medical treatment out of fear that their health status will be discovered. Sufferers attempting to receive medical treatment may also experience a lack of commitment and mistreatment by health professionals. In addition, stigma and discrimination may cause infected people to lose social and economic support from their families. Fear of being identified as positive and discriminated against discourage individuals from seeking voluntary testing of their HIV status, thus affecting prevention and surveillance efforts.

In Nepal, S&D stem from beliefs that HIV/AIDS is a fatal disease readily transmitted in causal or indirect contact with a person with infection. In addition, the social and intimate nature of its transmission and the emphasis on its spread through sex work and drug abuse have created stereotypes of PLWHAs and the mistaken image that only immoral people are infected. In order to address inaccurate and damaging attitudes towards PLWHA, it is important to identify the nature of the cultural beliefs and practices that underline them. This study will identify the sources and circumstances of S&D for PLWHA in Nepal.

The study will examine S&D from both the perspectives of PLWHA, community people, and service provider in a holistic manner. It also examines the current practice and the capacity/skill development needs of the service providers. With this information, programs may be planned to reduce stigma and discrimination and support PLWHA. This will help to promote Greater Involvement of People living with HIV/AIDS (GIPA) in HIV/AIDS prevention program.

The project
This project is designed to better understand the extent of S&D faced by PLWHAs and to explore different support mechanisms create more enabling environment for PLWHAs to lead a dignified life in their society. It also examines the current practice and the capacity/skill development needs of the service providers.

The pilot project has been launched in four Village Development Committees (VDCs) of Doti district. The project was started on April 2004 and will be completed on September 2004.

Overall objective
The general objective of the study is to promote greater involvement of people living with HIV/AIDS in HIV/AIDS prevention program through deeper understanding of the stigma and discrimination faced by PLWHA. The study aims to document the current situation of PLWHA, their livelihoods strategies, as well as identify capacity/skill development needs of service providers.

Specific objectives
· Identifying and understanding the situation of PLWHAs and their livelihoods/coping strategy
· Identifying the current practices and training needs of health workers related to HIV/AIDS
· Enhancing capacity of health workers and community people on HIV/AIDS
· Promote community mobilization to reduce stigma and discrimination on HIV/AIDS patients