Final Report for the
AIDSCAP Program in Nepal
August 1993 to July 1997: Country Program Description Introduction

This report comprehensively summarizes the FHI/AIDSCAP program in Nepal (1993-1997). The report includes a situation analysis, accomplishments and outcomes for each area of work, implementation and management issues, as well as a series of lessons learned and recommendations.

Table of Contents

I. Executive Summary

II. Background and Country Context

III. Country Program Description

A. Introduction (See Below)
B. Situation Analysis
C. Accomplishments and Outcomes
D. Implementation and Management Issues
E. Subproject Highlights

• Part 1
• Part 2

IV. Attachments

Glossary of Acronyms

Country Program Description

A. Introduction

According to the HIV Sentinel Surveillance of November 1992, the HIV seroprevalence among STI patients was 0.79 percent and 1.28 percent in commercial sex workers. In late 1993 HMG reported a cumulative total of only 188 HIV infections in Nepal. It appeared that Nepal was in its early stages of the global HIV/AIDS pandemic. The situation at that time presented a real opportunity to contain the spread of HIV infection with a series of targeted interventions in areas and with populations at risk.

Starting in August 1993, the AIDSCAP/Nepal country program, as designed in its initial strategic plan, was a three-year, $1.2 million project. The project goal was to reduce the rate of sexually transmitted infection targeting high risk behavior among commercial sex workers (CSWs) and their clients in five cities in Nepal's Terai, border region with India. The STI/HIV/AIDS prevention and control strategies to be implemented were:

• To reduce sexually transmitted infections;
• To increase the use of condoms among populations at risk; and
• To reduce risk behaviors through behavior change communications (BCC) and outreach education to targeted populations.

In addition to the project's primary interventions targeted to commercial sex workers and their clients in the Terai region, the initial strategy also called for policy and condom initiatives which would have a national impact.

Interventions were planned to be integrated and coordinated with the Ministry of Health's NAPCP's Medium Term Plan (MTP) and implemented primarily through a series of subagreements with nongovernmental organizations, associations, and private sector firms. Initially projected for only three years among specific risk groups in the Terai Region, it was felt that the proposed interventions could serve as the basis for expansion of interventions into the future as well as to additional risk groups during the project period.

The strategic plan was to be supported by USAID, initially with special HIV/AIDS program funding from the Asia Near East Bureau. Management of the proposed activities were to be coordinated through the AIDSCAP project, a USAID cooperative agreement with Family Health International.

The project's four expected outputs included the following:

1. Increased access of targeted populations to improved STI prevention and treatment services;
2. Expanded condom distribution systems to reach target populations.
3. Targeted communications for behavior change interventions to reduce risk behaviors.
4. Increased awareness by policy makers of HIV/AIDS/STI issues.

The project LogFrame, outlining the measurable indicators, means of verification and important assumptions for the Nepal program strategy is presented as Attachment C.