PurposeFemale sex workers (FSWs) are a key-affected population susceptible to acquiring HIV and sexually transmitted infections (STIs), as well as transmitting the virus to others. The aim of the study was to assess HIV and syphilis prevalence among FSWs in Nepal and to examine factors associated with it.Materials and methodsThe study was based on Integrated Biological and Behavioral Surveillance (IBBS) surveys among FSWs in Nepal from 2004 to 2015. Statistical analysis used chi-squared test to assess statistically significant risk factors for HIV and syphilis. Logistic regression models were used to identify the most important determinants for each outcome.ResultsA total of 5,958 FSWs were tested, and among them, 100 (1.7%) were HIV positive and 230 (3.9%) were syphilis positive. The multivariate analysis revealed that syphilis was higher among those street-based, aged ≥35 years, illiterate, and with a duration of sex work of >3 years. HIV was higher among those aged ≥35 years, illiterate, street-based, and with a duration of sex work >3 years. Syphilis was strongly correlated with HIV.ConclusionHIV epidemic among FSWs in Nepal appears in the stagnant trend, whereas STI epidemic has increased in recent years. The high influencing factors for HIV and syphilis prevalence were advanced age, street-based, lower education, and longer duration of sex work. Urgent efforts, as part of routine HIV/STI prevention and intervention, are required to reduce the high burden of syphilis among FSWs.

ObjectivesTo assess the demographic, behavioural, psychosocial and structural factors associated with non-utilisation of HIV testing and counselling (HTC) services by female sex workers (FSWs) and men who have sex with men/transgender (MSM/TG).MethodsThis study involved a cross-sectional design. We used the national surveillance survey data of 2012, which included 610 FSWs and 400 MSM/TG recruited randomly from 22 and three districts of Nepal, respectively. Adjusted prevalence ratio (aPR) and 95% confidence interval (CI) using modified Poisson regression was used to assess and infer the association between outcome (non-utilisation of HTC in last year) and independent variables.ResultsNon-utilisation of HTC in the last year was 54% for FSWs and 55% for MSM/TG. The significant factors for non-utilisation of HTC among FSWs were depression (aPR=1.4 (95% CI 1.1 to 1.6)), injectable drug abuse (ever) (aPR=1.4 (95% CI 1.1 to 1.8)), participation (ever) in HIV awareness programmes (aPR=1.2 (95% CI 1.0 to 1.4)), experience of forced sex in previous year (aPR=1.1 (95% CI 1.0 to 1.3)) and absence of dependents in the family (aPR=1.1 (95% CI 1.0 to 1.3)). Non-utilisation of HTC among MSM/TG had significant association with age 16–19 years (aPR=1.4 (95% CI 1.1 to 1.7)), non-condom use (aPR=1.2 (95% CI 1.0 to 1.4)), participation (ever) in HIV awareness programmes (aPR=1.6 (95% CI 1.3 to 2.0)), physical assault in previous year (aPR=1.8 (95% CI 1.0 to 3.1)), experience of forced sex in previous year (aPR=0.5 (95% CI 0.3 to 0.9)).ConclusionAlthough limited by cross-sectional design, we found many programmatically relevant findings. Creative strategies should be envisaged for effective behavioural change communication to improve access to HIV testing. Psychosocial and structural interventions should be integrated with HIV prevention programmes to support key populations in accessing HIV testing.

PurposeKnowledge on HIV and safe sex practices are the main determinants for the prevention and control of HIV/AIDS transmission. The aim of this study was to assess HIV awareness and safe sexual behavior among the female sex workers (FSWs) in the Kathmandu valley of Nepal.MethodsThe study was based on data secondary to Integrated Biological and Behavioral Surveillance surveys of 2093 FSWs in Kathmandu valley from 2006 to 2015. Bivariate and multivariate logistic regression models were used to identify the factors associated with knowledge and misconceptions about HIV (BCDEF) and safe sexual practices (consistent condom use with regular clients and nonpaying partners).ResultsFSWs who had secondary education (adjusted odds ratio [AOR]=2.08, 95% confidence interval [CI]=1.60, 2.70) and visited the drop-in center (DIC) (AOR=1.34, 95% CI=1.02, 1.75) in the last year had more knowledge and misconceptions about HIV (BCDEF). FSWs who had consistent condom use with nonpaying partners (AOR=1.60, 95% CI=1.23, 2.09), had a HIV test (AOR=1.34, 95% CI=1.02, 1.76), met peer educators (PEs) (AOR=1.49, 95% CI=1.17, 1.91) and visited the DIC in the last year (AOR=1.32, 95% CI=1.01, 1.72) had a higher chance of condom use with clients. Married FSWs (AOR=2.23, 95% CI=1.57, 3.17) and FSWs who met PEs in the last year were more likely to have condom use with nonpaying partners (AOR=1.42, 95% CI=1.04, 1.93).ConclusionKnowledge and misconceptions about HIV has decreased over the years among FSWs; however, consistent condom use with regular clients and nonpaying partners has significantly increased. HIV intervention programs were strongly associated with safe sexual practices among FSWs and need to be strengthened.

BackgroundNepal is facing double burden of injecting drug use and HIV, yet the problem of Hepatitis C Virus (HCV) has not been so well addressed, where there is large population known to be at risk for HCV. This study assessed the prevalence of HCV infection and HIV/HCV co-infection among male injection drug users (IDUs) in Nepal and identified factors associated with infection.MethodsCross-sectional surveys in 2015 aimed to sample 1045 male IDUs in the Kathmandu valley, Pokhara Valley and Eastern Terai districts of Nepal. Information about socio demographic characteristics, injecting and sexual risk behaviours were obtained, and biological specimens tested for HCV and HIV. The logistic regression model was used to identify the determinants associated with HCV and HIV/HCV co-infection.ResultsHCV prevalence was 28.8% and HIV/HCV co-infection was 4%. Among the 6% of HIV positive male IDUs, 65% were found to be co-infected. The multivariate logistic analysis revealed that HCV prevalence was higher in Eastern Terai districts, longer duration of drug use and injecting drugs and presence of HIV. Similarly, HIV/HCV co-infection was associated with Eastern highway districts, older age and longer duration of injecting drugs.ConclusionThe factors strongly contributing to HCV and HIV/HCV co-infection was longer duration of injecting drugs. Highest HCV and HIV/HCV co-infection was found in Eastern Terai districts. Target health interventions need to be focused in Eastern Terai districts and IDUs with longer duration of injecting drugs for the prevention of HCV and HIV/HCV transmission.

Background: Men who have sex with men (MSM) and transgender people are disproportionately affected by HIV and sexually transmitted infections. MSM and transgender people in Nepal experience considerable discrimination and marginalisation, they are subject to abuse from legal authorities and suffer from mental health issues. These social and structural factors can lead to increased sexual risk behaviour, barriers to accessing health care and result in adverse health outcomes. This study aims to assess the prevalence of HIV and syphilis, and how individual and socio-structural factors influence sexual risk behaviour and health care service uptake, among MSM and transgender women in the Terai highway districts of Nepal. Methods: A cross-sectional survey was conducted in June 2016 in eight Terai highway districts of Nepal, recruiting 340 MSM and transgender women through respondent driven sampling. The primary outcome variables were HIV and syphilis prevalence. The secondary outcome variables were sexual risk behaviour and health care service uptake. Logistic regression models were used to assess the individual and socio-structural determinants of sexual risk behaviour and health care service uptake.

Background HIV is a major public health issue around the world, especially in developing countries. Although the overall prevalence of HIV in Nepal is relatively low, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male people who inject drugs (male PWIDs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledge-based risk factors need to be assessed. Methods The study used a series of 7 cross-sectional survey datasets from Pokhara (Nepal), collected between 2003 and 2017 (N = 2235) to investigate trends in HIV prevalence among male PWIDs by socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV. Results HIV prevalence decreased from the levels seen in 2003 (22.0%) and 2005 (21.7%), with the lowest prevalence recorded in 2015 (2.6%), however prevalence has increased in the most recent period (4.9%). A lower risk of HIV was associated with younger age (<=24 years compared to > 24 years, OR = 0.17, 95% CI = 0.10–0.31), being married (OR = 1.91, 95% CI = 1.25–3.02) and shorter duration of drug use (<=4 years compared to > 4 years, OR = 0.16, 95% CI = 0.09–0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75–4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64–4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20–4.11). Conclusion The prevalence of HIV in male PWIDs in Pokhara has been variable, but overall has reduced in recent years to 2.6% before increasing in 2017 to 4.9%. The main determinants which increase the risk of HIV among male PWIDs in Pokhara are low education level, a lack of treatment for drug addiction and the recent use of unsterilised equipment. Each of these indicate the need to improve addiction treatment and education programs for intra-venous drug use to aid this key population in avoiding risk-taking behaviours.

Background: MSM and TG in Nepal experience considerable discrimination and marginalisation: they are subject to abuse from legal authorities and suffer from mental health issues and substance abuse. This study aims to assess the prevalence of HIV and syphilis, in addition to how individual and socio-structural factors influence sexual risk behaviour and health care service uptake, among MSM and TG in the Terai highway districts of Nepal. Methods: A cross-sectional survey was conducted in June 2016 among MSM and TG in eight Terai highway districts of Nepal, recruiting 340 MSM and TG through respondent driven sampling. The primary outcome variables were HIV and syphilis prevalence. The secondary outcome variables were sexual risk behaviour and health care service uptake. Logistic regression models were used to assess the individual and socio-structural determinants of sexual risk behaviour and health care service uptake. Results: The prevalence of HIV among MSM was 5%, whereas it was 13% in TG. The prevalence of active syphilis was 4% in the MSM group and 11% among TG. Among TG, 76% were involved in sex work, and 51% reported having experienced discrimination in one or more settings. In multivariable analysis, having visited an outreach centre was positively associated with condom use in the most recent sexual encounter among both MSM (AOR: 5.37, 95% CI: 2.42 - 11.94, p<0.001) and TG (AOR: 2.81, 95% CI: 1.30 – 6.09, p=0.009). Moreover, in the multivariable regression model assessing factors associated with visited outreach center among MSM, respondents that reported they had been forced to marry a female were 3 times more likely to have visited an outreach centre. Among TG, being open towards family about sexual identity/behaviour were positively associated with having visited an outreach centre. Conclusions: The high prevalence levels of HIV and syphilis, as well as indicators of marginalisation and discrimination among TG, highlights the increased burden TG in Nepal are facing and the need for tailored interventions for this group. Moreover, since health care service uptake seems to be an important factor in determining sexual risk behaviour among MSM and TG in Nepal, outreach services should be scaled up.

Background: Men who have sex with men (MSM) and transgender people are disproportionately affected by HIV and sexually transmitted infections. MSM and transgender people in Nepal experience considerable discrimination and marginalisation, they are subject to abuse from legal authorities and suffer from mental health issues. This study aims to assess the prevalence of HIV and syphilis, and how individual and socio-structural factors influence sexual risk behaviour and health care service uptake, among MSM and transgender women in the Terai highway districts of Nepal. Methods: A cross-sectional survey was conducted in June 2016 in eight Terai highway districts of Nepal, recruiting 340 MSM and transgender women through respondent driven sampling. The primary outcome variables were HIV and syphilis prevalence. The secondary outcome variables were sexual risk behaviour and health care service uptake. Logistic regression models were used to assess the individual and socio-structural determinants of sexual risk behaviour and health care service uptake. Results: The prevalence of HIV among MSM was 5%, whereas it was 13% in transgender women. The prevalence of active syphilis was 4% in MSM and 11% among transgender women. Among transgender women, 76% were involved in sex work, and 51% had experienced discrimination in one or more settings. In multivariable analysis, having visited an outreach centre was positively associated with condom use in the last sexual encounter among both MSM (AOR: 5.37, 95% CI: 2.42 - 11.94, p<0.001) and transgender women (AOR: 2.37, 95% CI: 1.12 – 5.02, p=0.025). Moreover, transgender women who reported being open towards family about sexual identity/behaviour were 2.4 more likely to have visited an outreach centre (AOR: 2.40, 95% CI: 1.04 – 5.57, p=0.041). Conclusions: The high prevalence of HIV and syphilis, as well as indicators of marginalisation and discrimination among transgender women, highlights the increased burden transgender women in Nepal are facing and the need for tailored interventions. Moreover, since health care service uptake is an important factor in determining sexual risk behaviour among MSM and transgender women in Nepal, outreach services should be scaled up.