Final Report

Voluntary Counselling Testing (VCT) Need

Assessment
In
Chitwan, Rupandehi, and Nawalparasi District

Family Health International

Kathmandu, Nepal

Submitted by
Irada Parajuli Gautam
Independent Consultant
May 2004
 Table of Content
I. ACKNOWLEDGEMENT .................................................................................................... 4
II. EXECUTIVE SUMMARY .............................................................................................. 5
1. INTRODUCTION................................................................................................................. 9
1. 1 BACKGROUND .................................................................................................................. 9
1. 2 SCOPE OF VCT NEEDS ASSESSMENT ............................................................................... 9
1. 3 OBJECTIVE OF VCT NEED ASSESSMENT ........................................................................ 10
1. 4 REVIEW OF LITERATURE ................................................................................................ 10
2. METHODOLOGY ............................................................................................................. 12
2. 1 STUDY LOCATION .......................................................................................................... 12
2. 2 STUDY DESIGN AND INFORMATION COLLECTION METHODS.......................................... 12
2. 4 PROCESS OF NEED ASSESSMENT .................................................................................... 14
2. 5 ETHICAL CONSIDERATION ............................................................................................. 15
2. 6 LIMITATION OF NEED ASSESSMENT .............................................................................. 15
3. FINDINGS ........................................................................................................................... 16
3.1 CHARACTERISTICS OF PLWHA ..................................................................................... 16
3. 2 CHARACTERISTICS OF IDU AND FSW ............................................................................ 16
3. 3 SOCIAL PROBLEMS OF PLWHA ..................................................................................... 17
3.4 HEALTH PROBLEMS OF PLWHA ................................................................................... 18
3. 5 HEALTH SEEKING BEHAVIOR AND ITS BARRIERS OF PLWHA....................................... 18
3. 6 BARRIERS OF TAKING HEALTH SERVICES FOR PLWHA ................................................ 19
3.6.1 Financial Barrier .................................................................................................. 19
3.6.2 Social Barriers ...................................................................................................... 19
3 .6 .3 Organizational Barriers........................................................................................ 20
3. 7 EMOTIONAL PROBLEMS AND MANAGEMENT ................................................................. 20
3. 8 CARE AND SUPPORT SERVICE ........................................................................................ 21
3. 9 SOCIAL PROBLEMS OF INJECTING DRUG USERS (IDUS) ................................................. 22
3.9.1 Health Problems of IDUs...................................................................................... 22
3.9.2 Health Seeking Practices of IDUs ........................................................................ 23
3.9.3 Major barriers for health seeking ......................................................................... 23
3. 10 FEMALE SEX WORKERS (FSW) ................................................................................. 23
3.10.1 Health Problems of FSW ...................................................................................... 24
3.10.2 Health seeking Practices and Barriers ................................................................ 24
3. 11 VCT SERVICE ............................................................................................................ 24
3.11.1 Needs and Expectation of PLWHA, IDUs, FSWs on VCT Service ....................... 24
3.11.2 Reason of HIV test ................................................................................................ 25
3.11.3 Reason of not willing to test .................................................................................. 25
3.11.4 Making VCT Service User Friendly ..................................................................... 26
3. 12 TARGET GROUP FOR VCT SERVICE ............................................................................ 26
3. 13 INCREASING DEMAND OF VCT SERVICE .................................................................... 27
3. 13 CHALLENGES OF VCT................................................................................................ 28
3. 14 VIEWS OF NGOS ........................................................................................................ 28
3.14.1 VCT and its Demand ............................................................................................. 28
3. 15 VIEWS OF MEDICAL PRESCRIBERS ............................................................................. 28
3.15.1 Common types of treatment provided to PLWHA by medical prescribers ........... 29
3.15.2 Names of service providers/ pathology ................................................................. 30
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 3.15.3 Prescriptions and Access of Drugs ....................................................................... 30
3.15.4 Supplies of medical prescribers ............................................................................ 30
3.15.4 Suggestion of medical prescribers ........................................................................ 31
4. RESOURCE DIRECTORY ............................................................................................... 32
4. 1 RUPANDEHI .................................................................................................................... 32
4. 2 CHITWAN ....................................................................................................................... 33
4.3 NAWALPARASI ............................................................................................................... 34
5. CONCLUSION AND RECOMMENDATION ................................................................ 36
5.1 CONCLUSION.................................................................................................................. 36
5.2 RECOMMENDATIONS ...................................................................................................... 37
III. REFERENCES................................................................................................................ 40
IV. ANNEXES ....................................................................................................................... 41
ANNEX 1: CONSENT FORM.................................................................................................. 41
ANNEX 2: VCT NEED ASSESSMENT QUESTIONNAIRES........................................................ 43
ANNEX 3: QUESTIONNAIRE FOR MEDICAL PRESCRIBERS .................................................... 49
ANNEX 4: RESOURCE DIRECTORY ..................................................................................... 55
ANNEX 5: SCHEDULE FOR VCT NEED ASSESSMENT TEAM ................................................ 57
ANNEX 6: WORK PLAN FOR VCT NEED ASSESSMENT ......................................................... 58
ANNEX 7: RESOURCE DIRECTORY OF RUPANDEHI DISTRICT ............................................... 59
ANNEX 7: RESOURCE DIRECTORY OF CHITWAN DISTRICT .................................................. 70
ANNEX7: RESOURCE DIRECTORY OF NAWALPARASI DISTRICT .......................................... 79
ANNEX 8: MAP OF RESOURCE DIRECTORY ......................................................................... 88

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I. ACKNOWLEDGEMENT

I would like to extend my heartfelt gratitude to Family Health International (FHI) for supporting
in undertaking this need assessment. I want to especially mention Jesper Svendsen, Senior
Technical Officer – Counseling, care and support, Bert Pelto, consultant to FHI, Kamala Moktan
and Bharat Mani Pant by providing valuable professional inputs all along and Jim Ross- Director
FHI, Asha Basnet Associate Director FHI country office by giving critical comments while
designing need assessment tools.

I am grateful to all colleagues of AMDA team in Hetaunda, Chitwan and Dr. Anil Kumar Das in
Kathmandu who encouraged doing need assessment in Chitwan, Rupendehi and Nawalparashi
and others who were supportive in various ways.

I would like to thank all those who made it possible to produce this report by giving their
valuable time and who contributed their ideas. Special thanks go to the PLWHAs, IDUs, FSWs,
BCI partners especially Manager and coordinator of GWP, TRINETRA, WATCH and Namuna
integrated development council, all Government and other agencies, medical prescribers, and
others who involved in need assessment process directly or indirectly in 3 districts and have
contributed immensely to the field study.

This research would not be possible without having strong team members in the field so I would
like to thank Thaneswor Koirala and Kamala B.K who played an active role in every aspect of
the need assessment and my appreciation goes to staff of BCI partners who had been involved in
data collection process through out the field study as team members.

Most importantly, my sincere gratitude to all the individuals who shared their pain and anguish
openly.

Thank you! Irada Parajuli Gautam

Consultant, FHI
May 2004

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II. EXECUTIVE SUMMARY

Need assessment commissioned by Family Health International was conducted with support
from AMDA VCT team and other BCI partners in Chitwan, Nawalparasi, and Rupandehi
Districts. The main purpose of the need assessment was to identify the resources across those
districts and to describe the nature of resources, support groups, NGOs and other organizations in
public and private sector in relation to HIV/AIDS and to explore the needs and expectations of
PLWHAs in connection with VCT program in the area of study. It was conducted in
February/March 2004 by using rapid qualitative research methodologies, especially mapping,
focus group discussion with NGOs, PLWHAs, IDUs, FSW, and in-depth interview with
PLWHAs.

Resources Related to HIV/AIDS

At the district level, there are many organizations working on preventive side and very few are
involved in care and support part. Comparatively, Nawalparasi district has fewer resources than
other two districts. PLWHAs of Nawalparasi are either referred to Chitwan or Butwol for testing
and better treatment.

There are several private institutions that are providing testing services without counseling
services. Likewise, resources for TB, STI treatment and FP services and treatment of general
illnesses in public and private institution is encouraging but there is lacking of care and support
program to deal with emotional aspect, nutritional aspect, and none of any institutions provides
prophylaxis treatment and ARV therapy. There are no any spiritual care practices and
rehabilitation facilities are available in any of the 3 districts. However for IDU with HIV positive
male clients, there is one rehabilitation center in Butwol and in Chitwan district. Furthermore,
there are no any PLWHAs networks and groups in Rupandehi and Nawalparasi district except
one in Chitwan called ‘Chitwan Sakriya Samuha’ (Chitwan active group).

There are some positive experiences of PLWHAs towards the service providers. According to
PLWHAs, there are some good doctors and nurses. Use of private practitioners for treatment and
testing was equally prevalent as public hospitals. The study revealed that PLWHAs, FSW and
IDUs prefer private clinic because of the short waiting time to get service and better maintenance
of confidentiality and privacy compared to the public facilities.

Regarding the medical support, most of them prefer to seek medical care rather than going to
traditional healers while they become sick. Most of the participants are in contact with some
organizations and getting either psychological or physical support or both. Most of them are
supported by WATCH, GWP, TRINTERA, Maiti Nepal, Namuna Integrated Development
Council, Support and Care Center (S & C), and Sahara rehabilitation center directly or indirectly.
Some are also working as peer educators and volunteers in those organizations. Most of the
PLWHA participated in VCT need assessment have heard ARV but no one had taken so far.

Contrary to the positive experiences, some of the PLWHAs had expressed negative feelings as
well. Police harassment to FSW and IDU is a major problem. Most of the PLWHAs and other
target group felt the discriminating behavior from some doctors, families and society. Due to that
reason some of the PLWHAs of Chitwan Sakriya Samuha did not disclose their status in society.

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Out of 26 PLWHAs, 4 HIV positive cases mentioned that they got full support from family and
society where as their dissatisfaction was like other PLWHAs towards the behavior of I/NGO
staff. Most of the organizations, despite the initial commitment, have limited their activities on
the paper rather than providing actual support. Furthermore, violation of rights (right of respect,
privacy, expressions, and dignity) by I/NGOs and service providers, lack of necessary treatment,
care and support, and discrimination are some of the problems existed in the society according to
PLWHAs. Lack of awareness about the social support mechanisms among target groups were
also observed during the study.

VCT service

Most of the participants were not aware of VCT concept. When discussed the objective of VCT
need assessment and the concept of VCT, participants were excited and highly welcomed such
services in their area and urge to ensure the availability of care and support program after VCT.
They also suggested raising awareness in society before and after starting VCT is also equally
important so that social discrimination against HIV cases could be reduced in future. They
further suggested the VCT service to be provided in the existing STI clinic or city centre where
transportation facilities are accessible. In their opinion, provision of free VCT service is required
in order to reach to all target groups.
Recommendations: Based on the findings of need assessment, following recommendations
have been made to make VCT program more effective:

1. Enhance the capacity of PLWHA to create conducive environment

Followings are some of the recommendations to increase the role of PLWHAs to confront with
the social environment:

• This need assessment revealed that most of the PLWHAs are unhappy because they are
under valued and given low status either in public or private spaces. Therefore, listening
to PLWHAs and other target groups, creating a climate of confidence, and discovering
new values and collecting their strength are highly recommended. Active participation in
the VCT service (e.g. through peer educators) may help to enhance the self-esteem and to
develop a sense of identity of PLWHA in the society. It may also give PLWHAs a
collective strength to fight against social discrimination in the society.

• PLWHAs group should be encouraged and expand in other district like Chitwan to meet
together to share, discuss and act for the improvement of their own and community
situation.

• The rights and hopes of PLWHAs and their achievement of them should be constantly on
the agenda at all levels especially in the family, VDC, DACC, DCWB, schools, women’s
groups, NGOs, children’s groups and other user committee at local levels.

• Involve PLWHAs in the decision making process and include them as full and active
partners in identifying their own issues and problems and in designing, planning,
implementing and assessing programs which affect their own lives will have more
sustainable impact.

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2. Establish community support systems at local level:

Followings are some of the recommendation for this:

• Organize orientation, training, and awareness activities prior to starting VCT and
continue afterwards to different stakeholders, partners, and peer educators at different
levels. It helps to protect the rights of PLWHA.

• Community support systems for PLWHAs need to be developed in every village to

enable PLWHAs to achieve their potential.

• A wide spread campaign through posters, TV, radio and other media should be organized
to aware on the VCT services and promote this theme inside and outside the family.

3. Movement to reduce discrimination against PLWHAs and change the society for
equality, peace and justice

Following recommendations have been made:

• Service providers and support organizations need to be aware of the psychological aspect
of PLWHAs and should not hurt to PLWHAs at any case and should be friendly while
dealing with PLWHAs by using the simple language. There should not be any
discrimination by service provider who has been involved for the treatment of PLWHA
based on poor and rich, ethnicities, and gender. Therefore, need to sensitize service
providers, family and society on the dignity and rights of PLWHAs so that safe,
comfortable, and friendly environment for HIV positive cases could be promoted.

• Sensitize media people regarding the issue of confidentiality and other ethical issues prior
to publishing the news because the media increases the discrimination in the society after
publishing or broadcasting the personal/sensitive information of PLWHA.

• Since the harassment has been found in different places including from service delivery
point to the street, provision of the law is required to punish/discourage the people who
discriminate and harass PLWHA.

4. Utilization of VCT Service: In order to increase the use of VCT service, following
recommendations have been made:

• Provide free testing among target group and free treatment for PLWHA as most of them
are facing financial crisis and many of them are dying due to the lack of money to buy
medicines and no timely treatment. It is further suggested for the provision of prompt
medical treatment, other care and support program needs to be incorporated. Along with
testing enough emotional and spiritual care needs to be ensured for PLWHA.

• VCT centers to be easily accessed by transportation facilities and in the urban area rather
than in the rural area and combining VCT service with existing mobile clinics would be
effective as mobile clinics are already popular among PLWHAs.

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 • Increase the confidence of clients regarding confidentiality and privacy of the outcome of
VCT. One by one testing and counseling would be good to maintain privacy.

• Establish good counseling to the people and educate them on the importance of VCT
service.

• Facilitate PLWHAs to discover meaning in life, build self-esteem and sense of humor.
Develop skills and feeling of having some control over what happens in life. This is
related to spiritual life and religion.

• Mechanism of regular monitoring of service sites and referral institutions would be

beneficial to maintain optimum care and support for PLWHAs and for the compliance of
standards, manuals, and protocols by service providers.

• Some organizations need to involve dealing nutritional aspect, prophylaxis treatment,

ARV therapy, and rehabilitation facilities for PLWHA in those districts.

5. Leading the way in advocacy campaigns:

Followings are some recommendations for this:

• Network building among service providers and social mobilization at the local level
needs to be strengthened for better referral and lasting benefit of PLWHAs. Therefore,
coordination meeting and partnership building should be an integral part of the program
and should encourage the local level coordination and social mobilization in the districts.

• The deficiency in present legislation and policies has caused harassment to PLWHAs in
public/private places. Policies and legal provisions should be made public both locally
and nationally so that people would be careful to deal with PLWHAs.

• Groups/networks have to be facilitated by NGOs and INGOs for PLWHAs.

• Organize regular sharing program among service providers, NGOs, PLWHAs and social
mobilizers at the local level to foster understanding on practical issues related on VCT
and HIV/AIDS and updating their knowledge base.

• Advocacy to protect PLWHA’s rights is virtually missing or very weak and not been able
to raise the voice of PLWHAs by organizations in cases of violating their rights.
Combined efforts of different stakeholders would be able to protect the rights of
PLWHAs.

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 CHAPTER - 1

1. INTRODUCTION

1. 1 Background

Nepal, despite being considered a low HIV prevalence country, HIV infection in certain risk
groups is increasing at an alarming rate. Now it is apparent from epidemiological evidence that
Nepal has passed from being a low risk country to one with a "concentrated epidemic" in which
the HIV/AIDS prevalence consistently exceeds more than 5% in one or more sub-groups.

At the end of 2003 about 60,000 adult HIV cases estimated in Nepal. Of this, about half the cases
estimated in the highway districts. About 26 percent of HIV cases are women. Among the high-
risk groups, seasonal labor migrants contribute almost 40 percent of the HIV cases followed by
18 percent clients of sex workers and 14 percent IDUs. About 15 percent of HIV cases are
women from rural areas of Nepal.

According to the recent HIV estimation, Kathmandu valley has the highest epidemic scenario
with this rising HIV prevalence among injecting drug users (IDUs) and female sex workers
(FSWs). Similarly, there is rapid spread of epidemic in the Far Western hilly districts among
Nepali migrant labors who travel to India to find work.

The vulnerability for rapid transmission of HIV/AIDS in Nepal is increased many fold by
pervasive poverty (40% of population below poverty line with annual income less than Rs 4400),
coupled with low literacy rate, gender inequity, labor migration, girl trafficking and increasing
sex trade. In addition to this current conflict has further added to vulnerability resulting into
massive labor migration and displaced population, broken family and social structure, increased
orphan and loss of caretakers, loss of income and access to productive assets.

1. 2 Scope of VCT Needs Assessment

A decade of national response with support from national and international agencies has clearly
shown that the response has been largely inadequate and ineffective to address PLWHA’s needs
and expectations in terms of care and support. The national HIV/AIDS strategy 2002–2006 has
also emphasized the Voluntary Counseling and Testing (VCT) as an important component as
well as pivotal entry point for comprehensive HIV/AIDS prevention, care support and treatment
services.

According to a study, 90% of those infected in Nepal do not know that they are infected which
shows the need for effective prevention and care activities for HIV positive people. Followings
are some of the advantages of VCT:

a) It promotes and sustains behavior change (prevention) and facilitates early referral to care
and support services - including access to antiretroviral therapy.

b) VCT links with PMTCT, STI, and OI services and assists in stigma reduction if any
people get tested and talk freely about.

9
 c) VCT increases awareness and knowledge by correcting misconceptions about HIV and
AIDS and increases the client's perception of his or her vulnerability to HIV and it also
alleviates anxiety.

d) For those who are already married, testing together, and the counselling process can
increase trust and strengthen the relationship irrespective of the results.

e) VCT can help clients make informed decisions about marriage, pregnancy and sexual
relationships.

In line with national guidelines and with FHI’s own experience for more than 10 years in
HIV/AIDS, FHI conducted the VCT need assessment for the effective intervention of VCT
service in their working districts prior to establish VCT service with the aim of finding out:

• What resources are available and what are missing?

• What are the health and social services available in the area,

• Who could be the future VCT partners including an appraisal of existing referral
mechanism,

• How could PLWHAs and other target can be involved in VCT service intervention
process, and

• How to create service demand in the community

1. 3 Objective of VCT Need Assessment

There were two major objectives of VCT need assessment conducted in 3 districts:

¾ Develop social mapping and directory of existing services, facilities and resources in
public/private sector in relation to HIV/AIDS. For example, explore the availability of
counseling services, treatment provisions for opportunistic infections/ARV/STI therapy,
accessibility of hospice care, mental health service and rehabilitation centers, situation of
socio-economic support mechanisms, support groups, home care, and spiritual counseling
for the care and support of PLWHA.

¾ Explore the needs and expectations of PLWHA, particularly of vulnerable groups [FSW,
IDU] with the focus on their needs for care and support services. Also to explore
inventory of current Testing, Counseling and Support Services including the potential
service providers in the community.

1. 4 Review of Literature

Research reports, documents reviewed to find out the existing information available mainly on
the area of awareness, behavior, and socio-economic status of target groups. As per the
behavioral surveillance survey in Highways, STD and HIV prevalence Survey among Female
10
Sex workers and truckers in the high way done by New Era, the following findings are the
summary of information elicited from the different literatures

9 The majority [87%] of the respondents said private drug store/pharmacy as the place to
obtain condoms, followed by public hospitals [58%] and health post [46%].

9 Participants of district said that the mean time [to go and come back] to obtain condoms
from the nearest place was 15.3 minutes.

9 Use of condom by the regular type [husband or boy friend] of sex partners during the last
intercourse was found to be very low [27%] compared to paying sex partners [80%] in
the district.

9 99% of the respondents mentioned radio, followed by drug store/pharmacy [82%], bill
boards / signboards [75%], hospital [74%] and friends/neighbors [66%] are the source of
information to obtain condom.

9 On average, sex workers work 3.7 days a week and they entertain with 2.6 persons per
week.

9 Types of clients visited with sex worker are: transport workers 53.8%, wage workers
47%, police/military 44%, businessmen 44%, local men 36%, civil servants 35% and
Rickshawala 13%. In addition to these persons some students, petty shop owners and
occasionally social and political leaders were also reported as their clients.

9 99.5% of FSW had the level of awareness on HIV /AIDS and 92% of FSW have heard
about STD.

9 Ethnically, almost 29% of interviewed sex workers were Chhetri/Thakuri, 18% were
from Matwali groups such as Magar/Tamang/Gurung/Rai/Limbu, 14% from occupational
groups such as Gaine/Kami/Damai/Sarki, 13% were Tharu from the Terai region, 10 %
were Brahamin from the hill region and Badi, and 5% from other groups of the people
from Terai.

9 Among sex workers, 70% were found illiterate and 50% had at least one STD including
20% with syphilis.

9 Among truckers, 75% were having sex with a sex worker, 10 % had at least one STD
including 5.3% with syphilis. HIV rate among truckers was 5 times higher than in the
general public and truckers with syphilis had a tenfold higher risk of HIV than those
without syphilis.

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 CHAPTER - 2

2. METHODOLOGY

2. 1 Study Location

Three districts namely Chitwan, Nawalparasi, and Rupandehi were purposively chosen for need
assessment. However, before selection of districts; discussion with AMDA was done.

Chitwan district is situated in the Central Development Region surrounded by Nawalparasi,

Makwanpur, Gorkha, Dhading, Tanahu district, and India (Bihar) in the south. Out of the total of
354,488 populations, urban population comprises of 26.93%. District has been divided into two
municipalities and 36 VDCs. Bharatpur is the district headquarters.

GWP is the main organization contacted for need assessment. With the help of GWP the team
contacted other organizations working in the districts and identified the target groups for focus
group discussion and in-depth interview. As a BCI partner of FHI, GWP unit office located in
Narayangadh was the key organization contacted by the team for collecting required preliminary
information.

Nawalparasi district lies in the Western Development Region of Nepal. According to census
2001, the total population of the district is 7562,870 (2001 census) of which 22,630 (4.02%)
people lives in urban area of the district. There is only one municipality and 73 VDCs in the
district. Parasi is the districts headquarter. The southern part of the district boundary joins with
India (Uttar Pradesh).

The main institution/organization contacted in Nawalparasi district for need assessment is

Trinetra. Trinetra as being the BCI Partners of FHI, Its field office based in Gaidakot, was the
key organization contacted by the team in order to explore about other existing organizations and
to obtain preliminary information about the target group.

Similarly, Rupandehi also lies in the Western Development Region, which has 708,419
populations (2001 census) including 52,569 (18.06%) urban population. The district consists of
two municipalities and twenty-four VDCs in the district and Bhairahawa is the district
headquarters. The southern part of the district also joins with India (Uttar Pradesh)

WATCH and Namuna are the main institutions contacted for obtaining preliminary information
regarding target groups and existing resources. WATCH, being the BCI partners of FHI, its field
office was contacted for all supports required during need assessment in Rupandehi. Namuna (a
local NGO) is working on harm reduction in Rupandehi.

2. 2 Study Design and Information Collection Methods

Descriptive exploratory design was used for need assessment. Participatory approaches were
highly emphasized during the whole process of information generation. Please see in ANNEX
for the tools.
Mostly the qualitative methods were used for information collection. Some quantitative data
were also obtained from secondary sources where applicable. About 10 participants from
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AMDA, GWP, WATCH, Namuna and Trinetra were involved in in-depth interview for the data
collection after providing orientation and training to them. FHI consultant along with AMDA
VCT team facilitated all focus group discussion + filled up resource directory. Following
qualitative methods were applied:

Documents Review: Literature and documents related to the topic were reviewed during the
process.

• Focus Group Discussion (FGD): Focus Group Discussions (FGD) were organized
separately with 2 groups of PLWHAs, 3 groups of FSW, 3 groups of IDU, and 3 groups
of NGO staff working in the district. FGD was focused to find out need and expectations
of PLWHA, health seeking behavior, existing care and support practices of PLWHA at
the local level and their views on VCT services. During the FGDs participants were
encouraged to participate in the discussion. Upon the consent of participants, discussion
was taped and later translated.

• Interactive Meeting with Service Providers: Interactive meeting was organized with
the service providers and managers of different organizations in order to explore their
activities, their experiences on the problems and opportunities of PLWHAs, their
suggestion for better VCT program etc.

• In-depth Interview with PLWHA: In-depth interview was done with about 16
PLWHAs in 3 districts using a semi-structured checklist. Interview was focused on to
explore their problems, their suggestions to make better VCT services, the ways of
increasing utilization etc.

• Resource Mapping: Different types of services/institutions related to HIV/AIDS were

located in the map of the concerned districts. In the beginning it was done with NGOs
and triangulate with PLWHAs and other target groups in the district so that all could have
been plotted in the map.

• Resource Directory: Based on the discussion with NGOs, PLWHAs, IDUs, and FSWs;
resource directory form were filled up with different organizations in public and private
sector.
Table 1: Number of participants as per group

Category Group Numbers

PLWHA FOCUS GROUP 2 10

In- depth interview of PLWHA 16
FSW FOCUS GROUP 3 29

IDU FOCUS GROUP 3 23

NGOs FOCUS GROUP 3 33
Total Focus Group Discussions 11

Medical prescriber 16
Resource directory form filled up on 79
HIV /AIDS in public and private

Total 206
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2. 4 Process of Need Assessment

Detail steps were followed to complete the need assessment. Major steps are the finalization of
need assessment tools, orientation and training to the selected staff of partner organization in the
districts, formation of working group to oversee the need assessment and to conduct the
fieldwork. Following flow chart shows the summary of chronological steps of need assessment
that was used in all three districts:

The terms of reference of VCT need assessment developed by FHI

Meeting with VCT team in Kathmandu, meeting with AMDA, discussed

TOR, brief about VCT, its objectives, methods and tools.

Literature review of target group, HIV/ AIDS situation in highway way

area

As per the TOR, designed training and designing tool for VCT need
assessment, getting comments from FHI and finalize the tools.

Moved to Hetauda and meeting with AMDA team, orientation to key

people of partners [AMDA, GWP, WATCH, Namuna and Trinetra.] on
VCT need assessment and discussed VCT concept, VCT need assessment
purpose and process, shared tools and findings of literature review.
Discussed the role of working group beyond VCT need assessment.

Identify participants of partners for training and trained for VCT Need
assessment, shared the detail tools, process, objective and time framework

Conduct fieldwork as per methodology designed, frequent contact with

NGOs through telephone and follow up.

Analysis of field information and Report writing

14
2. 5 Ethical Consideration

Confidentiality of any personal information about participating individual was strictly

maintained during discussions, interactions and analysis. During FGD and interactive session
extreme care were also taken to respect individual views, ethnic characteristics, and gender
differences. Used the strategies for minimizing the trauma in the process and shared the
objectives and expected outcomes of this process. Ensured Anonymity and confidentiality by
assuring that all information gathered will be used only for the stated purpose of the consultation
and were allowed to refuse and discontinue their particpatation in the discussion. Consent was
also taken for the use of tape recorder to record the discussion. Participants were provided snacks
and who were coming from long distance also provided bus fare as applicable.

2. 6 Limitation of Need Assessment

Due to frequent Bandh and lack of transportation services, need assessment team could not visit
the interior villages and most of the focus group discussions were compelled to conduct in the
NGO offices located near by the district headquarters. It may have lacked the representation of
the views of people/PLWHAs who are residing in the villages with difficulty in accessing
services compared to the same groups living near by the district head quarter. Since the
methodology of this assessment is primarily the qualitative, quantitative comparison of result is
not possible. FGD with PLWHAs was not possible in Rupandehi district since one organization
(WATCH) did not agree to disclose their status with others.

15
 CHAPTER - 3

3. FINDINGS

3.1 Characteristics of PLWHA

A total of 16 PLWHA participated in in-depth interview in 3 districts. The average age of

PLWHA is about 29 years and males were slightly higher (55%) than females (45%). Majority of
them were married and literate. Similarly, 10 PLWHA participated in FGD in Chitwan and
Nawalparasi whereas FGD could not be conducted in Rupandehi. All participants of FGD were
literate and married, and majority of them were in the age of 21-30.

Table 2: Characteristics of PLWHAs who participated in In-depth Interview and FGD

Participants Age group (Years) Sex Education Marital status

21-30 31-40 40+ M F Literate* Illiterate Married Unmarried

PLWHA in
in-depth 11 2 3 9 7 13 3 14 2
interview
PLWHA in
FGD (2 6 3 1 3 7 10 - 10 -
districts)
Note: * Literate includes those who can read and write with or with out having formal education

3. 2 Characteristics of IDU and FSW

Altogether 23 Injecting Drug Users and 29 Female Sex Workers participated in the Focus Group
Discussion in 3 districts. All IDUs were males and all of them completed grade 9 and above.
Almost all IDUs were married in Rupandehi and Nawalparasi whereas most of the IDUs in
Chitwan were married. Similarly, 26 out of 29 FSWs were married and all were literate. Age of
IDUs was between 18 and 30 years and the age group of Female Sex Workers were in between
15 and 42 years of age.

Table 3: Characteristics of IDUs and FSWs who participated in FGD

Participant Age group (Years) Sex Education Marital status

15-24 25-34 35-45 M F Literate* Illiterate Married Unmarried

IDU 15 8 - 23 - 23 - 8 15

FSW 8 15 6 29 29 - 26 3

Note: * Literate includes those who can read and write with or with out having formal education

16
3. 3 Social Problems of PLWHA

Most of the PLWHAs faced some forms of discrimination, exclusion, and misbehavior in
different places. They are feeling isolated in the family, village, work place and service delivery
points. Followings are some of the expressions of different PLWHAs, which reflect their social
problems facing in their own society.

“While I went to Bhairahawa teaching hospital due to some health problem, they discharged me
from hospital bed as soon as they knew I am HIV positive. Relatives of other patients near by my
bed expressed that this bed is used by AIDS patient and refused to use” – A male PLWHA.

Some of are even ostracized by husband or wife and family, and friends. One female client said,
“When my husband knew that I am HIV positive then he left me and went to India. Other family
members did not give me food and cloths and now I am living in my mother’s home” – a female
PLWHA.

Similarly, a man was left by his wife when doctor informed his wife regarding the result of his
blood test. The man expressed his anger since the doctor did not tell him about the result of his
blood test but informed his wife. PLWHAs do not want to share their HIV status with family
members and other people due to the fear of discrimination and isolation.

One PLWHA shared her friend’s experience. She said, “One of my friends arrived from India
with HIV positive after 10 years. The whole family and society refused to accept her. She went to
mother’s home and asked for shelter but flatly refused there too. After that she went to the
brother’s house/shop. While she lived there; no any customer came, did not take tea and snacks
by the customers from that shop, and then the brother threw out her from that house too……..”

“When I was sick my family members and wife ignored me. She (wife) hated and went to her
mother’s home. But currently we are living in the same house but we sleep in different beds.
When my wife shared to the family members they started very rude behavior and expression
which I have tolerated at every moment.” – A male PLWHA

A PLWHA shared his fear of loosing work if his owner knows his HIV status. He said, “I do not
like to share my status with others because if they know they hate me. If owner knows, he does
not allow for driving as I am working as a driver and I have to look after my 3 children. If they
sack me from the job then who will look after my children?”

Similarly PLWHAs have fear of sharing their HIV status in their own home due to possible
misbehavior. One of the female PLWHAs said, “I did not give information to my family
members because if I inform them about my status then they don’t allow me living at home”.
Some PLWHAs who shared their status in PLWHA group had not shared their status at their
home as they afraid family might hate and thrown out to them.

One PLWHA expressed that no one came to visit her when she had fever. Even in the hospitals,
service providers behaved in a different way. She requests to behave the HIV positive cases in
the same way as service providers behave to the non-HIV people.

However, according to PLWHAs, extent of discrimination and other social problems are
decreasing gradually. They expressed the positive impact of some NGOs’ work in reducing the

17
social problems. A female PLWHA expressed “In the beginning there was big discrimination to
me in the village. When Trinetra gave training to me on community health volunteer, then the
community people are becoming supportive”.

Another female PLWHA added, “In the beginning no one supported me and no one understood
my feelings when they knew my HIV status. After few months, my family members gave me the
separate room for me and separated me from the family. I started coping all the things myself.
Now I am getting full support from my family members”.

NGOs working at the local level are also feeling changes towards the HIV positive cases by the
society. However, PLWHAs are still not treated as the non-HIV people in the society. There is
yet lot to do to improve the social problems of PLWHAs, they added. They remembered one
incident occurred in an HIV/AIDS workshop in a VDC as: “One of the VDC chairperson said
that all HIV positive people should be killed by giving vitamin to free from HIV/AIDS in our
society”.

3.4 Health Problems of PLWHA

While discussed with PLWHAs in three district following are major health problems expressed
by PLWHAs during group discussion or in depth interview.

• Fever, Headache
• Feeling of isolation
• Dizziness, Blurred vision
• Cutting injuries if they are due to drug addict
• Skin itching
• Nodules in body
• Body ache
• Common cold
• Vaginal discharge and itching around private parts
• Tuberculosis
• Diarrhea
• Weaknesses feel, Loss of memory,
• Cough, fluid collection in Lung

3. 5 Health Seeking Behavior and Its Barriers of PLWHA

When PLWHA suffers from infection they go to hospital, seek support from NGOs or private
clinic for treatment. As the participants to whom we discussed almost all they are affiliated with
NGOs, PLWHA group and much aware on HIV / AIDS. Most of the PLWHAs mentioned that
they first seek advice from family and friends then go to the doctor. According to PLWHA, there
are many NGOs working for HIV/AIDS awareness but there is no any organizations who
provides care and support services. There is no any single organization that provides free
treatment for PLWHA and no facility for CD4 count.

18
3. 6 Barriers of Taking Health Services for PLWHA

Major barriers of PLWHA for receiving timely and complete health care are:

‰ Financial barriers
‰ Avoidance by family
‰ Doubts on confidentiality from service providers
‰ Distance of health facilities
‰ Lack of counseling
‰ Lack of information where to get treatment
‰ The hated behavior (Ghrina and tiraskar) of health professional

3.6.1 Financial Barrier

PLWHAs mentioned financial problem as one of their major issue of concerns. According to
Trinetra, most of the PLWHAs are from poor socio-economic background and they are not able
to seek medical care and not able to buy food and the complete course of medicines.

Followings are some of the expressions/experiences shared by PLWHAs during the need
assessment:

• Lack of money at the time of sickness caused delay in receiving treatment. One PLWHA
reported that her friend (PLWHA) died due to the lack of money to obtain medical
service and food. Family and other relatives ignored her to provide the care and support.

• Some PLWHAs reported that they either could not buy the medicine or could not comply
with the doctor’s prescription.

• PLWHA from sakriya samuha group said that they spent the whole day for awareness
raising about HIV/AIDS but in the evening they did not have enough food to eat.

• According to a group of PLWHA, Maiti Nepal is giving Rs.3000/month instead of

visiting villages for raising awareness. This amount of money is not enough for food and
treatment as they said.

3.6.2 Social Barriers

• Most of the PLWHAs mentioned the lack of confidentiality in all hospitals has made
them reluctant to visit health facilities.

• One of the PLWHAs did not go to hospital due to fear of blames and misbehavior and
died with out getting proper treatment.

• The fear of social stigma do not allow them to expose their status in front of the society
or even friends which prevent them from consultation with the concerned people
including health workers or even with the family members.

19
 • People including other patients and service providers hate PLWHAs. One PLWHA
shared that the patients and visitors near by her bed remove the blanket covered their face
and even deny talking to her.

3 .6 .3 Organizational Barriers

Organization itself sometimes creates barriers to PLWHA. Lack of clear policies, procedures,
and attitude of the staff causes problems to the PLWHAs. According to PLWHAs,
organizations have often exploited and given the false hopes for them. They have violated the
right of confidentiality and personal dignity. Followings are some of the expression of
PLWHA during need assessment on how can organizations create problems for PLWHAs:

¾ Although doctors are educated people, most of them are not good for PLWHA.
“One day I went to see my friend in the hospital and I sat on an empty bed near to
my friend’s bed. Patients of other beds, nurses, and doctor made a big issue as I
(AIDS patient) sat in that bed”.

¾ “One of the organizations organized a dohori program (folk song) to raise funds
for PLWHAs and we never got that money but they spent elsewhere for their
own”.
¾ One day one PLWHA client went to a hospital along with action aid staff. When
the staff introduced doctor as I am a PLWHA in front of many other people, then
people started staring at me. It was really a painful situation for me. The I/NGO
staff should be aware of our dignity.

¾ One day when one of our friends (PLWHA) became sick, we took her to the
hospital but the doctor refused to see her and returned to home.

¾ The lack of transparency of NGOs and behavior of the staff were also expressed
by PLWHA during need assessment. PLWHA expressed dissatisfaction towards
Action Aid. Action Aid people said, “You AIDS people die soon so why do you
need cloths and food” when asked by PLWHA for support.

3. 7 Emotional Problems and Management

Discussion was held about the immediate feeling and reactions when PLWHAs knew the HIV
positive. These emotional issues give idea for designing and implementing VCT services.
Appropriate linkages and support mechanism can be better developed based on their feelings.
Followings are some of the feelings expressed by PLWHAs:

Most of the PLWHAs expressed fear, anxiety, loss of appetite, insomnia, loneliness, lack of
interest to work and talk as the common problems they faced in the beginning. Due to support
from different NGOs, they were able to mange to these problems. They also suggested on the
need of enough activities to manage these problems along with VCT service.

Most of them were very much worried about the society’s dealings. Although they have coped
their problem but they are still facing problems from the community and family. This has created
them lots of psychological problems.

20
 One of the male PLWHAs said, “I felt big crisis when I knew that I have HIV positive. In my life
that was big devastation and felt and suicidal tendency came in my mind. While I was in process
to go gulf country, blood was tested and came positive. Doctor did not explain me directly but
just gave in a piece of paper. At that time I was just 19 years. Now it is more than 10 years that I
have HIV positive in my body. For one week I could not inform to anyone but severely
traumatized. At the end, I accepted reality. From my own effort, and I went to Saibaba in
Banglore to create positive feeling in my life. Eventually I accepted that one day everybody dies,
so am me. Then I started finding positive survive by doing meditation and creating spiritual
feelings in my mind”. - A male PLWHA

“I took Ayurvedic medicine for 11 months from near by Ayurved practitioner. At that time only
millet bread was advised to take, my condition became worse than before. As per the suggestion
of my senior, then I stopped that medicine and took other modern medicine. If I become
extremely frustrated then I go to Ramhari sir of GWP for counseling and psychological support.
Then I realized how psychological support is important for people like me”. – A female PLWHA

I met HIV positive group of people especially Rajiv dai (kafle) and Anjana Amatya in
Kathmandu and got opportunity to share feelings of each other. While I saw people like me it
increased self confident to survive and realized that I am not alone in this world. Then after I am
mentally adjusted with the problem”. - A male PLWHA

During need assessment, PLWHAs expressed that there is very nominal psychological support
from NGOs. Meeting PLWHA friends, listening music, avoiding living alone, doing meditation,
and keeping themselves busy are some of the strategies applied by PLWHAs to reduce emotional
problems. In Chitwan district, PLWHA group has become very effective to reduce their
psychological problems. They also suggest making such groups strong and effective in other
areas along with establishing VCT service.

3. 8 Care and Support Service

There are care and support centers for IDUs and HIV positive in Rupendehi and Chitwan for
male clients but not in Nawalparasi. However they accept clients from all districts.

Followings agencies/group that are providing social and emotional support/service for PLWHAs:

™ GWP, Trinetra, WATCH

™ Chitwan Sakriya Samuha
™ Namuna integrated development council
™ Red cross
™ Maiti Nepal
™ Mother’s home, Family’s support
™ Sahara Rehabilitation Cnter Butwol
™ Support and care (S & C) Chitwan

21
3. 9 Social problems of Injecting Drug Users (IDUs)

During FGD and in-depth interview, Injecting Drug Users expressed the following social
problems, which they are facing in the society:

• People do not believe and treat positively even if the drug users give up the drugs. Social
stigma is very prevalent. People do not stop ‘back biting’ and discourage their (drug
users’) parents even if family accepted them.

• When there is anything stolen in the village people suspect drug users and take action
against them without listening their clarification.

• People do not allow us making friends and restrict their kids to talk with drug users.

• Police arrest on the way and ask for money. If drug users refuse to give, police threatens
to keep in custody.

• If we (drug users) want to do something good in the society, people do not believe but
rather criticizes us by saying: “Oh!! What addict can do”.

• Always feel neglecting and discriminating behavior from family, friends, and community
people. They deal negatively with drug users. Parents are willing to spend the huge
amount of money for other kids but not for drug user even for good purpose.

• Police treats very badly, give heavy tortures when the police catch drug users.

• Due to the negative feeling of parents, some drug users expressed that they were not able
to join rehabilitation center due to financial problems.

“One of my best friends did recently marriage but he did not invite
me. I asked why you did not invite me. He pretended that he forgot
to invite but actually he ignored and avoided me since I was a drug
user”. – One drug user boy shared his experience of avoidance in
the society.

3.9.1 Health Problems of IDUs

Followings are some of the health problems that drug users are facing in the need assessment
districts. These problems are based on their experience.

22
 ¾ Backache
¾ Burning nerve
¾ Headache
¾ Tearing in the eyes, sneezing
¾ Quick anger
¾ Lack of control on verbal language
¾ Laziness
¾ Lean and thin
¾ Lingering in small problems
¾ Loose in memory power
¾ Weight loss
¾ Hepatitis B

3.9.2 Health Seeking Practices of IDUs

Injecting Drug Users do the first aid treatment themselves first in the rehabilitation center. If not
improved then they either go to private clinic or medical college teaching hospital. But Drug
users have a fear of possible misbehavior by the service providers if they know the patient is an
addict. One IDU shared, “When I went to Butwol nursing home, one doctor expressed that I am
addicted and referred to psychiatric rather giving treatment”.

3.9.3 Major barriers for health seeking

‰ Financial barriers
‰ Avoidance by family
‰ Doubts on confidentiality from service providers
‰ Distance of health facilities
‰ Lack of counseling
‰ Lack of information where to get treatment
‰ The hated behavior (Ghrina and tiraskar) of health professional

3. 10 Female Sex Workers (FSW)

Most of them said the financial problem is the main reason to involve in this profession. Fear
stigma, frustration, anxiety, and abuse from police and male clients were common problems
shared by the sex workers. Following problems were identified from the discussion with female
sex workers. Common Problems are;

o Left by a husband and brought another wife, hates by the society

o Sometimes verbally abused and beaten by the client when asked for money
after sex.
o The police harassment is very bad and negative attitude, sometimes tortured by
police blaming as a Maoist, feeling of frustration and guilty with oneself
o Lack of acceptance by the society when returned from India due to trafficking
and then compelled to involve in this profession.
o Health workers sometimes deal in a very rude way; speak vulgar words, and
gives less priority to sex workers’ treatment. Compelled to wait for longer
hours.
o Compelled to go distance health facilities from their locality due to the fear of 23
knowing their status by others.
3.10.1 Health Problems of FSW

¾ Body ache, Burning

¾ Lower abdominal pain during sexual intercourse
¾ Itching in vaginal area
¾ Sexual transmission infections
¾ Vaginal pain during sexual intercourse
¾ Foul Smelling Discharge
¾ Bhiringi (Syphilis)/Ulcer around genital area
¾ Burning urination
¾ Puss discharge from vagina
¾ Excessive bleeding during menstruation
¾ Ulcer on Breasts

3.10.2 Health seeking Practices and Barriers

Few participants expressed that if they do not have money they do not want to consult until and
unless it is very serious and necessary. Consultations are also made with the friends and
concerned NGOs as most of them are affiliated with some NGOs. For minor infection/injury
either self-treatment or ordinary medical stores have been approached. Some have even tried
herbal medicine but was not effective. They go sometimes to the traditional healer for
psychological healing.

3. 11 VCT Service

There is no voluntary counseling and testing facilities existed in the districts but testing is being
done if anybody applies for visa to go foreign country or for blood transfusion purpose. Testing
is also done on request and if it is referred by a doctor or health facility. At present, there are
testing facilities available in some private and public institutions but has been done without
proper counseling service. Most of the FSWs have false impression that the HIV test is done
while done of STI testing by AMDA. Although it is wrong impression but it is due to lack of
proper communication and counseling.

Most of the participants were unaware of VCT but participated on the discussion of outcome
and coverage of VCT. They suggested sensitizing target group and community people about its
importance for its wider acceptance. Most of the organizations with whom we discussed wished
to engage in providing VCT service in future.

3.11.1 Needs and Expectation of PLWHA, IDUs, FSWs on VCT Service

Followings are needs and expectations expressed on care ad support in 3 districts:

1. Provision of free testing and treatment

2. Ensure confidentiality by media and concerned organizations
3. Available of prompt treatment facilities as per commitment
24
 4. Increase positive attitude and behavior of health and I/NGOs staff towards PLWHA
5. Increase awareness to reduce stigma and discrimination in the family and community
6. Create employment opportunities for PLWHA
7. Form and mobilize groups of PLWHA
8. Establish effective counseling service
9. Provide skills training, income generation training
10. Increase awareness among PLWHA
11. Provide home based care for PLWHA
12. Focus on holistic care in a service center
13. Encourage PLWHA, FSWs and IDUs to be peer educator
14. Provide financial support to PLWHA especially for treatment and food.
15. Provision of strong legal action for any social discrimination and misbehavior.
16. Free and easy access to family planning services

3.11.2 Reason of HIV test

Participants expressed the following reasons of HIV test:

• To know the status of HIV and reduce the doubtful, confusion.

• Establish the linkages with other services that required for HIV positive.
• To protect partners by using condoms in case of HIV positive
• For making the blood transfusion safe
• To make the future life plan
• Increase life span by receiving timely treatment of illnesses
• To get right treatment and services such as for TB, ARV
• To cover more people in PLWHA group which helps to foster better sharing of
experiences and reduce loneliness. Strong group can fight against discrimination.
• To increase self-confidence and satisfaction by knowing the status of HIV.

3.11.3 Reason of not willing to test

People do not want to come for blood test due to different reasons. These factors should be
carefully considered prior to establishing VCT services. Followings are some of the fears that
contribute people to avoid blood test:

• Fear of being HIV positive

25
 • Fear of the possible discrimination and misbehavior from family, friends, and from the
whole society
• Due to uncertainty of future plan after becoming HIV positive.
• Due to the poor economic condition and fear of getting timely treatment
• Due to the risk of loosing job.
• Unable to bear the burden of anxiety by knowing the HIV status.

3.11.4 Making VCT Service User Friendly

When we discussed with PLWHA on how to make VCT service user friendly, they suggested the
following points:

• Majority of the PLWHA suggested combining VCT service with existing STI mobile
clinics because STI mobile clinics are already popular among PLWHAs.

• PLWHAS suggest VCT centers to be easily accessed by transportation facilities and in

the urban area rather than in the rural area.

• Testing must be free of cost considering the economic status of target group.

• Along with testing, provision of free treatment and enough emotional support needs to be
ensured for PLWHA.

• Mobilizing and considering the experience of PLWHA is important to raise awareness.

• In order to make VCT more effective, care and support program needs to be incorporated.

• VCT programs needs to be combined with other health services such as health check up,
primary health care, DOTS, and STI services in order to make VCT more accessible,
attractive and effective.

• Attempt should be made to involve PLWHA in providing service. They can provide good
service to the PLWHA because they understand the feelings and problems of other
PLWHA compared to ordinary people.

• Information and communication: Giving information through radio, television, and

newspapers is very important to encourage target group to seek help for VCT service.
Raising awareness through existing outreach program would be effective in the
community level. Training is also required to all peer educators and outreach workers to
start social awareness campaign on VCT.

3. 12 Target group for VCT Service

PLWHAs and other target group suggested following groups of people to be tested:

26
 ™ To test everybody who have unsafe sexual practices
™ The people who are injecting drug users.
™ All wives whose husband lives in India for seasonal works.
™ Those unmarried couples who is going to marry very soon
™ To all who are involved in prostitution or working in sex trade
™ Who lived many years in foreign country as migrant workers
™ All who returns from India
™ Clients of sex workers
™ People who have multiple sex partners
™ People who have STI and are frequently sick such as fever

3. 13 Increasing Demand of VCT Service

9 Establish good counseling to the people and educate them on the importance of VCT
service.

9 Launch awareness campaigns in the community and among target groups.

9 Improve performance and interpersonal communication of service providers to deal with

target groups and clients. It increases the trust of clients towards health services. The staff
should speak politely, and the VCT service should be friendly to each client

9 Promote target groups such as IDU, FSW, PLWHA to the peer educators

9 Utilization of VCT service would be higher if the service is provided free of cost at least
for those who are in need of financial support.

9 Involve PLWHAs in program planning and implementation, which helps to make the
program more responsive to the target group.

9 Advertisement and mass awareness such as speech program, concert program is

necessary for increasing demand of VCT service.

9 Increase the confidence of clients regarding confidentiality and privacy of the outcome of
VCT. One by one testing and counseling would be good to maintain privacy.

9 Provide other health services like primary health care, treatment of TB, STI etc from
VCT centers. It helps to save client’s time and reduce the fear of stigma.

9 Ensure clients that their rights and dignity are fully protected and considered and attempt
will be made to reduce social stigma once they are identified as HIV positive.

27
3. 13 Challenges of VCT

• If the counseling component is weak people will be in distress, anxiety, fear, and will
have negative consequences in their health.

• If the level of awareness is low among community people, service providers,

discrimination will be bigger.

• If VCT is not linked with care and support activities, clients should face emotional,
social, and health problems.

• In case of IDUs, if test becomes negative they will perceive that the drug is safe and
therefore may continue taking drugs. Effective counseling is mandatory to prevent this.

3. 14 Views of NGOs

Focus Group Discussion was conducted with FHI partners working in three districts. FGD with
those organizations revealed the following information:

NGO staff expressed the similar problems as expressed by PLWHAs. According to them, there is
lack of services to raise self-confidence and to provide emotional support to PLWHAs. There
was strong myths towards the problems and treated accordingly. For example, community people
even refused to burn dead body of AIDS patient and avoided to buy things from their house.
Furthermore, if husband died of AIDS, wife had to bear all punishment from society irrespective
of the result of her blood test.

Discrimination has not limited to the parents, their kids are being blamed in the school. Other
students and villagers did not allow the kid to sit in the same bench.

3.14.1 VCT and its Demand

They suggested establishing VCT services in those places where client flow is already high and
where there is more faith among PLWHAs such as STI clinic, Marie stoppes, and Kali Gandaki
clinic and in other clinics. They further suggested making the service mobile in order to cover
larger group of the people.

They emphasized the good counseling and good behavior as the prerequisites to increase VCT
demand. They equally emphasized to launch the awareness activities among NGOs and target
groups about the importance of VCT service. Other issues expressed by NGO people to increase
demand of VCT are to use media such as FM radio, mobilize peer educators, provide counseling
training to volunteers and out reach workers, provision of care and support program after testing,
and involvement of local leaders to reduce stigma.

3. 15 Views of Medical Prescribers

28
Most of the medical prescribers welcomed the proposed VCT service in the district. At present
no any medical prescriber have standard guidelines for treatment of PLWHA and there is no
mechanism of tracking the referrals. Found positive feelings, attitudes and beliefs about the
treatment for illnesses related to HIV/AIDS among prescribers. However, prescribers were little
worried since patients do not share that they were HIV positive which makes prescribers difficult
in taking precautions.

In their experience, TB treatments have been found most helpful to PLWHA. Doctors suggested
seeing HIV cases separately from other patients. Regarding treatment cost, user pays full costs
for treatments and no free treatment is available. Mostly, ELISA test is available in the private
clinic and hospital but they have to refer to Teku hospital for confirmatory test. In all 3 districts,
monitoring CD4/ viral loads are not available.

3.15.1 Common types of treatment provided to PLWHA by medical prescribers

• STIs
• TB
• Other infections such as bacterial, fungal, parasitic
• Skin problems
• Diarrhoea, abdominal pain
• Psychological problems

Medical prescribers felt that followings are some of the major organizational barriers of service
provision for PLWHA:

¾ Poor awareness on HIV/AIDS among hospital staff

¾ Very poor follow up mechanism
¾ Unavailability of CD4 cell count
¾ No separate ward for HIV/AIDS
¾ Lack of ARV treatment
¾ Lack of training to health personnel
¾ Lack of organized clinic for HIV/AIDS
¾ No counseling in pathology unit and very superficial psychological support in
private clinic or in hospital.
¾ Poor maintenance of privacy/confidentiality by the hospital about the test and
treatment of PLWHAs.
¾ Unavailability of protocol for management of PLWHAs

29
3.15.2 Names of service providers/ pathology

Followings are the names of service providers that PLWHA visited for testing and treatment in 3
districts:

1. Dr Tapas Kumar Aich- UCMS Teaching hospital, Bhairawa

2. Krishna Sapkota Dr Medical hall, Bhairawa
3. Raju Aghari Singh Medical Hall, Bhairawa
4. Dr. VP Poudel Lumbini Zonal Hospital, Butwol
5. Dr. Vijaya Poudel Bharatpur hospital, + chitwan diagnostic center
6. Dr. Sashi Sharma Private clinic in Chitwan ( once in a month)
7. Dr. Sashi Jung Pande Bharatpur hospital + Bhagbati Medical
8. Surya Prakash Ghimire Surydaya Pathology, Bharatpur
9. Ramkrishna Bhandari Geeta pathology, Bharatpur
10. Girish gangawal/ Dr Deepak CMS Bharatpur
11. Dr. Bijaya Raj Neupane Asha Hospital, Bharatpur
12. Shiva Prasad Shradda medical, Chormara, Nawalparashi
13. Dr. Ram Raj panthi PHC, Nawalparashi
14. Daya Koirala Janta Medical hall, Chormara, Nawalparashi
15. Dr. Chhabilal Thapa Dumkauli, PHC Nawalparashi
16. Rasu Nada Basa medical hall, Bardaghat, Nawalparashi

3.15.3 Prescriptions and Access of Drugs

Prescribers often experience following problems while prescribing drugs to PLWHAs:

¾ People are mostly too poor to afford any treatments

¾ People can afford simple treatments, but not expensive anti-infective drugs
¾ If drugs are unavailable or unaffordable, then change the prescription
¾ Treatment is sometimes interrupted if patients don’t have money

3.15.4 Supplies of medical prescribers

Table 4. Supplies that the medical prescribers have:

Supplies Always/almost Usually
HIV test kits 9
Syringes and needles 9
Gloves 9
30
 Sterilization materials 9
Disinfectants 9
Universal precaution 9

3.15.4 Suggestion of medical prescribers

Table 5. Suggestion of medical prescribers to provide better service for PLWHA

Activities How it helps

Increase networking among providers to share Helps for mutual transfer of knowledge
information on HIV care and available and expertise, better coordination and
resources. mobilization of resources

Provide training to gain additional Better and efficient management of

experience/knowledge on providing HIV care, PLWHA
such as ARV, dealing with opportunistic
infections, monitoring, and counseling
patient’s health status

Providing services in a more convenient Better services gives more benefit, good
manners (such as better office hours, quicker patients compliance and better outcomes
appointments, less waiting time)

Training on how to better advocate for Improves capacity of prescribers to

clients/patients protect clients rights and dignity

More funding More resources is available for PLWHA

31
 CHAPTER - 4
4. RESOURCE DIRECTORY

Please see in ANNEX for the resource map, target group location of district and detail resource
directory.

4. 1 Rupandehi

Following table shows the list of organizations working in Rupandehi district and their area of
focus:

SN Name Area of focus

1. Namuna Integrated Counseling for IDU, FSW, HIV test, referral, home base
Development Council care
2. Sahara rehabilitation Rehab center for IDU and HIV positive, Counseling, day
centre/SSG care center, Mass awareness, referral, Fund raising, HIV
positive group formation (support Sahara)
3. SPW HIV/AIDS awareness, sex education
4. RUPP Loan provide to PLWHA
5. Family Planning FP service, TB treatment, community/youth mobilization,
counseling, mass awareness, STI treatment, reproductive
health service
6. ADRA Psychosocial, Mental health service and sexual and
reproductive health

7. NRCS Testing, counseling, HIV/AIDS awareness in school

through peer education program
8. District Health Office Manage health services as per government policies and
plans. Coordination and awareness raising
9. UMC Testing, treatment, psychological care
10. WOREC HIV/AIDS awareness program focus to youth at
community
11. Paropakar Dan Bibhag Tuberculosis treatment
12. WATCH Behavior change, simple treatment, referral, awareness,
group formation, credit to PLWHA, free treatment,
vitamin, nutrition support, counseling
13. DAC/ DDC Budget allocation, awareness on HIV/AIDS
14. Rotary club Youth mobilization and tuberculosis treatment
15. World vision Focus on behavior change
16. TB Centre Tuberculosis treatment
17. Youth vision Rehabilitation, awareness, counseling, doctor visit, day
care center, meditation, spiritual
18. Marie stopes Family planning, reproductive health service, youth
mobilization
20. MTI TB treatment, DOTS
21. Joshi Medical Hall Testing and treatment

32
22. Singh Medical Hall Testing and treatment
23. Doctor Medical Hall Testing and treatment
24. Tilganga Medical Hall Testing and treatment
25. Mote Medical Hall Testing and treatment
24. Butwol Medical Testing and treatment
College
25. Lumbini Medical Testing and treatment
College
26. Butwol Government Testing, TB service and treatment, 24 hours service for
Hospital inpatient
27. AMDA Hospital Health service delivery for women and children

4. 2 Chitwan

Following table shows the list of organizations working in Chitwan district and their area of
focus:

SN Name Focus Area

TB treatment through out the district, counseling, awareness,

1. NATA home visit, school health program (TB + HIV), referral, home
base care
2. Support and Care ( Rehabilitation center for IDU, HIV positive, Counseling, day
SNC) care center, treatment, 24 hrs service providing food and lodging
Mass awareness, referral, Fund raise, positive group formation,
3. UNICEF Training for health personnel, awareness to CHV, TBA,
teachers, health personnel
4. RUPP Provide interest free loan to PLWHA up to 25-50 thousand to
refund within one year, awareness program at school, jail,
factory, dohori program and raise fund
5. Family Planning Provide FP service, condom promotion, MCH & reproductive
Association of Nepal health service, Plan for VCT, sex education for newly coupled
6. GWP Behavioral change, food and clothing support, treatment,
referral, counseling, condom distribution, home visit
7. NRCS Testing, counseling, HIV/AIDS awareness in school through
peer education program, special days celebration
8. District Health Office Manage health services as per government policies and plans.
Coordination and awareness raising
9. Ayurvedic Center Herbal treatment, psychological support
10. SMD/CRS Develop IEC materials, social marketing for condom, condom
distribution, safe home delivery
11. Maiti Nepal Skills training, employment to PLWHA, ARV therapy,
prevention, care and support, treatment, counseling, encourage
PLWHA group
13. DACC/DDC Linkages and coordination with HIV related organization
14. PLWHA Sakriya Care and Support, counseling, increase membership, linkages,
Samuha lobbying (Rs.17, 000 fund)

33
15. Action Aid Support for treatment, food and clothing, referral for testing,
stationery support for FSW and PLWHA children
16. TB Centre Tuberculosis treatment
17. Youth vision Rehabilitation, awareness, counseling, doctor visit, day care
center, meditation, spiritual
18. Marie stopes Family planning, reproductive health service, youth information
center and employment for PLWHA
19. Bharatpur government Testing and treatment
hospital
20. Bharatpur Medical Testing and treatment
College
21. ASHA Hospital Testing and treatment with counseling
22. Chitwan Diagnostic Testing and treatment
Center
23. Suryodoya Pathology Testing and treatment

4.3 Nawalparasi

Following table shows the list of organizations working in Nawalparasi district and their area of
focus:

SN Name Focus Area

1. Raya Medical hall Treatment provided to PLWHA

3. ABC Nepal HIV/AIDS awareness at community
5. Family Planning FP service, condom promotion, MCH & reproductive health
Association service,
6. Trinetra Behavioral change, awareness, support to PLWHA children,
IEC promotion, referral, counseling, home visit, linkage and
coordination
7. NRCS Testing, counseling, HIV/AIDS awareness in school through
peer education program, days celebration
8. District Health Office Manage health services as per government policies and plans.
Coordination and awareness raising
9. Ayurvedic Treatment Herbal treatment, psychosocial support, spiritual care
Centre
10. Law form Advocacy for human rights, interaction with PLWHA
11. Maiti Nepal Skills training for girls and rehabilitation center, Referral to
ARV therapy, prevention, counseling, encourage to form
PLWHA group
13. DACC/DDC Linkages and coordination with HIV related organization
15. Social Creative Group Preventive and curative services, Profile update of health
personnel, Doctor visit in center
17. Suseli Art Group Awareness on HIV/AIDS through street drama and theater for
development.
18. Marie Stopes Reproductive health service, TBA training, STI management,
HIV/AIDS awareness to TBA, CHV

34
19. Kaligandaki Private
Hospital
20. Sita Medical Store
21. Shradda Medical Hall
22. Govt. PHC center, attach
to Kaligandaki
23. Dumkibas health post
24. Nawa Prativa
Community
Development Center
25. Sajha health cooperative
26. Vijaya Development
Resource Center
27. Social development and
research center
28. PHC Center Chormara
29. Janta Pharmacy
HIV testing and TB treatment
Treatment and referral for PLWHA
Treatment and referral
Treatment and referral
Medical, nursing, home base care and spiritual care
Mental health service
Preventive, curative, and home based care
Poverty reduction, counseling, and awareness on HIV/AIDS
Economical support, sanitation, blood donation, health and
hygiene
Preventive, curative
Preventive and curative, Psychosocial
35
 CHAPTER - 5

5. CONCLUSION AND RECOMMENDATION

5.1 Conclusion

The need assessment has clearly revealed that the PLWHAs, FSWs and IDUs are regularly
facing social, religious, and cultural discriminations in the society. They are deprived of their
rights to adequate physical, mental and psychological development and it is still uncertain how
long they have to wait for equal treatment. Most of them are facing economic problems to
manage their daily expenses, which has limited the use of available services. Socio-economic
and cultural barriers are equally prevalent to prevent the access and use of health care and other
existing facilities.

All PLWHAs, IDUs, FSW, NGOs and medical prescribers expressed the need to create a social
conducive environment and to give equal opportunities to PLWHA so that they can express their
problems openly and can lead a life without any barriers. There are no any rehabilitation centers
for PLWHAS, especially for the women, and no any spiritual care for PLWHAs in three districts.
There are many organizations working on HIV/AIDS in preventive aspects at the community
level but services are not free in any of those organizations and lacking care and support
program.

All the organizations and target group welcomed the concept of VCT service. It is very
encouraging to start the VCT service however the PLWHAs and NGOs suggested integrating
care and support program along with it. There are very few organizations working to deal with
day-to-day problems of PLWHAs. Moreover, supports that are being provided by some
organizations are minimal and is only limited to few PLWHAs. The existing medical and
diagnostic facilities in public and private sector are not affordable and counseling service is not
being done properly. Only few NGOs and one PLWHA group in Chitwan are providing
counseling service.

Participation of PLWHAs, IDUs and FSWs at different levels of program was equally
emphasized in order to make VCT service more effective. They can be the good resource for
counseling, peer education, and other purposes in the VCT sites.

The commitment, skills and experiences of those organizations working closely with PLWHAs
were questioned by many of the PLWHAs and target groups. Therefore, for the effectiveness of
the VCT program, most of PLWHAs and other target groups suggested considering their views
and opinions while developing programs plans and interventions. More specifically, policy
makers and all key actors, who either work for PLWHAs or who have responsibility for
PLWHAs in one way or another needs to start thinking about how PLWHAs see their world,
how could be improve their life better, and how could their views be incorporated.

All most all the target groups are quite aware of their own needs and the solutions to obtain equal
status as Non HIV person. One of the worries expressed by PLWHAs and other target groups
during need assessment is the under estimation of their rights, values and dignity by the service
providers and the community people. This is the main reason of PLWHAs, FSW, and IDU for
being not able to disclose their status with service providers, family members and communities.

36
Therefore, we need to analyze the problems and strengths of PLWHAs, FSW and IDUs and use
their potentialities in making VCT program more effective, accessible, and user friendly for
PLWHAs. At the same time, strong commitment from different stakeholders is necessary at
different levels to address the specific needs of PLWHAs.

5.2 Recommendations

Based on the findings of need assessment, following recommendations have been made to make
VCT program more effective:

1. Enhance the capacity of PLWHA to create conducive environment

The Voluntary Counseling and Testing (VCT) is an important component as well as pivotal entry
point for comprehensive HIV/AIDS prevention, care support and treatment services. Therefore,
organizations that are working directly or indirectly on HIV/AIDS have to show strong
dedication and commitment at all levels. Efforts should target to create a more congenial
situation for PLWHAs with the joint effort among stakeholders. Followings are some of the
recommendations to increase the role of PLWHAs to confront with the social environment:

• This need assessment revealed that most of the PLWHAs are unhappy because they are
under valued and given low status either in public or private spaces. Therefore, listening
to PLWHAs and other target groups, creating a climate of confidence, and discovering
new values and collecting their strength are highly recommended. Active participation in
the VCT service (e.g. through peer educators) may help to enhance the self-esteem and to
develop a sense of identity of PLWHA in the society. It may also give PLWHAs a
collective strength to fight against social discrimination in the society.

• PLWHAs should be encouraged to meet together to share, discuss and act for the
improvement of their own and community situation.

• The rights and hopes of PLWHAs and their achievement of them should be constantly on
the agenda at all levels especially in the family, VDC, DACC, DCWB, district health
office, schools, women’s groups, NGOs, children’s groups and other user committee at
local levels.

• Involve PLWHAs in the decision making process and include them as full and active
partners in identifying their own issues and problems and in designing, planning,
implementing and assessing programs which affect their own lives will have more
sustainable impact.

2. Establish community support systems at local level:

Once we establish VCT service, many HIV positive cases will be identified so if
communities are not involved the PLWHA might be thrown out from the society. Unless the
community as a whole is involved in the VCT process, it cannot succeed and the change will
be difficult and slow. The support systems should identify PLWHAs who face more
difficulties so that they will not doubly victimize and other PLWHAs will not suffer.
PLWHAs who have faced many difficulties can be good teachers for a live giving strategy
and for restoring responsibility to the community.
37
 Followings are some of the recommendation for this:

• Organize orientation, training, and awareness activities prior to starting VCT and
continue afterwards to different stakeholders, health personnel, partners, and peer
educators at different levels. It helps to protect the rights of PLWHA.

• Community support systems for PLWHAs need to be developed in every village to

enable PLWHAs to achieve their potential.
• A wide spread campaign through posters, TV, radio and other media should be organized
to aware on the VCT services and promote this theme inside and outside the family.

3. Movement to reduce discrimination against PLWHAs and change the society for
equality, peace and justice

The current situation is an intolerable status quo, which has made PLWHA seriously
frustrated for not getting care and support services. We should have positive attitudes and
believe a small change in our perception can have a major impact to PLWHAs. Following
recommendations have been made:

• Service providers and support organizations need to be aware of the psychological aspect
of PLWHAs and should not hurt to PLWHAs at any case and should be friendly while
dealing with PLWHAs by using the simple language. There should not be any
discrimination by service provider who has been involved for the treatment of PLWHA
based on poor and rich, ethnicities, and gender. Therefore, need to sensitize service
providers, family and society on the dignity and rights of PLWHAs so that safe,
comfortable, and friendly environment for HIV positive cases could be promoted.

• Sensitize media people regarding the issue of confidentiality and other ethical issues prior
to publishing the news because the media increases the discrimination in the society after
publishing or broadcasting the personal/sensitive information of PLWHA.

• Since the harassment has been found in different places including from service delivery
point to the street, provision of the law is required to punish/discourage the people who
discriminate and harass PLWHA.

4. Utilization of VCT service: in order to increase the use of VCT service, following
recommendations have been made:

• Provide free testing among target group and free treatment for PLWHA as most of them
are facing financial crisis and many of them are dying due to the lack of money to buy
medicines and no timely treatment. It is further suggested for the provision of prompt
medical treatment and other care and support program needs to be incorporated. Along
with testing enough emotional and spiritual care needs to be ensured for PLWHA.

• VCT centers to be easily accessed by transportation facilities and in the urban area rather
than in the rural area and combining VCT service with existing mobile clinics would be
effective as mobile clinics are already popular among PLWHAs.
38
 • Increase the confidence of clients regarding confidentiality and privacy of the outcome of
VCT. One by one testing and counseling would be good to maintain privacy.

• Establish good counseling to the people and educate them on the importance of VCT
service.

• Facilitate PLWHAs to discover meaning in life, build self-esteem and sense of humor.
Develop skills and feeling of having some control over what happens in life. This is
related to spiritual life and religion.

• Mechanism of regular monitoring of service sites and referral institutions would be

beneficial to maintain optimum care and support for PLWHAs and for the compliance of
standards, manuals, and protocols by service providers.

• Some organizations need to involve dealing nutritional aspect, prophylaxis treatment, and
ARV therapy and rehabilitation facilities for PLWHA in those districts.

5. Leading the way in advocacy campaigns:

It is the solidarity that makes possible for their voices to be heard more loudly in the future. The
formation of PLWHAs group and network across a wide spectrum across sections of society at
the local, national, regional are of the utmost importance. Followings are some recommendations
for this:

• Network building among service providers and social mobilization at the local level
needs to be strengthened for better referral and lasting benefit of PLWHAs. Therefore,
coordination meeting and partnership building should be an integral part of the program
and should encourage the local level coordination and social mobilization in the districts.

• The deficiency in present legislation and policies has caused harassment to PLWHAs in
public/private places. Policies and legal provisions should be made public both locally
and nationally so that people would be careful to deal with PLWHAs.

• Groups/networks have to be facilitated by NGOs and INGOs for PLWHAs.

• Organize regular sharing program among service providers, NGOs, PLWHAs and social
mobilizers at the local level to foster understanding on practical issues related on VCT
and HIV/AIDS and updating their knowledge base.

• Advocacy to protect PLWHA’s rights is virtually missing or very weak and not been able
to raise the voice of PLWHAs by organizations in cases of violating their rights.
Combined efforts of different stakeholders would be able to protect the rights of
PLWHAs.

39
III. REFERENCES

• MOH, National Center for AIDS and STD Control, National Estimates of Adult HIV
Infections, March 2004.

• MOH, National Center for AIDS and STD Control, National Guidelines for Voulntary
HIV / AIDS Counseling and Testing, July 2003

• Crepha, draft report on estimations of Sex Workers and Potential Client Sub-Population
in Select Major Towns in Terai and Along the East-West Highway Districts, February
2004

• New Era, Behavioral surveillance survey in Western to Far - Western sector of Mahendra
Highway of Nepal, February 2003

• New Era, Behavioral Surveillance Survey in the Highway Route of Nepal: Round 4, May
2002

• STD and HIV prevalence Survey Among Female Sex workers and Truckers on Highway
Routes in the Terai, Nepal, May 2000

40
IV. ANNEXES

ANNEX 1: Consent form

The information collected using this guideline will be kept confidential and use for programme planning
purposes only.

ID.NO………. Date: …...…..…....

Start Time:…….….. Ending time………
PNGO: ...................
Interview place: District……………………. Location…………
Name of interviewer: …………………………

Introduction
Hello. My name is ………………………… …….…. I would like to discuss with you for about
an hour on problems related to HIV/AIDS and voluntary counseling and testing (VCT). It will
help us develop programs to help people and community protect their own health specifically
against HIV/AIDS. You are assured of confidentiality on all information you volunteer and no
reference will be made to your name if the findings of this study are published. You may refuse
to answer any question that you are uncomfortable with or not willing to answer and will not
prevent you to benefit from any services that are already available. However, your open and
candid answers to the questions will be highly appreciated. Are you all then willing to participate
in this conversation?

To Interviewer: If the participant gives his /her consent please continue, if not stop here.

[Just Tick of]

I will try to take notes of major things that you express. However, it would be difficult to
remember every thing and take notes that you say during the interview. For this reason we would
like to use tape recorder. This will capture all your ideas. I hope you would not mind using tape
recorder. No body will know who said what because your name would not be used.
To Interviewer: Be sure that the informant do not have any objection to using a
tape recorder. [Just Tick of]

Before starting our discussion, can you please give me some personal information?

Participant’s Identification

- Caste/Ethnic: ………………… Age and Sex: ………………..

41
 - Current address and duration of stay: ……………………
Dist………………………Location……………………
- Place of birth: Dist:……………………. Location…………………….
- Marital status: …………………………….
- Education: ……………………………...Occupation:………………….
- Mother tongue: …………………

Thank you very much. Let us start our discussion.

To Interviewer: Establish good interpersonal relationship with the informant by talking

informal issues before discussing the topic.

To Interviewer: Sharing Objectives:

1. Create mapping and directory of services, facilities and resources in public / private
sector in relation to HIV / AIDS such as counseling services, treatment for opportunistic
infections, hospice care, mental health service, rehabilitation centre, socio economic
support, ARV therapy, STI, FP, TB, support groups, home care and spiritual counseling
for the care and support of PLWHA.

2. Explore the needs and expectations of PLWHA particularly those in vulnerable groups
[FSW, IDU, clients of FSW] and more especially their needs concerning care and support
services. Assessment of those services in-terms of;

• Accessibility
• Acceptability
• Affordability
• Availability

42
ANNEX 2: VCT Need assessment questionnaires

The information collected using this guideline will be kept confidential and use for programme
planning purposes only.

Questionnaire for in-depth interview and FGD

A. Problems:

1. First of all, could you please tell me about any problems you have been having, and how you try to deal
with those problems?

What are the major problems (Economic, Social) faced by you and your friends?

(Spontaneous list of problems develop a checklist of problems now - and then grade these into
seriousness - most serious, moderate and least serious)

Pre developed checklist for interviewer

(Not enough money, Family breakdown, Neglected/discrimination, Stigma, Sore/infection, Strong
addiction)

For each major problem ask the whole story of exactly what it happen; Focus on one of the problems
the person mentioned, and ask: “Depending on ‘the story’ ask
- How serious was it?
- How did you try to get help for that problem?
- Who did you go to?
- Who did you talk with about it?
- When and where did this happen?
- Who is the person who helped you?
- Why it is serious

2. Where do you go when you are ill? Where you got support including address and location.
Ask details about;
Ask where she goes for assistance for each
problem, list of services? (For this, do a
• Emotional support, religious, NGO, etc, free listing first and then use a pre-
• Material support --food, clothing, etc, developed checklist focussing on services,
• Social support -relations hip, affection, persons, institutions, places where they are
etc., provided modern medicine, traditional,
• Economic support (money, what spiritual, others), persons to contact,
places/institutions).
happens if there is no business, you are
ill, etc.)
43
 3. If there is a health problem;
- What are the common health problems faced by you and your friends?
(Again for health problems too do a free listing and compare the problems with the pre-developed list and do
grading according to seriousness most serious, moderate and least serious)
Note for the facilitator:
• Diarrhea
• Chest infection/cough/common cold
• Loss of appetite
• Skin infections
• Weight loss
• Headaches
• Psychological problems
• Tuberculosis
• STIs: genital sores, swellings, discharge from penis or vagina

Choose the first three most serious health problems and explore the questions as above WH question
and below)

For the interviewer;

When you get ill, what is the first thing that you do? (rely on your own knowledge, consult other
member of the family, medical worker, local healer, take some kind of medicine)
For the treatment where do you go for help? (Self treated, hospital, clinic, traditional healer etc).
(For interviewer: after receiving the list, ask participant to draw map- specifying name of the
treatment place and locality).

4. Did you/other person consult someone about where to seek treatment? If yes, whom?
(For Interviewer; Friend/ relative –, friend/relative – with medical background, dhami/jhankri, went to
a temple, telephone hotline, other)

5. Where did receive treatment and from whom? Explore: (Probing: Modern health facility, traditional
or Ayurvedic etc

6. If went to a modern health facility

a. What was the health facility he/she went to?
b. What happened? Did they know you are HIV+?
c. If treated by someone who treats HIV+ persons: who is it? Where? What kinds of
advice and suggestions do they give?

If treated by a service where they didn’t know his/her HIV status; you could ask: “Have you ever been
treated for health problem in a place where they knew you are HIV+?”(Yes??) “Are they quite good at
treating people who are HIV positive?

7. How did she come to know about this health facility?

44
8. How was the service? (Probing questions for interviewer: Waiting time, crowded, privacy,
sex of health provider, attitude and behaviour of health worker, Knowledge and skill on subject),
did you find it comfortable to talk to the health provider about your problems.
(To interviewer: If the respondent did not visit a modern health facility for most serious health
problem) What are the major barriers for that? (For interviewer: ask informant a
spontaneous list of barriers - and then grade these into - 4 categorise)

Probing For interviewer

• Lack of knowledge,
• Believe on traditional healer instead,
• Negative attitude and behavior of health worker
• The opening time and distance is not suitable,
• The service is expensive,
• Crowded
• There is no privacy
• Others

For the interviewer: classify those barriers

Financial barriers – such as the cost of drugs and the need to prioritise other general supplies, such as
food.
Organisational barriers – such as poor administration of treatment services and lack of skilled staff.
Physical barriers – such as treatment facilities being distant and transport
not being available.
Social barriers – such as stigma being associated with a treatment and
people being concerned about confidentiality.

d. What were your/other person’s worries? (Curiosity about the disease, its seriousness, the way
it was contracted, what could be done, who could help, etc.)
e. How long did you/other person wait for seeking treatment (delay in seeking treatment).IF
WAITED: What were reasons to wait?

(After discussing about most serious health problems and related issues find out about the preference
of the respondent for certain health facilities and reasons for preference) [Use Matrix Chart to find out
preferences]

8. If psychological problems were not mentioned, ask: “Do you talk with anybody who gives
you psychological support or advises about keeping up your spirits, your inner strength or things
like that? Who? What kind of a person?

Probe: “Any other problems? Anything else you haven’t mentioned?”

Any other things you would like to tell me about how you deal with the problems

9. What about support from your family? and support from community?

10. If the person mentions problems of stigmatization in the family: “Did you ever get anybody to talk
with your family about HIV, to get them to understand better?” [If no such help: ‘Do you think that

45
could help? ---that someone comes to talk with your family members and explains more about HIV, etc.
etc…]

10. (Did he or she mention HIV positive groups??) What about HIV positive groups? (If s/ he goes to a
group.) What kind of help do you get in the group? How does the group help? What do you share in
groups?

B. Inventory of services, facilities and other resources for the treatment, care and support of
PLWA:

™ In your area, where do the PLWA group usually go for treatment of HIV related illness? give group a
task
Task 1: A simple treatment (such as paracetamol for pain relief).
Task 2: A well-known but less simple treatment (opportunistic inf such as for TB).
Task 3: An antiretroviral drug.

Mark the places in the community where the drugs for HIV treatment are available to a person with HIV.
These might include their home, clinic, hospital, pharmacy, NGO, traditional healer, private practice
practitioner or market place.

™ General Probe: Are there any other places or people that maybe helped you or gave some support
some time or other? Any organizations, or persons, anybody?

™ What types of health facilities are available for HIV/AIDS and where are they? Points out in map and
list the description. How is the service? (Affordable, accessible, acceptable, available).
™ What is generally available for HIV treatment and care? Where PLWA can go for health services?
™ Draw a map showing about the overall availability of drugs for HIV related treatment in the local
community? What types of drugs are more available than others? Why?

™ Do you know any doctor or clinic in the area that is known for good treatment of HIV people (where
is it on the map)
- If the respondents indicate that there is a doctor who is good with HIV persons, who is he or
she? What does she do? Have you been checked by her/him? Where do they refer the cases
for the further consultation? Please give us all the details about that person or clinic. Do you
sometimes accompany other PLWHAs to that clinic? Please tell more about that.
- For what kinds of illness do they treat specify. Such as: simple illness, treat TB, or ARV
therapy.

™ If there is a support group of PLWHA: Can you tell us all about that group? How long has it been
meeting? Who is the head of the group? What kinds of people are in the group? What types of
services they are providing? What type of support you have given and taken among your group?

™ Are there any PLWHA group /networks in your community? and other NGOs that focuses on
PLWHAs? How are they working?

™ Are there any other organizations or facilities (or NGOs) in your knowledge that could possibly play
a role in helping PLWHAs? What kinds of help they could offer (support, treatment, referral or
other)? List and Mark on the map

™ Do you know any other social organizations that working for PLWA beyond health services?

C. Concerning Testing and Counseling:

46
 1. Do you know of anybody who has gone for an HIV test? If yes where, when, how s/he decided
for testing? Who and where was test performed?
2. Who suggest them for test?
3. Why do people go for testing?
4. Do you think people should be tested?
5. Who should be tested?
6. Do many people go for testing? If no, why not?
7. What are the benefits/drawbacks of testing for HIV?
8. Have you /your friends ever been counseled? If yes, who and where have you been counseled?
And on what topic?
9. Have you ever heard of HIV/AIDS voluntary counseling and testing (VCT)? If no listen to me:

Explain concept of VCT

1. What is your opinion about the starting VCT program in your areas.[positive and negative aspects]

2. If you have NOT taken an HIV test before, what will motivate you to go for a test? (Only ask for
IDU and FSW (Checklist for interviewer, Do not read out the options.)

If I get sick often

If I had a partner/spouse who is sick or died from HIV/AIDS
If I had a child or family member who is sick or died of HIV/AIDS
If I am planning to get married
If recommended by the nurse/Doctor
If the results will not be disclosed to somebody else/ privacy
If medical treatment is easily available
If my partner/spouse recommends me
If cost of test is made cheaper /free
If the VCT center is near by
If health providers are co-operative
If I am in high-risk group

3. Can you suggest effective way to run this program for the maximum benefit to the beneficiaries?
How VCT service could be friendly to target group and any individual who like to do regardless of
status.

4. How could PLWA and vulnerable people’s involvement and participation can be done in the
designing and implementation of the VCT

D. Treatment, Care and Support:

1) What are your feelings, attitudes, beliefs about treatment for illnesses related to HIV /AIDS?

2) What are the experiences of PLWHAs regarding testing and follow-up, and related issues? What
kinds of special needs, services, has he or she contacted, or needs to contact?(Get plenty of
descriptive details; get specific events )

3) Did you or your friend tried for the treatment of HIV/AIDS (ARV)? If yes where did you go?
Who prescribed the ARV?

4) Where and how do you get information about HIV care and treatment? What drugs and
treatments are accessible locally, including pharmaceutical, drugs, traditional, herbal or home
remedies and supportive measures?
47
5) What is the existing support system for the PLWA? (psychological, material, referral etc) Do any
organizations providing support and care to you (PLWA)? If yes list the name and their area of
services. Spot on map for the location.

6) What is the input on care and support from the friends, family, and the community?

7) What is professional medical input? – Nurses, doctors, pharmacists etc? - Diagnosis, treatment, -
referral and follow up, - nursing care, - counselling, -support to meet psychological, spiritual,
economic, social, and legal needs.

8) What should we do to make the services user-friendly to you and your friends? What type of
support is important for HIV + positive?

9) What can you do against HIV as a group? Where you can get support in your city?

10) Who will help you to fight against HIV /AIDS?

11) When he or she went to a particular health service or other organization. What happened? Who is
helpful?

12) What recommendations concerning testing services, counseling, etc. does he or she suggest?
Who should provide HIV testing? In what kind of location(s)?

13) What are the kinds of supporting help that people have turned to, both for health care and other
support? What kinds of supporting services need to be developed? What organizations in the
community might help in these matters?

14) What do you think should be done—should there be more HIV testing available, and how, where
should it be done? Who all do you think should go for testing?

15) What measures are doing by Govt, NGOs and other agencies / individuals for the prevention,
care and support? What do you think about these services; are they effective?

16) What could be done for the improvement of existing health service and treatment system? in-
terms of quality of treatment, accessibility and user friendly?

17) Do you have anything more to tell me besides what we discussed?

Thank you very much for all the valuable information you have given me.

Namaste!!!! Good luck to you.

48
ANNEX 3: Questionnaire for Medical prescribers

The information collected using this guideline shall be kept confidential and used for programme planning
purposes only.

Name Person: Name of organization:

Specialty and training:
Training on HIV/AIDS related issues:
Year of treating/supporting the PLWA:

A. Personal and Policy Issues

1. How did you get involved in helping PLHA, what kind of helps do you give and what support
do you get? (Treatment, care, social support, economical support etc)

2. What shorts of treatment do you provide to the PLWA?

- Treatment needs
- STIs;
- Tuberculosis (TB);
- Specific treatment for HIV infection (Antiretroviral therapy);
- Other infections – such as bacterial, fungal, parasitic;
- Nutrition – including undernutrition and malnutrition;
- Skin problems; Sinusitis;
- Diarrhoea; Pain; and
- Psychological problems.
- Others specify………..

3. What are common problems you see with health and HIV when you are helping PLHA? How
do you find out and manage the problems?

4. What are your feelings, attitudes, beliefs about treatment for illnesses related to HIV /AIDS?

(For the interviewer guide - eg. some treatment is possible with simple drugs; simple drugs are
available but not really worth doing anything; if we can get antiretrovirals it is worth doing
something; don’t want HIV patients coming to my clinic - puts off other patients; worth treating
early illness but nothing can be done for late-stage patients; palliative care is important, but we
need good analgesics; can’t get morphine so can’t do palliative care)

- How much of your work relates to HIV-related conditions eg: proportion of time taken up,
- How has practice changed as epidemic developed?
- How do you decide what conditions to treat and with what?
- Tools e.g. do you have up to date information & training on HIV?; do you have up to date drug
information, if not what is the problem;
- Do you have standard treatment guidelines?

(a) Symptom based e.g. for diarrhoea, coughs, pain etc.

(b) Based on diagnosis e.g. for tuberculosis, sexually transmitted
Infections etc.? ARV therapy
49
(E.g.: nationally agreed guidelines, locally agreed guidelines, personal written guidelines based
on experience, WHO or other publications, use my own skills guidelines don’t suit my situation)

B. Treatment - prescribing, access, adherence, follow-up

5. Who pays for treatments?

(E.g. free to user, user fees, user pays full costs; insurance scheme pays full or part cost, NGO
pays full or part cost, community or joint NGO purchasing schemes, buyers’ clubs, donated by
NGOs, donated by well-wishers, donated by PLHAs)

6. What technical support is available for treatment? If you are providing ARV in what basis do
you give? How do you diagnose the cases?

(E.g.: diagnostic tests, monitoring CD4 / viral loads, improving adherence via pharmacist,
nurse, doctor, counseling, family/volunteers etc?)

7. What psychosocial help is available to support treatment?

8. Are you able to refer patients for specialist help when needed?(-eg: where to, under what
conditions, what barriers are there, what happens, are patients referred back to community when
specialist help no longer appropriate?)

9. Are you able to refer patients for home/community care when needed? eg: under what
conditions, what care and support is available, what other needs have to be met as well as
treatment?

10. What are the major problems do you encountered in the treatment process of
PLWA/PLWHA? how do you solve/ manage the situation ?

11. Do you know any persons/ agencies/doctor who are giving treatment to the PLWA? (Simple
treatment or ARV therapy). Approximately how many are there and where are they? How is
there treatment quality in your opinion? Do they share experience with you?

12. What are the encouraging and discouraging factors for you during the treatment process of
PLWA?

C. Contextual issues

12. Who supplies drugs etc. for treatment, (e.g.: sources of supply, local, national, international)
13. What alternatives are possible if the supplies you want are unavailable or unaffordable?
14. Are traditional treatments or local remedies used alongside or instead of conventional
medical treatments? How can use of these treatments/ remedies be improved?

15. What are your experiences with PLHA coming for treatments?
-Please tick all that apply:

15.1. Patients come for treatment whenever they have symptoms

15.2. Most patients do not know if they are HIV+
15.3. Patients only come when other measures have failed
50
15.4. Patients prefer to try traditional remedies or healers first
15.5. It’s better to see HIV+ patients separately from other patients
15.6. People believe there is no treatment for HIV/AIDS
15.7 People have heard of antiretroviral drugs and want to have them

16. What support is available to help you with treating PLHA?

-Please tick all that apply:

16.1. Treatment guidelines are available for HIV-related conditions

16.2. I can refer patients to hospital if necessary, specify referral places
16.3. Hospitals will refer patients back to local services when appropriate
16.4. Laboratory services are available for HIV testing only
16.5. Laboratory services are available for CD4 counts
16.6. Laboratory services are available for viral load testing
16.7. I mostly have to manage without laboratory services
16.8. Regular training and updates are available to me
16.9. I find it difficult to get up to date information
16.10. I am too busy to read new information or attend training sessions
16.11 Others…

17. Prescribing and access to drugs

-Please tick all that apply:

17.1. People are mostly too poor to afford any treatments

17.2. People can afford simple treatments, but not expensive anti-infective drugs
17.3. Patients can mostly get the treatments I prescribe
17.4. Patients can’t usually get what you prescribe
17.5. If drugs are unavailable or unaffordable, I have to change prescription
17.6. Treatment is sometimes interrupted if patients don’t have money
17.7. Patients are more interested in getting food than medicines
17.8. I try to give short courses of drugs so people can afford them
17.9. Patients usually understand and remember how to use their drugs
17.10. Patients often do not take their drugs as prescribed

18. What effects do the treatments prescribed by you have on the lives of the PLHA you
help?
Please, briefly, give us your opinions on each of the following questions:

18.1 What treatments have been most helpful to them?

18.2. What treatments have been most problematic?

18.3 What are your experiences in helping PLHA to get and use treatments?

18.4. Do treatments make a difference to PLHA and their families? What are the main
difficulties in accessing or using them, and what improvements could be made? - diagram:

18.5. What are some problems you see with health and HIV when you are helping
PLHA? How do you find out and decide what to do about them?

51
18.6 What are the current advantages and disadvantages of providing treatments? How might the
situation be improved or changed for the future? What are the barriers to future change?

19. Which of the following services do you provide? (For HIV AIDS service organizations)
Type of service YES NO

a. HIV counseling for clients

b. HIV counseling for the family
c. HIV testing
d. Medical care including management of HIV-
related diseases
e. Administration of TB prophylaxis
f. Administration of DOTS for TB
g. Community Education on HIV
h. Pain management
i. Nursing care
j. Nutrition supplantation
k. Psychological support
l. Material support (e.g. soap, gloves, clothes)
m. Spiritual support
n. Bereavement and care for survivors
o. Outreach service to home
p. Self support for PLWHA
q. Spiritual care
r. Other (please specify)

20. In the last 12 months please estimate the total number of patients/clients your institution
served?

21. Do you receive referrals from any of the following?

a. Medical services
b. Social services
c. Other counseling services
d. NGOs
e. Family planning
f. MCH services
g. TB/chest clinic
h. STI services
i. Traditional healers
j. Spiritual groups
k. HIV prevention programs
l. Others (specify)

22. Do you refer clients (PLWA) to any of the following? If yes where and how many for each?
a. Medical services
b. Social services
c. Other counselling services
d. NGOs
52
e. Family planning
f. MCH services
g. TB/chest clinic
h. STI services
i. Traditional healers
j. Spiritual groups
k. HIV prevention programs
l. Care and support service
m. Others (specify)

23. When you refer clients, does your agency/facility have a way of tracking referrals?

1. No
2. Yes, if so, how and by whom

24. Supplies

Do you have the following supplies?

Always/ Usually Sometimes Never/almost Don’t know

Almost/Always never
HIV test kits
Syringes and needles
Gloves
Sterilising materials
Disinfectants
Do you follow
universal precaution

Gaps and improvement:

25. What is the single most important change you would suggest for your organisation to
improve services for HIV-infected individuals or families affected by HIV?

26. List three barriers that your organisation/you has faced when providing care to people living
with HIV/AIDS.

27.Which of the following would help you to better serve clients/patients living with
HIV? Please explain how.
Would help? How?
1. Opportunities for networking □ Yes
among providers to share □ No
information and HIV care and
available resources.
2. Training to gain additional □ Yes
experience/knowledge about □ No
providing HIV care, such as ARV,
dealing with opportunistic
infections, and monitoring and
explaining patient’s health status
3. Providing services in a more □ Yes
convenient manners (such as □ No
better office hours, quicker
53
 appointments, less waiting)
4. Training on how to better □ Yes
advocate for clients/patients □ No
5. More funding □ Yes
□ No
6. Other specify □ Yes
□ No

28. What are the future plans (short term, mid term and long term) of this organization in term of
HIV/AIDS care and support?

Any further comments?

Date questionnaire completed: Day ………….…./ Month ………….. / Year ………….

Thank you for your time and cooperation.

54
ANNEX 4: Resource Directory

1. Name of the provider or agency ……………………………………………….

2. Contact person …………………………………………….

3. Postal address ………………………………………………

4. Telephone: 5. Fax …………….

6. E-mail addresses

8. Location:

9. District:

11. Type of staffs:

Number of professional staffs

Gender: (F/M) ……..
Ethnic (majority)
Age (majority)……..

12.Target population (s):

13. Current service area (s):

a.) Type of services (preventive, curative, palliative,)

b) Range of services:
(Medical, nursing, psychosocial, home base care, hospice, spiritual care, rehabilitation centre,
mental health service)

14. Hours of operation:

15. Capacity to provide service (numbers of clients/day): ………

16. Number of clients per/day …………

Gender (majority) ……………
Ethnic (majority) …………….
Age (majority) …………………

17.Where do clients come from?( geographical location )

18. Is it referred by someone or self?

55
19.How many clients did you referred last year? For what purposes?

20.Name of referral partners that collaborate

21 Client’s Eligibility (age, gender, referred by other agency, other criteria):

22. Policy and procedure to provide service to the clients: ……………..

23. Cost for services …………..

24. Accessibility to public transportation information

25. Future Plan: What are the future plans (short term, mid term and long term) of this
organization in term of HIV/AIDS care and support?, Do you like to engage on VCT service in
future.

Full name of person completing the questionnaire:

Title:

Date questionnaire completed: Day ………….…./ Month ………….. / Year ………….

56
ANNEX 5: Schedule for VCT Need Assessment Team

Day 1 Day 2 Day 3 Day 4

• Welcome Introduction of Revision of Review of 3

methodology previous day days
• Introductions

• Orientation on VCT, Introduction of Introduction of Note taker

objective of VCT need social mapping FGD tool of each and
assessment, group facilitator
role
• Sharing of findings Introduction of
from literature review in-depth interview Working as a
team
• Planning to form
working group
Practice between Practice among Site planning
• Sharing methodology peer and getting group and getting For actual
and tools and getting comments, clarity comments, clarity field work
consensus and finalize it. and finalize it.

• Confirms interviewer
for VCT need
assessment training

57
ANNEX 6: Work plan for VCT need assessment

Date Activities

Dec 12 to Jan end

a) Literature review
b) Meeting with Jesper and VCT team in KTM,
meeting with AMDA.
c) Discuss TOR, brief about VCT, its objectives,
methods and tools for the VCT assessment by
Jesper.
d) Meeting with Bert and getting ideas for tools
and designing training
e) Designing tool, getting comments from FHI and
finalize the tools.

1st Feb 2004 Move to Simara and then Hetauda

2 to 6 Feb
a. Informal meeting with AMDA team
b. Orientation to key people of partners [ AMDA,
GWP,WATCH and Trinetra]
c. Establish working group and discuss the role of working
group beyond VCT need assessment
d. Review tools in consultation with working group
e. Identify participants and train for VCT Need assessment

Whole February
a. Conduct field work as per methodology designed
b. Data analysis / discussion with working group

March to May 2004

a. Data analysis and draft report
b. Discuss findings and recommendations with FHI
c. Submit draft report to AMDA and working group for
comments
d. Conduct meeting for FHI team and finalize report

Participants of orientation:

All program co-coordinators + Managers of partners [AMDA, WATCH, GWP, TRINETRA]

For training: 2 staff from each partner + Namuna Integrated council and counselor and field co-
coordinator of AMDA had participated in training and assist for VCT need assessment.

58
ANNEX 7: Resource directory of Rupandehi district

1. Name of the provider or agency: Family planning association of Nepal (FPAN )

2. Contact person: Dinesh Kumar Joshi

3. Postal address Pulchowk, Haat Bazzar, Butwol, Rupandehi branch

4. Telephone 071-540081

5. Fax 071-543882

6. E-mail addresses dineshfpn@beci.com.np

7. Target population (s): Women / Men reproductive age and youth adolescence (girls and
boys)
8. Current service area (s):

• Family planning service

• STI Treatment
• Ante-natal service
• Counselling
• Youth / information mobilization centre
• Awareness on HIV / AIDS
• Home base care

9. Future engagement on VCT: Willing to involve in care and support program

----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: District AIDS Co-ordination Committee

2. Contact person: Ajaya Kumar Chaudhari

3. Postal address Bhairawa, Rupandehi, District AIDS co-ordination unit, DDC

4. Telephone 071-520630

5. Fax 071-520160

6. E-mail address NA

7. Target population (s): NA

8. Current service area (s):

• Co-ordination with HIV / AIDS related organization mainly with NGO/INGOs
• Raising awareness on HIV / AIDS
• Budget allocation for PLWHA

9. Future engagement on VCT: Willing to involve in VCT program through networking and co-
ordination with agencies

59
1. Name of the provider or agency: JICA / Community TB and Lung health project

2. Contact person: Sharan Gopali

3. Postal address: C/ O district public health office, Maitri Path, Rupandehi District

4. Telephone: 9841235879

5. Fax NA

6. E-mail addresses gwala73@hotmail.com

7. Target population (s): All TB clients in Butwol and Siddarth municipality

8. Current service area (s): TB program has been implemented through partners

9. Future engagement on VCT: Willing to involve in VCT program especially referral of HIV
clients with TB

------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Sahara drug treatment and Rehabilitation centre

2. Contact person: Basanta Thapa

3. Postal address: Kalikanagar, Horizon chowk, Butwol-13, Rupandehi District

4. Telephone: 071- 550302

5. Fax 071- 40416

6. E-mail addresses saharahome@yahoo.com

7. Target population (s): All drug addict + HIV positive male client with IDU

8. Current service area (s):

• Preventive such as mass awareness,

• Curative
• Psychosocial
• Spiritual care, Meditation
• Rehabilitation centre
• Mental health service
• Medical service
• Individual and family counselling

9. Future engagement on VCT: Willing to involve in VCT program especially care and support

60
1. Name of the provider or agency: Butwol DOTS Clinic

2. Contact person: Ram Prasad Dhakal

3. Postal address: Lumbini zonal hospital, hospital line Butwol, Rupandehi

District

4. Telephone: 071- 540200

5. Fax NA

6. E-mail addresses NA

7. Target population (s): All Tuberculosis and Leprosy clients

8. Current service area (s): Curative (DOTS )

9. Future engagement on VCT: Willing to involve in VCT program especially referral of TB

client with HIV

-----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Marie stopes centre

2. Contact person: Lal Mani Joshi

3. Postal address: Milan Chowk Butwol, Rupandehi District

4. Telephone:

5. Fax

6. E-mail addresses

7. Target population (s): Above 10 years population

8. Current service area (s): Preventive and curative

9. Future engagement on VCT: Willing to involve in VCT program

61
1. Name of the provider or agency: AMDA – Nepal, Siddharth children and women hospital

2. Contact person: Dr. Bimal Kumar Thapa

3. Postal address: Deepnagar, Butwol -9 PO Box -28 Rupandehi District

4. Telephone: 071- 544450

5. Fax : 071-544691

6. E-mail addresses: amdascwh_btw@wlink.com.np

7. Target population (s): Children and women

8. Current service area (s):

• Preventive
• Curative: Medical, nursing, psychosocial, spiritual care

9. Future engagement on VCT: Willing to involve in VCT program

--------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Namuna Integrated Development Council

2. Contact person: Ms Gyanu Poudyal

3. Postal address: Saligrampath near durga temple W.No -8, Bhairawa,

Rupandehi District

4. Telephone: 071- 527205, 071- 523147

5. Fax :

6. E-mail addresses: gyanupd@wlink.com.np

7. Target population (s): IDUs, sex workers and their clients, young people and women
group
8. Current service area (s):

• Preventive
• Counselling which include hot line telephone service too
• Psychosocial
• Home base care
• Spiritual care
• Rehabilitation

9. Future engagement on VCT: Willing to involve in VCT program especially work with
PLWHA, pre and post test counselling, home base care and risk
reduction activities

62
1. Name of the provider or agency: DDC / Local Development Fund (LDF)

2. Contact person: Upendra Raj Gyanwalee

3. Postal address: DDC / LDF main road, Hatbazzar Bhairawa, Rupandehi

District

4. Telephone: 071- 526971,

5. Fax : 071- 520160 / 071 - 521423

6. E-mail addresses:

7. Target population (s): NA

8. Current service area (s):

• Preventive
• Advocacy

9. Future engagement on VCT: Willing to involve in VCT program

-------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Lumbini Zonal Hospital, Butwol

2. Contact person: Dr Nanda Psd Sharma , Medical superintendent

3. Postal address: Lumbini Zonal Hospital, hospital line -8 Butwol , Rupandehi

District

4. Telephone: 071- 540200, 071 - 542248

5. Fax : 071- 541200

6. E-mail addresses: lzh@bcci.com.np

7. Target population (s): All clients

8. Current service area (s):

• Preventive
• Curative: Medical, testing, nursing, psychosocial, spiritual care

9. Future engagement on VCT: Willing to involve in VCT program

63
1. Name of the provider or agency: Nepal Red Cross society

2. Contact person: Mr. Sailendra Tuladhar Nanda Psd Sharma

3. Postal address: Nepal Redcross society, Siddharthanagar -13 Maltole, hatbazar,

Rupandehi District

4. Telephone: 071- 520263,

5. Fax : NA

6. E-mail addresses: NA

7. Target population (s): General public, young, adolescence, women

8. Current service area (s):

• Preventive
• Curative: Medical, HIV testing for blood transfusion purpose and ambulance service

9. Future engagement on VCT: Willing to involve in VCT program

------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Youth Vision

2. Contact person: Aryal Binod

3. Postal address: Uchmi Road, Anchalpur,ward no -8 Siddharthanagar

Municipality, Rupandehi District

4. Telephone: 071- 524153,

5. Fax :

6. E-mail addresses: binodaryal15@hotmail.com

7. Target population (s): IDUs

8. Current service area (s):

• Preventive
• Medical,
• Psychosocial
• Spiritual care
• Rehabilitation
• Counselling, Meditation

9. Future engagement on VCT: Willing to involve in VCT program

64
1. Name of the provider or agency: Singh Medical Hall

2. Contact person: Dr. Ramesh Man Singh

3. Postal address: Singh Medical Hall, Butwol Municipality, WN-6 Rupandehi

District

4. Telephone: 071- 540232??

5. Fax : NA

6. E-mail addresses: NA

7. Target population (s): General public, HIV positive

8. Current service area (s):

• Preventive
• Curative
• Palliative
• Medical,
• Psychosocial

9. Future engagement on VCT: Willing to involve in VCT program

-----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Mayadevi Technical Institute

2. Contact person: Chiranjeevi Joshi

3. Postal address: Mayadevi Technical Institute. Dhawaha, Butwol Municipality,

WN-14 Rupandehi District

4. Telephone: 071- 540041

5. Fax : 071 - 541262

6. E-mail addresses: mdti@hons.com.np or mdti@bcci.com.np

7. Target population (s): Paramedical and nursing human resource production

8. Current service area (s):

• Education course
• DOTs Programme
• CDP programme

9. Future engagement on VCT: Willing to involve in VCT program

65
1. Name of the provider or agency: ADRA – Nepal

2. Contact person: Rajan Khadka

3. Postal address: ADRA – Nepal, Basdinwa, Bhairawa, Rupandehi District

4. Telephone: 071- 520260

5. Fax : 071 - 524443

6. E-mail addresses: NA

7. Target population (s): Women Reproductive Age

8. Current service area (s):

• Psychosocial
• Mental health service
• Sexual and reproductive health

9. Future engagement on VCT: Not yet

---------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: District Health office, Rupandehi

2. Contact person: Asta Ratna Tuladhar

3. Postal address: District Health office, Basdilawa, Bhairawa Rupandehi

4. Telephone: 071- 520142

5. Fax : 071 - 524443

6. E-mail addresses: NA

7. Target population (s): All clients

8. Current service area (s):

• Medical
• Nursing
• Home base care
• Psychosocial
• Mental health service

9. Future engagement on VCT: Willing to engage at district and Zonal hospital on VCT
programme

66
1. Name of the provider or agency: WATCH

2. Contact person: Rajendra Bandu Aryal or Bam Dev Suvedi

3. Postal address: WATCH, Golpark-5 Butwol, Rupandehi

4. Telephone: 071- 543905

5. Fax : 071 – 543905

6. E-mail addresses: watchrup@wlink.com

7. Target population (s): Sex workers and their clients

8. Current service area (s):

• Medical
• Nursing
• Home base care
• Psychosocial
• Spiritual care

9. Future engagement on VCT: Willing to engage on VCT programme

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Student Partnership worldwide (SPW) Nepal

2. Contact person: Anita Gurung

3. Postal address: ( SPW) –shaligram path Bhairawa, Rupandehi

4. Telephone: 071- 527205

5. Fax :

6. E-mail addresses: gyanupd@wlink.com.np

7. Target population (s): School youth, out of school youth, community people

8. Current service area (s):

• Awareness
• Networking to related VDC, Health post, hospital

9. Future engagement on VCT: Willing to engage on VCT programme

67
1. Name of the provider or agency: Mahial Ekta Kendra

2. Contact person: Trishna Sharma

3. Postal address: Mahial Ekta Kendra , Belaya-, Rupandehi

4. Telephone: 071- 522633

5. Fax :

6. E-mail addresses:

7. Target population (s): Women

8. Current service area (s): Women rights and Economic support to PLWHA women

9. Future engagement on VCT: Willing to engage on VCT programme

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: SMD – Nepal

2. Contact person: Umesh Kandel

3. Postal address: SMD – Nepal, Kalika Nagar-, Rupandehi

4. Telephone: 071- 547428, 071- 545311

5. Fax :

6. E-mail addresses:

7. Target population (s): General population

8. Current service area (s): Preventive

9. Future engagement on VCT: Willing to engage on VCT programme

68
1. Name of the provider or agency: MCH clinic Butwol

2. Contact person: Durga Poudyal

3. Postal address: Lumbini Zonal Hospital-, Hospital line, Rupandehi

4. Telephone: 071- 540200,

5. Fax :

6. E-mail addresses:

7. Target population (s): Mother and child

8. Current service area (s):

• Preventive
• Curative: Nursing, Psychosocial, home base care
• Palliative

9. Future engagement on VCT: Willing to engage on VCT programme

69
ANNEX 7: Resource directory of Chitwan district

1. Name of the provider or agency: Support ‘N’ Care Rehabilitation centre

2. Contact person: Mr Shyam Krishna Maharjan

3. Postal address: Support ‘N’ Care Rehabilitation centre, Buddachowk-10,

Krishnapur, Chitwan

4. Telephone: 056 – 522777

5. Fax :

6. E-mail addresses: szinson11@hotmail.com

7. Target population (s): IDU, Drug addict, PLWHA,

8. Current service area (s):

• Medical
• Psychosocial
• Counselling
• Reintegration IDU cases
• Home base care, Spiritual care
• Rehabilitation centre
• Mental health service

9. Future engagement on VCT: Willing to involve in VCT program especially care and support

-----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: UNICEF, Chitwan

2. Contact person: Krishna Jayanti Poudel

3. Postal address: UNICEF, Bharatpur Municipality -10, DDC, Hospital line,

Chitwan

4. Telephone: 056- 522913,

5. Fax :

6. E-mail addresses:

7. Target population (s): Women and Children

8. Current service area (s):

• Preventive program
• Training to government health workers, CHV, TBAs

9. Future engagement on VCT: Not yet now

70
1. Name of the provider or agency: Chitwan Sakriya Samuha, Chitwan

2. Contact person: Nirmala Poudel

3. Postal address: C/ O Maiti Nepal

Chitwan Sakriya Samuha, Chitwan district

4. Telephone: 056- 527503,

4. Fax :

5. E-mail addresses:

7. Target population (s): PLWHA

8. Current service area (s):

• Preventive program: Mass awareness at community

• Counselling
• Home visit
• Referral and linkages to PLWHA for treatment, care and support

9. Future engagement on VCT: Willing to involve in VCT program

--------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Kamal Ayurvedic Treatment Centre, Chitwan

2. Contact person: Kamal Raj Bhandari

3. Postal address: Kamal Ayurvedic Treatment Center, Krishnapur -7 Chitwan

district

4. Telephone: 056- 521311, 056 – 521711

5. Fax :

6. E-mail addresses:

7. Target population (s): Treatment of all clients including PLWHA

8. Current service area (s):

• Psychosocial
• Home base care
• Ayurbedic treatment
• Mental health service

9. Future engagement on VCT: No

71
1. Name of the provider or agency: Diyalo Pariwar, Chitwan

2. Contact person: RajGovinda Shilpakar

3. Postal address: Diyalo Pariwar, Narayani Nadikinar -1, Gaureswor Pashupati
Mandir Narayaghad Chitwan district

4. Telephone: 056- 521828,

5. Fax : 056 – 522797

6. E-mail addresses: sitaram@gnet.com.np

7. Target population (s): Marginalized people

8. Current service area (s):

Preventive: HIV / AIDS component has been carried out as the cross cutting approach

9. Future engagement on VCT: Plan to implement HIV / AIDS program with support of
UNICEF, so VCT can integrate

----------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: B. P. Koirala Memorial Cancer Hospital

2. Contact person: Daya Laxmi Vaidya

3. Postal address: B. P. Koirala Memorial Cancer Hospital, Bharatpur Chitwan

district, PO. BOX 34

4. Telephone: 056- 524501, 056 – 527243

5. Fax : 056 -523747

6. E-mail addresses: daya932@hotmail.com

7. Target population (s): Cancer Patient

8. Current service area (s):

• Preventive:
• Curative: Medical, nursing, psychosocial, spiritual care for Kaposi’s sarcoma cases
• Palliative
• Hospice
• Counselling

9. Future engagement on VCT: Willing to involve in VCT program especially for referral and
care of AIDS cases

72
1. Name of the provider or agency: RHIYA

2. Contact person: Hemraj Giri,

3. Postal address: RHIYA Tandi, Sworaha chowk, near by shree tel Udyog
Chitwan district,

4. Telephone: 056- 561303

5. Fax :

6. E-mail addresses:

7. Target population (s): All 10 to 24 years adolescence/ youth married and unmarried
8. Current service area (s):

• Counselling, psychosocial, home base care

• FP services
• Minor treatment
• STI treatment
• Reproductive health services
• HIV / AIDS awareness

9. Future engagement on VCT: Willing to involve in VCT program especially for youth
mobilization

-------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Nava Kiran Plus, Chitwan

2. Contact person: Dipan Pokhrel

3. Postal address: Nava Kiran Plus, Bharatpur -10 Chaubish kothi Chitwan, near by
Balmandir chowk
4. Telephone:

6. Fax :

6. E-mail addresses: Dipan94@hotmail.com

7. Target population (s): All PLWHA

8. Current service area (s):

• Care and support, treatment

• Counselling, psychosocial, home base care , home base care, rehabilitation
• HIV / AIDS awareness

9. Future engagement on VCT: Willing to involve in VCT program especially for the treatment
of PLWHA

73
1. Name of the provider or agency: Action Aid Nepal, Chitwan

2. Contact person: Archana Khadaka

3. Postal address: Action Aid Nepal, Lila Chowk, near Narayani river Bharatpur,
Chitwan

4. Telephone: 056 - 528047

5. Fax : 056- 520165

6. E-mail addresses:
7. Target population (s): FSW, PLWHA

8. Current service area (s):

• HIV / AIDS STI awareness

• STI referral
• Treatment of opportunistic infection
• Scholarship support to children of FSW / PLWHA
• Home base care

9. Future engagement on VCT: Willing to involve in VCT program especially for care and
support program

---------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Nepal Red Cross Society

2. Contact person: Jagannath Neupane

3. Postal address: Nepal Red Cross Society Bharatpur Municipality,Narayangath

ward No-3 Chitwan

4. Telephone: 056 - 520133

5. Fax : 056- 526265

7. E-mail addresses:

7. Target population (s): Blood donors, school and college student

8. Current service area (s):

• HIV / AIDS awareness at school, college

• Blood testing for HIV
• Counselling

9. Future engagement on VCT: Willing to involve in VCT program

74
1. Name of the provider or agency: Marie Stopes centre

2. Contact person: Phadindra Sapkota

3. Postal address: Marie Stopes centre, Redcross Bhawan Narayangath Chitwan

4. Telephone: 056 - 520003

5. Fax :

7. E-mail addresses:

7. Target population (s): Reproductive age group

8. Current service area (s):

• Mobile clinic
• Economic support to PLWHA for income generating
• Counselling
• STI treatment

9. Future engagement on VCT: Willing to involve in VCT program

----------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Rural Urban Partnership Program (RUPP)

2. Contact person: Anil Wagle

3. Postal address: Rural Urban Partnership Program, Bharatpur Municipality,

Chitwan

4. Telephone: 056 – 521467, 056 - 522771

5. Fax : 056 - 522771

6. E-mail addresses: ruppbhr@gnet.com.np

7. Target population (s): Marginalized people including PLWHA

8. Current service area (s):

• Economic loan support to PLWHA without interest

• HIV / AIDS awareness
• Economic support for testing of HIV

9. Future engagement on VCT: Willing to involve in VCT program especially support to

PLWHA for income generation program and conduct awarness
program.

75
1. Name of the provider or agency: Bharatpur Hospital

2. Contact person: Dr. B. N. Chaudhary

3. Postal address: Bharatpur Hospital, Bharatpur -10 , Chitwan

4. Telephone: 056 – 520460

5. Fax :

6. E-mail addresses:

7. Target population (s): All patients including PLWHA

8. Current service area (s):

• Medical
• Nursing
• Psychosocial
• Rehabilitation
• Mental health service

9. Future engagement on VCT: Willing to involve in VCT program especially testing, treatment
and referral to PLWHA.

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Nepal CRS Company

2. Contact person: Mahesh Prasad Pokhrel

3. Postal address: Nepal CRS Company, Lilachowk, NATA Building Bharatpur -1,
Chitwan

4. Telephone: 056 – 520034

5. Fax :

6. E-mail addresses: crsngt@wlink.com.np

7. Target population (s): All patients including PLWHA

8. Current service area (s):

• Medical
• Home base care

9. Future engagement on VCT: Willing to involve in VCT program especially condom

promotion through community based approach.

76
1. Name of the provider or agency: Maiti Nepal, Bharatpur

2. Contact person: Mr. Madan Chaulagain

3. Postal address: Maiti Nepal, Bharatpur , near district police office

Chitwan

4. Telephone: 056 – 528350

5. Fax : 056 - 528350

6. E-mail addresses:

7. Target population (s): Victims of trafficking and PLWHA

8. Current service area (s):

• Medical: Referral to Kathmandu for ARV treatment which is free of cost

• Psychosocial
• Counselling
• Reintegration for trafficking
• Home base care

9. Future engagement on VCT: Willing to involve in VCT program especially care and support

----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Family Planning Association of Nepal, Chitwan

2. Contact person: Mr Dil Bahadur Nepali

3. Postal address: FPAN, Bharatpur, DPHO Road, Chitwan

4. Telephone: 056 – 520164

5. Fax : 056 - 520164

6. E-mail addresses: fpanchit@wlink.com.np

7. Target population (s): Adolescent, youth, married couple

8. Current service area (s):

• Medical
• Nursing
• Awareness and education focussed on sexual and reproductive health

9. Future engagement on VCT: Very soon FPAN is going to start VCT services.

77
1. Name of the provider or agency: DPHO, Chitwan

2. Contact person: Pancha Bahadur Gurung , Focal person HIV / AIDS

3. Postal address: DPHO, district hospital compound, medical college road,

Bharatpur, DPHO Road, Chitwan

4. Telephone: 056 – 520269

5. Fax : 056 - 520269

6. E-mail addresses:

7. Target population (s): District coverage as per target population

8. Current service area (s):

• Preventive
• Curative: DOTS, safer motherhood, child hood program

9. Future engagement on VCT: No any plan for VCT.

78
ANNEX 8: Resource directory of Nawalparasi district

1. Name of the provider or agency: Nepal Red Cross Society

2. Contact person: Keshav Raj Gupta

3. Postal address: Nepal Red cross society, hospital line Ram Gram -5
Nawalparashi

4. Telephone: 078 – 520526

5. Fax :

6. E-mail addresses:

7. Target population (s): General community people

8. Current service area (s):

• Counselling
• Blood testing for HIV
• Preventive
• Curative

9. Future engagement on VCT: Willing to involve in VCT program especially care and support

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Sita Medical Store

2. Contact person: Ram Bahadur Nepal

3. Postal address: Sunwal VDC, in front of police post, Nawalparashi

4. Telephone: 078- 570187,

5. Fax :

6. E-mail addresses:

7. Target population (s): General Population

8. Current service area (s):

• Curative: Treatment to PLWHA

9. Future engagement on VCT: Willing to engage.

79
1. Name of the provider or agency: Suseli Art group

2. Contact person: Badri Prasad Subedi

3. Postal address: Suseli Art group, Panchanagar VDC, ward -2, 4 km west from
Bardaghat, Nawalparshi

4. Telephone: 078- 580142, 078 - 580168

5. Fax :

6. E-mail addresses:

7. Target population (s): General public

8. Current service area (s):

• Preventive program: Mass awareness at community through street drama and theatre for
development on HIV / AIDS and other social issues

9. Future engagement on VCT: Willing to involve in VCT program

-----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Murari Ayurvedic Treatment Center , Nawalparashi

2. Contact person: Murari Raman Poudel

3. Postal address: Murari Ayurvedic Treatment Center, Amarapuri VDC ward no -

3, Mejhi Nawalparashi

4. Telephone: 078- 545116

5. Fax :

6. E-mail addresses:

7. Target population (s): Treatment of all clients including PLWHA

8. Current service area (s):

• Psychosocial
• Home base care
• Ayurbedic treatment
• Mental health service
• Spiritual care

9. Future engagement on VCT: Yes

80
1. Name of the provider or agency: Raya Medical hall

2. Contact person: Mahatam Chaudhari

3. Postal address: Raya, Medical hall Tilakpur VDC -5 , Nawalparashi

4. Telephone: 078 - 580246, 520072

5. Fax :

6. E-mail addresses:

7. Target population (s): All clients including PLWHA

8. Current service area (s):

Curative: Medical treatment to PLWHA, STI treatment

9. Future engagement on VCT: Willing to engage in VCT especially treatment part

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Sahaj Health Co-operative

2. Contact person: Bhim Prasad Sharma

3. Postal address: Gaindakot Adarsha VDC-5, Nawalparashi

4. Telephone: 056- 524249, 056 – 524123

5. Fax : 056 -526755

6. E-mail addresses: sahamati@gnet.com.np, sahaj@gnet.com.np

7. Target population (s): All clients

8. Current service area (s):

• Preventive:
• Curative : Medical, Testing, psychosocial,
• Home base care
• Nursing

9. Future engagement on VCT: Willing to involve in VCT program especially for referral and
care of AIDS cases and awarness at society

81
1. Name of the provider or agency: Vijaya Development Resource Center

2. Contact person: Indra Raj Jyoti Poudel, Keshav Prasad Sapkota

3. Postal address: Gaidakot-8, Vijaya Nagar, Vijaya Chowk, Nawalparashi

4. Telephone: 056- 522965

5. Fax : 056- 522965

6. E-mail addresses: vdrc@gnet.com.np

7. Target population (s): Poorest of the poor group

8. Current service area (s):

• Counselling,
• Preventive, awareness arising, training

9. Future engagement on VCT: Willing to involve in VCT program especially for community
mobilization

---------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Trinetra Nepal

2. Contact person: Lok Nath Kandel

3. Postal address: Trinetra Nepal Gaindakot -, Nawalparashi

4. Telephone: 056 -526077

5. Fax :

6. E-mail addresses:

7. Target population (s): FSW, FSW clients and PLWHA

8. Current service area (s):

• Care and support,

• Counselling, psychosocial, home base care,
• HIV / AIDS awareness

9. Future engagement on VCT: Willing to involve in VCT program especially for the treatment
of PLWHA

82
1. Name of the provider or agency: Social Development and research centre (SDRC – Nepal)

2. Contact person: Purna Narayan Pradhan

3. Postal address: Gaindakot VDC, ward No -2, Nawalparashi, Nepal

4. Telephone: 056 - 524320

5. Fax : 056- 522245

6. E-mail addresses: gycnepal@wlink.com.np

7. Target population (s): Rural marginalized people

8. Current service area (s):

• Preventive,
• Joint work with VDC, DDC, CBOs, NGOs

9. Future engagement on VCT: Willing to involve in VCT program

--------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Primary Health Care Centre

2. Contact person: Mr. Bhuwan Baral

3. Postal address: Primary Health Care Centre, Tamsariya -5 chaurandi bazzar,

Chormara highway

4. Telephone: 078 - 539704

5. Fax :

6. E-mail addresses:

7. Target population (s): All clients including PLWHAs

8. Current service area (s):

• Health education on HIV / AIDS

• Medical treatment
• Nursing
• Palliative
• Counselling

9. Future engagement on VCT: Willing to involve in VCT program as per Govt plan

83
1. Name of the provider or agency: Sraddha Medical Hall

2. Contact person: Shiva Prasad Gyawali

3. Postal address: Sraddha Medical Hall, Arunkhola, Nawalparashi

4. Telephone: 078 - 555106

5. Fax : 078- 555103

6. E-mail addresses:

7. Target population (s): General patients

8. Current service area (s):

• Preventive
• Curative: Medical, referral, mental health service
• Psychosocial
• Home base care

9. Future engagement on VCT: Willing to involve in VCT program

-------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Himalayan Community Development Forum( HICODEF)

2. Contact person: Krishna Ghimire

3. Postal address: Himalayan Community Development Forum( HICODEF), Shiva

Mandir -3, North of Kawasoti police station, Nawalparashi

4. Telephone: 078 – 540172,

5. Fax : 078 - 540212

6. E-mail addresses: hicodef@hotmail.com

7. Target population (s): Marginalised community

8. Current service area (s):

• Prevention: HIV / AIDS awareness

9. Future engagement on VCT: Willing to involve in VCT program especially conduct awarness
program.

84
1. Name of the provider or agency: Kali Gandaki Hospital / PHC

2. Contact person: Dr. Chhabilal Thapa

3. Postal address: Kali Gandaki Hospital, Kawasoti, Nawalparashi

4. Telephone: 078 – 40182

5. Fax :

6. E-mail addresses:

7. Target population (s): All patients including PLWHA

8. Current service area (s):

• Medical
• Nursing
• Psychosocial

9. Future engagement on VCT: Willing to involve in VCT program especially testing, treatment
and referral to PLWHA.

-----------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Nawa Prativa community development centre

2. Contact person: Ram Prasad Kafle

3. Postal address: Nawa Prativa community development centre

Naya Belahani VDC ward no -8, Arun Khola

4. Telephone: 078 -555037 / 555072

5. Fax :

6. E-mail addresses:

7. Target population (s): General public

8. Current service area (s):

• Mental health service

9. Future engagement on VCT: Willing to involve in VCT program

85
1. Name of the provider or agency: Social Creative Group

2. Contact person: Mr Madhav Bhandari

3. Postal address: Social Creative Group, Shiva Mandir VDC -3 Kawasoti,

Thanachowk, Nawalparashi

4. Telephone: 078 – 540354

5. Fax :

6. E-mail addresses:

7. Target population (s): General public

8. Current service area (s):

• Preventive
• Curative

9. Future engagement on VCT: Not yet

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Dumkibas health post

2. Contact person: Mr Jeevan Kumar Shrestha

3. Postal address: Dumkibas health post, Nawalparashi

4. Telephone: 078 – 590046

5. Fax :

6. E-mail addresses:

7. Target population (s): General clients including PLWHA

8. Current service area (s):

• Medical
• Nursing
• Home base care
• Spiritual care

9. Future engagement on VCT:

86
1. Name of the provider or agency: Disabled Rehabilitation Center

2. Contact person: Juddha Saru

3. Postal address: Disabled Rehabilitation Center, Shivamandir VDC -3, Bank

road, near telecommunication office Nawalparashi

4. Telephone: 078 – 540414

5. Fax : 078 - 540261

6. E-mail addresses:

7. Target population (s): Focus on disabled people

8. Current service area (s):

• Preventive
• Home base care
• Medical

9. Future engagement on VCT: Willing to involve in VCT.

------------------------------------------------------------------------------------------------------------------------------

1. Name of the provider or agency: Nepal Anti – TB Association ( NATA)

2. Contact person: Gyanu Ram Ghimire / Arjun Tripathe

3. Postal address: Nepal Anti – TB Association, Bharatpur, Lila chowk,

Narayanghat, Chitwan

4. Telephone: 056 – 520034

5. Fax : 056 - 526265

6. E-mail addresses: crsngt@wlink.com.np

7. Target population (s): All tuberculosis patient and general public

8. Current service area (s):

• Preventive: Awareness on TB, HIV / AIDS

• Curative: TB treatment

9. Future engagement on VCT: Willing to involve in VCT program especially care and support
of TB with HIV

87
ANNEX 9: Map of Resource Directory

88