The Use of Female Sex Workers Among Men in Nepal: Prevalence, STIs/HIV-Related Risk Behaviors, and Gender Ideology

Heterosexual sex involving female sex workers (FSWs) is widely documented for its role in facilitating the spread of sexually transmitted infections (STIs)/HIV. Critical to such studies, and increasingly considered essential to HIV prevention efforts, is the gender constructs and power dynamics within relationships. However, little efforts have been made, which focus on male clients of FSWs, particularly on the relationship between gender ideologies and men’s sexual contact with FSWs, within the Nepali context. 

The present study aims to fill this critical gap by assessing the prevalence of use of FSWs and its association with STIs/HIV-related risk behaviors and gender ideologies among Nepali men. We used data from the nationally representative Nepal Demographic Health Survey (NDHS) 2011. For the purpose of analyses, we included a sample of 4,121 men, aged 15–49 years. During data analyses, we used multivariate logistic regression models, adjusted for the following variables: age, region, residence, religion, educational level, wealth index, employment status, and cigarette smoking status. 

Of the total sample, approximately 5% reported the use of FSWs in their lifetime. In regression models, men who had sex with FSWs were more likely to report a history of STIs, not using condom all the time, more than one sexual partner, and have had early sexual debut. Respondents reporting the endorsement of violence against wives and male sexual entitlement were significantly more likely to report sexual contact with FSWs. 

Our findings highlight the need to develop and implement specifically tailored interventions toward male clients of FSWs, with a particular emphasis on promoting equitable gender roles and beliefs.

Full article at:    http://goo.gl/e97o7T

By: Roman Shrestha,^1,2 Pramila Karki,^2,3 and Michael Copenhaver^2,3

¹Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA

²Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA

³Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA

Prim Prev Insights. Author manuscript; available in PMC 2016 Jun 27.

Published in final edited form as:

Prim Prev Insights. 2016; 6: 11–17.

Published online 2016 Jun 9. doi:  10.4137/PPRI.S39664

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Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers

OBJECTIVES:

Sex workers face stigma, discrimination and violence across the globe and are almost 14 times more likely to be HIV infected than other women in low-and middle income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions it is important to understand micro-level social and structural factors that influence sexual behaviors of sex workers to be sustainable. This study assesses the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers in Nepal.

METHODS:

This quantitative study included 610 female sex workers that were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioral information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills) and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex.

RESULTS:

The HIV prevalence was 1% and this is presumably representative with a large sample of female sex workers in Nepal. The prevalence of unprotected sex with client was high (24%). For each additional adverse physical, social and economic condition, the probability of non-use of condoms with clients increased substantially: 1 problem=12%, p-value 0.005; 2 problems=19%, p-value <0.001; 3-5 problems= 38%, p-value <0.001.

CONCLUSIONS:

Interactions between two or more adverse conditions linked to physical, social and economic environment increased the risk of unprotected sex among Nepalese female sex workers.

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By:  Deuba K¹, Anderson S², Ekström AM³, Pandey SR⁴, Shrestha R⁵, Karki DK⁶, Marrone G³.

¹Public Health and Environment Research Center, Kathmandu, Nepal; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address: deuba4k@gmail.com.

²Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

³Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.

⁴FHI360, Kathmandu, Nepal.

⁵Centre for International Health, University of Bergen, Bergen, Norway.

⁶Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal.

Int J Infect Dis. 2016 Jun 13. pii: S1201-9712(16)31091-8. doi: 10.1016/j.ijid.2016.06.007. [Epub ahead of print]

  

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Experience of Intimate Partner Violence among Young Pregnant Women in Urban Slums of Kathmandu Valley, Nepal

Background

Intimate partner violence (IPV) is an urgent public health priority. It is a neglected issue in women’s health, especially in urban slums in Nepal and globally. This study was designed to better understand the IPV experienced by young pregnant women in urban slums of the Kathmandu Valley, as well as to identify their coping strategies, care and support seeking behaviours. Womens’ views on ways to prevent IPV were also addressed.

Methods

20 young pregnant women from 13 urban slums in the Kathmandu valley were recruited purposively for this qualitative study, based on pre-defined criteria. In-depth interviews were conducted and transcribed, with qualitative content analysis used to analyse the transcripts.

Results

14 respondents were survivors of violence in urban slums. Their intimate partner(s) committed most of the violent acts. These young pregnant women were more likely to experience different forms of violence (psychological, physical and sexual) if they refused to have sex, gave birth to a girl, or if their husband had alcohol use disorder. The identification of foetal gender also increased the experience of physical violence at the prenatal stage. Interference from in-laws prevented further escalation of physical abuse. The most common coping strategy adopted to avoid violence among these women was to tolerate and accept the husbands’ abuse because of economic dependence. Violence survivors sought informal support from their close family members. Women suggested multiple short and long term actions to reduce intimate partner violence such as female education, economic independence of young women, banning identification of foetal gender during pregnancy and establishing separate institutions within their community to handle violence against young pregnant women.

Conclusions

Diversity in the design and implementation of culturally and socially acceptable interventions might be effective in addressing violence against young pregnant women in humanitarian settings such as urban slums. These include, but are not limited to, treatment of alcohol use disorder, raising men’s awareness about pregnancy, addressing young women’s economic vulnerability, emphasising the role of health care professionals in preventing adverse consequences resulting from gender selection technologies and working with family members of violence survivors.

...A 23-year-old woman, four months pregnant, described a similar situation of lack of control of sexual relations with her husband:

" My husband has kept me in chains (overly protective). He is a very possessive man and controls me by not allowing me to go to others' home, to not talk to men. If I talk to them he will suspect me of having affairs. He does not even allow me to go to my maternal home because I have two unmarried brothers (angry expression). He wants me to have sexual intercourse all 24 h. He forces me for sex, and if I say no then he will say- " Why don't you want to sleep with me? Have you slept with someone else" ? I have to do sex according to his wishes and interests and if I say anything he beats me up" (sad expression)...

Full article at:   http://goo.gl/LouFAW

By:   Keshab Deuba,* Anustha Mainali, Helle M. Alvesson, and Deepak K. Karki

Public Health and Environment Research Center, Kathmandu, Nepal

Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal

Nepal Health Economics Association, Kathmandu, Nepal

Keshab Deuba, Phone: +977 9843064279, http://percnepal.org/

Contributor Information.

*Corresponding author.

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‘We are looked down upon and rejected socially’: A qualitative study on the experiences of trafficking survivors in Nepal

Background

The successful reintegration of sexual trafficking survivors into Nepalese society is challenging. This paper aims to explore the trafficking process, abuses faced during sexual slavery,and the challenges faced by women and girl survivors for successful reintegration.

Method

This exploratory study used qualitative methods to identify that poverty, illiteracy, lack of opportunities, and varied social stigma initiate the victimization process, and continuity of this vicious circle increases the risk for (re)entrapment.

Result

The reasons for sexual trafficking have also become the reasons for restricting survivors from opportunities for growth and mainstreaming.

Conclusion

Non-existent support systems, detachment from familial ties, being outcast by society, and an uncertain livelihood make reintegration difficult for survivors.

...Period of sexual slavery

The lives of the survivors during sexual slavery at the brothels speak of severe abuse. Arriving at a new place, without any acquaintances, and being subjected to continuous sexual slavery broke down the women. It was noted that the repeated physical violence and unwilling monotony of being just an object of sexual gratification caused the development of sudden suicidal tendencies in most of the trafficked survivors.

I landed in Hong Kong in the evening and was immediately taken to a hotel. After reaching the hotel, my passport was seized and then I was told that I had been sold for prostitution. At times, I used to hide in the warehouse filled with shoes and cover myself with the boxes. I felt that committing suicide was better than selling my body.

The survivors are cut off from the outside world and forced to live in conditions similar to a prison. The captors, on the other hand, use all kinds of methods to continue the enslavement of the trafficked; any documents of identification and money remaining to the survivors were immediately seized, and their movements were always monitored and restricted.

For three months, I didn't know that I had already been sold. There were almost seventy women from different countries in the building where I was kept. For three months, I kept nursing four to five children and learning the language. At the end of the three months, I was shifted to another room but in the same building. Since then, I had to offer sexual services to six to seven men during a day. After exactly a week, I thought of killing myself rather than living a life in hell. The living room of the house was ornamented with spears and swords; I managed to grab a spear and was determined to kill myself by plunging a spear in the electric circuit box. I remember waking up at the hospital with bandages below my waist. I stayed in the hospital for a month receiving treatments for my injuries and burns. After being discharged from the hospital, I was taken to the same house and kept under even stronger captivity on the twenty-fifth floor. I decided to escape using a rope made out of curtains, bedsheets, wire and quilt covers. I managed to reach the ground but my hands, knees, and legs were hurt badly and I was bleeding profusely. I walked into the Nepalese embassy, bleeding heavily with just a cloth wrapped around my body.

The survivors were subjected to severe inhumane practices. The consequence of continued physical abuse and repeated abortions also increase health risks. The survivors have to remain at the mercy of their captors if they develop any known symptoms of diseases, and spending money for health checkups does not fall in the priority list for these captors.

After reaching Lebanon, my passport was immediately seized and I started living as a prisoner in a big house. Later on, I realized that I was in a house where I had to sexually serve the owner and guests visiting the house. I found out that I had been sold for $1000. I felt like killing myself when I had to sleep with the drunken Arab men, but the constant thought of my child back home stopped me from committing suicide. I got pregnant twice and both times I was taken to a hospital for abortions. Later on, I was sent back to Nepal after two years with nothing but a developing child in my womb...

Full article at:   http://goo.gl/wqvaio

By:   Pranab Dahal,1,* Sunil Kumar Joshi,2 and Katarina Swahnberg1

¹Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden

²Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal

^*Correspondence to: Pranab Dahal, Department of Health and Caring Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden, Email:es.unl@lahad.banarp

Responsible Editor: Isabel Goicolea, Umeå University, Sweden.

 

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Experience of Violence in the Past Year among Surveyed MSM in Nepal

Background

Men who have sex with men (MSM) are marginalized, hidden, underserved and at high risk for HIV in Nepal. We examined the association between MSM sub-populations, psychosocial health problems and support, access to prevention and non-use of condoms.

Methods

Between September-November of 2010, a cross-sectional survey on HIV-related risk behavior was performed across Nepal through snowball sampling facilitated by non-governmental organizations, recruiting 339 MSM, age 15 or older. The primary outcomes were: (a) non-use of condoms at least once in last three anal sex encounters with men and (b) non-use of condoms with women in the last encounter. The secondary outcome was participation in HIV prevention interventions in the past year.

Results

Among the 339 MSM interviewed, 78% did not use condoms at their last anal sex with another man, 35% did not use condoms in their last sex with a woman, 70% had experienced violence in the last 12 months, 61% were experiencing depression and 47% had thought of committing suicide. After adjustment for age, religion, marital status, and MSM subpopulations (bisexual, ta, meti, gay), non-use of condoms at last anal sex with a man was significantly associated with non-participation in HIV interventions, experience of physical and sexual violence, depression, repeated suicidal thoughts, small social support network and being dissatisfied with social support. Depression was marginally associated with non-use of condoms with women. The findings suggest that among MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance were the least likely to have participated in any preventive interventions.

Conclusions

MSM in Nepal have a prevalence of psychosocial health problems in turn associated with high risk behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should cover all MSM subpopulations and prioritize psychosocial health interventions.

Full article at:  http://goo.gl/0Gchu8

By:   Keshab Deuba,1,* Anna Mia Ekström,2,3 Rachana Shrestha,4 George Ionita,5 Laxmi Bhatta,4 and Deepak Kumar Karki6

¹Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

²Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

³Department of Infectious Diseases, Huddinge, Karolinska University Hospital, Stockholm, Sweden

⁴Nobel College, Pokhara University, Kathmandu, Nepal

⁵United Nations Development Programme (UNDP), Kathmandu, Nepal

⁶National Centre for AIDS and STD Control, Kathmandu, Nepal

University of Washington, United States of America

* E-mail: moc.liamg@k4abued

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Sexual Relationships in Last 12 months among Men Who Have Sex with Men in Nepal

Background

Men who have sex with men (MSM) are marginalized, hidden, underserved and at high risk for HIV in Nepal. We examined the association between MSM sub-populations, psychosocial health problems and support, access to prevention and non-use of condoms.

Methods

Between September-November of 2010, a cross-sectional survey on HIV-related risk behavior was performed across Nepal through snowball sampling facilitated by non-governmental organizations, recruiting 339 MSM, age 15 or older. The primary outcomes were: (a) non-use of condoms at least once in last three anal sex encounters with men and (b) non-use of condoms with women in the last encounter. The secondary outcome was participation in HIV prevention interventions in the past year.

Results

Among the 339 MSM interviewed, 78% did not use condoms at their last anal sex with another man, 35% did not use condoms in their last sex with a woman, 70% had experienced violence in the last 12 months, 61% were experiencing depression and 47% had thought of committing suicide. After adjustment for age, religion, marital status, and MSM subpopulations (bisexual, ta, meti, gay), non-use of condoms at last anal sex with a man was significantly associated with non-participation in HIV interventions, experience of physical and sexual violence, depression, repeated suicidal thoughts, small social support network and being dissatisfied with social support. Depression was marginally associated with non-use of condoms with women. The findings suggest that among MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance were the least likely to have participated in any preventive interventions.

Conclusions

MSM in Nepal have a prevalence of psychosocial health problems in turn associated with high risk behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should cover all MSM subpopulations and prioritize psychosocial health interventions.

Full article at:  http://goo.gl/0Gchu8

By:   Keshab Deuba,1,* Anna Mia Ekström,2,3 Rachana Shrestha,4 George Ionita,5 Laxmi Bhatta,4 and Deepak Kumar Karki6

¹Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

²Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

³Department of Infectious Diseases, Huddinge, Karolinska University Hospital, Stockholm, Sweden

⁴Nobel College, Pokhara University, Kathmandu, Nepal

⁵United Nations Development Programme (UNDP), Kathmandu, Nepal

⁶National Centre for AIDS and STD Control, Kathmandu, Nepal

University of Washington, United States of America

* E-mail: moc.liamg@k4abued

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Sex Roles in Percentages among 339 Surveyed MSM in Nepal

Background

Men who have sex with men (MSM) are marginalized, hidden, underserved and at high risk for HIV in Nepal. We examined the association between MSM sub-populations, psychosocial health problems and support, access to prevention and non-use of condoms.

Methods

Between September-November of 2010, a cross-sectional survey on HIV-related risk behavior was performed across Nepal through snowball sampling facilitated by non-governmental organizations, recruiting 339 MSM, age 15 or older. The primary outcomes were: (a) non-use of condoms at least once in last three anal sex encounters with men and (b) non-use of condoms with women in the last encounter. The secondary outcome was participation in HIV prevention interventions in the past year.

Results

Among the 339 MSM interviewed, 78% did not use condoms at their last anal sex with another man, 35% did not use condoms in their last sex with a woman, 70% had experienced violence in the last 12 months, 61% were experiencing depression and 47% had thought of committing suicide. After adjustment for age, religion, marital status, and MSM subpopulations (bisexual, ta, meti, gay), non-use of condoms at last anal sex with a man was significantly associated with non-participation in HIV interventions, experience of physical and sexual violence, depression, repeated suicidal thoughts, small social support network and being dissatisfied with social support. Depression was marginally associated with non-use of condoms with women. The findings suggest that among MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance were the least likely to have participated in any preventive interventions.

Conclusions

MSM in Nepal have a prevalence of psychosocial health problems in turn associated with high risk behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should cover all MSM subpopulations and prioritize psychosocial health interventions.

Full article at:  http://goo.gl/0Gchu8

By:   Keshab Deuba,1,* Anna Mia Ekström,2,3 Rachana Shrestha,4 George Ionita,5 Laxmi Bhatta,4 and Deepak Kumar Karki6

¹Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

²Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

³Department of Infectious Diseases, Huddinge, Karolinska University Hospital, Stockholm, Sweden

⁴Nobel College, Pokhara University, Kathmandu, Nepal

⁵United Nations Development Programme (UNDP), Kathmandu, Nepal

⁶National Centre for AIDS and STD Control, Kathmandu, Nepal

University of Washington, United States of America

* E-mail: moc.liamg@k4abued

 

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Vulnerability of Wives of Nepalese Labor Migrants to HIV Infection: Integrating Quantitative and Qualitative Evidence

HIV risk is determined by the interaction between social and individual risk factors, but information about such factors among Nepalese women is not yet understood. Therefore, to assess the risk factors and vulnerability of the wives of Nepalese labor migrants to HIV infection, we conducted a mixed-methods study in which a descriptive qualitative study was embedded within a case-control study. 

We interviewed 224 wives of labor migrants in the case-control study, and conducted two focus group discussions (n = 8 and 9) in the qualitative study. We found that illiteracy, low socio-economic status and gender inequality contributed to poor knowledge and poor sexual negotiation among the wives of labor migrants and increased their risk of HIV through unprotected sex. 

Among male labor migrants, illiteracy, low socio-economic status, migration to India before marriage and alcohol consumption contributed to liaisons with female sex workers, increasing the risk of HIV to the men and their wives through unprotected sex. 

Both labor migrants and their wives feared disclosure of positive HIV status due to HIV stigma and thus were less likely to be tested for HIV. HIV prevention programs should consider the interaction among these risk factors when targeting labor migrants and their wives.

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By:  Thapa S1,2, Bista N3, Hannes K4, Buve A2, Vermandere M1, Mathei C1.

• 1 Department of Public Health and Primary Care , Katholieke Universiteit Leuven , Kapucijnenvoer 33, Block J-Box 7001. 3000 Leuven , Belgium .
• 2 Department of Public Health , Institute of Tropical Medicine , Nationalestraat 155, 2000 Antwerp , Belgium .
• 3 Department of Public Health , Nobel College Pokhara University , Kathmandu , Nepal.
• 4 Faculty of Psychology and Educational Sciences , Katholieke Universiteit Leuven , Andreas Vesaliusstraat 2-Box 3762, 3000 Leuven , Belgium. 

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HIV/AIDS: A Persistent Health Issue for Women and Children in Mid and Far Western Nepal

This article reviews the effect of male migration on the spread of HIV infections in mid and far-western Nepal. It explains the link between male mobility and HIV in women and children. Materials were collected by a systematic search of the databases and the websites of national and international agencies. HIV infection amongst male migrants was found to be high. 

Their risk behaviors such as unprotected sex with multiple partners and sex workers increase the risk of HIV infection. Substance abuse, loneliness, separation from families, peer pressure, long working hours and poor living conditions are factors that promote unsafe sex. Literacy and awareness about HIV is a key measure to decrease the prevalence of the disease and reduce social stigma among people affected. 

HIV is a major public health issue especially in Nepal with migration playing a major role in its spread. Negligence to sexual health and lack of comprehensive knowledge on the disease among male migrants are the major obstacles that have exacerbated the disease. 

There is a need for further research on the existing HIV cases affecting women and children of these two regions to get a clear picture of the gravity of the disease.

Purchase full article at:  http://goo.gl/hYPqmH

By:  Awasthi KR1, Adefemi K1, Tamrakar M2.

• 1School of Public Health Faculty of Health Sciences Curtin University, Bentley 6102, WA.
• 2Department of Dentistry Kathmandu University School of Medical Sciences Dhulikhel, Kavre. 

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Sexual Behaviour of People Living with HIV Attending a Tertiary Care Government Hospital in Kathmandu, Nepal

Clinical improvements that follow antiretroviral therapy (ART) may lead to increase or resumption of high risk activities that could unintentionally result in HIV transmission. The objective was to investigate whether treatment status is a significant predictor of sexual risk behaviour (unprotected sex).

A cross sectional study was conducted among 160 people living with HIV (PLHIV) (89 ART experienced and 71 ART naïve) attending Sukraraj Tropical and Infectious Disease Hospital in Kathmandu, Nepal. A structured questionnaire was used for data collection. Logistic regression with stepwise modeling was used to obtain adjusted odds ratios (OR) with 95 % CI.

In this study, 92 % of sexually active respondents reported sex with a regular partner. ART experienced PLHIV were significantly more likely to report consistent condom use with their regular partners compared to ART naïve PLHIV (83 vs. 53%) during the past six months. In multivariate analysis, sex, treatment status and alcohol consumption during last sex with regular partners were significantly associated with unprotected sex.

ART naïve PLHIV were five times more likely to exhibit sexual risk behaviour (have unprotected sex) than ART experienced PLHIV. Thus the study provided no evidence to suggest that ART experienced PLHIV exhibit greater sexual risk behaviour compared to ART naïve PLHIV. Prevention programmes need to emphasize on counselling to PLHIV and their regular partners with focused interventions such as couple counselling and education programmes.

Table 3

Predictors of unprotected sex with regular partners

Variables	Unprotected n (%)	Protected n (%)	Univariate OR (95 % CI)	P-value	Multivariate OR (95 % CI)	P-value
Sex
Female	9 (45.0)	11 (55.0)	2.46 (0.84–7.15)	0.100	4.59 (1.15–18.39)	0.031
Male	14 (25.0)	42 (75.0)
Marital status
Not living with a partner	1 (50.0)	1 (50.0)	2.36 (0.14–39.5)	0.549
Living with a partner	22 (30.0)	52 (70.0)
Education levelb
Formal education	18 (30.5)	41 (69.5)	1.05 (0.32–3.43)	0.931
No formal education	5 (29.4)	12 (70.6)
Occupation
Unemployed	6 (46.2)	7 (53.8)	2.32 (0.68–7.89)	0.178
Employed	17 (26.9)	46 (73.1)
Treatment status
ART naïve	16 (47.1)	18 (52.9)	4.44 (1.55–12.76)	0.006	4.76 (1.29–17.52)	0.019
ART experienced	7 (16.7)	35 (83.3)
Partner’s HIV status
Not known	7 (41.2)	10 (58.8)	1.35 (0.43–4.27)	0.606
HIV negative	1 (6.7)	14 (93.3)	0.14 (0.02–1.15)	0.068
HIV positive	15 (34.1)	29 (65.9)
Disclosure of own HIV status
No	5 (50.0)	5 (50.0)	2.67 (0.69–10.31)	0.155
Yes	18 (27.3)	48 (72.7)
Alcohol consumption during last sex
Yes	9 (69.2)	4 (30.8)	7.88 (2.11–29.45)	0.002	14.75 (2.75–79.29)	0.002
No	14 (22.2)	49 (77.8)
Time since HIV was diagnoseda
≤24 months	14 (40.0)	21 (60.0)	2.37 (0.87–6.46)	0.091
>24 months	9 (21.9)	32 (78.1)
CD4 Cell count (cells/mm3)a
≤224	12 (37.5)	20 (62.5)	2.18 (0.75–6.28)	0.151
>224	8 (21.6)	29 (78.4)
Can ART prevent the transmission of HIV
Yes/don’t know	14 (35.0)	26 (65.0)	1.61 (0.60–4.37)	0.345
No	9 (25.0)	27 (75.0)
With availability of ART would it make a difference if HIV transmits from you to others
Yes	18 (27.7)	47 (72.3)	0.46 (0.12–1.70)	0.243
No/don’t know	5 (45.4)	6 (54.6)

aDichotomization based on sample median

bFormal education includes primary (grade 1–5), secondary (grade 6–10), higher secondary/high school (grade 11–12), under graduate and post graduate

Full article at: http://goo.gl/BXRxrG

By: Angdembe MR1, Lohani SP2, Karki DK3, Bhattarai K4, Shrestha N5.

• 1Department of Public Health, Central Institute of Science and Technology, Pokhara University, Kathmandu, Nepal. mirak.angdembe@gmail.com.
• 2Centre for Health Research and International Relations, Nobel College, Pokhara University, Kathmandu, Nepal. lohanis@gmail.com.
• 3National Centre for AIDS and STD Control, Kathmandu, Nepal. dekarki@gmail.com.
• 4Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel. kreepa.bhattarai@gmail.com.
• 5Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. nirajshrestha44@gmail.com.

 

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