Two years ago, at his local health clinic in Kathmandu, Sujan* learned he was HIV positive.
“When I found out about my [HIV] status, I felt like the world collided and the sky fell to the ground,” he says.
Sujan knew he was at risk, but it was still a shock. “I am gay, and I’m still in the closet,” he says. “I’ve come out to my brother and my cousins. They’re supportive, thankfully.”
Sujan started antiretroviral treatment (ART) immediately, but it took time to adjust to the news emotionally and psychologically. Fortunately, he had a supportive and knowledgeable confidant on his side: his clinic case manager, Pabitra Thapa. “Pabitra guided me from ground zero,” he says. “She answered all my questions, and she eased my journey to overcoming the pain.”
A concentrated epidemic in Nepal
Thapa works at the Kathmandu City Clinic, which is managed by STD/AIDS Counseling and Training Services, known as SACTS. SACTS is supported by FHI 360 under the global Meeting Targets and Maintaining Epidemic Control (EpiC) project. EpiC, which is funded by PEPFAR and USAID, is an eight-year initiative focused on attaining and maintaining HIV epidemic control and strengthening the capacity of government and civil society organizations for self-reliant management of national HIV programs.
Nepal has made significant progress in achieving HIV epidemic control, realizing a 77% decline in new HIV infections between 2010 and 2022.
However, it is still experiencing a concentrated epidemic, meaning there is a low prevalence of infection in the general population but a higher prevalence in groups of people known as key populations. Key populations in Nepal include transgender people, people who inject drugs, sex workers, and men who have sex with men. Globally, despite the progress made against the HIV epidemic, stigma and discrimination against people living with HIV and against key populations persist. Sujan says he has experienced that discrimination firsthand, because of his HIV status.
Integrating mental health care with HIV services
Receiving an HIV diagnosis can challenge one’s mental health, introducing additional barriers to accessing lifesaving care and treatment services. And it goes both ways — research has shown that those who have mental health disorders are less likely to initiate and continue lifesaving ART.
That’s why a key priority of the Global AIDS Strategy 2021-2026 is the integration of mental health and psychosocial support with HIV services and interventions.
EpiC Nepal’s progress in integrating mental health services
While EpiC-supported clinics have always provided emotional and social support to clients like Sujan, the Nepal team expanded their programming over the past year to integrate mental health services into the HIV care continuum.
At the 37 EpiC-supported clinics in Nepal, the EpiC team has trained case managers and community workers to offer mental health services alongside their core services of HIV prevention, testing and treatment. This means clients can see just one provider who addresses their needs related to an HIV diagnosis and subsequent care. Case managers at all EpiC-supported clinics in Nepal conduct screenings for mental health conditions and provide counseling and referrals. They also offer periodic psychosocial assessments to understand their clients’ barriers to treatment and better address their needs.
Delivering individualized services with empathy
The Kathmandu City Clinic is busy, with around 180 patients each month from all over the country. Thapa, who sees up to 15 clients a day, is skilled in making her patients feel comfortable, taking care to develop relationships and build trust. “Counseling is about working together, understanding each other, and keeping things private, so the clients can feel free to share and heal,” Thapa says. “The client and counselor need to form a special alliance, a unique bond, to go through the healing journey together.
People living with HIV who visit EpiC-supported clinics say the emotional support they receive at the time of their diagnosis affects whether they come to their next appointment and stick to their ART schedule. “Even though I completed a postgraduate program, I believed that the virus would kill me in less than a decade, because that was what I was taught from when I was young,” Sujan says. “Pabitra guided me on taking my ART medication and how HIV is transmitted. She inspired me and assured me that I can live a long and healthy life, just like anyone else.
Support for the long-term
Sujan’s life has resumed as it was, for the most part. His medication hasn’t come with any side effects, and he’s upbeat. He still works the same job as a banker, and he hasn’t felt the need to come out to the rest of his family and friends.
Sujan visits the clinic regularly to monitor his viral load and pick up his medication. The clinic staff wrote his prescription so that he only needs to pick it up every other month. If he can’t, the case managers have his medication discretely delivered to him at work, improving the likelihood that he continues taking it regularly.
“People should know that HIV can be treated, and people can live as normally as other people,” says Sujan. “To young people I would say, this is not the end of life. Medicine has advanced, and you can still do whatever you like; be a doctor, be an engineer … It’s not the end of life.”
*Name has been changed
All photos are credited to Pramin Manandhar for FHI 360.
