HIV in Nepal: is it rare or the tip of an iceberg?

Acquired immunodeficiency syndrome (AIDS) has reached alarming proportions in SE Asia. The magnitude of the epidemic is projected to exceed that of sub-Saharan Africa as we enter the 21st century. Nepal has much in common with India geopolitically and socially and the prevalence of HIV is expected to be no different from the rest of SE Asia. However, evidence thus far paints a different picture altogether--a very low prevalence of HlV even in high-risk population groups. This is surprising, particularly since high-risk behaviour is evidenced by a high rate of drug abuse. In addition, other communicable diseases commonly associated with HIV infection, such as tuberculosis and HBV/HCV infection, are common in Nepal and yet still the prevalence of HIV infection in these patients and in the general population is reported to be low. This paper identifies some of these anomalies and attempts to analyse the reasons for this discrepancy. We emphasize the need for extended survey and strict surveillance to avoid an explosion of this dreaded infection.