Nepalese trekking guides: A quantitative study of sexual health knowledge and sexual behaviour

Background: Tourism, a global industry, brings with it a number of public health problems, one of which is the spread of sexually transmitted infections transmitted between travellers and hosts. Previous studies have largely focused on sex workers and sex tourists. This study assesses sexual behaviour, knowledge and condom use among male trekking guides in Nepal. Methods: A self-administered questionnaire survey (n=324) was conducted using snowball sampling amongst men working as mountain trekking guides in Nepal. Results: Most respondents (59%) had initiated sex before the age of 18. Most (84 %) reported sexual relations with a woman other than their partner, 46% reported foreign partners, 43% had Nepalese partners, and 28% had concurrent foreign and Nepalese partners. Most (70 %) reported ever having sex with a foreign woman and two-thirds had had sexual intercourse with foreign women in the previous 12 months. Participants’ age, education status, age of first sex, smoking and drinking habits and English proficiency were significant predictors of having sex with foreign women. About 60% reported condom use during their most recent occasion of extra-martial sex. A similar proportion had used a condom during last sexual intercourse with a foreign woman. The likelihood of condom use was associated with a guide’s age, educational level, ethnicity, age of first sex and work experience. Conclusions: Most trekking guides reported sexual relations with foreign women as well as irregular use of condoms. Although sexual health knowledge about among trekking guides is high, some misconceptions still result in unsafe sex. Hence there is an urgent need to revise the existing training for trekking guides and implement appropriate health promotion programmes

Experts warn Nepal Government not to reduce local Public Health spending

The health system in Nepal is currently undergoing some very interesting radical reforms. The new Constitution in 2015 brought a complete restructuring of the country’s political system, creating a Federal Republic with seven Provinces. This change involves a significant devolution of power and resources from central to local level in many sectors including the health sector. This editorial warns of the risk of moving away the political focus from Public Health in a centralised political syste

Cardiovascular Risk Factors Among People being Treated for HIV in Nepal: a Cross-Sectional Study.

Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity [34.6%, 95% Confidence Interval (CI): 25.3% to 43.9%], chronic kidney disease [20.7% (95% CI: 11.6% to 29.7%)] and tachycardia [20.6% (95% CI: 12.7% to 28.5%)]. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked [65% (95% CI: 57%-72.3%)], used tobacco products [66% (95% CI: 56.4%-74.4%)] or drugs (53.8% of the men) and consumed alcohol [60.2% (95% CI: 50.5%-69.1%)]. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region

The presentation of academic self in the digital age: the role of electronic databases

A growing number of online electronic resources present academic work. We are not focusing here on specialised electronic databases that store bibliographic research data, such as Medline, PubMed, ASSIA, ERIC, JSTOR, but databases or social networking websites /platforms for academics/researchers that profile research, academic and professional activities, such as SCOPUS, WoS (Web of Science), Academia.edu, KUDOS, ORCiD, ResearchGate, LinkedIn, GoogleScholar and Mendeley. We discuss databases or platforms can promote the profile of an individual academic, highligthing their research interests, grants and publications. These databases are good outlets for Early Career Researchers (ECRs) to build, improve and promote their public profile. However, the level of efforts requires to open an account or to maintain these databases regularly can be a daunting task for some scholars. This paper outlines some of these key databases and their functions and reflects on advantages and disadvantages of engaging with the most popular ones. We remind the reader that many of these databases require academics’ attention and input, and thus create more work

Young people's knowledge, attitude, and behaviour on STI/HIV/AIDS in the context of Nepal: a systematic review.

Sexual and reproductive health of young people has become a major health problem in recent decades. Recent and rapidly increasing Human Immune Deficiency Virus (HIV) rates show an urgent need for Sexually Transmitted Infections (STIs) and HIV prevention interventions in Nepal

Pregnancy and COVID-19: Lessons so far

Since COVID-19 is a new disease, we are still learning how it spreads, what the best prevention measures are and how it affects different groups of people including pregnant women (CDC 2020)

Sex trafficking in Nepal: A qualitative study of process and context. Abstract.

Thousands of Nepalese girls are trafficked to India and other neighbouring countries every year, primarily for sex work and the majority return to Nepal after spending a years in sex trade. The sub‐group of Nepalese girls who become involved in sex work via trafficking are the focus of this paper. The aim of this study was to increase understanding regarding the context of sex trafficking, the methods and means of trafficking, living conditions in brothels and survival strategies among trafficked girls. We conducted 33 in‐depth interviews in early 2013 with returned trafficking survivors (n=14) and policy‐makers, people working in trafficking related NGOs/INGOs (n=19) in Nepal. All 14 trafficking survivors were recruited in Nepal through the NGO working on trafficking field. The young girls trafficked from Nepal to India in this study were typically unmarried, illiterate and very young (8 to 14 years at the time of trafficking). The key methods of trafficking were false marriage, fake job offer, and abduction. Among the 14 respondents, some had spent one month and others nearly 5 years in Indian brothels. Respondents were either rescued, escaped or released by brothel owners. Four out of 14 were HIV positive. Most policy makers mentioned that poverty, unemployment and illiteracy are the causes behind the trafficking of young girls. The anti‐trafficking interventions need to be considered at a) community level before movement has begun; b) urban centres which are both source and transitory centres for trafficking; c) trafficking level when girls are highly mobile and when they are in brothels; and d) return from trafficking as girls to m ove back into the community

Economic Burden of HIV/AIDS upon Households in Nepal: A Critical Review

Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations. It is concluded that there was a considerable knowledge gap about the issue, and the economic burden exerted by HIV/AIDS was big enough to push the affected households into poverty. It is suggested that more studies need to be conducted to fill the knowledge gap. Similarly, Government of Nepal and other organisations working in the field of HIV/AIDS need to provide economic supports (e.g.- support for travel costs) to the HIV positive people and need to increase the awareness level among general population for reducing stigma and discrimination, and reducing economic burden on them

Ethical and Practical Challenges in Conducting Fieldwork on a Sensitive Topic (HIV) in Nepal

This short one-page piece addresses issues that arose during the fieldwork of the first author. He as a PhD student experienced a number of practical issues and challenges while conducting fieldwork for his PhD thesis in Nepal at the end of 2009. The key issues that arose involved gaining access to and conducting interviews in hospitals in Nepal, especially in out-patient departments. Obtaining access to people living with HIV was a major challenge. He faced difficulties getting approval/support for the research because HIV is a stigmatising and sensitive issue in Nepal, and research is still not considered a priority area. Delays increased the costs of research and shortened the time available to complete the fieldwork. Without obtaining written approval from the hospital director, it was not possible to start and the absence of such a key person on the days of fieldwork caused delays in obtaining approval and consequently resulted in delayed data collection. Ethical issues and challenges inevitably arose during the fieldwork. Confidentiality was a major issue, and conducting interviews in out-patient departments made recruitment difficult due to lack of privacy

Factors that promote or hinder maternal health service provision by female community health volunteers in rural Nepal

Female Community Health Volunteers (FCHVs) provide basic Maternal Health Services (MHSs) to pregnant women and mothers in their communities. Their contribution to maternal health has been praised, as Nepal managed to reduce its maternal mortality by more than two-thirds and met the Millennium Development Goal 5. However, little published evidence is available on FCHVs’ views and the factors that promote or hinder their services. This thesis explores the role of FCHVs in MHS provision in two regions (the hill and Terai ) of Nepal, from the perspectives of health workers, service users, and FCHVs themselves. A qualitative approach was adopted using semi-structured interviews, focus group discussions (FGDs) and field notes. Interviews were conducted with 20 FCHVs, 11 health workers and 26 women in villages from the two study regions. In addition, four FGDs were held with 19 FCHVs and field notes were taken throughout the data collection. Data were analysed using thematic analysis. Findings indicate that FCHVs play an important role in MHS provision in the hill villages where there is limited access to professional healthcare. The FCHVs detected pregnancies, referred them for health check-ups, accompanied them for deliveries and assisted in child-births. They also distributed medicines and informed women on the availability of safe abortion services. In both regions, the FCHVs raised health awareness among pregnant women/mothers casually or through organised meetings. In the hill villages, they used interesting casual approaches to share maternal health information, for example, singing folk songs with health messages in them or visiting new mothers with nutritious food hampers. Such services were beneficial to the women in the remote villages, who otherwise would not have received any healthcare. The FCHVs also shared maternal health messages through regularly organised mothers' group meetings. Unfortunately, these meetings were also used for monetary discussions, which left a little time for discussion on health topics. Such activity combined with the lack of FCHVs’ education often proved to be counterproductive on their service provision. They have a desire to volunteer, as they saw their service as social responsibility, felt empowered and enjoyed community recognition. However, a lack of financial and non-financial incentives was the key hindrance for them followed by perceived community misconceptions regarding their voluntary status. The FCHVs’ illiteracy and older age also affected their services. Finally, various health systems related factors also hindered their services: a lack of access to medical supplies, inadequate training and supervision. In general, volunteers in the terai region were less supported than those in the hill region. In addition, a perceived lack of respect by some health workers towards volunteers and a lack of coordination between government health centres and NGOs were noted. Overall, the study found that most interviewees perceived FCHVs as a valuable resource in improving the maternal health of the poor women. In some remote hill villages, they are the only MHS providers. Therefore, their contribution to MHS needs to be recognised and respected by both the health workers and the communities. It is important that FCHVs are provided with context specific support - incentives, access to supplies and supportive supervision - to enable them to deliver services more productively and to ensure that these services flourish in the future