Project Title: AMDA LINKAGES Project (HIV care, support and treatment services among FSWs, Clients of FSW, and PLHIV in Jhapa, Morang and Sunsari districts)
Project Site: Jhapa, Morang, Sunsari districts
Project Duration: 1 October, 2016 - 31 December 2017
Project beneficiary: Female Sex Worker (FSW), Clients of FSW and People Living with HIV/AIDS (PLHIV)

Project Status/Background
The LINKAGES project (HIV care, support and treatment services among FSWs, Clients of FSW, and PLHIV in Jhapa, Morang and Sunsari districts) is a part of continuation of AMDA Saath Saath Project. AMDA Nepal has been working with FHI360/Nepal since 1998 for the prevention and combating HIV/AIDS. The LINKAGES project supports to implement evidenceā€based HIV interventions for key populations (KP) at scale and to sustain those services.

LINKAGES project use the continuum of HIV prevention, care, support and treatment (CoPCT) cascade of services as the overall strategic framework for the project. The HIV cascade illustrates how individuals should ideally move through the CoPCT services to reduce HIV transmission as well as to ensure a high quality of life for PLHIV. HIV cascade emphasizes the intervention stages of “reach, test, treat, and retain” as key steps to ensure long-term ART adherence that results in low viral load. Use of the HIV cascade and, the enhanced use of programmatic data associated with it, will allow local stakeholders to
(1) identify “leaks” in the system where KPs are lost to follow up or unable to access the services;
(2) analyze the root causes of those gaps;
(3) identify the most effective solutions for improvement; and
(4) refine and focus interventions and services to ultimately reduce HIV transmission and impact.
The project approach envisions close collaboration with the GoN, local NGOs, and national networks of KPs and PLHIV and their Community-Based Organizations (CBOs) to develop enhanced models for maintaining improved prevention programs with links to the CoPCT. Backed by the institutionalized HIV cascade model, the project will have the ability to constantly analyze the current situation and make informed decisions about the changes that need to be made to minimize the leakage observed in the cascade.
The project adopts four broad approaches to ensure contribution to achievement of 90-90-90 targets:
(1) Reach, test, treat and retain
(2) mobilization of local NGOs and national networks KPs and PLHIV and their CBOs;
(3) linkage with government HIV facilities and
(4) use of new and innovative methods and technologies for HIV prevention and testing.
The portion of LINKAGES Nepal that AMDA-Nepal will implement in Jhapa, Morang and Sunsari districts will include HIV care, support and treatment services for FSWs, clients of FSWs and PLHIV.

HIV/AIDS situation in Nepal
Since the first case of HIV infection was identified in 1988, Nepal has been able to make some substantial progress in National HIV & AIDS response; nevertheless, still there is a lot to do. HIV prevalence among adult population has been declining in slow pace (from 0.34% in 2005 to 0.20% in 2015), however, country has made significant achievement in reduction of new HIV infection from 7,512 annually in 2,000 to 1,331 in 2015, despite of high HIV prevalence among certain population groups such as people who inject drugs and male and transgender sex workers. HIV prevalence among this sub-groups is more than 5% due to which Nepal’s HIV epidemic is categorized as concentrated epidemic. These achievements so far in terms of reduction in HIV prevalence and new HIV infection is the result of collaborative efforts of government entities, non-governmental organizations, civil society organization and communities of key affected populations.

As of end of 2015, there are 263 HIV testing and counseling (HTC) and, Sexually Transmitted Infection (STI) management services sites across 75 districts. National HIV & AIDS Strategy (2011-2016) is the current guiding document for Nepal’s HIV response which has direct alignment with GoN’s Poverty Reduction Strategy Paper (PRSP), Millennium Development Goals (MDG) and Nepal Health Sector Plan NHSP II.

Nepal continues to face a concentrated HIV epidemic, and HIV transmission is largely driven by Key Populations (KPs). Female Sex Workers (FSWs), clients of FSWs, Men who have Sex with Men (MSM), Male Sex Workers (MSW), Transgender (TG) people, People Who Inject Drugs (PWID) and migrant workers who engage in commercial sex are considered as KPs at higher risk of HIV infection in Nepal. The 2015 national HIV infection estimates project approximately 39,397 adults (including 1,589 children) in Nepal to be infected with HIV, with an estimated overall adult HIV prevalence of 0.20%. The estimates also show that 26% of total infections are distributed among PWID (8%), MSM (9%), clients of sex workers (5%), MSW/TGSWs (3%), and FSWs (1%). There were 27,495 HIV positive cases identified and reported as of December 2015.
Project objective:
Project objective is to reduce the transmission and impact of HIV and AIDS, and improve the reproductive health among female sex workers (FSWs) and their clients by increasing the access to and utilization of STI and HIV related services. The project will continue its efforts to maintain contacts and cooperation among the high risk group in the project area.
 Activities under the project:
  • Increased availability of comprehensive prevention, care and treatment services, including reliable coverage across the continuum of care for FSWs, clients of FSWs and PLHIV.
  • Demand for comprehensive prevention, care and treatment services among FSWs, Clients of FSWs and PLHIV enhanced and sustained.
  • Strengthened systems for planning, monitoring, evaluating and assuring the quality of programs for FSWs, Client of FSWs and PLHIV.
Expected Results (Key Indicator)
Sn Performance Indicator Number
1 HIV testing and counselling service 4756
2 HIV care service to newly enrolled HIV positive 96
3 People living with HIV, screed for TB symptoms 154
4 KP clients screened for Sexually Transmitted Infections 2378


Contact Address:
Itahari 4, AaitabareMarg
Sunsari, Nepal
Phone: +977-25-586951
Fax: +977-25-580791