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 su b-Saharan Af rica as we enter the 21st century. Nepal has much in common wi th 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 pai nts a different picture altogether - a very low prevalence of HIV even in h igh-risk population groups. This is surprising, particularly since high-ris k behaviour is evidenced by a high rate of drug abuse. In addition, other c ommunicable diseases commonly associated with HIV infection, such as tuberc ulosis and HBV/HCV infection, are common in Nepal and yet still the prevale nce of HIV infection in these patients and in the general population is rep orted to be low. This paper identifies some of these anomalies and attempts to analyse the r easons for this discrepancy. We emphasize the need for extended survey and strict surveillance to avoid an explosion of this dreaded infection.