{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:39:23Z","timestamp":1777927163319,"version":"3.51.4"},"reference-count":57,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2016,10,31]],"date-time":"2016-10-31T00:00:00Z","timestamp":1477872000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:p>We assessed changes in HIV prevalence and risk behaviours among young key populations in Nepal. A total of 7505 participants (aged 16\u201324 years) from key populations who were at increased risk of HIV infection (2767 people who inject drugs (PWID); 852 men who have sex with men\/transgender (MSM\/TG); 2851 female sex workers (FSW) and 1035 male labour migrants) were recruited randomly over a 12-year period, 2001\u20132012. Local epidemic zones of Nepal (Kathmandu valley, Pokhara valley, Terai Highway and West to Far West hills) were analysed separately. We found a very strong and consistent decline in HIV prevalence over the past decade in different epidemic zones among PWID and MSM\/TG in Kathmandu, the capital city, most likely due to a parallel increase in safe needle and syringe use and increased condom use. A decrease in HIV prevalence in 22 Terai highway districts, sharing an open border with India, was also consistent with increased condom use among FSW. Among male labour migrants, HIV prevalence was low throughout the period in the West to Far West hilly regions. Condom use by migrant workers involved with FSW abroad increased while their condom use with Nepalese FSW declined. Other risk determinants such as mean age at starting first injection, injection frequency, place of commercial sex solicitation, their mean age when leaving to work abroad did not change consistently across epidemic zones among the young key populations under study. In Nepal, the decline in HIV prevalence over the past decade was remarkably significant and consistent with an increase in condom use and safer use of clean needles and syringes. However, diverging trends in risk behaviours across local epidemic zones of Nepal suggest a varying degree of implementation of national HIV prevention policies. This calls for continued preventive efforts as well as surveillance to sustain the observed downward trend.<\/jats:p>","DOI":"10.1177\/0956462416678303","type":"journal-article","created":{"date-parts":[[2016,10,31]],"date-time":"2016-10-31T20:38:48Z","timestamp":1477946328000},"page":"864-875","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["HIV decline associated with changes in risk behaviours among young key populations in Nepal: analysis of population-based HIV prevalence surveys between 2001 and 2012"],"prefix":"10.1177","volume":"28","author":[{"given":"Keshab","family":"Deuba","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden"},{"name":"Public Health and Environment Research Center, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Mia","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Infectious Diseases, Huddinge, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6ran","family":"Tomson","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachana","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Public Health and Environment Research Center, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Marrone","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,10,31]]},"reference":[{"key":"bibr1-0956462416678303","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.18.2.19833"},{"key":"bibr2-0956462416678303","volume-title":"Redefining AIDS in Asia: crafting an effective response","author":"Treat Asia","year":"2008"},{"key":"bibr3-0956462416678303","volume-title":"In or out? Asia-Pacific review of young key populations in national AIDS strategic plans","author":"UNESCO","year":"2014"},{"key":"bibr4-0956462416678303","unstructured":"UNAIDS.\n                      HIV in Asia and the Pacific.\n                      Bangkok, Thailand: UNAIDS, 2013."},{"key":"bibr5-0956462416678303","doi-asserted-by":"crossref","unstructured":"Chiu J and Burris S. Punitive drug law and the risk environment for injecting drug users: understanding the connections. In:\n                      Working paper prepared for the third meeting of the technical advisory group of the global commission on HIV and the law\n                      , New York, 7\u20139 July 2012.","DOI":"10.2139\/ssrn.2102841"},{"key":"bibr6-0956462416678303","volume-title":"Building partnerships on HIV and sexwork","author":"UNFPA","year":"2011"},{"key":"bibr7-0956462416678303","first-page":"ii72","volume":"86","author":"Ghys PD","year":"2010","journal-title":"Sex Transm Infect"},{"key":"bibr8-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62230-8"},{"key":"bibr9-0956462416678303","volume-title":"Local epidemics issues brief","author":"UNAIDS","year":"2013"},{"key":"bibr10-0956462416678303","volume-title":"Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations","author":"WHO","year":"2014"},{"key":"bibr11-0956462416678303","unstructured":"Central Bureau of Statistics (CBS).\n                      Nepal population and housing census.\n                      Kathmandu, Nepal: CBS, 2011."},{"key":"bibr12-0956462416678303","volume-title":"Nepal country progress report 2012","author":"NCASC","year":"2012"},{"key":"bibr13-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfda.2013.09.047"},{"key":"bibr14-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199509000-00013"},{"key":"bibr15-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czq061"},{"key":"bibr16-0956462416678303","first-page":"62","volume":"13","author":"Chu SK","year":"2008","journal-title":"HIV AIDS Policy Law Rev"},{"key":"bibr17-0956462416678303","unstructured":"UNAIDS. Methods for estimating HIV incidence. 2010; UNAIDS quarterly update on HIV epidemiology, http:\/\/www.unaids.org\/en\/media\/unaids\/contentassets\/documents\/dataanalysis\/epi_alert_2010Q1_en.pdf (2011, accessed 22 October 2016)."},{"key":"bibr18-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1016\/S2222-1808(14)60688-5"},{"key":"bibr19-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-13-604"},{"key":"bibr20-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-8080(03)02292-4"},{"key":"bibr21-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000172879.20628.e1"},{"key":"bibr22-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-008-9421-1"},{"key":"bibr23-0956462416678303","doi-asserted-by":"publisher","DOI":"10.1111\/j.0081-1750.2004.00152.x"},{"key":"bibr24-0956462416678303","unstructured":"United Nations. Official list of MDG indicators, http:\/\/mdgs.un.org\/unsd\/mdg\/Host.aspx?Content=indicators\/officiallist.htm (n.d., accessed 15 June 2015)."},{"key":"bibr25-0956462416678303","unstructured":"Equator Network. Strengthening the reporting of observational studies in epidemiology for respondent-driven sampling studies: STROBE-RDS statement, http:\/\/www.equator-network.org\/wp-content\/uploads\/2013\/09\/5204_STROBE-RDS-Checklist.pdf (2013, accessed March 2014)."},{"key":"bibr26-0956462416678303","first-page":"79","volume":"24","author":"Volz E","year":"2008","journal-title":"J Offic Stat"},{"key":"bibr27-0956462416678303","unstructured":"RDS analyst: software for the analysis of respondent-driven sampling data (computer program). Version 0.42. 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