Since its inception, TP has been providing care, support and treatment services to PLHIV with the support and partnership with different INGOs and on its own effort. During the course of implementation of positive prevention, community care centers and awareness raining activities in the district, Trishuli Plus emerged as one of the leading agencies for HIV-related activities in the district. Tris
huli Plus has strong financial and administrative system, policies and procedures. It also has very strong and functional relationship with DHO, DDC, DACC and other district level and local level government authorities and non-governmental stakeholders. While the HIV/AIDS epidemic continues to expand into segment of society, it also continues to disproportionately expand into and affect communities, trafficking women and migrant communities which have been considered largely ‘Dispensable’ by the larger society; communities who have traditionally had difficulties accessing the health care and social services they need to live complete and productive lives. This situation only worsens for those from these communities who are diagnosed with HIV/AIDS, who have all of the traditional barriers to overcome in addition to the stigma attached to HIV/AIDS and the increased needs associated with maintaining oneself both physically and mentally. Since those services being offered to HIV-positive individuals; and HIV affected were established towards the beginning of the epidemic, these expands and changes, are becoming increasingly distant and inaccessible to the communities these services are now supposed to serve, and are often not either culturally appropriate or geographically accessible to the people who need the services most. Additionally, the HIV/AIDS services system has generally been set up to serve those who have been diagnosed in the later stage of AIDS and who are dependent on a variety medical and social supports. As the epidemic has expanded ,however ,the majority of people living with HIV are relatively healthy, and do not require intensive, ongoing case management service :however because of poverty and other consideration ,the primary immediate threat to their quality of life are factor such as lack of education or employment, drug and substance abuse, mental management of HIV disease. While the HIV/AIDS service system has made enormous strides in meeting the needs of some dependent, ill people with HIV/AIDS, it has not yet fully developed mechanism to assure access of indigent and minority people whose lives are less functional and who struggle with many obstacles to obtaining the care they need. These individuals –the target population of all of Trishuli Plus activities-require specialized approaches to their care if they are too able to obtain much service they need to lead stable lives and affectively manage the impact of HIV infection. Nuwakot is a district where majorities of the men and women are with HIV/AIDS infection. This is a major area of concern due to the impact that it has had on the district, which is evident in terms of health, education and development. The problem is overall concentrated among FSW, IDU, Drivers, Migrant people, and Trafficking Women. The present impact in the form of HIV/AIDS and other blood borne infection (BBI) has started to reach pandemic proportions, especially in the east part of district and capital of Nuwakot district. This problem lies intertwined with many other problems such as illiteracy, poverty, unemployment, prostitution and crime. Because of poverty and unemployment in Nuwakot, the numbers of those migrant workers traveling to other countries has significantly increased. Many of them are returning with the infection and impact is widely visible with their spouses and children being infected.
