Nepal's first cases of HIV/AIDS were reported in 1988 and the disease has primarily been transmitted by intravenous drug use and unprotected sex. Among the two, the HIV epidemic is largely attributed to sexual transmissions. They account for more than 85% of the total new HIV infections. Available data indicate that there was a sharp increase in the number of new infections starting in 1996, coinciding with the outbreak of civil unrest. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and Male Labor Migrants (MLMs) as well as their spouses. Cultural factors have also been shown to play a significant role in the spread of HIV and AIDS in Nepal. Some of these cultural factors are related with social taboos which creates challenges for open discussions regarding sex and sexual habits, as do denial, stigma, and discrimination that surround HIV and AIDS. Other factors such as poverty, low levels of education and literacy, political instability combined with gender inequality make the tasks challenging.