As the aids related stigma runs rampant in Nepal and people often come very late into treatment, the more advance and lethal stage of opportunistic infections is very often the face of the initial treatment challange here. The economy of the country is down in the dumps prompted on largely by the decade long conflict over political intrests. The quality of Medical supervision alongwith the quality of drugs seem to be worsening. As the latter or rather more advanced stage of hiv infection often results in more complicated and lethal opportunistic infections like Mycobacterium avium complex, cytomegalo virus and cryptococcal meningitis, the significantly lacklustre services PLWHAs get concerning medical supervision and drugs is appalling.I personally have had a colleague of mine die of advanced cryptococcal meningitis infection before me because of the lacklustre treatment and very late diagnosis. Infact the diagnosis was not possible even after repeated ´tests´ until very late. The below average medical supervision and the low quality of drugs are increasing the mortality rate alarmingly. We need to increase the quality of Medical personnels and the quality of drugs.As the ´more´ skilled personnels are busy with offering private services which cost more, we need to woo these personnels into offering a part of their services in the goverment facilities. We also need to upgrade the qualities of those in the goverment facilities.