Published:  12:00 AM, 04 January 2017

HIV/AIDS on the rise in Bangladesh

HIV/AIDS on the rise in Bangladesh
While the total number of HIV and AIDS infected people has declined globally for last 10 years, Bangladesh sees a rise in numbers of people becoming infected by AIDS. Bangladesh is one of the few countries in the world where the frequency of HIV and AIDS infections is increasing.

Although Bangladesh is still considered to be a low prevalence country, it remains extremely vulnerable to HIV epidemic, given its dire poverty, overpopulation, gender inequality and high levels of transactional sex. The emergence of a generalized HIV epidemic would be a disaster that poverty-stricken Bangladesh can ill-afford. It is estimated that without any intervention the prevalence in the general adult population could be as high as 2% in 2012 and 8% by 2025, according to a UNICEF study.

Government data shows that over 84,000 people were tested for HIV last year and of them 578 were found HIV positive while 141 people died in last 12 months. With this new infection, the number of government-recorded HIV positive people stood at 4,721 in Bangladesh since the detection of the first case in the late 1980s and 799 died of AIDS so far.

Injecting drug users, sex workers and men having sex with men are considered most-at-risk groups to HIV infection in Bangladesh.Commercial sex work occurs in Bangladesh as it does in other Asian countries. Most married men who have unprotected sex with sex workers continue to have unprotected sex with their wives, exposing them to infection with HIV and other sexually transmitted diseases. Low condom use, risky behavior and lack of general understanding about HIV are not limited to clients of sex workers. In fact, these traits are widespread and it heightens the chances of HIV epidemic in Bangladesh. Although many people have heard of HIV, their knowledge is limited in regards to how it is transmitted and how they can protect themselves. Nearly one in five married women who had heard of AIDS did not know if there was any way to prevent it.

Men having sex with men are largely hidden due to the powerful stigma and discrimination they face in Bangladesh. Many men who have sex with men are bisexual and do not necessarily expose themselves as such. Men buying sex from other men rarely use condoms and many continue to have sex with their wives. Migrant workers are another important group identified as a priority in the Bangladesh National Strategic Plan for HIV and AIDS 2005-2010. Approximately 250,000 people leave Bangladesh for employment every year. The risk is that they will get infected during their stay in broad and return to Bangladesh where they may transmit the virus to others especially their wives who could in turn infect their babies.

However, The UNAIDS says two-thirds of the estimated people living with HIV in Bangladesh are unaware of their HIV status due to a lack of adequate testing as well as treatment facilities and social stigma. Bangladesh is one of the four countries in South and South-East Asia where HIV prevalence is less than 0.1% of the total population. But the number of new infected people is increasing day by day. This has clearly demonstrated that not all the actions taken in private and public sectors to prevent AIDS have been effective and fruitful.

Although the prevalence of HIV and AIDS is low in the country, Bangladesh is still at high risk of the deadly disease spreading due to its demographic transition and easy access to drugs, say experts. The recent population demography shows the high number of youths and they have an easy access to drugs, which eventually put them at risk of spreading AIDS. Experts says, if government and non-government organizations stop working on prevention of HIV, its prevalence will rise to 7% within 25 years which is now only at 0.1% in Bangladesh.

Violence against female sex workers still remains a big threat in terms of AIDS. They are one of the key groups most vulnerable to HIV infection in Bangladesh and also in other countries of the world, along with people who inject drugs, men who have sex with men, male sex workers, and transgender. But sex workers are among those who are most vulnerable to HIV infection, as it spreads rapidly among them. In many cases, sex workers have no access to condoms or are not aware of their importance. They are simply powerless to negotiate safer sex. Clients may refuse to pay for sex if they have to use a condom, and use intimidation or violence to force unprotected sex, and in many cases, they are raped. But because of the social stigma and marginalization, they can't even bring charges against their attackers. Criminalization of sex work contributes to an environment in which violence against sex workers is tolerated, leaving them less likely to be protected from it. Many sex workers consider violence "normal" or "part of the job", and do not have information about their rights. As a result, these contribute to their vulnerability to HIV.

UNAIDS says that in Bangladesh, the estimated new infections had increased by 25% from 2001 to 2012, though the reported new cases has risen by about 1.5 times over the past five years. Expert said the number would go up if key population segments like sex workers, gays, intravenous drug users, and transgender were more thoroughly checked. The UNAIDS suggested using new technologies and mixed models of community-based testing to supplement the current ways of testing - using whole blood, finger prick testing that anyone can do at home and using the easy saliva testing method. It also urged to use the existing reproductive, maternal, child health centers, and TB treatment units for extending HIV services.

Encouraging people to undergo tests every time they go to health facilities and bolstering work among key population can be ways to change the situation in Bangladesh. The HIV testing rate in Bangladesh among the people is the lowest in the Asia-Pacific region. UNAIDS also suggests adopting strategies focusing on prevention, treatment and care for adolescents and young people infected and affected by HIV. It also calls for prioritization of geographical regions where most of the people with HIV and key population live, safe migration, end to sexual, and gender violence. It also stresses that people with HIV get "continuum of prevention, treatment care and support" so that they are treated for their other diseases apart from getting antiretroviral drugs. This has kept the prevalence low in the general population to less than 0.1%, though it is higher among the key population.

The cornerstone of HIV prevention is safer sex. Young people need practical help in the form of appropriate life skills and youth-friendly health services where they can seek advice, have their queries answered and obtain condoms and treatment for STIs. Young people need and have the right to access comprehensive information about STIs, HIV and AIDS prevention and positive living. They should also be provided with proper sex education.

The writer is Deputy Manager at Palli Karma-Sahayak Foundation (PKSF)

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