Today the hype and propaganda about HIV and STD (sexual transmitted disease) related diseases being discussed to aware the people how to protect themselves from it and how to behave each other when sexual intercourse committed. Let us check, of that what amount of part is true or the approach of awareness on HIV/STD is substantially propaganda? According to Bangladesh Serological Surveillance Survey 2006, the overall prevalence of HIV in Bangladesh is less than 0.1%, however, high levels of HIV infection have been found among people who inject drug (PWID), almost 7% in one part of the capital city, Dhaka.
In Bangladesh, there are several types of people like PWID, sex workers and men having sex with men are considered most at-risk groups to HIV infection. The report of National AIDS and STD Program 2005 revealed that between 20,000 - 40,000 people in Bangladesh inject drugs, 57% borrow needles and only one in three used sterile equipment. This percentage is much higher in female injecting drug users (74%). In Bangladesh's capital city, Dhaka, the HIV rate among PWIDs is 6.4%.
However, another study and surveillance revealed that through sexual contact the chance of spread STI and HIV is high, among the female sex worker the STI rate is 10.7% and HIV prevalence is below 0.1% but all the factors are existed among them. Our study is not to addressing the comparative analysis on HIV prevalence rate in Bangladesh. Instead, we are going to make an assessment on to what extent are the factors associated with HIV prevention significant?
There are many factors like condom use, safe sexual behavior, avoiding used syringe, protected blood transmission that are associated with HIV/STI prevention. Though condom is considered to striven force to prevent HIV and STI related disease during sexual orientation. Not only Bangladesh government but also there is huge number of organizations working in our country to stop the spread of human killing disease like HIV. Every year million-million dollar has been spent on HIV or STD intervention across the country.
There are many more tones of condom have been imported as keep the people remain safe from the evil disease but the consequence of condom use is not more expectant yet. According to the daily star news on Made in Bangladesh: Contraceptive, the country has an annual demand of 300 crore condoms but there is no domestic company producing condoms to meet up this demand every year.
As a result every year the government spends nearly Tk 250 crore to import these items. Beside this, there are dozens of NGOs spending money every year for distributing condoms to the target group who are most at risk to HIV infection. Generally, NGOs are adopting their program or intervention for those who are most vulnerable to spread HIV or sexually transmitted disease, while the department of family planning of Bangladesh aims to control overwhelming population.
So there is specific difference between the NGOs and the government to approach the using contraceptive like condom or other protective measure. Meanwhile, the third National Strategic Plan for HIV-AIDS, 2010-2015 was adopted after extensive consultation and involvement of ministries, NGOs, the private sector and the affected community; with a strong focus on its first strategic objective: to provide support and services for priority groups (those with the highest HIV prevalence and risk).
Low condom use is sometimes attributed to unreliable supply and poor distribution to those who need condoms the most. It is reported that condom use among populations at high risk of acquiring HIV/STIs has increased, but despite increased acceptability, condom availability in many countries remains low. In Bangladesh, the condom availability is as much as easier that one does not go to health center as they received from health assistant duly.
Despite, the experience and attitude of condom use is remain low because of claiming that they (users) are imposed to wear it to protect them from evil dead caused by HIV or other sexually transmitted infections. Other factors; past mindset- starting something new is their greatest hurdle, myths and misperceptions, which generate dismissive or negative views of condoms and/or condom use, religious views or teachings or social inequities which prohibit discussing or negotiating safer sexual practices are still functioning behind their attitude to use contraceptive during physical communication.
What exactly did men not like about condoms; an unmarried man said that lubrication and smell of the condoms were irritating. Men reported that women also ejaculate when they feel sexual excitement. They thought that if "a woman's joni (vagina) fills with jouno ros (sexual secretions), then she is enjoying sex." The notion of women's enjoyment is described in many Bengali pornographic story books (choti) in slang such as guder pani jhora (sexual secretions of vagina) of sexually excited women.
Men, especially unmarried young men, voiced similar terms to describe their feelings to indicate a woman's excitation in sex, which they wanted to feel by an uncovered penis. Therefore, men's perceptions of sexual pleasure on these occasions were being constructed in the context of women's sexual enjoyment, as portrayed in pornographic magazines. Supporting findings of many cross-cultural studies (Flood, 2003; Ross, 1992; Chapman and Hodgson, 1988; Browne & Minichiello, 1994), we found men concerned about reduced sexual pleasure with condom. By never using a condom in previous life, some men claimed that both their body and mind were accustomed to sequencing of sexual acts without condom. Therefore, putting on a condom to these men appeared as a big challenge.
This kind of sequencing of sexual interactions is described as sexual "choreography" (Dowsett, 1996:41, Flood, 2003:358). Findings from other cross-cultural studies argue that men's perception of uncontrollable sex drive and the attempt to keep the uninterrupted "natural" sequence of sexual interactions are barriers to condom use (Flood, 2003; Wilton and Aggeton, 1991; Browne and Minichiello, 1994). When finally forced to wear condoms, men's inexperience made the first use of condom embarrassing causing female partners/wives to laugh. Erection failure destroyed sexual performance threatening masculine sexual potency.
However, condom use in personal life as not big challenge as it is very challenging to wear condom to brothel based clients who want to meet up their sexual demand sporadically. Especially in brothel, the female sex workers are most vulnerable due to their customer flow and high demand from the client side. Lack of continues HIV prevention services in the brothel clients are not very much sensitize about to use of condom for protecting HIV and STI. Other hand low negotiation skill of the sex workers some time they fail to convince to customer for condom use. So risk of HIV and STI transmission chance is high among the sex provider. They also suffer different types of general health problem due to restless customer flow. Another risk is maintaining Babu by most the sex worker. Babu don't use condom with her fixed partner though evidence said that Babu visit to others sex workers mostly. In the brothel setting there are concepts of Madam who buy a new girl as sex worker and involve in sex trade. For earning big amount they influence to sex without condom.
Recently we have conducted a study aimed at finding out the rate of condom utilization by the young sex worker and barriers they are facing in Tangail brothel under Kandapara area also revealed that same findings. A total of 96 respondents were participated into the study, of them 48.96% of the respondents were young sex worker. The study revealed that consistent use of condom was low at 15.62%. This finding is in tandem with the declaration in the Prevention convention resolution (2010) that inconsistent use of condoms is one of the key drivers which is propelling HIV/AIDS pandemic worldwide.
These findings suggest that sex workers in Tangail Brothel are at risk of contracting sexually transmitted infections, including HIV. Most of the comparable studies show slightly higher consistent condom utilization than revealed by the current study. It could be attributed to the fact that the sex trader population in Tangail Brothel is bounded by client's satisfaction and has limited scope of using condom due to their dependency. However, it is pleasing to note that the age group 15-25 years consistently used condoms more than any other age group because this is a very sexually active age group. In terms of consistent condom use the study shows that the percentages of respondents of different age group like 15-25, 26-35 and 36+; using condom consistently were 53.3, 33.3 and 13.3 respectively.
Our study also revealed that there are some barrier respondents faced during condom utilization: client's genital desensitization (client went away if forced to wear condom), losses more time to understand client to use condom, prohibited by landlady/madam to force the client wearing condom and sometimes they receive less money from client after intercourse by wearing condom. 92.7% of the respondents claimed that client went away if forced them to wear condom. Half of the respondents think that more time lost to understand the client to wear condom thus the sex trade per day decreased. However, all of the respondents reported that without condom use sexual intercourse might causes HIV/STI and still they think that use of condom with each client is one of the main preventive measures to check HIV/STI related diseases. Most of the respondents opined, there are some NGOs available in tangail brothel providing information on HIV/STI but there are lacks of government initiatives to provide them information and services on HIV or STI related diseases.
Still it is recognized that condom use is only the strong driver to control birth and keep human being remain safe from life killing disease HIV but the practice of using condom is very low that was revealed by the different study. Now it is a matter of question that how the human being will be safe and in which direction they will guide their next generation to maintain their sexual life? First of all, awareness on HIV/STI should be emphasized and the coverage of HIV/STI intervention should be increased. There should have awareness program initiated by both GoB and NGOs among men who are likely to be client like street worker, lorry driver, slum dwellers and worker living outside from their family as well as different types of mess inhabitants.
Thus, different types of poster and leaflet can be disseminated addressing the usages of condom using in different public places like hospital, railway station, launch station and bus station. However, religious institutions can play a vital role in this connection as it considered to all a reverential place forever. TV/Electronic media is another important tool to take the initiative to disseminate the HIV/STI related issues. Play or theme song regarding AIDS and of its consequences can be telecasted through electronic media. Secondly, women can be encouraged to wear it though most of the people think that it is only for men.
Specially, brothel based active younger sex workers should be encouraged wearing condom that they deal most of the clients than others. And of course, the land lady who bring sex worker for earning more money; most of the time she prohibit the sex worker wearing condom, should be enlighten in a close consultation that if you are all take the initiative imposing client to wear condom, there is no chance to lose money. In addition, HIV/STI related issues with preventive measure like role of using condom can be entitled in the text book at secondary level so that the awareness will be raised among students.
Finally, government initiative must be ensured specially among most at risk population group, pragmatic intervention like specialized health care center in the brothel based areas and in the locality in which people are more likely to be infected by HIV/STI should be established; because the section of people are always unwilling to receive treatment in a general way. As there is no alternative way to prevent HIV/STI instead of condom, so awareness of using condom during sexual orientation should be addressed with pragmatic way through proper channel. Abdullah Al- Mamun is Literacy Program Operations Officer, Room to Read Bangladesh. Dr. Umme Salma is Medical Officer, SNP Charitable Health Center, Mirzapur, Tangail
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