AIDS: Facing facts best solution

Bangladesh may face a serious AIDS epidemic in the not-too-distant future. According to a UN agency report there are about 13,000 HIV infected people. Since the first reported case in 1997 so far until now only about 20 full-blown AIDS cases have been reported. However, it is believed that the actual number is much higher. Voluntary testing and counselling, the norm in developed countries, is severely limited leading to underreporting. Also at play is the stigma and fear of being identified and detected as HIV positive. The HIV prevalence rate among adults between the ages of 15-49 is still relatively low, at 0.03 percent. As expected, rates are higher in specific groups, such as injecting drug users who have left treatment (1.7 percent) and commercial sex workers (0.5 percent). (National behavioural and serological surveillance 2001).

Though up to now overall prevalence of HIV or AIDS is rather low, behaviour patterns and extensive risk factors that facilitate the rapid spread of the infection are widespread, making Bangladesh highly vulnerable to an HIV/AIDS epidemic. Bangladesh has a large commercial sex industry with around 36,000 sex workers, each seeing an average of 18.8 clients per week for brothel-based sex workers, and 44 clients per week for hotel-based workers. Data is difficult to find about the countless streetwalkers. Unfortunately, use of condom while performing casual sex act is not really common in Bangladesh. The majority of brothel-based sex workers report of sex without protective measures with their clients. Jarina, a sex worker at the Daulatdia brothel, about 110 kilometres from the capital said, "If I refuse to entertain a customer who is not willing to use condom he will simply go to another girl. I just can’t be strict about the matter even though I know it can be dangerous."

Among the clients, such as rickshaw pullers and truckers, about 83 per cent have never used condoms when buying sex. Also, the prevalence of different sexually transmitted diseases among the sex workers is alarming. A survey carried out by local NGO reveals that about 43 per cent of sex workers have syphilis. STDs are a major factor in the spread of HIV infection and serve as indicators for low condom use and other high risk sexual behaviours. Drug abuse is rampant in certain sections of the population. Among those who abuse injectible drugs, needle sharing is the rule. Many of the drug addicts are married and may be commercial blood donors. All these are factors that may contribute to an AIDS epidemic. What makes the situation worse is that Bangladesh is one of the few countries with no National Health policy. A policy was introduced during HM Ershad’s regime but was scrapped once he was ousted from power. People here in general have very little basic idea about AIDS. Most obviously have heard about it but their idea of AIDS is rather vague. Let’s start with the basics. HIV is the virus that damages the body’s ability to fight off infection. As the body’s defences weaken, a person faces the risk of various infections. HIV is transmitted from person to person by sexual contact, sharing needles when using drugs, during pregnancy, or by breastfeeding. On a more positive note while there is no cure, people do live a long healthy life with HIV.

For too long we have swept the issue under carpet. But, of course, refusing to acknowledge the existence of a problem will not make it go away. "Bangladesh is at a cross-roads," said Dr Nasir Uddin of the Voluntary Health Services Society in Bangladesh. "If the country and the people take action now, they have the opportunity to save thousands of lives and millions of dollars – otherwise Bangladesh faces an AIDS epidemic of appalling social and economic proportions." Experts believe HIV may kill more people in South and Southeast Asia than anywhere else in the world in the coming decades. Bangladesh’s neighbours, India and Burma, are already in the throes of a serious and rapidly worsening epidemic of HIV. In the past the government argued that the forces behind epidemics in other countries, such as sexual practices and drug injecting behaviour, are less pronounced in Bangladesh. But a quick reality check will make it clear that this argument does not hold water. The Bangladesh economy relies on more than 1.5 million migrant workers, including truck drivers, businessmen and labourers. These migrants, who spend much of the year away from their families, are known to be at increased risk of contracting HIV.

— from UNESCAP, Friday, November 1, 2002