The New Nation - Internet Edition

Syful Islam

Low prevalent Bangladesh gradually turning into high prevalent country in HIV/AIDS, like the neighbouring one, as sharing of needle among the Injecting Drug Users (IDUs) increasing alarmingly.

"Deadly HIV and AIDS spread in India, Indonesia and some other highly infected countries through needle sharing of IDUs… in Bangladesh the rate of HIV prevalence of IDUs reached to over 7 per cent which is very much alarming… we are in doubt how long Bangladesh would be able to remain as low prevalent country," said Dr. Yasmin Jahan, a consultant of the National AIDS/STD Programme (NASP).

"Spreading of HIV at the rate of 5 per cent among the high-risk groups is being considered as concentrated epidemic. In 2000 the rate of HIV infection among IDUs was 1.4 per cent, in 2004 it raised to 4.9 per cent and in 2006 it reached to7.1 per cent. The trend illustrates a risky growth which needs strong intervention," she added.

Dr Md Hanifuddin, Deputy Programme Manager of NASP, believes that the number of infected people might rise in the next HIV Serological Surveillance (HSS) as many risk factors like high prevalence of HIV in the neighbouring countries, increased population movement both internal and external, lack of awareness of HIV infection, existence of commercial sex and MSM with multiple clients, high prevalence of Sexually Transmitted Infections (STIs) amongst the commercial sex workers, spread of HIV through bridging population, needle sharing of IDUs and low condom use are in existence how in the country.

According to the government data, a cumulative total of 874 cases of HIV/AIDS has been confirmed and reported as of 31st December 2006. A total of 240 AIDS cases were had detected so far of which 109 have already died. Government agencies estimate that nearly 7,500 people are infected by HIV/AIDS. However, donor agencies including the UNAIDS estimates that nearly 11,000 people are living with HIV/AIDS in Bangladesh.

A government survey found that out of 216 new HIV positive cases identified in 2006, unemployed people were on top of the list at 39.35 per cent followed by housewives at 21.29 per cent and businessmen at 10.18 per cent. The data shows that unemployment is also causing spread of HIV/AIDS.

Lack of proper knowledge on HIV/AIDS is helping the deadly virus spread at an alarming rate. According to data on knowledge and behaviour, only 17 per cent of the most-at-risk populations have correct knowledge about prevention and most people misconceptions on HIV/AIDS. A population based survey among adolescents and young people (15-24 years) in 2005 indicated that only one out of three males in urban and one out of four in rural areas had correct knowledge of HIV and AIDS. Nearly 59 per cent of married women and 42 per cent of men of age 15-54 group have no idea as how to avoid HIV.

Donor agencies, which are assisting government efforts to prevent spread of deadly virus, have identified lack of urgency in dealing with HIV-related issues as the major challenge for Bangladesh.

"HIV is not seen as posing an immediate threat and as a result the idea of going to scale has not caught on. The continued focus on high-risk groups has created a false sense of security and complacency in the general population including policy makers. Also among the high-risk groups there is a continual challenge to protect their rights and ensure a comprehensive package," UNAIDS said in its website.

However, the government is working hard to prevent spread of HIV with the assistance of different donor agencies. One of the major achievements of the government is securing of US$ 40 million from the sixth round of the Global Fund to deal with problems of youths.

Health Ministry sources said the government in late 1996 outlined a National Policy on HIV/AIDS. A high-level National AIDS Committee (NAC) was formed, with a Technical Advisory Committee, and a NASP unit in the ministry. Action has been taken to develop a multi-sector response to HIV/AIDS. Strategic action plans for the NASP set forth fundamental principles, with specific guidelines on a range of HIV issues including testing, care, blood safety and prevention among youth, women, migrant workers, commercial sex workers, and STIs.

The government also prepared the National Strategic Plan for HIV/AIDS for the period of 2004-2010 under the guidance of NAC and with the involvement and support of different stakeholders. Efforts to mainstream HIV/AIDS in public sectors outside the Ministry of Health and Family Welfare were initiated through designation and training of focal points on HIV/AIDS in 16 government ministries.

One of the major projects under NASP is the HIV/AIDS Prevention Project (HAPP) which is financed by IDA Credit US$ 19.22 million, DFID Grant US$ 6.38 million and GoB US$ 0.63 million. The project was scheduled to be ended on June 2006 but fund providers agreed to an extension of HAPP for another 18 months up to December 2007. More than 100 NGOs are working for the implementation of HAPP activities.

The Infection Disease Hospital at Mohakhali is giving treatment to the HIV/AIDS patients and they have access to the BSMMU and the Armed Forces Pathology where they get service at discounted rate. Government established Voluntary Counselling Testing Centres in each and every district and upzila levels.

More than 380 NGOs, AIDS Service Organisations and Civil Society Organisations have been implementing programs/projects in different parts of the country. These initiatives focused on prevention of sexually transmission of virus among high-risk groups. There are some self-help groups working with the HIV positive patients which are providing counselling and financial helps to them.

The British Department for International Development (DfID), USAID, Sida and GTZ are financing a number of HIV/AIDS control activities in Bangladesh. These include a social marketing program; peer education and condom promotion activities; information, education, and communication efforts; STI treatment; surveillance and operational research; and capacity building for NGOs.

However, experts believe that spread of HIV/AIDS is adversely negating on national development of the country. They said the country could have used these funds in other development works other than spending on preventing HIV/AIDS if the virus was not spread.

Dr Md Hanifuddin said the HIV positives as well as the AIDS patients are burden for the society. The government has to pay extra effort to care them and prevent spread of the disease. He said, "HIV may rise at an epidemic stage within next 3 to 4 years which may go beyond the control." However, he hoped that establishment of the VCT centres around the country might help prevent transmission of HIV to children from parents as more people are coming for testing.

Sex workers think that their entrance in this 'profession' itself is the result of continuous violation of human rights in the country. They are being harassed and tortured by law enforcing agencies as well as by people due to lack of transparency in the country's law about their profession. According to them, government detains sex workers and compels them to stay in the shelter homes, which is a gross violation of rights, as they do not want to stay there. On the other hand, the shelter homes are producing more sex workers in the country as the staffs of the homes violates the teenager detainees who have been brought from roadside during selling flowers, chocolates and water bottles.

"Shelter homes are not for us, we want to stay at our places and continue our profession," said Shahnaj Begum, president of the Durjoy Nari Sangha, an organisation working with roadside and hotel based sex workers. "Law enforcing agencies even arrest our activists if they find any condoms in their bags, who are working to raise awareness about HIV/AIDS and using the safety measures among the high risk groups."

She said sex workers are being tortured by the staffs in the shelter homes besides being sexually abused.

Sex workers and other inmates in the shelter homes sometimes become very violent and want to go out as they are being treated by stick very often, said Afreen Khan, an NGO worker after visiting several shelter homes run by the government.

Raju Rozario, executive director of the Mukto Akash, an organisation working with the HIV positive patients, said recently an English language daily published the name and particulars of a sex worker who have been found infected with HIV positive virus. "The sex worker has a 10 years old daughter who might face difficulties in the future as the case is being documented and our society is still much conservative."

Experts said Hijra community have a high-risk exposure to HIV and other STIs and they are most financially vulnerable group as they have very little access to the income generation and suffer from social exclusion traditionally.

Lazeena Muna of UNAIDS at a workshop titled 'Hidden Sexualities: Hijras and HIV' said, "We had to immediately work to establish human rights for Hijras."

Executive director of the Bandhu Social Welfare Society Shale Ahmed said, "Government strategies and policies for the Hijra community is good enough but implementation rate is very weak."

Boys' bane, girls' boon: Birth of a female child in the brothels of the country is highly appreciated, while the male child becomes a burden to the sex workers.

"A female child begins earning from the very first week of her adolescence but the male child has nothing to do except to be a burden on his mother," said Romela Akter, a sex worker of Doulatdia Brothel under Rajbari district.

"As the male child even cannot go to work with general people, he becomes muscleman or a drug peddler inside the brothel or find petty job which makes his life financially voulnarable," she added.

The sex workers become pregnant by unknown men with a dream to give birth to a female child, which will be their source of earning both in the early and old age. But when they give birth to a male child they become angry and, according to sources, they muffle most of the male child to death in the labour room. At present the rate of male and female children inside the brothel is 1:3.

Brothel inmates celebrate the birth of a female child through different functions including distribution of sweet among the neighbours, special prayers and donating money to mazars inside the brothels.

While visiting the Doulatdia Brothel this correspondent found very few male children inside the sex centre. Insiders said sex workers put their kids under the cot while they attend clients. But the male children, who have attained seven to eight years of age, have to stay outside the brothel and sleep at bus stands or railway stations.

They sometimes get money from their mothers but sometimes they have to stay hungry for one or more days. Sex workers never care for their male children as they shower all their cares on the female children, their sustainers in old age.

Ratan, 17, a male child of a sex worker in the brothel said that he has no alternative but to become a muscleman or a drug peddler as there was no other source of income in the brothel.

"None will give us a chance of getting education or job, we are neglected by our mothers, too," he said expressing his annoyance at his fate.

Narrating the miserable life of male children in the brothel, Shamim, another ill-fated boy of a sex worker, asked, "What is my offence, why I have to lead such inhuman life?"

A safe home for female children of sex workers is located near the Doulatdia brothel that can rehabilitate very few children. But there is no such safe home or initiative for the male children where they can get education, training and job. There is no such initiative that can bring change to the miserable life of male children of the brothels.