HIV/AIDS in Bangladesh

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With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

Contents

Prevalence

The country faces a concentrated epidemic, and its very low HIV-prevalence rate is partly due to prevention efforts, focusing on men who have sex with men, female sex workers, and intravenous drug users. Four years before the disease's 1989 appearance in the country, the government implemented numerous prevention efforts targeting the above high-risk populations as well as migrant workers. Although these activities have helped keep the incidence of HIV down, the number of HIV-positive individuals has increased steadily since 1994 to approximately 7,500 people in 2005 according to the International Center for Diarrhoeal Disease Research, Bangladesh. UNAIDS estimates the number to be slightly higher at 11,000 people. [1]

While HIV prevalence is very low in the general population, among most at risk populations it rises to 0.7%. In some cases it is as high as 3.7%, for instance among casual sex workers in Hili, a small border town in northwest Bangladesh. [2] Many of the estimated 11,000 people living with HIV are migrant workers. The 2006 National AIDS/STD programme estimated that 67% of identified HIV positive cases in the country were returnee migrant workers and their spouses. [2] This is similar to findings from other organisations. According to the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), 47 of 259 cases of people living with HIV during the period 2002–2004 were identified during the migration process. [2] Other data from 2004 (from the National AIDS/Sexually Transmitted Disease (STD) programme of the Ministry of Health and Family Welfare (MoHFW)) shows that 57 of 102 newly reported HIV cases were among returning migrants. [2]

While HIV prevalence among male homosexuals and sex workers has remained below 1 percent, unsafe practices among drug users, particularly needle sharing, have caused a sharp increase in the number of people infected. Measurements at one central surveillance point showed that between 2001 and 2005, incidence of HIV in IDUs more than doubled – from 1.4 percent to 4.9 percent, according to UNAIDS. In 2004, 9 percent of IDUs at one location in Dhaka were HIV-positive. Compounding the risk of an epidemic, a large proportion of IDUs (up to 20 percent in some regions) reported buying sex, fewer than 10 percent of whom said they consistently used a condom. [1]

Preventive programs

HIV/AIDS prevention programs have successfully reached 71.6 percent of commercial sex workers (CSWs) in Bangladesh, according to the 2005 United Nations General Assembly Special Session (UNGASS) Country Report. However, only 39.8 percent of sex workers reported using a condom with their most recent client, and just 23.4 percent both correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission. Other factors contributing to Bangladesh's HIV/AIDS vulnerability include cross-border interaction with high-prevalence regions in Burma and northeast India, low condom use among the general population, and a general lack of knowledge about HIV/AIDS and other sexually transmitted infections (STIs). [1] For instance, a study in 2008 found poor HIV knowledge among female migrant workers who were flying for an overseas job. [3] Research performed by Islam & Conigrave (2007) found that there were substantial gaps between current needs and the ongoing prevention efforts. [4] [5] The authors stressed the importance of developing a pre-departure and post-departure program for international migrants; increased co-ordination among intervening agencies and equitable coverage of prevention programs.

Tuberculosis

Bangladesh also has a high tuberculosis (TB) burden, with 102 new cases per 100,000 people in 2005, according to the World Health Organization. HIV infects about 0.1 percent of adult TB patients in Bangladesh and HIV-TB co-infections complicate treatment and care for both diseases. [1]

National response

Bangladesh's HIV/AIDS prevention program started in 1985, when the Minister of Health and Family Welfare established the National AIDS and Sexually Transmitted Diseases Program under the overall policy support of the National AIDS Council (NAC), headed by the President and chaired by the Minister of Health and Family Welfare. The National AIDS/STD Program has set in place guidelines on key issues including testing, care, blood safety, sexually transmitted infections, and prevention among youth, women, migrant populations, and sex workers. In 2004, a six-year National Strategic Plan (2004–2010) was approved. The country's HIV policies and strategies are based on other successful family planning programs in Bangladesh and include participation from schools, as well as religious and community organisations. The AIDS Initiative Organization was launched in 2007 to fund for those without proper medication to combat the virus. The National HIV and AIDS Communication Strategy (2006–2010) was also developed and launched. [1]

Since 2000, the Government of Bangladesh has worked with the World Bank on the HIV/AIDS Prevention Project, a $26 million program designed to prevent HIV from spreading within most-at-risk populations and into the general population. The program is being integrated into the country's Health, Nutrition and Population Program, which is supported by the government and external donors. In 2003, a national youth policy was established on reproductive health, including HIV/AIDS awareness. Since 2006, students in 21,500 secondary and upper-secondary schools have been taught about HIV/AIDS issues. The educational program introduces a "life skills" curriculum, including a chapter on HIV/AIDS drafted with assistance from the United Nations Children's Fund (UNICEF). [1]

Bangladesh developed its first Antiretroviral Therapy (ART) treatment guidelines in 2006, with PLHIV able to buy subsidised antiretroviral drugs from specified pharmacies. [2] Unfortunately, most HIV diagnostic facilities are provided by NGOs based in Dhaka and most rural and cross-border migrants miss out on ART, HIV testing and other associated care and support services. If they seek private care, the cost is often beyond their means. [2]

Currently, the program funded by the Global Fund is leading the national response to fight HIV and AIDS. Bangladesh had received 3 grants on HIV/AIDS from The Global Fund to fight AIDS, Tuberculosis and Malaria: Round 2 from 2004 to 2009, Round 6 from 2007 to 2012 and Rolling Continuation Channel (RCC) from 2009 to 2015. The Round 2 grant focused mainly on prevention of HIV among young people with strategies including:

  1. HIV/AIDS prevention messages dissemination through information campaign in mass and print media
  2. HIV/AIDS orientation, training and services via Life skills education, Youth Friendly Health services and accessing condom
  3. Integration of HIV/AIDS in school and college curriculum
  4. Advocacy and sensitisation of religious leaders, parents and policy makers
  5. Generating information for policies and programs.

The main focus of the Round 6 grant was on most at risk populations and scaling up of the Round 2 project including interventions with vulnerable youth. The interventions for High Risk population and vulnerable young people includes essential services for injecting drug users and female sex workers; treatment, care and support for PLHIV; and awareness and prevention strategy for vulnerable young people including garment industry workers. National level capacity building, strengthening district co-ordination, support to networks and self-help groups are also among the strategies.

Round 2 and Round 6 have been implemented through Public–Private Partnership where the Economic Relations Division of the Government of Bangladesh worked as Principal Recipient and Save the Children USA managed the grants as Management Agency in collaboration with Ministry of Health and Family Welfare. Based on the satisfactory level of completion of the Round 2 project, Global Fund awarded Bangladesh with the 6 year fund termed as "Rolling Continuation Channel (RCC)" from 2009 to 2015, which is consolidated with the Round 6 grant. For high level of performance the Project is appreciated as a "best practice" example in Asia and is rated as "A" by the Global Fund. The program is being implemented through 13 technical packages by 13 consortiums comprising 61 organisations nationwide. Save the Children, as a Principle Recipient of the grant is facilitating implementation through technical and compliance related support to all the consortia. Other Principal Recipients are National AIDS/STD Program and ICDDR B. The main objectives of RCC Program are:

  1. Increase the scale of prevention services for key populations at higher risk: Injecting Drug Users (IDUs), Sex Workers (FSWs), hijras (transgender people) & Men who have Sex with Men (MSM)
  2. Increase the scale of the most effective HIV/AIDS activities conducted through Round 2
  3. Build capacity of partners to increase scale of national response to the HIV/AIDS epidemic

Some significant achievements of the HIV/AIDS program funded by the Global Fund are:

  1. Overall HIV Prevalence remains <1%
  2. HIV/AIDS information is included in text books of secondary and higher secondary level education, from grades VI to XII, in both Bangla and English
  3. HIV/AIDS prevention, care & support related information now mainstreamed within the training curriculum of five different Ministries
  4. National standards for Youth Friendly Health Services (YFHS) have been established, now practised in public, NGO & private health service facilities countrywide
  5. Standard Operating Procedures (SOP) for services to PLHIV have been endorsed by the government
  6. Public–private partnership has been proved to be an effective model for fighting AIDS
  7. Over 300 people living with HIV and AIDS (PLHIV) are receiving anti-retroviral treatment (ARV) per year
  8. Workplace policy on Life Skills-based Education (LSE) on HIV/AIDS endorsed by Bangladesh Garments Manufacturers' association (BGMEA)
  9. Under the Ministry of Religious Affairs, 4 booklets on HIV/AIDS have been published for the 4 major practising religions in the country

Related Research Articles

HIV is recognized as a health concern in Pakistan with the number of cases growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the HIV epidemic to take hold in Pakistan, mainly among injecting drug users (IDU), male, female and transvestite sex workers as well as the repatriated migrant workers. HIV infection can lead to AIDS that may become a major health issue.

Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country is Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.

<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

HIV/AIDS infection in the Philippines might be low but growing fast. The Philippines has one of the lowest rates of infection, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic. According to a population-based survey conducted in Peru’s 24 largest cities in 2002, adult HIV prevalence was estimated to be less than 1 percent. The survey demonstrated that cases are unevenly distributed in the country, affecting mostly young people between the ages of 25 and 34. As of July 2010, the cumulative reported number of persons infected with HIV was 41,638, and there were 26,566 cases of AIDS, according to the Ministry of Health (MOH), and the male/female ratio for AIDS diagnoses in 2009 was 3.02 to 1. The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates 76,000 Peruvians are HIV-positive, meaning that many people at risk do not know their status. There were 3,300 deaths due to AIDS in Peru in 2007, down from 5,600 deaths in 2005.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total, with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive, El Salvador and therefore there is a low-HIV-prevalence country, but the virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).

According to the Global Fund, Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. As of 1998, Honduras had the highest prevalence of HIV out of all seven Central American countries according to a study published by the office of the Honduran Secretary of Public Health. As of that same year, Hondurans made up only 17% of the Central American population, yet Honduras contained 50% of the initial AIDS cases in Central America and 60% of all Central American cases in 2001. In more recent years, new HIV infections have decreased by 29% since 2010 while AIDS-related deaths have increased by 11% since then. HIV/AIDS heavily affects the young, active, working population in Honduras, and HIV/AIDS deaths account for 10% of the overall national mortality rate. As of 2008, AIDS was the leading cause of death among Honduran women of childbearing age and the second-leading cause of hospitalization among both men and women. Sexually transmitted infections are common, and condom use in risky sexual encounters is sporadic and variable. HIV remains a mainly heterosexual epidemic in Honduras, as 90% of emerging infections are attributed to heterosexual transmission. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission.. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

With only 0.2 percent of the adult population estimated to be HIV-positive, Nicaragua has one of the lowest HIV prevalence rates in Central America. HIV was first detected in Nicaragua in 1987, after concentrated epidemics had been reported in other Central American nations. The onset of the epidemic was likely delayed by Nicaragua’s 10-year civil war and the U.S.-led economic blockade, both of which left the country isolated for several years. Relative control over commercial sex work, low infection rates among injecting drug users, and a ban on the commercial sale of blood also slowed HIV transmission. However, the country is at risk of a broader epidemic because of social conditions such as multiple sex partners, gender inequality, and widespread poverty. Many people are unaware of their HIV status and could unwittingly spread the disease. UNAIDS estimates Nicaragua has 7,300 HIV-positive people, nearly half of whom were identified over the past three years.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year. But, in 2012 and 2013 it increased to about 600 new cases and in 2014 it reached 880 new cases per year. According to UNAIDS 2016 statistics, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

Vietnam faces a concentrated HIV epidemic.

Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.

<span class="mw-page-title-main">Youth of JAZAS</span> Serbian non-profit organization

Yugoslav Youth Association Against AIDS – Youth of JAZAS is non-profit, humanitarian organization committed to HIV prevention and support to the people living with HIV. Ever since its establishment in 1994, it has continuously been implementing projects of peer education, social and psychological support, protection of human rights, promoting voluntary activism, distribution of condoms etc.

<span class="mw-page-title-main">India HIV/AIDS Alliance</span> Indian non-governmental organisation

Founded in 1999, Alliance India is a non-governmental organisation operating in partnership with civil society, government and communities to support sustained responses to HIV in India that protect rights and improve health. Complementing the Indian national programme, we build capacity, provide technical support and advocate to strengthen the delivery of effective, innovative, community-based HIV programmes to vulnerable populations: sex workers, men who have sex with men (MSM), transgender people, hijras, people who inject drugs (PWID), and people living with HIV.

Morocco has been identified as one of the best countries within the MENA region in dealing with the HIV epidemic based on their research capacities, surveillance systems, and evidence-informed and comprehensive responses. While the general public has a fairly low HIV prevalence, the majority of HIV/AIDS cases can be found in 3 high risk groups, which is important when deciding how to approach intervention and prevention.

References

  1. 1 2 3 4 5 6 "Health Profile: Bangladesh" Archived 17 August 2008 at the Wayback Machine . United States Agency for International Development (March 2008). Accessed 25 August 2008. PD-icon.svg This article incorporates text from this source, which is in the public domain .
  2. 1 2 3 4 5 6 Fiona Samuels and Sanju Wagle 2011. Population mobility and HIV and AIDS: review of laws, policies and treaties between Bangladesh, Nepal and India Archived 20 September 2012 at the Wayback Machine . London: Overseas Development Institute
  3. ↑ Islam, M. M., Conigrave, K. M., Miah, M. S., Kalam, K. A. (2010). "HIV awareness of outgoing female migrant workers of Bangladesh: a pilot study". Journal of Immigrant and Minority Health . 12 (6): 940–946. doi:10.1007/s10903-010-9329-5. PMID   20155324. S2CID   22767370.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ↑ Islam, M. M., Conigrave, K. M. (2007). "Increasing prevalence of HIV, and persistent high-risk behaviours among drug users in Bangladesh: need for a comprehensive harm reduction programme". Drug and Alcohol Review. 26 (4): 445–454. doi:10.1080/09595230701373925. PMID   17564883. S2CID   11534216.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ↑ Islam, M. M., Conigrave, K. M. (2008). "HIV and sexual risk behaviors among recognized high-risk groups in Bangladesh: need for a comprehensive prevention program". International Journal of Infectious Diseases. 12 (4): 363–370. doi: 10.1016/j.ijid.2007.12.002 . PMID   18325810.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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