BANGLADESH: HIV prevalence rising fast
The global news suggests that the world's experts got the global picture wrong and that there are fewer AIDS cases, with the conclusion from UNAIDS that the epidemic has plateaud. Yet here we see stories like this one, from today's headlines, about the reality on the ground in hard hit communities. What the global experts still fail to do is show the edge of the fire, and where the flames are burning highest, places like the mining towns of Carletonville, South Africa, where local researchers say over 80% of young girls who are engaging in sex work to survive poverty now have HIV. Consider that when you read the headlines in weeks to come and hear pundits argue that AIDS is maybe not as catastropic as we thought. We still don't see the epidemic clearly, but it's clear to those like the labourers in Bangladesh, below. The issue that's also clear is poverty and the economics of AIDS and gender inequity that drive the epidemic. -AC
BANGLADESH: HIV prevalence rising fast
Photo: Shamsuddin Ahmed/IRIN
"The highest rate of HIV infection is amongst the country's intravenous drug users".
DHAKA, 13 November 2007 (PlusNews) - Borhanuddin Mia, a casual labourer in the Bangladeshi capital, Dhaka, earns just US$2 a day, but in the evening always manages to meet his fellow users at a small park opposite Dhaka medical college. “We buy one vial of pethidine for five users and inject it,” the 24-year-old said.
In another part of town, Shahara Banu is a commercial sex worker (CSW). “I live on the sidewalks. I attend to customers in the dark spots of public parks. On a lucky night I am taken to a hotel by some rich customer, but such nights are rare,” said the 16-year-old girl.
In impoverished Bangladesh, there are literally tens of thousands of people like Mia and Banu, who are increasingly at risk of contracting HIV.
In December 2006, the government of Bangladesh reported that 874 people were living with HIV in the country, with a total of 240 AIDS cases. However, UNAIDS reported in June 2007 there were some 11,000 people living with HIV out of a total population of 150 million.
Significant underreporting occurs because of the country's limited voluntary testing and counselling capacity – compounded by the social stigma attached to the disease.
While overall prevalence rates remain low, high risk groups such as CSWs, injecting drug users (IDUs) and men who have sex with men (MSM) record much higher rates, health experts say.
“The major challenge faced by Bangladesh at present is to keep the prevalence of HIV low,” Arunthia Zaidi, who coordinates the counselling and testing unit of the International Centre for Diarrhoeal Diseases and Research Centre, Bangladesh (ICDDR,B) in the capital, Dhaka, said.
Low prevalence, high risks
The latest round of the serological surveillance (sixth round) conducted between October 2004 through May 2005 recorded 4.9 percent of IDUs to be HIV-positive in Dhaka. In neighbouring India which has the world’s second highest number of HIV positive people - 2.5 million - the prevalence rate amongst IDUs nationwide is 10.2 percent, according to the Indian government’s 2005 surveillance report.
HIV was detected in Dhaka drug users as far back as 1989. However, in the latest round of surveillance, HIV was detected in IDUs in Chittagong, the commercial capital, and Bogra, the communication hub of the northern region.
And though HIV prevalence among female IDUs is reportedly zero, syphillis rates among them were high - 9.2 percent - which is comparable to the rates among female CSWs, suggesting that female injection drug users engage in unsafe sex, according to government’s sixth round technical report published in September 2005.
In male IDUs, active syphillis rates of 9 percent were recorded from Dhaka, while in all other cities the rates range between 0.0-3.9 percent, it added.
HIV prevalence remains low – below 1 percent - in most other vulnerable groups such as female sex workers in brothels, hotels, streets, and part-time sex workers, male sex workers, MSM, heroin users and some groups of internal migrants considered as possible bridges to the general population, including rickshaw pullers, dock workers and truckers.
In a pocket of IDUs in Dhaka, HIV prevalence rates jumped from 1.4 percent in 2003 to 8.9 percent in 2006. This level of infection among IDUs poses a significant risk as infection can spread rapidly within the group, then through their sexual partners and their clients into the general population.
Photo: David Swanson/IRIN
On the busy streets of Dhaka, rickshaw drivers often act as "go betweens" for commercial sex workers and their clients
Another concern is the significant number of IDUs in the country who sell their blood professionally. Bangladesh relies on professional blood-sellers to meet most of the transfusion needs of its people.
To ensure safe blood transfusion the government of Bangladesh has established seven HIV screening facilities across the country.
“The highest national HIV infection levels in Asia continue to be found in Southeast Asia where a combination of unprotected paid sex and sex between men, along with unsafe injection drug use are sustaining the epidemic,” said the 2006 UNAIDS global report.
In Bangladesh brothel-based female sex workers reportedly see 18 clients per week, while street-based and hotel-based workers see an average of 17 and 44 clients per week respectively. The majority of brothel-based sex workers report condom use with 2.8 per cent of their regular clients, and 5.2 per cent with new clients.
Among the clients, who include rickshaw pullers and truckers, only 1.5 to 4.6 percent report consistent condom usage when buying sex from CSWs, according to the ICDDR,B.
“Despite high-risk practices, the HIV prevalence is still quite low. But that is no reason for complacency. The high risk behaviour of commercial sex users remains a constant threat for a wide scale outbreak of HIV, especially if we consider the fact that our neighbour India has the highest number of people living with HIV/AIDS,” said Dr. Mohammad Hanif Uddin, programme manager for the National AIDS and STD Programme.
Uddin identified several challenges for Bangladesh including the need to support policy through legal frameworks, as well as difficulties in coordinating and scaling-up without stronger empirical data.
“Safer practices for blood safety and standard precautions for infection prevention in both the private and public health care sectors are additional challenges for Bangladesh,” he observed.
Dr Tasnim Azim, a scientist and head of ICDDR,B’s HIV/AIDS programme emphasised the need to attract greater attention from political leaders, scaling-up activities where barriers exist, addressing social and legal norms, and addressing institutional factors such as blood safety and universal precautions to combat the pandemic.
“Continuing to do ‘business as usual’ could mean devastating financial costs for treatment in the future,” Azim warned.