HIV/AIDS in Bangladesh

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

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.

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.

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 23.3 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).

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. [http://www.usaid.gov/our_work/global_health/aids/Countries/ane/bangladesh_profile.pdf "Health Profile: Bangladesh"] . United States Agency for International Development (March 2008). Accessed August 25, 2008. PD-notice]

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). 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 organizations. The National HIV and AIDS Communication Strategy (2006–2010) was also developed and launched.

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 21,000 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).

Government and public figures in Bangladesh, including retired Major General Dr. ASM Matiur Rahman, former adviser of the Ministries of Health and Family Welfare, Water Resources, and Religious Affairs, are vocal supporters of HIV/AIDS education. Outside of the government, more than 380 non-governmental organizations (NGOs) and AIDS service organizations work in Bangladesh implementing programs designed to reach most-at-risk populations and stem the spread of HIV/AIDS. Local imams and other religious leaders, the Islamic Foundation of Bangladesh, and community leaders help distribute accurate information on HIV/AIDS.

Since Bangladesh is still considered a low-prevalence country, no special focus has been placed on the general population – and women in particular. The major challenge in the country is the lack of urgency in dealing with HIV-related issues. HIV is not seen as posing an immediate threat, and as a result, there is continued focus mainly on high-risk groups. However, the response is beginning to acknowledge young people through life skills education and safer sex promotion, according to UNAIDS.Bangladesh also received a $40 million, five-year grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2007 to prevent and control HIV/AIDS among the high-risk population and vulnerable young people in the country.

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