AIDS: Epidemic bell ringing

HIV has turned into a concentrated epidemic among injecting drug users (IDUs).

The battle against AIDS has taken in many directions over the last three decades. HIV infection continues to grow rapidly among high risk groups and there is concerning evidence of increasing new HIV infection rate despite prevalence rate said to remain low.
Bangladesh has been identified as one of the five countries in the Asia-Pacific region where HIV/AIDS infections are rising. It was revealed at the recent 8th International Congress on AIDS in Asia and the Pacific (ICAAP8) in Colombo 2007. This report gives us real cause for concern.
Experts are predicting that the AIDS pandemic could be set to explode in the country. They identified political instability, human trafficking into prostitution, stigmatisation of those infected, conservative social attitudes and most importantly intravenous drug use as the key obstacles in the fight against the spread of HIV and make our people more vulnerable to HIV infection.
"In our country, HIV has turned into a concentrated epidemic among injecting drug users (IDUs). Spreading of HIV at a rate of 5 per cent among the high-risk groups is 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 percent", said Dr Yasmin Jahan, a consultant of the National AIDS/STD Programme (NASP).
"Ironically the IDUs are the very people who supply blood for transfusions, thus fuelling the risk of spread to the generalised population. The trend illustrates a risky growth which needs strong intervention without undue prolongation," she added.
"All sorts of high risk behaviour such as sharing of needles and syringes, resorting to drug use through injection, multiple sex partners and having commercial sex are prevalent among IDUs and make them the most vulnerable to spread infection. Current intervention programmes for the IDUs provided by different organisations can rehabilitate only a few portion of the 4.6 million IDUs in the country. This programme should be boost up immediately", Dr Yasmin pointed out.
According to the government statistics, 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 detected so far of which 109 had already died. Government agencies estimate that nearly 7,500 people are infected by HIV/AIDS. However, World Bank figures that nearly 12,000 people are affected by HIV in Bangladesh, with around 700 deaths in the past year.
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.
"All the statistics regarding HIV are based on high risk population. Nobody knows the actual condition of HIV infection among general population, as we have no data. The continued focus on high-risk groups has created a false sense of security and complacency in the general population including policy makers.
Bangladesh has many suspected unreported cases because of social stigma in both rural and urban communities. Many people living with HIV/AIDS are unwilling to be tested and even though there are private and public laboratories carrying out HIV testing. Among the high-risk groups HIV testing is also challenging as they have their right to give consent and nothing should not be done against their will to protect their right.
The daunting epidemic burden and momentum, however may be masked by the large population leading to low reported prevalence, which has resulted in considerable complications among government and developmental stakeholders. This is a key challenge fighting HIV/AIDS", expressed Dr Mozammel Hoque, an HIV adviser of United Nations Office on Drugs and Crime (UNDOC).
"Another major concern in the region, in the context of HIV/AIDS, is the large scale of movement of people within and across national borders and trafficking of women and children. Bangladesh has been reported as one of the top countries having the highest incidences of trafficked women who are highly vulnerable to HIV/AIDS. This sector remains relatively under focused and there is no strong measure to curb trafficking.
Many countries require people to get mandatory testing for HIV infection before travelling but for those returning from countries with high HIV/AIDS prevalence have no arrangement for voluntary counseling which is badly required in present situation. There is evidence of high rates of HIV transmission to wives from their husbands after their return from abroad", he added.
Lack of proper knowledge and risky sexual behaviour on HIV/AIDS facilitates the deadly virus to spread at an alarming rate. According to the existing 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 survey among adolescents and young people (15-24 years) in 2005 revealed that only one out of three males in urban and one out of four in rural areas had correct knowledge of HIV/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.
Statistics on commercial sex workers also shows that although these women have every intention of using condom and understand the risk of not protecting themselves. In most cases it was found that their clients refused to use condoms.
Rakhi, (not a real name) a sex worker from a city suburb says, "Most of my clients do not enjoy sex with a condom. Since they are buying sex, they rule the business".
Many experts point out that a decade ago, India had almost the same low level status but it now has an uncontrollable epidemic of HIV/AIDS. The Indian government was initially in denial voice regarding the fact that India could have so many people living with HIV/AIDS.
Experts doubt that Bangladesh may not remain as low prevalent country for long. We should get prepared to take action now.