countries in the world. The relatively young age structure of the population indicates continued rapid population growth in the future.
In 1992, Bangladesh had around 22 million married
women of reproductive age; by the year 2001, this number was projected to rise to 31 million. Instead of a positive demographic transition over last two decades, the country is still in a vicious cycle of population expansion and poverty, and this continues to be a tremendous burden on the nation (Amanullah, 2002).
Various national studies, including Bangladesh
Demographic and Health Survey (BDHS), indicate that more than 90 percent of ever-married women living in rural areas are covered by FP workers, however, adolescents/younger women are less likely to have been visited, and the status of
primary health services in rural areas is still very
poor. Neonatal tetanus, birth-related complications, diarrheal disease, tuberculosis, STDs and other Reproductive Tract Infections (RTIs) continue to be the major killers of the Bangladeshi infants, children and adults.
Bangladesh is also affected with high levels of
bacterial, viral, mycotic and parasitic disease which are the major causes of morbidity and mortality.
These infectious diseases could be the prime
mover for a vicious cycle of HIV epidemic (Amanullah, 2002).
HIV-related wider risk factors
*Vulnerability of women and children: Trafficking,
forced prostitution/labor, rape of detainees in
police or other official custody, vigilantism
(humiliating, whipping) and discrimination against women/female children are serious problems in Bangladesh.
The government has acceded to the U.N.
Protocols, and enacted laws specifically prohibiting certain forms of discrimination against women.
But enforcement of these protocols is rare and a
large number of child SWs are still working in countrys brothels/streets in the presence of police. Because of widespread poverty, about 6.3 million Bangladeshi children are not only deprived of the basic rights of life, but are also compelled to work in hazardous environments at a very young age, often as child-laborers, sex workers, beggars, etc.
This frequently results in conditions that resemble
servitude and many suffer physical abuse by their masters. Specially, Bangladeshi young girls face double burdens, discriminations, and prejudices of society in the early stages of their lives.
In the above situation adolescent girls and women
do not have the knowledge and means to prevent HIV infection (Amanullah, 2002).
HIV/AIDS from global and Bangladesh perspective
According to UNAIDS/WHO estimation, nearly 65
million people have been infected with HIV to date. Of them, more than 30 million have already died of AIDS. More than 35 million adults and children were living with HIV/AIDS throughout the world by the end of 2010. Of them, nearly 95 percent were living in the developing world. In the course of the year 2010, about 3 million people were newly infected, which included 370,000 children aged <15.
Only in 2010, more than 18 lac people died of
AIDS, which included 2,600,000 children. The ratio of infection is now almost equal between men and women.
Compared to men, women were more susceptible
to the infection accounting for more than 50 percent of adult deaths in 2009 and 2010. According to UNAIDS, In sub -Saharan Africa, 57 percent of adults with HIV are women, and young women aged 15 to 24 are more than three times as likely to be infected as young men.
Despite this alarming trend, women know less than
men about how HIV/AIDS is transmitted and how to prevent infection, and what little they do know is often rendered useless by the discrimination and violence they face.
The epidemic is receding in industrializedcountries
and spreading faster than feared in developing countries like India, China, Myanmar and Cambodia.
Although HIV/AIDS is spreading in all regions of the
world, some poor countries in the regions of subSaharan Africa and Asia have been experiencing an explosive outbreak of the epidemic in the recent past.
UNAIDS/WHO data show that many African
countries have started experiencing the adverse socioeconomic, demographic and cultural consequences of the epidemic. Recently the epicenter of the epidemic has changed its direction towards South and Southeast Asia and the new infections continue to occur among IDUs, CSWs and their clients, migrant workers, and women (Amanullah, 2002).
Risk and vulnerability in the Asia-Pacific region
Overall, as of the end of 2010, an estimated 5 to 7
million adults andchildren have become infected with HIV in South and Southeast Asia.
Most of these infections occurred in a few large
countries (particularly in certain pockets) of thisregion. In this region, as available behavioural and epidemiological data suggest, an increased vulnerability and rapid outbreak of the epidemic in near future is inevitable.
It is feared that the explosive sex trade,
widespread use of illicit drugs, increasing rates of STDs, abject poverty, illiteracy, patriarchy and large scale populationmovements have already made this region a fertile ground for rapid expansion of HIV epidemic (Amanullah, 2002).
Unprotected sex with female SWs and sharing
needles and syringes are two major factors in severe transmission of HIV/STDs in Thailand, Cambodia, Myanmar, China and India.
In these states, a significant proportion of SWs and
IDUs are already infected with HIV and the rates vary from <1percent to >40percent in some settings.
It is widely believed that the increasing sex trade in
this region has resulted from significant sociopolitical and economic changes and unrest. Therefore, the nature and profile of SWs vary enormously within and between countries. There are male and female SWs, who work fulltime, parttime or seasonally in variety of settings such as in registered/organised and unorganised brothels, residences, bars, massage parlors, streets or hotels.
Bangladesh: geographical proximity to HIV
epicentres
Unfortunately Bangladesh is in the Asian HIV
epicentre and the country traditionally shares a popular crossroad of South-Asian migration/frequent mobility.
The country has an area of 147,570 square
kilometres bordered on the west, north and east by a 2,400 kilometres land frontier with India and, in the southeast, by a short land and water frontier (193 kilometres) with Myanmar.
After Thailand, the HIV epidemic is currently
expanding in India, Cambodia, China and Myanmar. According to a recent nationwide surveillance, HIV cases were found to be concentrated in central areas and some border districts of Bangladesh. Like India and Pakistan, the prevalence of HIV is largely concentrated in some central urban, seaports and border areas in Bangladesh. Since the discovery of the first case in 1986, the pandemic has exploded in India and according to UNAIDS/WHO and other authentic estimates, this poor country has the largest number of HIV infections in the world approximately 5 to 9 million. In India, 2000 people are being infected newly with HIV every day.
An estimated 50,000 Sex Workers (SWs) have been
playing the dominant role in the heterosexual transmission of HIV only in Mumbai.
In Myanmar, HIV infection among sex workers
increased from 4 percent in 1992 to more than 20 percent during 1996-2004. This country currently has more than 2.4 to 5 million HIV infected people. With about 1.5 percent to 2 percent prevalence rate and rapidly growing epidemic in the region, Cambodia and Myanmar are the highest infected areas in South and Southeast Asia (Amanullah, 2002). Poverty, prostitution and HIV in Bangladesh
Poverty and prostitution are the prime causes of
heterosexual transmission of HIV in many countries of Asia. Not only in Asia, HIV has spread in many European, Pacific, African, and north-American countries where people belonged to stigmatized ethnic communities, were of lower socioeconomic status, or faced volatile political/regional conflicts.
Studies from the above regions testified that
structural factors exacerbated the vulnerabilities of those people. The current experience of India, Nepal, Vietnam, Myanmar, Cambodia, Laos, China and Thailand also confirms the fact that HIV is a disease of poverty and dislocation (Amanullah, 2002).
Explaining the situation of African, North American
and other regional contexts, HIV social researchers already established the importance of a sociocultural perspective on the pandemic.
In this context, the transformation of thinking
about the pandemic and behavior change has already moved from the narrow notion of individual cognition to questions of greater socio-cultural and other societal vulnerabilities (Amanullah, 2002).
Increasing commercial sex working in Bangladesh
The sex industry has been well established in
Bangladesh since the nineteenth century. The urban and semi-urban brothels are organised and controlled by formal/informal functionaries such as vested local influential, rabbles, police and madams/managers. These established brothels are evidence of a large customer base among the general population. Women who join brothels/streets come from most disadvantaged sections of the society and are predominantly the products of abject poverty.
A considerable number of impoverished
housewives, destitute widows and students are assumed to have been involved with part-time commercial sex working recently (Amanullah, 2002).
Prostitution is not an illegal or punishable offence
in Bangladesh and therefore, there is no law in the country to prevent a girl becoming a sex worker.
However, article 18(2) of the Constitution states,
the State shall adopt effective measures to prevent prostitution and gambling.
The outcome of this paradoxical situation is that
the government often violates SWs human rights or their rights of profession by destructive ways.
Although the prime target of the act is to prevent
child and forced prostitution, there is no implementation of the act in these respects.
Currently, a large number of child sex workers are
assumed to be working in many organised/unorganised brothels of the country under enforced conditions.
The state appears in the role of oppressor rather
than protector of the rights of occupation and livelihood.
An estimated 150,000 SWs are currently working in
Bangladesh. Several studies show that the floating SWs are largely available in the capital and other major cities in Bangladesh.
The most frequent visitors to brothel, street and
house-based SWs are businessmen, students, transport workers, security personnel and foreign tourists. In 1997, some researchers estimated that at least 10,000 child prostitutes were working in Dhaka City alone (Amanullah, 2002). In recent years, the academicians have conducted several studies on Bangladeshi commercial sex workers. These studies are largely based on brothel based SWs, descriptive in nature, and seriously lacking in theoretical orientation. Because of the rapid spread of HIV in the region, NGO researchers have recently started focusing on the health and other risk behaviors of both institutionalized and floating sex workers, and some of them tried to correlate their findings with existing socio-cultural factors.
A few of them attempted to show the structural
barriers and contextual/institutionalized risk factors surrounding the brothels and sex working communities as a whole. Although most of these recent researchers designed their studies by combining survey and anthropological techniques, none was found relating their findings to existing psychosocial model/theories of behavior change (Amanullah, 2002).
Though people generally believe sexual intercourse
with SWs to be wrong, the above review indicates that a large number of commercial sex workers operate in Bangladesh. Important findings of these studies include: relatively high frequency of foreign tourists and migrant workers, extremely low level of condom use, lack of proper knowledge and misconceptions about prevention/cure of STDs/HIV/AIDS, present or past history of STDs, extremely low literacy/educational levels, societal violence, clients pressure for non-use of condoms and the history of drug use among SWs.
Together, these factors may hasten the incidence
of HIV infection among SWs and their clients in near future. Scholars from all over the world have been predicting since the early 1990s that the future spread of epidemic in any country will correlate closely with the current and future prevalence of STDs, injecting drug using, poverty, culturally constructed risk-behaviours, socioeconomic conditions, political/regional conflicts, race and ethnicity, and emerging sex business.
Bangladesh clearly qualifies in terms of all
conditions stated above. The following section will try to reveal the truth (Amanullah, 2002). Current status of HIV/AIDS in Bangladesh
Although many South and Southeast Asian
countries started documenting their HIV epidemic in the late 1980s, due to scarcity of authentic data, it was difficult to assess the burden of HIV epidemic precisely for Bangladesh.
Ten years ago, WHO estimated that Bangladesh
belonged to pattern III countries for HIV/AIDS epidemic, meaning the infection had not reached one adult per 1000 in the country.
In the year 2010, the country still does not know
the exact number of its HIV positive people. Analyzing latest surveillance data, some national and international researchers have suspected that HIV prevalence is just beginning to increase in Bangladesh (Amanullah, 2002). The people in South and Southeast Asia regularly practice high-risk behaviors, some of which are traditional and implicit in nature. These disguised risk behaviors are very much conducive to an explosive outbreak of HIV. It is now clearly established that the HIV-1 virus has been spreading virulently in South and South Asian countries through sex workers and IDUs.
According to epidemiological sources, all HIV strain
s found in Bangladesh are HIV-1. HIV-2 or any other clear retro-viral strains have not been detected yet in the country. Indexed publication on the
epidemiological, behavioral and cultural aspects of
HIV and prostitution has been voluminous for Thailand, India and some island states of Southeast Asia.
In contrast, although, recently some international
NGOs have started epidemiological inquires, there is still a scarcity of publication on behavioral and cultural construction of HIV/AIDS in Bangladesh. Various national and international studies observe that the prime risk factor for HIV invasion in Bangladesh is heterosexual transmission, to and from SWs, followed by IDUs and blood transfusion.
The countrys religious rigidity, sociocultural taboo
on sexual discussion/sexuality, and traditional social structure are seemingly dysfunctional in preventing a large segment of its population from practicing unsafe commercial sex, or other implicit risk-behaviors.
Transmission of HIV through IDUs and heterosexual
contact are believed to be the prime mover of AIDS
epidemic in the South and Southeast Asian
countries.
Since the first diagnosis of AIDS in 1989, up until
now, Bangladesh has officially reported only a few HIV infections (2088) and AIDS (850) cases.
There is no doubt that these numbers represent an
undercounting. Besides, the available surveillance stem of the country does not allow researchers to approximate the HIV-1 seroprevalence in this country.
National and international experts suspect that the
actual number of infections is much higher. According to a WHO estimate, about 20,000 Bangladeshi adults and children were infected with the HIV by the end of 1993, and over 100,000 could have been infected by 1997.
A sentinel surveillance system has not been
established yet in this country to prove or disprove this estimate and therefore, the experts and policy
makers often depend on guessing, or inappropriate
surveillance, in estimating the number of HIV infection.
However, the government has recently
acknowledged that about 7,500 people could have been infected with HIV in Bangladesh. Furthermore, researchers do not know exactly the route(s) of entry of HIV infection in Bangladesh. It is assumed that the frequent mobility of Bangladeshis to its neighboring India, Myanmar, Thailand, Middle East, or western countries may be an important source of entry.
It is also feared that the virus has entered
Bangladesh through foreign tourists/businessmen who are the regular customers of local/regional sex industry (Amanullah, 2002). The explosive outbreak of HIV in certain pockets of India, Indonesia, Nepal, and Myanmar is believed to have occurred through heterosexual IDUs.
Now, Bangladesh also qualifies for this trend. In
Bangladesh, although the overall HIV prevalence rates among population groups most vulnerable to HIV infection is less than 1 percent (0.3 percent), the overall HIV prevalence among IDUs is 4 percent.
More importantly, in some pockets in central
Bangladesh the prevalence of HIV among IDUs is about 9 percent. These IDUs have high rates of HEP-C prevalence (59percent) and about 21-44 percent of them regularly visit sex workers.
The rate of consistence use of condom among
these IDUs is less than 5 percent, which is seriously low compared to their counterparts in many Asian countries. These IDUs should be treated as being major risk factors for the transmission of HIV/STDs in Bangladesh (Amanullah, 2002). The prevalence of HIV, as indicated by the recent sero-surveillance, among floating SWs is 2 percent in central Bangladesh. This figure may be very low compared to
regional neighbors, however, it is a signal that the
country is not immune to the spread of HIV through sex workers. Another point prevalence study among STD patients in port city Chittagonj shows a 0.5 percent and a 4.5 percent of HIV and syphilis seroprevalence respectively. In the study, 79 percent of the subjects never used condoms. The study cautioned that its subjects were at risk for further spread of HIV because of their increasing syphilis prevalence and high-risk sexual practices.
Finally, the researchers concluded from their clad
analysis that this strain was more analogous to the clades seen in India than in Thailand. Currently there are no scientific behavioural/epidemiological studies on other types of Bangladeshi SWs who operate in rented house, hotels, or boats. Because of their clandestinity and frequent mobility, it is very difficult to study these groups and thus the country does not have a proper understanding either of the prevalence or knowledge, attitudes and practices concerning HIV
and condom use for these large segments of the
sex working population (Amanullah, 2002). Bangladesh has many guarded/unguarded traditional trade routes as well a common sociocultural identity with these neighbouring countries. It is believed that a large number of people and SWs cross between the borders of each country every year for business, travel and sex tours.
A recent Indian study has confirmed that about 12
percent of SWs working in Calcutta brothels are from Bangladesh.
Therefore, Bangladesh is in grave danger of the
epidemic spreading to it. The factors which led India to become the worlds most HIV infected country are very much present in Bangladesh, although the country has been showing a fatal silence by depending on its strong religiosity, social taboos on sex and traditionalism.
The following review of existing literature does not
support the authoritys complacency any more (Amanullah, 2002). Non-marital sexual relations Pre-marital sex: Despite strong religiosity and sociocultural norms, severalqualitative and quantitative studies show that promiscuity, illicit sexual behaviour and multiple sex partners are common among Bangladeshi youths.
In an anthropological study, eminent ICDDR,B
researchers reported that, 50 percent of their subjects (young men) had engaged in intercourse before their marriage, adolescents were not punished for their premarital sex, and such sexual activities were related to respondents socioeconomic status.
About half of the subjects (Bangladeshi males)
admitted having premarital sex in a joint study of ICDDR,B and the Health Transition Center of Australian National University.
Furthermore, about 50 percent of
married/unmarried men, who reported having premarital sex, had visited sex workers. In a recent study of adolescents, some BRAC researchers reported that by the age of 16-18 years, 80-90 percent of urban males had sexual experience compared to 40-60 percent of rural males. Of the men, who had sex outside of marriage, 71 percent mentioned SWs as their sexual partners (Amanullah, 2002). Extra-marital sex: The practice of extra-marital sex is also very frequent amongdifferent transport workers and small professional groups.
In an international study 52 percent of married and
47 percent of unmarried men had had extramarital coitus mostly with their girl friends, sisters-in-law and SWs.
In a SMC study on HIV/AIDS, 56 percent truckers
mentioned visiting SWs and other sex partners, and their averageage of first sex was 20. Among truckers, 26 percent stated that they had serial sexwith a common SW, 79 percent were aware of
HIV/AIDS, only 19 percent thought that the
infection could be checked by using condoms, and a dismal 8 percent thought that they were susceptible to the disease.
The actual incident of condom use with SWs and
other kin/sex partners was not recalled (Amanullah, 2002). Sexually Transmitted Diseases (STDs) It is now well established that the presence of both ulcerative and non-ulcerative STDs increases the risk of HIV transmission as much as 3 to 10 folds. Specifically, various genital ulcers, such as herpes simplex II or syphilis and trichomonas virginals, Chlamydia trachoma is and neisseria gonococcal infections, have been identified as catalyzing agents in increasing the susceptibility to HIV infection all over the world. In the absence of a comprehensive and routine screening, a scientific STD prevalence is not available for Bangladeshi population. Gonorrhea, syphilis, genital herpes and genital warts are the most prevalent STDs among Bangladeshi commercial sex workers.
In a serological investigation, researchers noticed
that, of SWs, 57 percent were positive for syphilis, 14 percent had gonorrhea, 20 percent had Chlamydia, 20 percent had herpes, and 6percent were carriers of Hepatitis-B virus. All gonorrhoea cases were associated with syphilis.
Recent national sero-surveillance data by ICDDR,B
show that the prevalence of syphilis among Bangladeshi SWs is 7 percent. In a 1993 situational analysis, about 41 percent of skin/VD out-door patients had genital tract injection, 14 percent had syphilis, 6 percent had non-gonococcal urethritis (NGU) infections, 38 percent had some combination of STDs, and the treatment facilities were non-specific and insufficient. In another study of 3,000 currently married village women of reproductive age, 640 (21.9 percent) reported some symptoms of RTIs.
In 1992, Save the Children (USA) studied 980
women over the age of thirteen and 70 men during
a four-day free health clinic conducted in rural
Rangunia, Chittagong.
In the study, 54 percent of the women had a
history of present or past STDs, 61 percent, having current symptoms of STDs, had an abnormal vaginal discharge, 5 percent had genital ulcers, 34 percent had lower abdominal tenderness and 4 percent had genital warts.
Because of anal intercourse, some women had anal
warts. Among men, 57 percent had Human Papilloma Virus (genital warts).
The study warned that in the absence of adequate
testing and treatment facilities, the high incidence of STDs in such a poor and remote rural community would provide a fertile ground for explosive and unchecked outbreak of HIV (Amanullah, 2002). Usage of condoms Several national studies show that awareness of the usefulness of condoms has risen in Bangladesh for last few decades among ever-married
women/men, adolescents, and SWs and their
clients. However, the most disturbing fact for HIV program planners is that, of those women and men who are currently using FP methods, only a nominal number of women and men stated that they were using condoms and the practice was strikingly related to their education and place of residence.
As indicated by recent BDHS, although the current
use of condoms has risen steadily among women, the discontinuation of its usage was highest among all contraceptive methods.
In addition, the consistent use rates of condoms
are largely unknown for them. For various sociocultural reasons, the FP program planners have advocated condoms cautiously during their initial condom intervention, and by now, the issue is so less important that Bangladeshi FP workers do not feel confident about discussing/recommending or promoting condoms to their clients.
The above national scenario confirms that the
condom is not a part of sex culture in Bangladesh (Amanullah, 2002). Eminent Australian researchers observed that although by international standards the recorded levels of non-marital and commercial sex are not high in Bangladesh, however, most of this sexual activity was reported to be unprotected.
In their study, only about 12 percent of the
subjects reported always using condoms with nonmarital/causal sexual partners. Their findings are more or less similar to existing condom use rates reported by available condom and prostitution studies in Bangladesh (Amanullah, 2002).
Other risk factors
Drug use: In the absence of systematic research,
the extent of drug use, specificallythe prevalence
of Injecting Drug Use (IDU) is not well documented
in Bangladesh. Some haphazard studies carried out in this field indicated the presence of huge number of drug users and wide-scale availability of various local/imported drugs such as heroin, charas/ganja (Indian hemp plant), alcohol, morphine, pethidine, phensidyl, buprenorphine etc.
It is feared that already a high proportion of
inhalers has converted into injectors in Bangladesh (Amanullah, 2002).
Because of its geographical proximity to other HIV
infected South Asian countries, Bangladesh is particularly at risk of transmitting HIV through IDUs.
In 1998, the prevalence of HIV was highest in the
world among the IDUs in Myanmar: 74 percent in Rangoon, 84 percent in Mandalay and 91 percent in Myitkyina.
In 1997, the overall sero-positivity rate of IDUs in a
pocket of India, where heroin was the drug of choice, was 54.56 percent.
The rate was just about 4 percent in 1991. In 1991,
the prevalence of HIV was 1 percent among the IDUs in Kathmundu.
In 2002, the overall sero-positivity rate of IDUs in
Kathmundu was more than 60 percent. Jakarta also experienced the same trend.
These IDUs are the potential sources of explosive
heterosexual and perinatal transmission of HIV infection in the region. It is estimated that around 100,000 IDUs are in Bangladesh now.
Most of them share needles/syringes and have not
tested yet for HIV. Unsafe blood transfusion: About 8090percent of blood supply in Bangladesh ispurchased, usually from unscreened professional blood donors (clients of SWs, drug users, STD patient etc.).
The HIV positivity rate among Phnom Penh blood
donors has risen from 0.1 percent in 1991 to about 10 percent in 1995. Men who have sex with men (MSM): Unprotected anal intercourse is one of thedominant routes of transmitting HIV. Male to male sex in Bangladesh is politically, socially, and religiously sensitive and extremely difficult to address. Under old British law, incorporated into Bangladesh Penal Code, these behaviours are illegal in the country.
Furthermore the Quran and Sharia strictly had
forbidden the practice. In contrast, several studies show the practice of anal intercourse among SWs and general populations (Amanullah, 2002). Researchers recently observed that the transmission of STDs/HIV is invisible among Bangladeshi gays because of insufficient anal/oral testing and denial of such behaviours by the participating males themselves.
In a Bangladeshi study 81 percent of subjects had
multiple sex partners and were sexually active between their age of 1318 and the majority had had sex relationships with women and female SWs.
These men are not interested to test their HIV
status because of personal security, about half of them do not use condoms, and most importantly, only 6.3 percent of them stated a consistent use of condoms (Amanullah, 2002). Awareness of HIV/AIDS among SWs and clients The awareness of HIV/AIDS among SWs and their clienteles is recently reported by some national and sub-national studies. In a 1996 baseline survey of HIV/AIDS and Condom Use among six Bangladeshi brothels, 83 percent of SWs and 74.5 percent of their clients stated that they had heard of HIV/AIDS.
In the survey, about 90 percent of subjects stated
that AIDS has no cure, while 72 percent86 percent of them stated that AIDS is a fatal disease.
Despite their increasing awareness, both SWs and
clients expressed considerable misconceptions on the modes of transmission, ways of protection and their personal susceptibility to the disease.
For example, only 36 percent of clients and 38
percent of SWs thought that they could get HIV. Of them, only 6 percent of clients and 13 percent of SWs thought that they could get the disease because of non-use of condoms.
Recent HAPP baseline survey also revealed the
same results (Amanullah, 2002). The major findings of the above baseline survey were found consistent with thef indings of another baseline survey carried out in Tangail brothel by CAREBangladesh in 1996.
A majority of the subjects in that survey had heard
about AIDS, but their levels of knowledge were extremely poor and incomplete.
Some of them stated that HIV transmits through
food, clothing, foreigners (Koreans), and black cats. These findings are further consistent with other studies carried out among brothel and floating SWs. Because of NGO interventions, subsequent Bangladeshi follow-up KAP surveys revealed a dramatic rise in various rates of the earlier baseline surveys.
However, despite much improvement, these followup studies reported misunderstanding among SWs and their clients concerning modes of transmission and ways of prevention of HIV.
They also revealed disjunctures between
knowledge and practices. These studies further observed that the SWs were forced to practice risk behaviours and were less likely to care about risk information provided by the media or NGO workers (Amanullah, 2002).
Diffusion of HIV/AIDS information
There is a dearth of indexed data on the extent and
effectiveness of HIV/AIDS related riskcommunication/diffusion channels among Bangladeshi SWs and their clienteles. A few studies have been carried out recently to assess the media habits of SWs and their clients. In these studies, Radio, television and cinema appeared as the dominant electronic channels.
However, these studies have not addressed
whether the SWs and their clients act based on the risk information they receive from the media and existing risk-communication channels(Amanullah, 2002). Despite the low prevalence of HIV, the above discussion suggests that HIV may spread rapidly in Bangladesh in near future.
As the AIDS pandemic continues to devastate
South-Asia, no nation from this region can consider itself immune. Complacency in Bangladesh would lead to more rapid and widespread infection. In this country, already some AIDS patients died of persistent
diarrhoea (possibly due to cryptosporidiosis),
tuberculosis, malaria and encephalitis. Most of the Bangladeshi AIDS patients now alive are suffering from tuberculosis.
From the above analysis three conclusions can be
drawn. First, if unchecked in the initial stages, the assumed low-profile HIV situation of Bangladesh could evolve rapidly into an escalating epidemic, like its neighboring India, with tremendous health and socio-economic burdens(Amanullah, 2002). Secondly, in Bangladesh, STDs and TB are the epidemic, not AIDS. Therefore, there is complacency instilled by the knowledge that the country has limited numbers of AIDS cases; this attitude obscures awareness of the leading edge of the epidemic for a clearly risk-practising society.
This detailed article has provided evidence that the
country cannot afford to sit back and wait for HIV to spread. The country needs to be proactive about prevention (Amanullah, 2002).
Thirdly, given the magnitude of the wider
socioeconomic risk factors and structural barriers to safe sex practices, the possibility of changing unsafe sexual practices of adolescents and youths, adult population, and other stigmatised group by employing western strategies is questionable (Amanullah, 2002).
Against this background, the government of
Bangladesh has recognized HIV/AIDS as not just a health problem but largely as a development issue inextricably linked to cultural, social and economic determinants demanding a wide and accelerated multi-sectoral response.
Recently, the government has approved National
Strategic Plan for HIV/AIDS (NSP) for the period 2004-2010. In 2004, the government has received a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) for the Prevention of HIV/AIDS among Youths and Adolescents in Bangladesh.
The Ministry of Health and Family Welfare (MOHFW)
has selected Save the Children-USA as the Management Agency (MA) for the project under the umbrella of National AIDS/STD Program (NASP).
Out of five packages under the project, PIACT
Bangladesh, a national NGO, has been awarded to implement the package titled Integrating HIV/AIDS into Secondary School & College Curriculum as well as Dissemination of Developed Materials (Package: GF 903).
The objective of the package is to include HIV/AIDS
information into the curricula of secondary and higher secondary education and distribution of advocacy materials to youths. Under another package (GF: 901), a consortium of Mattra and PIACT is diffusing HIV/AIDS information throughout the country using various electronic, print, folk, and interpersonal channels.
Using culture sensitive ideas and diffusion
techniques, their campaign has already attracted huge audiences. The other packages of the project
are also working in overcoming the socio-cultural
constraints faced by the HIV program mangers in earlier times.
As such, this GFATM project is a remarkable step,
advocated by the highest level policy makers of Bangladesh, which could produce an informed youth audience throughout the country in near future and help preventing HIV transmission not only among the general audiences but also among the risk-practicing population of the country.
The success achieved in Thailand and many other
African Muslim and Non-Muslim countries such as Senegal, Zimbabwe and Uganda reveals that, despite structural and cultural barriers such as gender inequalities, poverty, illiteracy, stigma and male dominance, there is still some hope to increase safe sex practices through culturally sustainable HIV/AIDS prevention programs, school and college education, and providing support services to vulnerable groups, specially riskpracticing women and children (Amanullah, 2002).