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Bangladesh Fights Off HIV

A sex worker in Bangladesh demonstrates use of a condom to prevent HIV. Credit: Naimul Haq/IPS.

DHAKA, Apr 28 2014 (IPS) - Shohagi, 19, walks down a corridor to an audience of about a dozen commercial sex workers. In a loud and confident voice, the fellow sex worker shares her knowledge on the use of the condom.

“This is your protection from any sexually transmitted disease (STD). Without it you could suffer a lot,” warns the young girl at a drop-in centre (DIC) organised by the Bangladesh Manobadhikar Sangbadik Forum (BMSF), an NGO working to prevent the transmission of HIV and other STDs.

"Initially we acted as catalysts to train and educate sex workers. Now sex workers educate their peers for their own safety.”

As Shohagi demonstrates how to slip on a condom over a dummy, Kohinoor Banu speaks up from the audience, “We could not have learnt about such things anywhere else.”

Located around 200 km southwest of capital Dhaka, Kushtia is a small district where people subsist mostly on agriculture. But there are also those who have turned to drugs or prostitution due to poverty and lack of jobs.

“Prostitution and drug addiction are nothing new, but they are a big threat in a society where education levels are low,” Mohammad Alamgir Kabir, coordinator of BMSF in Kushtia, tells IPS.

They focus on high-risk groups like sex workers. “Awareness lessons work like magic,” Kabir says. “They virtually cost nothing. Initially we acted as catalysts to train and educate sex workers. Now sex workers educate their peers for their own safety.”

For a densely populated country of 150 million, Bangladesh is fortunate to have no more than about 3,000 known HIV positive cases. This is despite a high incidence of STDs, a low literacy rate and porous borders with countries like India and Myanmar.

A total of 1,300 AIDS cases have been identified till December 2013.

Strong political commitment, timely donor support and effective government-NGO collaboration are behind Bangladesh’s successes on this front.

Bangladesh, according to UNAIDS, is among the few developing nations which saw early intervention in combating HIV/AIDS – it was made a priority in the mid-nineties.

Dr Hussain Sarwar, chief of the National AIDS/STD Programme (NASP), tells IPS, “We focused on providing support for priority groups, preventing vulnerability to HIV infection and promoting safe practices.

“Many countries, despite having high burdens of HIV infection, did not even recognise its prevalence. We were well ahead in preparing to minimise the impact of HIV/AIDS.”

Rabeya Khatun, 21, and Kohinoor Begum, 27, are both regular visitors at the DIC in Kushtia. “Such a user-friendly centre really helps,” says Kohinoor who has two school-going children. Khatun says, “We get free condoms, counselling and testing for STDs. The centre has given us the right education at the right time.”

Most commercial sex workers in Bangladesh have access to DICs, which have been opened with the help of NGOs and are part of the national HIV intervention programme.

“It is these thoughtful initiatives that have kept the figures low. Voluntary blood tests among high risk groups show an HIV infection rate of less than one percent,” says Dr Nazmul Hussain of NASP.

However, the figure is higher among intravenous drug users (IDUs).

“In 2002, we found that the figure had crossed four percent among IDUs, who have been a major concern. Unlike other groups, IDUs are hard to persuade.”

Rabiul Islam is one such heroin addict.

“I tried to quit, but it keeps coming back,” says the youngster in his mid-20s. Rabiul and some of his friends work as cooks at a hotel in Kushtia.

Light House, an NGO in Kushtia, has been working with them for four years to prevent the spread of HIV, and bring some discipline into their lives.

Mohammad A.K. Abdul Bari, programme coordinator of Light House, told IPS, “We work through our peers who identify IDUs and send them to our DIC where we offer all support related to STDs and HIV/AIDS.”

Mohammad Anisuzzaman, the DIC manager, says, “We have a very strong vigilance team. Every IDU is tracked down and registered. New IDUs are also sent for friendly counselling.”

The low HIV/AIDS prevalence rate can be credited to about 45 local and national level NGOs.

“The government and civil society have a strong partnership,” Dr Leo Kenny, UNAIDS Bangladesh Coordinator, tells IPS. “NGOs have implemented around 75 percent of HIV/AIDS prevention, treatment and care activities nationwide.”

In partnership with NGOs, media and civil society, a total of 309 DICs, 61 voluntary counselling testing (VCT) centres and 98 blood transfusion centres for HIV screening in hospitals are in operation.

The NGOs mainly concentrate on high-risk groups such as 110,581 known men who have sex with men (MSM), 74,300 female sex workers and 8,882 transgenders.

The government admits that it needs more HIV Testing and Counselling (HTC) centres. Dr Sarwar says, “HTC provisions should be such that all people who want to know their HIV status can access these centres.”

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