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. [1] 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. [1] 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. 4 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). [1] 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.
[1] 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 AIDS Initiative Organization was launched in 2007 to fund for those without proper medication in order to combat the virus. The National HIV and AIDS Communication Strategy (2006–2010) was also developed and launched.
[1] 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 21,500 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). [1] Currently, the program funded by the Global Fund is leading the national response to fight HIV and AIDS. Bangladesh had received 3 grants on HIV/AIDS from The Global Fund to fight AIDS, Tuberculosis and Malaria- Round 2 from 2004-2009, Round 6 from 2007-2012 and Rolling Continuation Channel (RCC) from 2009-2015.
The Round 2 grant focused mainly on prevention of HIV among young people with strategies including- 1. HIV/AIDS prevention messages dissemination through information campaign in mass and print media 2. HIV/AIDS orientation, training and services via Life skills education, Youth Friendly Health services and accessing condom 3. Integration of HIV/AIDS in school and college curriculum 4. Advocacy and sensitization of religious leaders, parents and policy makers 5. Generating information for policies and programs.
The main focus of Round 6 grant was on Most at Risk Populations (MARP) and scaling up of the Round 2 project including interventions with vulnerable youth. The iterventions for High Risk population and vulnerable young people includes essential services for injecting drug users and female sex workers; treatment, care and support for PLHIV; and awareness and prevention strategy for vulnerable young people including garment industry workers. National level capacity building, strengthening district coordination, support to networks and self help groups are also among the strategies.
Round 2 and Round 6 has been implemented through Public-Private Partnership where Economic Relations Division of the Government of Bangladesh worked as Principal Recipient and Save the Children USA managed the grants as Management Agency in collaboration with Ministry of Health and Family Welfare. Based on the satisfactory level of completion of the Round 2 project, Global Fund awarded Bangladesh with the 6 year fund termed as “Rolling Continuation Channel (RCC)” from 2009-2015, which is consolidated with the Round 6 grant.
For high level of performance the Project is appreciated as a” best practice” example in Asia and is rated as “A” by the Global Fund. The program is being implemented through 13 technical packages by 13 consortiums comprising of 61 organizations nationwide. Save the Children, as a Principle Recipient of the grant is facilitating implementation through technical and compliance related support to all the consortia. Other Principal Recipients are National AIDS/STD Program and ICDDR,B. The main objectives of RCC Program are- A).
Increase the scale of prevention services for key populations at higher risk: Injecting Drug Users (IDUs), Sex Workers (FSWs), hijras (transgendered) & Men who have Sex with Men (MSM) B). Increase the scale of the most effective HIV/AIDS activities conducted through Round 2 C). Build capacity of partners to increase scale of national response to the HIV/AIDS epidemic Some significant achievements of the HIV/AIDS program funded by the Global Fund are- 1. Overall HIV Prevalence remains.