HIV/AIDS

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HIV/AIDS

HIV & AIDS Data Hub

Up until recently Bangladesh has been a low prevalence country for HIV/AIDS. The most recent serological surveillance however (conducted in 2006) indicates a concentrated epidemic in the capital city Dhaka, amongst male injecting drug users (IDU), where prevalence has dramatically risen from 4.9% to 7%, and up to 10.5% in one area. The epidemic is largely confined to one neighbourhood in Dhaka which may be considered to be the epicentre.

Many factors which may allow rapid spread of infection leading to a more generalised epidemic are present. These factors include high-risk behaviour, lack of awareness, mobile populations and being surrounded by countries that have a higher prevalence of HIV.

Biological evidence suggesting high-risk behaviour such as sexually transmitted infections (STIs) and hepatitis C is common in some of the key vulnerable groups including sex workers and injecting drug users. STIs are low in the general population but are higher in the bridging population groups such as truckers, and highest in sex workers.

Shared use of non-sterile injection equipment is common in many injecting drug users surveyed. These same populations are part of sexual networks (both commercial and non-commercial), rarely using condoms and sometimes selling blood. IDU are also mobile travelling from one city to another and sharing injection equipment in different cities. Passive case reporting suggests that another population group vulnerable to HIV may be migrants returning from jobs overseas or through cross-border traffic to regions of high prevalence.

The Government of Bangladesh has been compiling annual HIV and AIDS case figures via passive reporting from a number of different organizations since 1989. In December 2006, the government reported that there are 874 people living with HIV and 240 people living with AIDS in Bangladesh. WHO and UNAIDS , on behalf of the National AIDS/STD Programme, have estimated that at the end of 2005 the number of adults and children living with HIV in Bangladesh was approximately 7500.

Bangladesh is fortunate to have this window of opportunity to prevent an HIV epidemic and it is imperative not to waste this opportunity by ensuring that appropriate interventions are in place. Although many interventions for preventing HIV have been in place for many years in Bangladesh, data suggest that these have not been very effective at promoting safer behaviours. Interventions can be made more effective if they are evidence based. ICDDR,B is suitably placed to provide data that will enable monitoring of the epidemic and identify possible new groups that may be at risk. ICDDR,B can also provide an understanding of the dynamics of certain behaviours and conduct laboratory studies on STIs, HIV and hepatitis. This will provide microbiological and virological data necessary for treatment and prevention.

ICDDR,B has been conducting second generation surveillance for HIV in the country on behalf of the Government of Bangladesh in collaboration with other partners. The data from surveillance have been used to monitor the progress of the epidemic and changes in risk behaviour over time and these data have also been used effectively in mobilising and directing resources appropriately.

To prevent a major epidemic, Bangladesh needs to address HIV/AIDS using a multi-pronged strategy. Firstly the onset of the epidemic has to be slowed in the immediate future by concentrating on groups most vulnerable to the infection; secondly a longer term generalised epidemic has to be avoided by working with the general population; and thirdly, care and support to those already infected and affected by HIV/AIDS has to be provided. ICDDR,B has developed and is developing projects addressing all three approaches. For the most vulnerable groups, projects on risk behaviours, anthropological studies, epidemiological studies, STI and virological studies are being launched among IDU, migrants, sex workers, and other vulnerable groups such as fishermen and ethnic minority populations.

For care and support Voluntary Counselling and Testing (VCT) services have been established at ICDDR,B and will be expanded to more cities. Through VCT, physicians are available, as is laboratory support such as measurement of absolute CD4 counts. Efforts are being made to make a more comprehensive network of services available to people affected and infected by HIV/AIDS.

Priorities for the HIV/AIDS programme at ICDDR,B include:

Monitor HIV/STIs epidemics and risk factors that enhance HIV transmission.
Conduct research that leads to a better understanding of the risk factors of transmission of HIV/STIs among the most vulnerable population groups, e.g. injecting drug users, sex workers, and others.
Conduct research to identify factors that lead to increased vulnerability to HIV/AIDS in adolescents and youths.
Determine routes of transmission between high-risk groups and the general population to limit the wide spread of HIV to the general population.
Develop strategies for care and support of HIV-infected people in Bangladesh.
Coordinate our research findings with other groups active in HIV/AIDS and assist them in advocacy and strategy development.