Bangladesh HIV Surveillance - 9th Round

The National AIDS/STD Programme (NASP) of Directorate General of Health Services under Ministry of Health and Family Welfare, is responsible for HIV surveillance in Bangladesh. The 9th round of HIV surveillance was conducted on behalf of the Government of Bangladesh by the International Centre for Diarrhoeal Diseases, Bangladesh (icddr,b) and the Institute of Epidemiology, Disease Control and Research (IEDCR), DGHS. A large number of non-government organisations (NGOs), private organisations and community groups participated in the surveillance by providing access to the vulnerable population groups and helped in various aspects of the surveillance.

As in previous years the 9th round of serological surveillance was conducted in populations most at risk of HIV-sex workers, people who inject drugs (PWID), heroin smokers, combined PWID and heroin smokers, males who have sex with males (MSM) and transgendered people (hijra). This round was conducted between December 2010 to June 2011 and 12,894 individuals were sampled from 36 geographical areas of Bangladesh. The overall prevalence of HIV and active syphilis is 0.7% and 3% respectively.

The population group with the highest rate of HIV continues to be PWID in Dhaka but the prevalence declined to 5.3% from 7% (in the 8th round). However, the decline is not statistically significant. Fortunately, the localization of the PWID epidemic to one neighbourhood of Dhaka observed in previous years has also remained.

Antibodies to Hepatitis C virus (HCV) were measured in all PWID and groups of combined PWID and heroin smokers but not in the groups consisting of only heroin smokers. The rates varied in the different cities and in six cities >50% were HCV positive. The higher prevalence for HCV was found among PWID from several cities of Rajshahi Division with Kanshat having the highest prevalence (95.7%). In Dhaka HCV rates have declined significantly (P<0.05) over the rounds of surveillance.

A total of 3568 female sex workers were sampled from 13 areas of Bangladesh. Overall, HIV prevalence was low (<1%) in all groups of female sex workers except in casual sex workers from Hili where two in 125 samples were positive (1.6%). Active syphilis rates at >5% was detected in three sites - street sex workers of Hili (12.5%) and Chittagong (10.3%) and hotel sex workers of Sylhet (9.3%). Male sex workers (MSW) and MSM continue to have low levels of HIV and active syphilis. Approximately 1% of hijra had HIV. Among the group of MSM, MSW and hijra, active syphilis rates were highest in hijra of Dhaka, Manikgonj (6.1%).

In summary, this round of serological surveillance taken together with the trends obtained over the years, suggests that with continued efforts, it may be possible to reverse- the HIV epidemic in PWID in Dhaka. However, harm reduction services for PWID in other areas especially in Rajshahi Division need to be enhanced. Although HIV has declined in Dhaka among PWID, Dhaka in general appears to be vulnerable to an HIV epidemic as most cases were detected here. In addition, vigilance and intense programming are required in border towns.

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