HIV-AIDS

Introduction

The main goals of HIV/AIDS programming at WHO Bangladesh are to prevent the spread of HIV and STIs, and to mitigate the impact of the dual HIV and AIDS in the society. Following are the main objectives of HIV/AIDS programme:

  • Provide support to build capacity for voluntary counseling and testing (VCT) services for HIV/AIDS in the country.
  • Assist in developing and updating manuals, guidelines and forms and organization of training programmes.
  • Provide support for equitable access to essential medicines for HIV/AIDS with rational use of quality drugs and strengthened diagnostic support for HIV/AIDS.

Country situation

The first case of HIV/AIDS in Bangladesh was detected in 1989. As far back as 1998 a sentinel surveillance system was instituted to monitor trends of HIV infection and risk behaviours for HIV transmission among most vulnerable groups - Injecting Drug Users (IDU), female and male sex workers (FSW and MSW), men who have sex with men (MSM), and some of the bridge population.

In all the five rounds of National HIV Serological and Behavioural Surveillance (NHBS) that have been carried out to date, the HIV rates have remained below 1% in all groups except in IDUs in Central Bangladesh where HIV positivity reached 1.4% and 1.7% in 2000 and 2001 respectively and increased sharply to 4% in 2002 and 2003/2004. HIV infection of this level and above among IDUs poses serious risk as the epidemic may expand rapidly to sex workers and their clients and eventually to the general population.

The 5th round NHBS (2003/2004) has shown high rates of active syphilis of 9.7% and 12% among FSWs surveyed in Central and South East Bangladesh. Hepatitis C prevalence rates of up to 83% among IDUs (5th round NHBS) are comparable to those in other countries in the region that are experiencing a concentrated and growing HIV epidemic. Active syphilis like other STls and Hepatitis C are major risk factors for HIV transmission.

In an effort to improve data on the extent of HIV/AIDS plans are under way to strengthen the HIV/AIDS surveillance and reporting system. Current low prevalence situation can possibly mask an increasing prevalence in the general population due to high risk factors in Bangladesh. The factors relating to open borders, sex industry, the link between more vulnerable groups and bridging populations, gaps in healthcare delivery, low levels of HIV/AIDS awareness, heavy labour migration, gender inequities and poverty have been identified as being important factors in the spread of HIV infection.

The first HIV case detected in 1989 in Bangladesh, the rate of infection has not been increased in comparison to other neighboring countries.

Cumulative numbers as of 1st December 2009 Total reported HIV case: 1,745 Total AIDS case: 619 Total deaths: 204 Estimated HIV cases: 7,500 (Govt. of Bangladesh) and 12,000 (UNAIDS)

New cases and deaths in 2009 Total HIV infected: 250 Total AIDS cases: 143 Total deaths: 39

Challenges:

  • HIV prevalence is low. However, there are signs of increase in HIV infections among IDU and other groups.
  • Treatment, care and support in the country are still small with ART related to HIV/AIDS positive people in the country.
  • Establishment or expansion of Voluntary Counseling and Testing (VCT) services in government settings across the country
  • There is an increasing need and demand for access to quality treatment including ARVs.
  • The technical expertise for diagnosis and treatment needs to be strengthened in the government system.

WHO Contribution

  • Support provided for conducting divisional HIV Counseling and Testing (HCT) Training and Provided TOT training in HCT in favour of antenatal care (ANC), TB and STI clinic nurses
  • Technical support for the evaluation of the anti-retroviroal (ARV) drugs produced in Bangladesh
  • Technical support for designing a monitoring and evaluation and reporting system (MERS)
  • Review of HIV/AIDS surveillance system in Bangladesh and Support for the conduction of a yearly surveillance
  • Supporting World AIDS day activities

WHO current collaboration

  • Need assessment of voluntary counseling and testing (VCT) services in the country
  • Observation of World AIDS day
  • Evaluation of the country situation of HIV/AIDS prevention, care and treatment
  • Preparation of strategies and guidelines for equitable access to ARV drugs including diagnostic support for HIV/AIDS
  • Conduction of operational research on HIV/AIDS and STI
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