Afia (given name) spends her days lying on a ragged bed. She is virtually undetectable on it. Her dreams- her own little girl will grow up and stay healthy. Both Afia and her daughter are carrying HIV virus which causes AIDS.

About 30-35 years back, Afia’s family went to India. She grew up there and got married. Her husband used to work at a distant location. But soon came back from work with illness. He died before her daughter’s first birthday.

Afia herself was also frequently suffering from dysentery, hemorrhoids and fever. Once she came back to her home country (Bangladesh) without a penny. Earlier this year, when she went to a hospital in Khulna for treatment, HIV virus was detected in her blood.

I had a talk with Kamruddin (false name) in a neighboring village. His wife and one of his three children died in AIDS about six months back. He himself and the other two kids are also infected with HIV virus. His wife took six bags of blood from a government hospital while delivering her first child. It is assumed that this family got the virus from this source.

‘Ashar Alo Society’ is one of the two NGOs which have been developed under the constitution of helping HIV infected people on the basis of mutual cooperation. Since 1998, a total of 398 HIV infected people have become member of this organization. Executive director of the organization Habiba Akhtar has said to ‘Prothom Alo’ “number of member is increasing. This year we have got 107 new members.”

Habiba informed that most of the members are returned migrated laborer and their wives and children. Most of them are of above type as many Bangladeshis are identified with HIV infection since 1990. But the reason behind the high percentage of infected migrated people is different. They are bound to test their blood for HIV infection.

Unsafe sexual relationship, sharing needles and syringes during addiction, taking in blood before test, using non-sterilized machineries and appliances during medical treatment- all these risks are common in Bangladesh. Moreover there are deficits of actual information and awareness.

Warning sign of Epidemic: Bangladesh government is conducting a survey since 1998 among the ‘Population groups at risk of infection’ by yearly blood testing and behavioral monitoring. According to the blood test the percentage of HIV infection among Injecting Drug Users (IDU) was 4.9 last year in Dhaka region. The outcome of the test of 2005-06 will come out this Friday i.e. today (01 December, 2006). But it is reported from various sources that this year the rate of infection among IDU has increased like concentrated epidemic. Overall infection rate is still low among the groups under test – less than one percent.

If the infection rate reaches five percent among the people at risk then it is called ‘concentrated epidemic’. This is the warning sign of widespread infection. If one percent of the total population of a country is infected by a HIV virus, then it is considered as an epidemic.

Within the governmental risk-test groups- IDU, male and female sex workers, homosexual males, transsexuals and heroin addicted persons are included. Besides them, there are rickshaw-pullers, truck drivers, truck workers, port workers and the regular companions of sex workers- through whom HIV infection can spread out in the whole society.

But the migrated workers are not included in this test. Blood test program is directed by ICDDRB on behalf of the government, a non-governmental medical service provider and research institution. Dr. Tasneem Azeem is head of the HIV/AIDS department of this institution. She has said to Prothom Alo, “they are part of the general people. We have to work in a different way regarding their risk. Another source of hidden risk is some sex workers who work from their own home. Their total number is sufficient enough to consider as risk. We even do not know about high-class or middle-class society.”
Those who are being observed in this test are more or less under the treatment of fighting with the virus program. Dr. Tasneem thinks, although there are weaknesses, this test is still giving almost accurate picture regarding certain groups under this program.

Chief Advisor-HIV of Health and Family Planning Ministry Major General (Retd.) Dr. A.S.M. Motiur Rahman has said, “For the last seventeen years HIV infection in our country stays low. In this situation we have to focus on those groups who are at higher risk. But this year IDU situation warns us that we can not stay cool. We have plenty of risk.”

Different aspects of risk: A patient who is under treatment in KRIA NGO located in old Dhaka has informed to the reporter that he continued his addiction for the last 12-13 years through needles. He used to stay in streets, shared needles and syringes with friends. It is regular among IDUs. In 2002 Risk-Testing workshop of the government in Dhaka, this behavior was watched within 58 % people amongst fighting with the deadly virus program and it is also found that 71% people go to sex workers without condoms. Most of these males have wives at home.

According to the government statistics, there are 40000 IDUs in the country. Among them only 9500 persons are under treatment to fight back the situation. Two NGOs are working on this under government programs. CARE is one of the two. They have conducted research works among IDUs in Dhaka since 1998. CARE HIV program executive Dr. Munir Ahmed has said, “We need to work more on this and has to be fast.”
Dr. Ahmed also informed that in Manipur, a bordering state of India with Bangladesh, HIV infection rate rose from 0 to 50%within one year (1990-1991). By 1997 it jumped to 80%. Same thing happened in Katmandu of Nepal. None of these two places had proper protection program. Planners and programmers have completely ignored the duties that needed to be done.
According to different researches, total number of sex workers in Bangladesh who work in brothels, streets or in hotels is within 60,000 to more than 100,000. Again according to the Risk-testing programs, sex workers of Bangladesh get most clients and use of condom is least among them. Also, they are found with high rate of Syphilis which alerts us about the risk of HIV.

Number of infected persons: Government of Bangladesh has announced in 2004 that there are around 7,500 HIV/AIDS affected persons in Bangladesh. Last year UNAIDS has reported that this number is 11000. At that time govt. was able to detect only 658 HIV infected persons amongst which 134 got AIDS and 74 of them died. In Khulna 16 HIV/AIDS affected members run their own program ‘JION Bangladesh’. Md. Shahidul Islam is with them. He told,” HIV has spread a lot. Many have kept it as secret.”

Dr. Sayed Md. Al Amin who is also a specialist in HIV has been practicing in Khulna and surrounding areas since 2002. He has informed that, till now about 70 HIV affected persons have taken treatment and advise from him directly and indirectly. More than 50% of them are from well-off or rich family. There are four families among the treatment taker.

All of the 137 member of a NGO that works with the vision to fight back the deadly virus, ‘Ashar Alo’ are from Sylhet region. Head of Skin and sexual diseases of Sylhet’s Osmani Medical College Dr. Sirajuddin have given treatment to 15 HIV patients in addition with his expertise related regular patients in last five years. He says that some other doctors are getting such patients.

Former Head of Skin and sexual diseases of Chittagong Medical College, professor Dr.A. Q.M. Sirajul Islam is seeing HIV patients for last 15 years. Earlier he treated 11 fishermen of Myanmar who were captured here. He has seen 61 Bangladeshi HIV patients in his own chamber. Out of these 61 persons 26 have died (about 43%). Among the rest 35 patients, most of them are from upper middle class families. Besides them, he is seeing 79 patients of Ashar Alo.

Another NGO known as Confidential Approach to AIDS Prevention-CAAP has tested 3000 blood samples in Dhaka for HIV possibility since 1997. They have found 149 HIV infected persons (4.996 or 5 %). Total number of HIV infected members in Dhaka of Ashar Alo and Mukto Akash (another NGO with the same vision as Ashar Alo) is 112 and 100 respectively.

Rising out of sight: Prof Nazrul Islam, Chairman of the Virology department of Bangabandhu Sheikh Mujib Medical University-BSMMU is working on HIV/AIDS since 1985. He said, “I would say, we are in great danger. Do we really know the overall real situation of our country? Researches result that either before or after marriage people have sexual relationship with more than one companion. Migrated workers, middle or higher class population, residents of bordering areas with India and Myanmar and fishermen and boatmen in sea staying out of the risk-testing programs”.

Last year UNAIDS has reported that India has 57 lakhs HIV positive population. Myanmar has 3 lakhs 60 thousands. HIV has already turned to an epidemic there. People of Bangladesh have regular communications with these two neighboring countries through border areas both legally and illegally. In last year’s risk-testing program, part time sex workers were tested in three bordering regions. Women living near Indian border often go to other side of the border to sell sex.

Advocacy advisor of UNAIDS Lazina Muna has said, “We are saying low infection may be because we are testing risk repeatedly within the same groups of people. Perhaps we are not focusing at the proper place. We have to have or create the opportunity where general people including the migrated people would voluntarily test their blood for HIV possibility. Those who are already infected should get proper care and treatment – which have been neglected. Also, as we are concentrating on some special groups, society has identified them and is condemning them. As a result people are tending to hide their diseases. So, the risk of spreading the infection is increasing. And so does the suffering."


Translated by: Mir Laila Ferdous
Newspaper: The Daily Prothom Alo
Published on: 01-12-2006