Arif Ahmed (false name) is from a farmer family. In 2002 he managed to borrow money from different sources and went to a Middle Eastern country to work there. In 2004 he had to do medical test to renew his work permit. Right after that he was sent back to Bangladesh with a group of 10-12 people.
Arif heard a little bit that he had some kind of disease. A doctor in town near his home saw his medical papers and tests his blood. Then the doctor reported that he had AIDS and he is going to die.
When it was heard by all in the village, police and deputies came to his house but he ran away. After traveling so many places he reached Dhaka. Professor Dr. Nazrul Islam, chairman of the Virology department of Bangabandhu Sheikh Mujib Medical College saw him and sent him to a NGO who helps people with HIV virus.
By that time Arif became very weak and completely frustrated. But after getting treatment and advises he is better now. Now he is also working in that NGO. But it is true that people hardly get this kind of opportunity.
Some Big Worries: ‘Ashar Alo Society’ NGO is working on people who are infected by HIV virus with the vision to help them with mutual cooperation. Prevention of this disease is also their aim. Executive Director Habiba Akhtar has said to ‘Prothom Alo’, “There are very little fund to give treatment and nursing to HIV infected people. Infection can spread from them. If they do not get help and treatment would they come out to screen or become aware not to spread it? How we will be able to prevent this infection then?”
Others said, government says that there is enough money for this sector. But the government is just passing time to handover that money to the proper authorities. To prevent HIV/AIDS government has two big projects in its hand. But none of them have any sanction for the welfare of the HIV infected people.
On the other hand this year government’s risk test result says that infection was most on IDU. In Dhaka region, it has started as an epidemic. Yet only one fourth of the total IDU in the country is under HIV prevention program.
Women sex workers are one of the largest groups who are at risk of HIV infection. For the last two decades they have developed some “Self Help Organizations’ as a necessary part of their work. Tasnim Azeem, head of the HIV/AIDS section of international health service organization ICDDRB said that from various programs, some services finally reached to them. But to ensure their own personal opinion in their job is still neglected. She said, “If the sex workers can not establish their rights, they can never become successful over their clients to be bound to use condoms.”
To prevent HIV/AIDS among the at-risk groups, group members play major role as pair educator or field worker. They said that to prevent HIV/AIDS self-help organizations are also very important. Sometimes those organizations work with the renowned NGOs, still they hardly get funds.
On the other hand, although little work was done on emigrants but almost nothing is done on immigrant workers like Arif. This group was supposed to be included in government’s programs rather it was excluded.
Different research agencies are complaining that Bangladesh have past about two decades working on HIV/AIDS, yet there is a great deficit of awareness growth among general people and insufficient accurate information available to them. Even use of condoms, a safe practice which reduces the risk of infection at a significant level, is not increasing either.
Several donors including World Bank, government officials and NGO executives are looking at it with a different perspective. They expressed their opinions to Prothom Alo like this, ‘for the last 17 years HIV/AIDS infection rate stayed very low compared to neighboring countries like India and Myanmar’. They consider that as the success of works done to prevent HIV/AIDS in Bangladesh. But Dr. Azeem said there could have been much more work done on this issue if all the funds were properly utilized.
How much money, what kind of work: Prevention works on HIV/AIDS in Bangladesh is totally based on donation. Right now available fund for this sector is 12 crores and 60 lakhs US dollar.
Currently government is running two programs to prevent HIV/AIDS in Bangladesh. HAP is one of them. World Bank is donating 4 crores and DFID- a donor agency of UK, is donating one crore US dollar. With a fund of 5 crores and 20 lakhs US dollar this program started in 2000. But because of slow progress the donation came down to 50% in 2003.
On government’s second program, international organization GFATM- Global Fund for AIDS, Tuberculosis and Malaria, has given 2 crores US dollar. Aim of the program is to build and develop awareness among youngster about HIV/AIDS. Side by side separate treatment service for them will be available in 20 districts.
To coordinate all kinds of work on HIV/AIDS and on other sexually transmitted diseases in government and private levels, there is another organization which is National AIDS and STD Program (NASP). They informed that ADB (Asian Development Bank) has given 1 crore US dollar to local government ministry for this program.
Out of these, there are 1 crore 25 lakhs US dollar donation of USAID and another 20 lakhs US dollar from Germany. Several countries and some donor agencies also donate money directly for works on HIV/AIDS.
Although work has not started yet, government’s programs on health, nutrition and population sectors (HNPSP) up to 2010 has already got the grant of donation of 5 crores and 60 lakhs US dollar. Moreover, government has got the assurance of 4 crores US dollar donation from GFATM.
As Bangladesh is within the low infection rated countries, so prevention work is done on at-risk groups of population. More than 60% of HAP fund is for this purpose only. 34 NGOs are participating on implementing this. Another 74 NGOs are working on building awareness. Within HAP there is safe blood transfusion. Besides these, to develop awareness on people and to ensure safe behavioral act among people, broadcasting sufficient information and strengthen the organizational skill of NASP is part of their job.
This type of work will continue till December, 2007. Board of directors of HAP is UNICEF, WHO and UNFPA. Save the Children-USA is directing GFATM’s work through 17 NGOs and some private organizations.
According to NASP, there are 385 NGOs are working in Bangladesh to prevent HIV/AIDS. Questions rose among NGOs about the sincerity of the workers and efficiency of the NGOs are maintained or not to test the eligibility of getting work. Different sources, who did not want their names to be printed, complained that many inexperienced NGOs have got works. Chief advisor of health ministry Major General (Retd.) A S M Motiur Rahman has said, “NASP must be strengthened for effective observation and evaluation.”
Addiction through needles: According to government’s estimate there are about 40,000 IDU in Bangladesh. Among them only 9500 is under HAP. Work is done by CARE and Podokkhep NGOs.
CARE is working with IDU in Dhaka for a long time. Many researchers think if this work was not done, infection rate would have increased more. In new projects assured by HNPSP and GFATM, there are plans to work on another 10,000 IDU. Everybody is admitting that there is a need to work more on this in no time.
Risk among IDU is most as they share needles. To reduce this risk, one of the main work of the above two NGOs is to distribute needles and syringes among them. Head of HIV/AIDS section of CARE, Dr. Munir Ahmed has said to Prothom Alo, “Although we have the permission from the national level yet it is illegal to distribute needles for addiction. We are doing illegal works with the help of the government because we are getting good results. A supportive law is necessary for this.” He added, “To stop addiction with needles, many countries supply an oral supplementary addiction item. They have got successful results by encouraging oral addiction instead of addiction with needles to prevent HIV/AIDS.” Major General (Retd.) Dr. Rahman said, “We need to make a new law to bring and let use that oral addiction item in Bangladesh.”
Related NGO officials complain that sometimes police arrests street sex workers or IDU for nothing or drive them away from one place to another. This is also hampering their prevention work on HIV/AIDS.
No Fund, Work Closed: Last year, government’s risk-testing organization expressed worry about hampering continuing works for not getting fund on time. We were informed from several NGOs that after completion of HAP’s second project in June, Everything has stopped. For the third project of HAP, government came to an agreement with UNICEF on 16th October. But yet not received any money from donors.
Durjoy, a NGO, used to work on floating sex-workers in Dhaka and some other cities along with CARE with a separate fund from DFID. This year, Durjoy have got international award for its work. But as the contract ended in January, Durjoy NGO is almost closed and so does its distribution of condoms.
Deficit of condom supply is fairly common. People related to this matter informed that recently condom was completely unavailable for last 4 months.
Fighting of HIV/AIDS infected people: In HNPSP and GFATM’s next projects of government, there are provisions for treatment and care giving of 820 persons and 500 persons respectively. But exactly when these will be available, nobody knows.
HIV infected Arifa of a remote village in Khulna needs nutritious food and medicine. She gets help from 3 NGOs but still that is not enough. Another NGO ‘Mukto Akash, Bangladeh’ is working to help HIV infected people. Executive Director of this NGO M. S. Mukti has said, “We get projects for short term with little fund. So, we can not do much with this limitation.”
Habiba Akhtar of Ashar Alo informed, “Antiretroviral, a medicine which is needed at a certain stage of infection, is very expensive. Besides, including various infections, treatment cost for a single person is a lot.”
She added, among the government hospitals, only viral disease hospital in Dhaka admits HIV patients where they have arrangements for 6 beds in 6th floor. But nobody wants to go there. Because the room, toilets etc. are very dirty, elevator is out of function for a long time and doctors do not see patients regularly.
Professor Dr. Nazrul Islam uttered with frustration, “In 1990 when we got our first HIV patient in Bangladesh, since then we are saying that doctors and nurses have to be prepared. Their reluctance, fear has to be removed as the infected person will need both physical treatment and mental support at the same time. We have passed a long time after that and have got enough money for this purpose; but that preparation has never been taken.”
(Reports were submitted by Prothom Alo’s Biani Bazaar, Shalla, Cox’s Bazaar, Lohagara, Netrokona, Manikganj, Badarganj, Gaurnadi, Senbag, Raiganj,and Mongla’s reporters and representatives.)
Translated by: Mir Laila Ferdous
The Daily Prothom Alo, 04-12-06
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