Mankind confronts several fatal diseases from time immemorial. Nothing seems to be comparable to AIDS. AIDS has broken out in almost all countries- developed and developing including Bangladesh due to carelessness in our day to day lifestyles.

As per late 2005 estimates, nearly 25 million people died of AIDS over last 25 years. HIV/AIDS is considered the major causes of deaths of global population aged between 15 to 59 years. The estimates of late 2004 states that till now 14 million children are orphaned because of AIDS. Everyday 14 thousand people are getting affected with HIV virus, 50% (of them) belonging to 12 to 24 years’ age-group.

HIV/AIDS has spread over Asia like an epidemic. In 2005, around 8.3 million people were affected with HIV virus. 520 thousand died of AIDS in Asia alone in 2005. Amongst the adult females, 2 million were affected.

India is a neighbouring country of Bangladesh. In 2003, there were 5.1 million people who were HIV affected in India alone. Notwithstanding, HIV/AIDS prevalence amongst the adults is estimated at less than 1% of the population.

As per prevalence studies amongst the at-risk population in Myanmar, 54% injecting drug users, 37% female sex workers, and 8% of the STD affected people tested positive. UNAIDS estimates in Myanmar about 2% pregnant women are affected with HIV virus.

Julia Ahmed, Deputy Executive Director of BWHC talks. . . . . . While we are working for awareness raising, we have put much emphasis on that AIDS is more a sexually transmitted disease, but we need to also consider that AIDS is a blood-borne disease as well. In the context of Bangladesh we need to acknowledge this fact very much. Because, everyday we require a good quantity of blood for medical treatments, particularly for the pregnant women. Recently it is observed, pregnant mothers, who need blood during their deliver, when they collect blood from blood-banks, they are getting infected, and their children could easily then get infected.

AIDS is a grave concern for Bangladesh. Because, Bangladesh shares common border with India and Myanmar. AIDS is spreading unexpectedly in these countries. HIV/AIDS prevalence is not properly measured till now in many Asian countries for poor and inadequate testing and surveillance system.

Bangladesh identified its first HIV/AIDS case in 1989. Since then, HIV/AIDS prevalence has not been increased much as happened in other neighbouring countries. Till 2005, total 658 persons tested positive. 44 of them died. Most of them have died of tuberculosis.

The govt. estimates of 2005 states that positive people number around 7500, while the UNAIDS/WHO estimates reports around 13000 are carrying HIV virus.

Prof Nazrul Islam of Virology Department of the BSSMU talks. . . . . . In Bangladesh HIV/AIDS prevalence is very low. The basis of this demand is that Bangladesh govt. is running the sentinel surveillances for last 6-7 years. Commercial sex workers, injecting drug users, people visiting STDs clinics, MSM and Hizra (Hermaphrodites) being amongst the most-at-risk population are included in the surveillance. The study, sero-surveillance, says the prevalence is low, it is less than 1% amongst the sample of them. Only one group amongst them is showing gradually increasing prevalence. They are injecting-drug users (IDUs) and they are from Dhaka only from a few locations. But, other groups of the IDUs’ from elsewhere of the country are not showing that increasing trend. But with this low prevalence status, we can’t stay contented. We have STD prevalence at a very high level (amongst general population). If HIV virus is introduced into these STD affected people, HIV/AIDS will spread all on a sudden like flood-water.

HIV/AIDS prevalence is comparatively very low in our country of 140 million people. However, high internal migration, lack of awareness and knowledge about HIV/AIDS transmission, commercial sex-trades, untreated sexual diseases amongst the sex workers, use of un-sterilized syringes in drugs and blood or medicines injecting or collecting, untested blood transmission and collection can aggravate the HIV/AIDS spread scenario. Refusal to use of condoms (in penetrative sexual activities) and collection of bloods from commercial donors are risky.

Religious practices and family bondages and responsibility through marriages may contribute to the low transmission of HIV/AIDS in Bangladesh through sexual intercourses; however irregularity and ill-governance of the blood transmission and transfusion system may cause HIV/AIDS to spread like an epidemic.

Prof Nazrul Islam of Virology Department of the BSSMU talks. . . . . . Now we see apparently a very low level. We may feel good, but we need to be careful. But there are reports that in some families in a south-east district in Bangladesh, all family members are affected with HIV/AIDS. And nothing very specific information or the history could be gathered about these families. Some says from blood transfusion they get infected, first the mother and then children and later all the family members got infected. From these districts we need to collect data and pay attention to these findings.

In developed countries, nearly 94% blood is collected from the voluntary donors. 39 countries in the world have reached 100% target of their blood collection from voluntary donors. In our country this rate is only 0.4%, what meets only 2% of the required blood estimated based on our population size. In our country we need around 375 thousand bags of blood in a year.

Dr Md. Hanif Uddin, Deputy Programme Manager of NASP talks. . . . . .AIDS is primarily spread in 3 ways- one of them is ‘through blood exchange’. In order to prevent infection of virus through blood exchange, Bangladesh Govt. is very much concerned about blood transfusion, and is taking necessary pre-cautions. We have 98 centres where each bag of blood is screened and tested for HIV before delivery. More 100 centres are being set up soon. This is under process. You know now-a-days we have several non-govt. clinics who are providing medical and treatment services and who need to transfuse blood. Iin order to ensure such procedure of checking every blood bag before transfusion not only in govt. run centres, but also in other non-govt. clinics, centres and hospitals, we have enacted the safe blood transfusion act in 2002 which was approved and passed into the safe blood transfusion law in 2000. Other Non-govt. centres need to comply with this law. We urge all to follow safe blood transfusion requirements. We have established the National blood Council and district level committees. Not only do we need to make laws, but we need to enact and abide by this law as well. Accordingly we are taking steps so that people know about these and do practice. There are 98 centres, and more 100 will join these, but both in govt. and in non-govt. arrangements, everywhere blood needs to be screened, that we will ensure.

HIV/AIDS incidences amongst the drug users who inject drugs using syringes are alarmingly increasing. Now the prevalence stands at 4.9% which is close to a concentrated epidemic. Another study says these people are engaged in both non-commercial and commercial sex. Many of them are married and do not use condoms.

Anonymous blood seller talks. . . . . . I need heroin, I have monies anyway, but I could not arrange. Heroin was not available. One person suggested me to use the ‘sui’ (needle/syringe) instead. He said it would work as a substitute. If I take syringe, I don’t need heroin any more. I got used to using the syringes. I was unaware that sharing of syringe will spread diseases like HIV/AIDS. My diseases will pass on to others and others’ diseases will infect me, if I share my syringe or use other’s syringe. I was not aware. CARE tests my blood and informs me that I am infected. I was terrified. I was requested to be careful and not to share syringes. I become conscious. And I don’t share my syringe or use others’ syringes.

In capital city Dhaka, most of the drug users are youths. The injecting drug users are closely related with the community for both sex and blood sale. This is why the greater population runs a risk of infecting with HIV/AIDS. Adolescents and younger population are also turning into one of the most vulnerable groups.

Anonymous blood seller talks. . . . . . Sometime before I sold blood. I cant say how much, but not very much. I was very vulnerable, only then I decided to sell blood. I had no food, I need to pay for my ‘maal’ (drugs). I sold blood.

Unless we reorganize and make effective blood transfusion facilities in service in Bangladesh, HIV/AIDS can not be prevented only through campaigns for safe needles and syringes. Even knowledge on HIV/AIDS infection due to use of unsafe syringes do not bar these people to use other people’s used syringes or needles.

Julia Ahmed, Deputy Executive Director of BWHC talks. . . . . . It is matter of great hope that our Govt has put much emphasis on the safe blood transfusion and is taking up many activities besides awareness raising one. Blood is being tested for HIV/AIDS. Also voluntary blood donation is being promoted.

Blood is the indispensable element of body for life. For health for millions, we need a huge quantity of blood, safe blood. However, most of the blood donors are commercial donors and they are drug users. Testing them for HIV/AIDS is difficult. Therefore, those who are taking this blood remain at risk.

Yasmin Reema, Panos Fellow, Comilla talks. . . . . . I work in Comilla. In district hospitals, the provision of safe blood is the most challenging task for work to prevent HIV/AIDS spread. Commercial blood sale is widespread. These commercial donors change their names and donate blood very frequently even before less than three months’ period. In the district hospital, we need around 220 bags of blood everyday, while we have a supply of 63 bags from the voluntary donors, only 30%. Other than the hospital authorities, the relatives of patients who buy blood or commercial blood donors who sell blood need to be careful and cautious. It needs to confirm that the commercial blood donor is not a drug user.

In Bangladesh, testing of HIV/AIDS and its treatment facilities are limited. Counseling and testing facilities are available only in a few big cities. The medicines for STDs being difficult for procurement in govt. hospitals, the implementation of the HIV/AIDS policies are becoming very challenging.

Julia Ahmed, Deputy Executive Director of BWHC talks. . . . . . It is also a matter of great hope that our Govt. is emphasizing much on Safe Blood Transfusion (SBT) and has taken up a SBT programme, started regular screening. Voluntary blood donation is also promoted much, instead of professional blood donation. Voluntary blood donors have come forward, now increased by 70%. Govt’s project titled HAPP that works through NGOs includes a strategy of ‘harm reduction’. Syringes and needles are provided under this programme. Drug users are provided with sterilized needles and syringes. It deserves mention here, some people argue that by providing syringes to these drug users we are in fact promoting drug abuse, this is not true. In fact it works to the contrary. In Australia and in some other countries, the strategy proved good, drug use does not increase, rather it is noticed that the HIV prevalence rate has declined. Another important issue is that we also need to be careful about health service providers’ safety- they are vulnerable at needle pricks, cuts and in their work with equipment and machinery. We must ensure universal precaution, not only in Dhaka city rather in everywhere in the country, at the grassroots level where there are medical facilities. If this is ensured to such an effect, we can control HIV transmission through blood transfusion. Also we need to consider that public private partnership. Bangladesh Govt. is making such partnership which is good. Red Cross societies, Sandhani and Rotary are working jointly with the Govt. They run programmes amongst the youths around safe blood and voluntary blood donations. People should be provided with safe blood, they need to be involved. Here Govt. and other stakeholders need to ensure that involvement of people. That will be the most important factor and our next immediate responsibility to effect that involvement.

Whole world is counting up relentlessly HIV/AIDS affected people. Also people across the countries are working together to invent the effective treatment and medicines against HIV/AIDS. Every state and its people should join this campaign actively. We need a strong national campaign against this epidemic.

Dr Md. Hanif Uddin, Deputy Programme Manager of NASP talks. . . . . .AIDS is not only a medical or treatment problem, AIDS is a medico-social problem. To fight back AIDS in Bangladesh and in every state so people from all strata need to participate. We need community participation. We are glad our people in Bangladesh are aware and have come forward. We all will continue to work together.

AIDS is not a health concern only. Civil society, you, I and we all have the responsibility to fight back this disease through making the greater population aware about HIV/AIDS.