The Red Ribbon of Hope

In its third National Strategic Plan for HIV/AIDS 2011-2015, the Government of Bangladesh finally included the provision of treatment next to the strengthening of prevention, coordination and information sharing. Given that the Government provides treatment, the Swiss Red Cross revised its programme strategy on HIV/AIDS for Bangladesh with the aim that by 2015 the patients of CAAP on ART support will be fully integrated in the Government programme.

This approach strengthens the scope of the health system as well as it fosters an integrated approach to HIV/AIDS.

Her first two deliveries were conducted by a caesarean section. By then she was still HIV negative. When she was in her sixth month in her third pregnancy, she visited CAAP where her husband was registered as a person living with HIV. She was discovered as being HIV positive. The day she started labour, the CAAP team took her to a private hospital for delivery. Despite the agreement between CAAP and that hospital to admit HIV positive women, the doctor refused to admit her. In anguish they turned to a public hospital, which also refused to assist her due to her HIV status. Then CAAP took the patient to the third hospital, a public one, where she was finally admitted. A healthy baby was born. However, she was made to leave the hospital quickly, because she was HIV positive. This case study shows that people living with HIV are still struggling to receive adequate health services in Bangladesh

Prevention

The first case of HIV/AIDS in Bangladesh was detected in 1989 and currently with an estimated rate of 0.1 to 0.2%, the prevalence is low in comparison to other countries in the region (Myanmar with 0.7% and India with 0.3%) according to WHO/UNAIDS. From early on, the Government endeavoured to keep the HIV infection rate low through prevention programs.  Its major role has been in drafting policies, assuring coordination and regulation, and implementation of country wide HIV/AIDS awareness programs. To complement the efforts of the government, a large number of NGOs are actively working on HIV and AIDS, primarily in prevention.  CAAP is one out of three National NGOs that raises awareness in the community since 1996. Secondly CAAP negotiates with recruiting agencies to be able to give information to departing migrant workers related to HIV prevention. Partnerships are established with medical check-up centres/pathological laboratories that transfer HIV positive people to CAAPs clinic for treatment and health care.

Counselling

Access to voluntary counselling and testing services is still limited and very few Bangladeshis are aware of their HIV status. CAAP along with other development partners provides voluntary counselling and testing (VCT) to people who are willing to disclose their status and rapid test to confirm the diagnosis. From January 2009 till December 2012 CAAP conducted 2,994 VCTs.  A ‘hot line’ exists and information is given to people who call and have HIV/STI related questions and concerns.  A fully equipped laboratory provided 9,887 tests from 2009 to 2012 that included various biochemical tests for example related to sexually transmitted infections (STI). Laboratory services have been extended to other organisations over the years and UNICEF and the two national NGO’s Mukto Akash Bangladesh and Ashar Alo are referring their clients for pathological tests. 

Treatment

It is estimated that in Bangladesh around 7,500 people (UNAIDS, 2012) are in need of treatment while only 852 are receiving ART. According to a recent progress report (WHO, 2011) Bangladesh has not moved closer to the universal goal of achieving access to ART by 2015 even though this is part of their National Strategy. Bottlenecks are the lack of finance for ARV treatment for all the HIV/AIDS cases, limitation of management skills of government bodies and bureaucratic processes within various governmental departments.

CAAP was the first one to providing ART for HIV positive people and AIDS patients in Bangladesh in 2005 with support of SRC. Currently CAAP and two other National NGOs provide ART to people living with HIV/AIDS and collectively they are providing ARV medicine to these 852 HIV infected patients.

Complete adherence to ART is the key to successful therapy and counselling sessions are organised for the patients in order to share the importance of continuing ART drugs.  To prevent mother to child transmission any new-born baby is given milk substitute for a period of two years. Till to date no baby was found HIV positive when tested after these two years of milk substitute. CAAP encourages people with HIV to live a healthy life as that has been proven to show positive effects on the health status. In addition caregivers/family members receive training in home based care.

In order to check drug adherence and status of the patients, the computerised database is a great asset to monitor the ART patients and react immediately on defaulters.  

Can there be a Bangladesh without AIDS?

Even though Bangladesh is (still) a low prevalence country, increasing labour migration, a high prevalence among people who inject drugs and high levels of prostitution increase the likelihood of HIV infections.  The fact that only 10 % of the positive people which require treatment, actually get it, enhances the danger of transmission.

Major gaps were also found in the knowledge and awareness about safe sex among the population aged 15 to 49 years. A national survey in 2008 found that they lack knowledge and awareness about HIV and that many are engaged in risky sexual practices while having limited access to reproductive health information and services. A majority of the people surveyed (90%) had heard about HIV/AIDS but their level of knowledge of the disease was low. Only 38% of the people surveyed could correctly identify two or more routes of HIV transmission and only 40% could identify two or more routes of prevention (The World Bank, 2012).

The role of men and women in Bangladesh society is another important factor to concern. Around 35 percent of the women diagnosed with HIV get infections from their male partners. In this highly male-dominated society, men exercise their power to influence women's sexual and reproductive health choices. Therefore, involving only women is not enough to prevent HIV (The Daily Star, 21^st November, 2011).

In addition, a lack of biosafety and correct sterilization procedures for syringes and unsafe blood transfusions are further important risk factors for HIV in Bangladesh.  

The Red Ribbion of Hope 

The still low prevalence rate is a window of opportunity in Bangladesh, if bold action from the government in cooperation with the non-governmental sector, development partners and other stakeholders can be launched in a coordinated and efficient manner. An important step forward has been taken since December 2012. The government of Bangladesh is currently supplying free drugs to the previous mentioned number of 852 people living with HIV/AIDS through three national NGOs and drugs will also be made available at five public hospitals.  For 2013 the government plans to assist 1100 people and by 2014 there will be 3’300 people on ART. However, more and immediate action is needed to address the remaining 50% of HIV positive people in need for drugs.

Next to the treatment, key tasks include the provision of comprehensive care, support & treatment for people living with HIV through public health facilities. This requires reduction of stigma and discrimination against people living with HIV/AIDS through appropriate advocacy, policies, and related measures.

Actions are required in an increased effort of prevention among young people, scaling up behaviour change activities and health promotion interventions for key populations and empowering men and women to jointly take decisions on reproductive health choices. 

As result of all the interventions we hope for more people fearlessly disclosing their HIV status, we hope for all positive people to receive ART and that no HIV positive pregnant women will be going to a hospital in vain.  That is The Red Ribbon of hope.

* Letitia Kleij, RN, OT, MSc. works as Country Representative of Swiss Red Cross, Bangladesh. Email: Letitia.Kleij@redcross.ch

*Tuhin Samaddar, M.A, B.S Ed. works as Monitoring and Advocacy Coordinator of Swiss Red Cross, Bangladesh. Email: tuhinsamaddar@gmail.com