Building the momentum to prevent HIV

Abu Sayeed A large metallic gravestone was seen being engraved with the single word "AIDS," the chiselling sounded like a death knell. The disease has killed more than 25 million people between 1981 and 2007. HIV is treatable now if only diagnosed early. We can live. But the pandemic proved to be vastly greater in scale and scope that took the lives of many men, women, and children. World AIDS Day today brings together people from around the world to raise awareness about HIVAIDS and demonstrate international solidarity to face the pandemic. The day is an opportunity for public and private partners to spread awareness about the status of the pandemic and encourage progress in HIVAIDS prevention, treatment and care in high prevalence countries and around the world. Between 2011 and 2015, World AIDS Days will have the theme of "Getting to zero: zero new HIV infections; zero discrimination; zero AIDS related deaths." The ten goals for 2015 are: i) sexual transmission of HIV reduced by half, including among young people, men who have sex with men and transmission in the context of sex work; ii) vertical transmission of HIV eliminated and AIDS-related maternal deaths reduced by half; iii) all new HIV infections prevented among people who use drugs; iv) universal access to antiretroviral therapy for people living with HIV who are eligible for treatment; v) TB deaths among people living with HIV reduced by half; vi) all people living with HIV and households affected by HIV are addressed in all national social protection strategies and have access to essential care and support; vii) countries with punitive laws and practises around HIV transmission, sex work, drug use or homosexuality that block effective responses reduced by half; viii) HIV-related restrictions on entry, stay and residence eliminated in half of the countries that have such restrictions; ix) HIV-specific needs of women and girls are addressed in at least half of all national HIV responses, and x) zero tolerance for gender-based violence. The World AIDS Campaign focus on "zero AIDS related deaths" signifies a push towards greater access to treatment for all; a call for governments to act now. It is a call to honour promises like the Abuja Declaration and for African governments to at least hit targets for domestic spending on health and HIV. The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10 to 15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further. HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth and breastfeeding. HIV prevalence in Bangladesh is under 1.0 per cent, which means it is about three times lower than that of Washington, DC. According to government statistics, there were 2088 reported HIV cases last year, 850 AIDS cases and 241 deaths related to AIDS. It is very low in the general population, amongst Most at Risk Populations (MARPs) it rises to 0.7 per cent. In some cases it is as high as 2.7 per cent, for instance among casual sex workers in Hili, a small border town in northwest Bangladesh. Many of the estimated 2088 people living with HIV are migrant workers. The 2006 National AIDSSTD programme estimated that 67 per cent of identified HIV positive cases in the country were returnee migrant workers and their spouses. This is similar to findings from other organisations. According to the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), 47 of 259 cases of people living with HIV during the period 2002-2004 were identified during the migration process. Other data from 2004 (from the National AIDSSexually Transmitted Disease (STD) programme of the Ministry of Health and Family Welfare (MOHFW)) shows that 57 of 102 newly reported HIV cases were among returning migrants. While HIV prevalence among male homosexuals and sex workers has remained below 1.0 per cent, unsafe practices among drug users, particularly needle sharing have caused a sharp increase in the number of people infected. Measurements at one central surveillance point showed that between 2001 and 2005, incidence of HIV in IDUs (injection drug users) more than doubled - from 1.4 per cent to 4.9 per cent, according to UNAIDS. In 2004, 9.0 per cent of IDUs at one location in Dhaka were HIV-positive. Compounding the risk of an epidemic, a large proportion of IDUs (up to 20 per cent in some regions) reported buying sex, fewer than 10 per cent of whom said they consistently used a condom. In late 1996, the Directorate of Health Services in the MOHFW issued a National Policy on HIVAIDS. A high-level National AIDS Committee (NAC) was formed, with a Technical Advisory Committee, and an STDAIDS Programme Unit in the ministry. The NAC includes representatives from key ministries and NGOs and a few parliamentarians. Action has been taken to develop a multi-sectoral response to HIVAIDS. Strategic action plans for the National STDAIDS Programme set forth fundamental principles, with specific guidelines on a range of HIVAIDS issues including testing, care, blood safety, prevention among youth, women, migrant workers, commercial sex workers, and STDs. While earlier commitment was limited and implementation of HIVAIDS control activities was very slow, recently, Bangladesh has strengthened programmes to improve its response. Around 200 non-governmental organisations (NGOs), working with STDAIDS, have formed a network, and about 50 are actively engaged in HIVAIDS-related activities, particularly in working with marginalised and hard-to-reach groups. Despite all efforts AIDS victims are increasing day by day. So, vigorous action is required to prevent an epidemic in Bangladesh. Key tasks ahead are as follows: a) to scale up behavioural change activities and health promotion interventions for high-risk behaviours and vulnerable groups; b) to expand advocacy and awareness among the population at large through multi-sectoral agencies; c) to promote social acceptability of condom use and ensure adequate supply and access; d) to reduce discrimination against those infected with HIV, or groups engaging in high-risk behaviours, through appropriate advocacy, policies, and related measures; e) to strengthen government's capacity for programme implementation, monitoring and evaluation; f)) to promote NGO capacity for programme planning, implementation, monitoring, and evaluation; g) to strengthen mechanisms for collaboration and coordination within and between government, the non-governmental sector, development partners, and other stakeholders. Dr Abu Sayeed is an officer on special duty at the Directorate General of Health Services. He can be reached at email: ishtisayeed9@gmail.com