World AIDS Day: icddr,b works to tackle HIV epidemic in Bangladesh

icddr,bs programme for HIV and AIDS has worked with multiple community-based groups to gain access to vulnerable populations at risk of HIV infection, and to provide them with high-quality sexual health and other services as well as with the Bangladesh government to generate strategic information to guide programmes. This commitment to relationship building reflects wider national and international networking that has made an important contribution to limiting the HIV epidemic in Bangladesh.

Bangladesh is officially categorised as a country with a low HIV epidemic, with HIV infection less than 1% among key populations at risk of HIV. In part, this reflects the country’s early recognition that HIV is a potentially major threat to population health – it established a National AIDS Committee in 1985, four years before the first HIV infection was detected.

Dr Tasnim Azim, former director of the centre for HIV/AIDS at icddr,b  recognised the threat posed by HIV, and particularly the need for data to guide evidence-based interventions. Programmes were set up to provide services to vulnerable groups, including sex workers, men who have sex with men (MSM) and people who inject drugs, and attempts are made to ensure that these programmes are guided by evidence.

However, gathering of surveillance data which is crucial to national programming is often delayed. Working in partnership with the Government of Bangladesh’s Institute of Epidemiology and Disease Control Research (IEDCR), Dr Azim received funding from UNAIDS to carry out the first national surveillance exercise, in 1998, to map the prevalence of HIV. The relationships developed with NGOs enabled Dr Azim and her colleagues to access otherwise difficult to reach populations in the field – at sites such as drug injecting sites in public venues, brothels and on the streets – and to reach stigmatised groups.

 

C BY-NC-ND 2.035,000 sexual minority people are receiving HIV 

Photo: Trinn Suwannapha / World Bank. CC-BY-NC-ND 2.0

Currently, around 35,000 sexual minority people are receiving HIV prevention services through 66 health centers established across 43 districts in collaboration with Bandhu Social Welfare Society (BSWS) and Light House (LH). Based on achieving targets set under the performance based funding model and overall efficient grant management, the Global Fund has rated this project with highest grant rating as A1 since its inception in 2010.

Dr Sharful Islam Khan, head of programme for HIV and AIDS, infectious diseases division (IDD) of icddr,b says “Our Global Fund project has provided the opportunity to translate findings and evidence into programming with efficient grant management and capacity building initiatives of the NGOs of Bangladesh and assisted the GOB to continue an effective national response to HIV and AIDS.”

The programme received financial support from The Global Fund to Fight AIDS, Tuberculosis and Malaria, and was implemented in collaboration with the National AIDS and STD Programme, the Director General of Health Services, and the Ministry of Health and Family Welfare of Bangladesh.

 

Returnee migrant workers: an important  but missing population group in Bangladesh

In a cross-sectional study of patients at HIV testing and counseling clinics in Bangladesh, 75% of those who tested positive for the chronic infectious disease were either at one point a migrant worker or the domestic spouse of a migrant worker. Out of a total of 8973 individuals in this study, 558 (6.2%) tested positive for HIV, including 33 children. The risk factors identified for HIV included ever having worked in the Middle East, rural domestic residence, being married, older age and longer duration of migrant work.

These findings therefore provide new evidence for targeting health services and HIV prevention efforts at migrant workers and their spouses in a non-discriminatory way. However, these data is not without limitations, says Dr Azim. ‘The data currently available on returnee migrants is mostly derived from the HIV testing centres, and does provide a true picture of the prevalence of HIV in the relatively large population group’.

To address this gap in information, a cross-sectional study was recently conducted among a random sample of 297 returnee migrant men and women living in the rural area of Matlab, Bangladesh. Given the high level of stigma associated with HIV and the resulting reluctance to get tested, a rapid home based diagnostic test kit (OraQuick) was utilised and testing with counseling was provided at the village homes. Only one individual was found to be HIV positive, suggesting that the overall prevalence may not be high.

 

HIV/Aids Test. Photo: Bordecia34. CC-BY 2.0

 

Opioid Substitution Therapy (OST) for the People Who Inject Drugs (PWID) in Bangladesh

icddr,b is currently engaged in a project to prevent further spread of HIV among people who inject drugs (PWID).  In this regard, OST interventions are being implemented by icddr,b in collaboration with GOB and other relevant stakeholders.  

Methadone is a long-acting, orally administered synthetic opiod drug which is used as a pain reliever. It produces effects similar to morphine, heroine and other opioid analgesics, but in a milder fashion . During OST, it is expected that one will not take any other opioid drugs except Methadone, when given in optimal doses. Its goal is to improve the health status and psychological and social wellbeing of the opioid-dependent person.

Limited scale up of OST has occurred since 2012 in the country, with assistance from the Government of Bangladesh through health sector programs and the Global Fund. At present, there are five OST clinics operating in Dhaka, four of them are located in Drop in Centres (DICs) for PWID and one at the Central Drug Treatment Centre (CTC), Department of Narcotics Control where approximately 750 PWID are receiving methadone.

At the CTC where the OST programme has been continuing for more than six years now, the retention rate is 75%. Analysis of data from the OST project shows that of those PWID who have continued with OST for two years, there has been significant improvement in all aspects of their quality of Life, mental status and frequency of HIV risk behaviours (unsafe injections and unsafe sex).

Dr Sharful Islam Khan, says ‘Given the positive experiences from the current OST programme in Bangladesh, it is evident that OST is effective among PWID in Bangladesh in reducing HIV related risk behaviour, psychological distress and in improving quality of life.’

The staff members of the Programme for HIV and AIDS and other colleagues of icddr,b will be participating in various activities of the World AIDS Day 2016 in Dhaka Bangladesh - performing free HIV screening tests and  Behavioural Change Communication (BCC) materials.

AWR

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