The husband of Sumona Akhter of Gopalganj died of AIDS over two years back. At that time, she came to know that she was also an AIDS affected. The case of Sumona Akhter is not an isolated incident. In our country, there are other women and children who fell sick to the deadly disease.
AIDS remains a menace for mankind since the identification of a devastating immune deficiency disease in a young gay in USA in June 1981.
Bangladesh remained vulnerable to HIV epidemic due to the prevalence of behavior patterns and risk factors that facilitate the rapid spread of HIV.
According to experts, the level of HIV infection among the IDUs poses a significant risk, as it can spread rapidly within the group and then, through their sexual partners and the latter's clients, among the general population.
There is significant number of IDUs who sell their blood professionally. Bangladesh rely on professional blood sellers to meet most of the blood transfusion needs of its people. Lack of proper knowledge on HIV/AIDS is another high risk factor. HIV/AIDS prevalence and the number of AIDS cases remain low in Bangladesh , but they are on the increase in some risk groups.
According to publication of National AIDS/STD programme of Health and Family Welfare Ministry, the first case of HIV/AIDS in Bangladesh was detected in 1989. Since then, a total cumulative of 1495 cases of HIV/AIDS have been confirmed and reported till December 1, 2008 of these, 476 have developed AIDS out of whom 165 have since died.
Till December 2008, WHO/UNAIDS estimated that 33.3 million adults and children have been infected with HIV all over the world.
Women and girls arc disproportionately infected with HIV/AIDS for biological, social and economic reasons.
According to written publication of Dr Hasan Mahmud, Deputy Programme Manager, National AIDS/STD Programme, Director General of Health Services, throughout the world. unequal social status of women places them at higher risk for contracting HIV. Women are at a disadvantage when it conies to access to information about HIV prevention, the ability to negotiate safe sexual encounters and access to treatment for IIIV/AIDS once infected.
In accordance with these inequities, the HIV infection rate among the women is rising faster than the infection rate among men in different parts of the world. Women often cannot choose with whom or under what circumstances they have sex. Women and girls arc often forced to resort to sex work to support their families because they have no other income generating opportunities.
Women's risk is further exacerbated because they are physiologically 2 to 4 times susceptible to HIV. Young girls and adolescents, whose reproductive tracts are not fully developed, arc even more susceptible to STIs and HIV. Untreated STIs increase women's risk of HIV infection, said Dr Mahmud.
Quoting study report, Dr Mahmud said that girls and boys who are victims of physical and or sexual abuse during childhood are more likely to exhibit high-risk sexual behaviour later in life, and decreased ability to negotiate safer sex due to lowered self-esteem. Being infected by HIV/AIDS, women can transmit the virus to their babies before or during birth or through breastfeeding, said Dr Hasan.
Dr Mahmud said, in many cultures, male dominance is demonstrated and maintained through sexual coercion or violence. Women, who have been coerced into unprotected sex or raped, are more likely to be infected with H1V since rough, forced sex causes more lesions in vaginal and anal tissue.
Former Consultant Coordinator of National AIDS/STD programme Dr Yasmin Jahan aired a note of caution that every woman is at risk position regarding HIV/AIDS. She said women and adolescents are vulnerable to HIV infection for several factors. These are ignorance or inadequate information about HIV transmission and prevention, premarital sex, migration, sexual exploitation and abuse, commercial and non-commercial sex, low condom use, gender inequalities and lack of empowerment which reduce negotiating power of women during sex (use of condom). Injecting drug use (IDU), male-to-male sex, unsafe blood transfusion.
In Bangladesh most of the HIV positive cases are deported migrant workers, their spouse and children. HIV positive migrant workers are deported from most of the countries without receiving any counseling and back in home they infect their wives and outcome of which a HIV positive baby, said Dr Yasmin.
Clients of the sex workers are the bridging population they may acquire HIV infection during sex with most at risk population. She mentioned that high proportion of IDUs visit to commercial sex workers and in Bangladesh there is concentrated HIV epidemic (7%) among IDUs and which is alarming.
National Behavioural surveillance data shows that condom use among the female hotel and residence based sex workers is very low. These clients do not use condom during sex for
ignorance, non-availability or accessibility of condom which in turn increases the risk of HIV
infection. Sometime sex workers fail to persuade their clients to use condoms, as they have no negotiating power.
In Bangladesh gender inequality is a major factor along with social norms and culture which increases the chances of sexually transmitted infection (STIs), Reproductive tract infections (RTIs), maternal mortality, physical, mental and sexual violence and HIV. Most of the women at home are illiterate, lack power to negotiate or to raise their voice, to take decisions. Moreover, they are ignorant about reproductive health rights, national responses towards women empowerment and also the knowledge about HIV transmission and prevention. They usually by norms accept and respect all the actions and decisions made by their husbands.
In Bangladesh adolescent constitute one-third of the total population approximately 43 million. They are especially vulnerable to HIV & STIs because of their recent pubertal changes, low level knowledge regarding HIV and risky sexual behavior.
A Baseline HIV/AIDS Survey conducted in 2005 among youth under GFATM (Global Fund to fight against AIDS, Tuberculodis and Malaria) provided baseline information that includes young peoples knowledge of HIV, STIs, access to information and services, misconceptions about HIV/AIDS, premarital sex and use of condom, risk behavior and prevalence of STIs.
Survey data shows that only 2.2% male and 1% among female are aware of getting infected with H1V/AIDS. Poor knowledge level may turn to bring a disaster in the country unless awareness raising measure is taken. Condom use is also very low. Only 35% reported to have had used condom in the last sex act and only 25% parents, teachers and community leaders approve use of condom to unmarried youth.
Around 22% of unmarried males and 2% of unmarried females reported history of premarital sex. However, in more than 25% of cases, the sex partners were sex workers. Fifty five percent of youth with history of premarital sex reported that they had never used condoms. Among married youth, 7% had history of extramarital sex and the most common sex partners were sex workers (57%). Although availability of condoms is fairly high, social norms with stigma associated with purchasing condom are the major barriers to condom use by youth. Dr Yasmin called for raising awareness at all level in this connection.
(PID-UNICEF Feature)
