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HIV/AIDS Related Issues
package for HIV prevention
awareness about rights of
up to Reality
Bus Campaign in London to
AIDS Day to be Observed in
Goal Missed, but Effort by
U.N. Branch Is Praised
Education Can Be Creative,
ED: AIDS: The Strategy Is
Breeds on Complacent
Attitudes Among Youth
package for HIV prevention
Md Mozammel Hoque, Dhaka, 29 November:
HIV/AIDS has been well recognisd to
be a serious challenge all over the world. Despite
several efforts to address the epidemic, the trend of
HIV spread is still unbroken and this is more apparent
in poor resource setting countries. The HIV epidemic is
leading to significant impact on health, development,
and the economy, especially in the developing countries.
The HIV epidemic is growing very rapidly in South East
is still a low prevalence country for HIV infection.
However, there are reasons for huge anxiety. Inadequate
knowledge and education about HIV/AIDS has largely
increased the vulnerability. Existence of substance
consumption especially the injecting drug use,
commercial sex, high rates of sexually transmitted
infections (STIs), have made the country at higher risk
for HIV epidemic. The geographical location with its
close proximity to high HIV prevalence countries (e.g.
India, Myanmar, Nepal etc.), porous border at several
places associated with frequent legal and illegal
migration have increased the vulnerability. Moreover,
sexual violence against women, women trafficking etc.
are some of the important factors, which can add more
fuel to the risk for HIV. About one third of the
country’s populations are young people. In many of the
cases their lifestyle and behavioral practices (e.g.
substance use, unsafe sexual practices etc.) are very
much risky for HIV infection. The epidemic has already
reached the way to drive around in the country.
According to the 6th round of sero-surveillance
(2004-2005), the prevalence among the Injecting Drug
Users (IDUs) has already reached to 4.9% in central
region of Bangladesh, which is very close to a
concentrate epidemic. Therefore, it is the high time to
contain the epidemic.
Counseling and Testing (VCT) services – a wide-ranging
approach for HIV prevention.
prevention of HIV infection and care and support
services to the positive people and their partners and
families is very essential in HIV prevention strategies.
Voluntary Counseling and Testing (VCT) service is a
public health strategy aims to reduce HIV transmission.
It is a wide ranging approach that can provide people
adequate knowledge, can encourage people to voluntarily
participate to know their HIV status, and guide them in
planning healthy life style that could protect them from
the infection and prevent the transmission to others.
The VCT services develop an essential link with proper
care and support services in order to support the people
who need it. The psychological support provided by VCT
services guide the people to contain their stress.
People affected by HIV need counseling and testing
services for future planning (e.g. planning for marriage
and children), emotional support, medical services, and
other referral services. It improves the quality of life
and may play a key role in reduction of stigma and
discriminations relating to HIV/AIDS. Voluntary
Counseling and Testing services has been well recognised
as one of the few potentially effective and affordable
methods for reducing the transmission of HIV in the
of service delivery through VCT centers
VCT includes pre-test counseling, voluntary and
confidential HIV testing and post test counseling. The
person seeking his HIV status is appropriately counseled
before the testing for HIV (Pre Test Counseling). It
enhances the client’s mental preparedness for a test
result. The proper counseling enables the client
developing his/her mental strength in reducing the
stress for HIV positive status. The Pre Test Counseling
emphasises confidentiality. This specialised counseling
technique follows specified standard protocol. It
includes Pre Test Counseling, Voluntary Testing and Post
Test Counseling. Well-trained counselors provide the
counseling services at Voluntary Counseling and Testing
Pre Test Counseling includes the discussion about the
client’s current knowledge of HIV and the basic facts
about HIV/AIDS. The discussion is also done about the
reasons of the client for wanting the test. Moreover,
discussion about the potential benefit of either test
result is also done. It helps the client to plan his/her
life, change lifestyle, live positively, look after
health and not put others at risk. It also helps the
person to decide who would he inform and not inform
about his/her positive result, if necessary. The process
creates the environment where the client is enabled to
voluntarily give consent or request for HIV testing.
Counseling and Testing Centers (VCTCs) apply the Enzyme
Linked Immunosorbant Assay (ELISA) technology, which has
a high sensitivity and specificity of over 99% and
require no special equipment. After the test result, the
client is given the Post Test Counseling.
method of Post Test Counseling depends on the HIV
status. If the test is negative, the client is further
counseled for repeating the test after three months,
because of the window period, which may prolong up to
three months from the date of first entry of the virus
to human blood. The client is counseled further to
change the risky behavior and lead a healthy lifestyle,
which will reduce his/her risk for HIV infection. If the
status is positive, the client is assured and counseled
in such a empathetic and specified manner, which helps
the person enable to plan a lifestyle that can guide
him/her towards a productive life. Usually the client is
referred to a reference center to confirm the result by
doing a superior testing technology (e.g. Western blot).
The positive person is counseled for time-to-time
follow-up counseling sessions. If necessary he/she is
linked with the appropriate care and support services.
If the client desires to make his family and/or partner
known about his/her status, the family and/or partner
counseling also provided from the VCTC.
VCTCs link the services with the interventions such as
prevention of parent-to-child transmission (PPTCT),
prevention of sexually transmitted infections (STIs) and
prevention and treatment of opportunistic infections (OIs).
It also facilitates early referral to comprehensive
clinical and community-based prevention, care and
support services, including access to antiretroviral
formulates successful VCT services
of information, which is accurate and updated regularly
to reflect the changing situation, is important to deal
with the VCT services. For example, counselors need to
know the details, the latest findings and treatment
information to be able to provide support. The community
also requires information to raise awareness and know
what to fear and what not to fear. Good support services
and support network is also very important. The informed
consent, confidentiality, appropriate counseling, good
referral systems, adequate and sustainable supply of
kits and other logistics and quality control are the key
components for services to be ethical and effective.
Advocacy, programme networking, preparing communities
for VCT so that they understand its benefits, and
provides support for those testing positive is
essential. VCT uptake and acceptability will otherwise
be limited by fear of discrimination and stigma.
prevention and VCT services in Bangladesh:
is lacking in providing a comprehensive system of
complete range of voluntary counseling with testing (VCT)
services. However, government and some NGOs have
developed some VCT centers in Dhaka and other Divisional
cities. Though insufficient in number, the initiative is
praiseworthy. The number of government and autonomous
health facilities initiated to develop voluntary
counseling and testing centers (VCTCs) are, - Institute
of Epidemiology Disease Control and Research (IEDCR),
Mohakhali, Dhaka; Institute of Public Health (IPH),
Mohakhali, Dhaka; Bangabandhu Sheikh Mujib Medical
University (BSMMU), Armed Forces Institute of Pathology
(AFIP), Dhaka Cantonment, Chittagong Medical College,
Sylhet MAG Osmani Medical College and Khulna Medical
College. Government is planning to develop quality VCTCs
in different geographical locations having the
populations with high vulnerability towards HIV
infection. All the districts will be ultimately covered
by the VCT services in a phase wise manner.
NGOs also have established few but exemplary VCT
centers. Especially the ICDDR,B has established a
full-fledged VCTC at ICDDR,B, Mohakhali, Dhaka. It has
also branches in Chittagong and Sylhet managed in
collaboration with Marie Stops Clinic Society (MSCS)
Bangladesh. Few other organisations are also providing
VCT services, e.g. Confidential Approach to AIDS
Patients (CAAP) is operating one VCT center at Banani,
Dhaka. FHI Bangladesh has planned to develop a
substantial number of VCTCs throughout the country
during the next three years period through the project
“Bangladesh AIDS Programme (BAP)” funded by USAID.
However, quality control of all the mentioned VCTCs is
very crucial. Provision of anti retroviral treatment
(ART) or proper linkage to ART facilities is necessary
to incorporate with the exiting VCT facilities. Adequate
and continuous supply of commodities is very vital for
quality service delivery. Lack of trained counselors is
a big problem for the VCT services. NASP, FHI Bangladesh
and HASAB have jointly organised training programmes for
the counselors. However, it was not enough in terms of
the number of counselors trained and developed. More
training programmes are needed to amplify the number as
well as the quality for the future need.
of the risk factors for HIV infection is at an upsetting
level in Bangladesh. Being a low prevalence country,
containing the epidemic in the early stage is very
essential. The Voluntary Counseling and Testing (VCT)
services for HIV is now acknowledged within the
international arena as an efficacious and pivotal
strategy for both HIV/AIDS prevention and care. The need
for VCT is increasingly compelling as HIV infection
rates continue to rise, and many countries recognised
the need for their populations to know their sero-status
as an important prevention and intervention tool.
However, access to VCT services in Bangladesh like many
developing countries is limited. People’s
participation to receive the services is vital for
successful VCTCs. Many people are still very reluctant
to be tested for HIV. This reluctance is the result of
barriers to VCT, which are: stigma, gender inequalities
and lack of perceived benefit. A well-planned joint
effort of the government, Development Partners (DPs) and
NGOs is very important to establish sufficient quality
VCTCs in the country. The Non Government Organizations
(NGOs) should come up with more innovation to scale up
the VCT services through out the country.
writer, a public health specialist, currently works as
deputy programme manager in National AIDS/STD Programme,
to the Top
awareness about rights of HIV-positives'
28 November: Speakers at a discussion yesterday called
for extensive media coverage to raise awareness about
the rights of HIV/Aids patients.
HIV-positives are not an isolated segment of the
society. Rather, they have equal rights as patients with
other diseases, they added.
also urged the media persons to be more sympathetic
while publishing reports on HIV-infected people so that
they can protect themselves from stigma and
Internews Network in cooperation with the Unicef and the
USAID organised the discussion titled 'Bangladesh Media
Leadership Meeting on HIV/Aids' at a city hotel.
meeting was part of a programme initiative of UNAIDS
Asia Pacific Leadership Forum (APLF) on HIV/Aids,
according to organisers.
as the chief guest at the inaugural session, Information
Minister M Shamsul Islam said the role of media leaders
is crucial to making the people aware about HIV/Aids.
Abdus Salam, programme manager, National Aids/STD
Programme (NASP), and Shamsuddin Ahmed, an official of
Unicef, presented two papers.
the prevalence rate of HIV/Aids infections is low,
Bangladesh is highly vulnerable because of rapid
increase in the number of HIV-positives in neighbouring
countries, according to the papers.
to an official estimate, a total of 465 HIV-infected
persons were detected so far, but the number could be as
high as 7,500.
Rahan, editor of the daily Sangbad, presided over the
discussion while Iqbal Sobhan Chowdhury, editor of The
Bangladesh Observer, moderated it.
still hesitate to discuss the HIV issue in public, but
they should talk it more in order to reduce the risk of
HIV infection, said Maj. Gen. Matiur Rahman, chief
advisor to the National AIDS Committee.
Akhter, executive director of Ashar Alo, called for
reducing HIV stigma to prevent spread of the deadly
Quaiyum, joint editor of the Prothom Alo, Gaziul Hasan
Khan, chief editor of BSS, Apel Mahmud, deputy director
general of Bangladesh Betar, Shyamal Dutta, acting
editor of the Bhorer Kagoj, Naimul Islam Khan, editor of
the Amader Somoy, Rashed Chowdhury, editor of the
BDNews24, Mostafa Kamal, editor of the New Nation, Abul
Asad, editor of the Sangram, M Liakot, editor of the
Purbanchal, and Delwar Hossain Khokon, editor of
Loksamaj also spoke.
to the Top
up to Reality
25 November: Recent
surveys reveal that the number of injecting drug users (IDUs)
in Bangladesh is rising. What is more frightening is
that many of them are HIV positive. Indiscriminate
needle sharing and unprotected sex among the IDUs pose a
high risk of the virus spreading into the general
population. As the World AIDS Day approaches on
December1 SWM takes a look at the threat of an epidemic
in Bangladesh in the context of inadequate state
interventions and the efforts of a few organisations to
introduce sustainable methods to rehabilitate IDUs and
contain the spread
of the virus.
a farmer from Elaipur village in Rupsha upazila and his
wife were in for the greatest shock of their lives when
they took their sick son to Khulna Shishu Hospital.
Blood tests revealed that the infant was HIV positive.
This prompted the doctors to get blood samples from the
other family members. All of them - the father, mother
and two other children were tested positive for HIV. A
physician who knows the family, suspects that the mother
may have been infected with the virus when she received
six bags of blood 11 years ago during the complicated
delivery of her first child.
frightening tale gives a glimpse of the gravity of the
problem. First, of the complete lack of awareness about
HIV (Human Immunodeficiency Virus) and AIDS (Acquired
Immune Deficiency Syndrome) and secondly that we have no
idea about how fast and how widely it is spreading.
While sexual intercourse is the most obvious way for the
virus to be transmitted from one person to the other,
needle sharing between drug users has been found to be
the most common cause for the spread of the virus.
year, a survey detected a near HIV epidemic among
injecting drug users (IDUs) in a pocket of central
Bangladesh. The fifth round of HIV surveillance by the
Centre for Health and Population Research of the ICDDR,B
(International Centre for Diarrhoeal Disease Research,
Bangladesh) reports, "The HIV epidemic in
Bangladesh, from an epidemiological perspective, is
evolving rapidly. While still a low prevalence country
for overall HIV rates, a small pocket of IDUs under
second generation surveillance, has shown an HIV
prevalence increase from 1.4% to 4% to 8.9% (in one
locality) in the past three years." The prevalence
rate is what health experts consider a concentrated
epidemic in a particular social section. It also means
there is too high a risk of the epidemic fanning out for
the society to remain complacent about.
Bangladesh continues to remain indifferent to the
frightening report. Since the first case detected in
1989, only 465 cases of HIV infection were officially
reported until December 2004. Of the infected, 87 have
developed AIDS and 44 have died. On the other hand, even
back in 2002, UNAIDS estimated that some 13,000 adults
and children were HIV positive in the country, which by
now should have increased at least three-fold,
considering the upward trend detected in the ICDDR,B
survey. Explaining the chasm between the government and
the UN estimates, National AIDS/STD Program (NAP)
states, "Significant underreporting of cases occurs
because of the country's limited voluntary testing and
counseling capacity. The social stigma attached to the
disease is a further impediment."
we consider the five unfortunate members of the farmer
family, this is even more relevant. Many IDUs sell their
blood to get money to buy drugs, increasing the risk of
spreading the virus. As the NAP says, "Bangladesh
relies on professional blood-sellers to meet most of the
transfusion needs of its people" Referring to the
jump of HIV prevalence among a section of IDUs from 1.4
percent to 8.9 percent over just three years time, NAP
observes the virus can spread rapidly within the group,
then through their sexual partners, many of them sexual
workers and their clients into the general population.
are lessons for us to learn from what happened in
Vietnam and Nepal as a consequence of reluctance of the
authorities to intervene quickly in similar situations.
According to a November 2001 NAP document, "No drug
injectors in the northern Vietnam city of Haipong were
infected with HIV just two years ago. Now, HIV
prevalence in this group has risen above 60 percent.
Since new data confirm that drug injectors in Bangladesh
share needles even more frequently than they do in
Vietnam, similar rises are inevitable here at some point
in the future, unless needle sharing falls
at that time, in 2001, when the third round of sero and
behavioural surveillance on HIV infection found its
prevalence among IDUs to be 1.7 percent, brothel-based
sex workers 0.3 to 0.5 percent and floating sex workers
0.5 percent, NAP cautioned, "The information now
available should set alarm bells ringing for
at the end of 2005, the alarm bells should be clamouring
even louder. The latest Behavioural Surveillance Survey
(BSS) data indicates an increase in risk behaviour such
as sharing of needles and a decline in condom use in
sexual encounters between IDUs and female sex workers.
Around 70 percent of the IDUs routinely share needles.
The BSS data also indicates that the IDU population is
well integrated into the surrounding urban community,
socially and sexually, thus raising a grave concern
about the spread of HIV infection.
fifth BSS shows a large proportion of the IDUs to have
commercial and non-commercial female sex partners and
condom use is infrequent. A significant number of IDUs -
4.3-6.7 percent - has also sold blood over the last
year. Moreover, IDUs travel from other cities to the
capital to inject drugs, increasing the chance of
spreading the virus.
passing by the Dhaka Medical College Hospital (DMCH) one
cannot miss seeing a number of people looking like they
have just come out of hell. Their skin ashen, with
ill-health, they wear tattered dirty rags and sit around
in scattered groups, sharing a syringe or two to get
their daily 'fix'. A particularly dangerous practice of
the IDUs is called 'shooting gallery', says Iqbal Faruk,
a director of Crea, a pioneering rehabilitation service
provider to drug addicts in Bangladesh. "In fear of
getting caught red--handed by the police, they share a
large syringe to inject drugs very quickly. This
practice is particularly widespread in Rajshahi and also
in some pockets of Dhaka," he elaborates.
alarming aspect is the very high prevalence of Hepatitis
C (HCV) among the IDUs, which the NAP puts at 83
percent. NAP says, "This is comparable to levels in
countries that are experiencing a concentrated and
growing HIV epidemic." Hepatitis C causes damage to
the liver and can lead to fatal diseases such as liver
cirrhosis and liver cancer. The hepatitis C virus can be
contracted through transmission of infected blood or
body fluids by transfusions, needleshaving, sexual
intercourse or from an infected mother to her baby.
fifth sero survey also reveals that about 8 percent of
heroin addicts often switch to injectable drugs as an
alternative. Thus they too should be counted among those
who share needles in shooting drugs.
two months old, Modhu, a baby boy, lives in a
rehabilitation centre for drug addicts at Lalbagh in Old
Dhaka. He is actually lucky to be alive. His mother, an
intravenous drug user resorted to prostitution to
sustain her habit and was admitted at the centre in an
advanced stage of pregnancy. If she were not here, Modhu
might not have seen the light of life at all or might
have ended up forsaken on a footpath. His mother
certainly could not have borne the costs of a caesarean
or the subsequent complications of a premature baby. She
was also in no state to take care of a child, being
preoccupied with how to get her next fix.
was born in the small hours of October 2. "His
mother had been in labour since the previous
evening," says Lavlu, Crea-Modhumita rehab centre-in-charge.
"We took her first to Azimpur maternity centre. But
when the hospital staff learnt about her drug addiction
and her occuptaion, they refused to admit her. The same
thing happened when we went to Bangladesh Medical
College and Hospital. At last we managed to get her
admitted to Ibne Sina Hospital."
amniotic sac was ruptured, and it was a pre-mature
delivery at only seven and a half months of pregnancy.
The birth weight was low, too only 1.9 kg," pitches
in Dr. Baquirul Islam Khan, who left his prestigious job
as programme manager of Grameen Kalyan to manage the
Crea-FHI HIV Prevention Project. "So, we had to go
for a caesarean section and keep the child in an
incubator for several days. Then he caught
bronchopneumonia and we had to transfer him to Shishu
Hospital," he adds.
the woman returned to the rehab centre with the baby,
the 30 plus inmates including 11 women and the 25 staff
members felt a sudden shift in the environment. Two
months into its launching, the centre seems more like a
home than a detention camp. They decided to name the boy
Modhu and if any girl-child is born here in future to
name her Mita.
has become the brand name of a range of HIV/AIDS
prevention services such as the needle exchange
programme, drop-in and crisis support centres for drug
addicts, medical facilities for sex workers etc. These
services are provided under the IMPACT project of Family
Health International (FHI). IMPACT works with government
and non-governmental organisations (NGOs) at the
community level to strengthen the care and support
systems, to prevent HIV transmission and to promote
behavioural change among the high-risk groups.
fifth Behavioural Surveillance Survey found virtually no
change in the behavioural patterns of the most high-risk
groups between 1997 and 2004. This has shaken up all the
agents associated with HIV/AIDS, prevention and control.
The FHI and its partners including the government, CARE,
Marie Stopes and USAID have realised the urgency of a
new and more comprehensive approach to combat the
most of the government, NGO-run and private sector
clinical facilities used to offer short-term, usually
14-day, detoxification services to drug addicts
including the IDUs, leaving out a crucial follow up
rehabilitation. Detoxified patients, without having
psychological therapy, social and financial
rehabilitation, and counselling, went back to their
addiction, particularly those who had lost their means
of livelihood. Considering the new findings, IMPACT
early this year, decided to launch a completely free and
comprehensive package of physical, social and financial
rehabilitation for the drug addicts. This initiative
offered for the first time an opportunity for the
dirt-poor addicts to return to the social mainstream.
has contracted three renowned organisations Apon, Crea
and Ahsania Mission working with the rehabilitation of
drug addicts, to provide this service in Dhaka, which is
the most high-risk zone in terms of an HIV epidemic.
Preference is given to the destitute, IDUs and women.
The government, too, is going to expand its 40-bed
central treatment centre for drug addicts to a 250-bed
one, of which 100 beds will be for patients seeking
detoxification and 150 beds for rehabilitation. Of the
three IMPACT partners working with the Modhumita brand,
Apon will launch a rehab centre exclusively for female
drug addicts and Ahsania Mission for males only. They
are in the process of setting up the centres.
has already opened its centre at Lalbagh that tends to
both male and female patients. The patients are referred
by CARE drop-in centres but can also seek treatment
voluntarily, by themselves, Crea Executive Director
Tarun Kanti Gayen, a psychologist working for around two
decades in this field.
basic rehab process takes six months, followed by
support services, said Gayen. Of the six months, 14 days
are for detoxification, then three months for various
rehab therapies and training, and the rest are for
day-care services, followed by after-care. Again, the
detox service is available in three categories:
in-house, home and community detoxification. The last
two categories are particularly novel. Home
detoxification is most suitable for certain categories
of addicts such as women, elderly people and
service-holders, to whom taking admission to a rehab
centre poses the risk of getting stigmatised by society.
However, in home detox, the family members of the
patient have to be intensely involved in caring for the
patient. The patients also are required to go through
the rest of the programme at the centre, with leave to
stay at home only overnight.
community detoxification, on the other hand, the entire
community becomes involved by providing the
accommodation for a detox camp, volunteer staff, etc.
The Crea-Modhumita has already carried out a community
detox programme at Hazaribagh in the city, says Dr.
Khan. The October 14-27 programme held at the local
community centre started with 24 patients. The local
city corporation ward commissioner, Mujibur Rahman,
played a key role in arranging the venue, while a local
youth club came up with the volunteer staff. Of the
initial 24 patients, one had to be transferred to the
DMCH as his condition became medically critical and one
was expelled for violent behaviour. The remaining 22
successfully completed the course.
says the community detoxification method has proved to
be highly successful and sustainable in India,
particularly in the southern states. It is because,
after detoxification, the patients are helped to get a
job and more importantly are treated with compassion and
understanding by community members. Thus it also helps
eradicate the stigma and segregation attached to drug
addiction. This approach, Gayen noted, has the potential
to revolutionise the drug addiction and HIV scenarios in
Bangladesh, where the government, NGO and private-sector
interventions are either too meagre or too ineffectual
to make any real difference.
on the difference between the previously available
interventions and that of Crea-Modhumita, Dr Khan says,
"They did not link other essential psycho-social
services for relapse prevention, for changing
behavioural pattern and mindset, and for increasing
self-efficacy with detoxification, which we are doing.
After admission to the centre, we screen the patients
for sexually transmitted infection (STI) and provide
abscess management, bio-safety, counselling to the
patients and their family members, as well as vocational
present, patients get in-house training in block
printing, tailoring, embroidery and carpentry. Dr Khan
says the range of training area will be widened
gradually. Those who already have some kind of
vocational skills will be referred to higher training
institutes. "We will get the patients graduating
the course to form self-help groups and are trying to
get funds to provide them with micro-credit to set up
small businesses or enterprises so that they can survive
financially. We are also considering launching a sort of
recovery home for the women who have no shelter or
family or have lost it to drug addiction, to help them
stay clean," Khan adds.
of end-October, 38 patients including 11 women joined
the Modhumita course, says Tuheen, a staff member of the
centre, against the target of treating 475 in-house
patients a year. Half of them, he says, are IDUs. The
identity of patients who know they are HIV positive as
well as those who are found so in tests are kept
strictly confidential. They are completely free to
decide whether to get treatment and/or counselling or
not. The HIV/AIDS services are provided by Jagori of the
ICDDR,B while Marie Stopes helps treat the STI cases.
(not her real name) a patient, says that she has not
been taunted or harassed by the male-in-mates of the
centre. She was referred to this centre by a CARE
drop-in centre in September. After the 14-day
detoxification, she went home for a day and relapsed
when she heard her husband had married again. For two
days she lived her former life of addiction, but then
realised her mistake and returned to the centre to start
recovering once again.
was introduced to drugs at a very young age. "I was
married at the age of 17. My husband used to drink,
smoke ganja and take other stuff. We lived in City Palli.
I started to smoke pot with him. After
two/three years I began to drink Phensidyl and then
started taking heroin." To feed her addiction, she
started to steal from her mother and relatives' homes.
Every day, she needed at least 300 taka and sometimes
spent up to 1,000 taka on drugs. Eventually, she fell
into prostitution and injecting drugs with others in the
has a nine-year-old boy who does not live with her. Only
her mother may give her shelter now on the condition
that she stays off addiction and returns to normal life.
"I want to be good again, so that nobody can blame
me anymore. Then I will bring my son to me." She is
learning embroidery and tailoring, and hopes to make a
living from it someday.
the IMPACT-Modhumita drive, Apon, Crea and Ahsania
Mission together aim at rehabilitating at least 3,000
drug addicts in three years from now. But, considering
the huge number of drug addicts _ around 4600000 in the
country according to FHI estimates (including some 25 to
30 thousand IDUs) _ 3,000 is just a drop in the bucket.
The intervention appears even more inadequate as a
recent baseline survey by CARE in 20 districts reports
the tendency of drug injecting to be rising rather than
government must acknowledge the extent of the threat of
the spread of HIV. While the prevalence is higher among
marginal groups such as IDUs and sex workers; it is from
these groups that the virus will reach the general
populace because of lack of knowledge about the risks of
needle-sharing, unprotected sex and transfusion of
untested blood. Along with state interventions,
communities must take responsibility to educate its
members about HIV and take care of them when they are
The Daily Star Magazine, 25 November. www.thedailystar.net
to the Top
Bus Campaign in London to Stop AIDS
Hai, November 29: On
the occasion of World AIDS Day 2005, Students
Partnership Worldwide (SPW) and its co-organization
Students Stop AIDS (SSA) arranged weeklong programs. As
a part of the program, SPW and SSA conducted Eyeball Bus
Campaign at the premises of University of London Union.
Members of Bangladesh Advanced Students Alliance (BASA),
co-organization of CCD Bangladesh actively took part in
activists of SPW, SSA and BASA wore red T-shirts, held
long white box of eyeball and invited the pedestrians
and city commuters to draw attention of the world
leaders through their comments and signature to take
immediate step to ensure treatment for HIV/AIDS infected
people by 2010. They also played on drums and musical
tune round the bus to draw the attention of the city
people to express their solidarity with the humanitarian
demand for the AIDS vulnerable people.
others, Coordinator of CF Project in British Council, UK
Sally Anderson, Campaign and Network Coordinator of SPW
Finnuala Murphy, SSA Member Sahil Dutta and Katy
Athersuch and BASA Members A S M Anisur Rahman and A H M
Abdul Hai attended the campaign program with much
the 2-member BASA delegation is now working with SSA to
observe World AIDS Day 2005 in different cities of UK.
Under the Connecting Futures (CF) project, the British
Council is supporting this exchange visit of BASA in UK.
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AIDS Day to be Observed in US, UK
Hai, Sussex, 29 November: Students
Stop AIDS (SSA), co-organization of Students Partnership
Worldwide (SPW) chalked out elaborate program to observe
World AIDS Day 2005 in a befitting manner in the
premises of University of Sussex (US) in United Kingdom
(UK). The members of Bangladesh Advanced Students
Alliance (BASA), co-organization of CCD Bangladesh
actively took part in all the preparatory and
key-activities relating to the day in US campus in UK.
planning and weekly meeting of SSA was held at the US
Students Union conference room in the afternoon on
Monday. SSA members including Sahil Dutta, Katy
Athersuch, Kelly Zimbler, Rebecca Ashley, Romy Dervis,
Camilla Alfred, BASA members A S M Anisur Rahman Litu
and A H M Abdul Hai and UNISEX Representative Tom Borne
addressed the meeting.
expressed solidarity and commitment to work together to
combat HIV/AIDS considering it a global crisis for the
humanity. They also recommended developing more
communication programs to improve mutual respect and
understanding among the youths of two countries.
members expressed gratitude for the cordial hospitality
and sincerity of SSA members. In their speech, BASA
members focused on HIV/AIDS scenario and AIDS prevention
activities of BASA and other GO and NGOs of Bangladesh.
was decided in the meeting that SSA will arrange Red
Fair, Sex Quiz and music function ‘Let’s make
Eastslope Red’ in Library Square in the morning,
Candle Vigil in the afternoon and film show ‘A Closer
Walk’ in the evening on December 01.
BASA members also visited the main office of UNISEX in
the university campus in the evening and expressed
interest to work together to promote AIDS prevention
movement more in the concerned countries.
the 2-member BASA delegation is now working with SSA to
observe World AIDS Day 2005 in different cities of UK.
Under the Connecting Futures project, the British
Council is supporting this exchange visit of BASA in UK.
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of people in poor countries get sick and die from a
common tool for getting well: the hypodermic syringe. In
some countries, most injections are done with needles
that are reused without sterilization.
Twenty-one million people each year get hepatitis B this
way, two million get hepatitis C and 650,000 get
infected with H.I.V.
As third-world health problems go, this one seems
solvable. Single-use syringes, whose plungers break or
are blocked after first use, cost about 6 cents apiece.
Countries could simply follow the lead of Botswana and
Uganda and ban all other kinds of syringes.
But nothing is ever simple in places where health care
is disorganized and threadbare. The biggest problem is
that many poor countries are injection-crazy. For every
injection given as a vaccination, 20 are given as cures.
Many injected medicines are snake oil, and even
effective injections are mostly unnecessary, as a pill
would work just as well. But patients demand injections
because they think the medicine is stronger, and health
care workers like to give them because they can charge
It is hard for governments to change dearly held beliefs
about medicine. Dirty needles kill many years after a
shot. In some places, it took a health crisis to bring
progress. In Romania, people became aware of the problem
of unsafe injection after children in orphanages had
been given contaminated blood and vaccinated with dirty
needles, resulting in the infamous wave of AIDS
In Burkina Faso, a severe meningitis outbreak helped,
paradoxically, by producing an extreme shortage of
medicines and syringes. This led the government to
reform its medical-supply system. Small pharmacies
stocked with essentials including single-shot syringes
now exist in health posts throughout the country. From
1995 to 2000, the percentage of injections with reused
needles declined in Burkina Faso to 4 percent from 55
The most direct course is to ban reusable needles. But
in countries spending $10 a year per capita on health
care, 6 cents a shot is a lot when a traditional syringe
can be reused some 200 times.
The Safe Injection Global Network, backed partly by the
World Health Organization, is trying to help countries
develop educational programs for health care workers and
doctors. The Bush administration also works on injection
safety as part of its AIDS efforts overseas. But more
needs to be done, particularly since such a small amount
of money can save so many lives.
Sent by: Mariette Correa
Email: [email protected]
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Goal Missed, but Effort by U.N. Branch Is Praised
K. ALTMAN, 29 November: The World Health Organization's
failure to meet a goal of treating
three million H.I.V.-infected people by the end of this
year owes to inadequate international coordination and
lack of national leadership, a group of leading
advocates for AIDS patients said yesterday.
Although the health agency has said it cannot meet the
advocacy group, the International Treatment Preparedness
Coalition, credited it with bold efforts.
The world agency has missed its goal by more than a
millions more infected people urgently need treatment,
the group said in a report.
W.H.O., a Geneva-based United Nations agency, helped
antiretroviral treatment can be delivered effectively,
lives of hundreds of thousands of people, even in the
settings, the coalition said.
Still, efforts by the United Nations and nongovernmental
groups are unevenly coordinated and would benefit from a
more pragmatic strategy to meet their goals in treating
the tens of millions of people in need of antiretroviral
therapy, the report said.
Crucial to that strategy is "a much more systematic
setting goals, measuring progress, and assessing and
barriers" to providing AIDS treatment, the report
In citing a pledge by leaders of the Group of 8
countries to come as close as possible to providing
universal access to AIDS treatment by 2010, the
coalition said it would be a hollow promise unless
governments and international agencies learned lessons
from the World Health Organization's successes and
More effective collaboration among agencies and groups
countries, eliminating existing bureaucratic barriers
more money will be vital to meeting the G-8 goal.
The more pragmatic approach recommended by the coalition
includes country-specific strategies and goals with
dedicated timelines and milestones as well as clear
assignments of responsibility for specific tasks. Some
financing agencies have taken steps toward that
The coalition said its report was the first systematic
efforts to scale up antiretroviral therapy based on the
people living in communities in six of the countries
most devastated by AIDS: the Dominican Republic, India,
Kenya, Nigeria, Russia and South Africa.
The group found inadequate national leadership that
failed to dedicate enough resources or mobilize
government agencies; bureaucratic delays; procurement
and logistic challenges; a global system that did not
collaborate speedily and efficiently to address such
bottlenecks; inadequate and uncertain financing levels;
and pervasive stigmatization of people with H.I.V.
Critics say efforts to increase antiretroviral therapy
will not be
useful in the long-term if they fail to improve the
The report also criticized countries for missing
detect and treat tuberculosis and H.I.V., two diseases
strongly related, and failing to establish coordinated
The coalition said that President Bush's emergency plan
relief should deliver treatment to thousands more people
months and cite specific examples of how it is building
health care systems in its 15 target countries.
The coalition urged all countries that told W.H.O. they
wanted to be part of its goal of treating three million
people by now to provide detailed action plans to
improve their future responses.
"National governments must be the primary engine
for increasing access to care," the report said.
In Africa, the continent hardest hit by AIDS, countries
need to live
up to their commitment made in a declaration in 2001 to
percent of their budgets to addressing AIDS and other
In challenging countries and agencies to abide by their
pledges, the coalition said they could not set goals of
improved access to
treatment and then underfinance the response by billions
Efforts should include more than technical support
infected "people need to know how the drugs work,
why adherence is important and the risks of
resistance," Greg Gonsalves of the Gay Men's Health
Crisis in New York, and an author of the report, told
reporters in a telephone news conference.
In Russia, nongovernmental groups have made important
contributions in programs to prevent H.I.V., and some
have made innovative suggestions about how to scale up
treatment, said Shona Schonning who represented a group
of people living with AIDS.
Last week, the lower house of Russia's Parliament moved
to impose greater control over charities and other
private organizations. If the Russian crackdown affects
groups that are supporting efforts to prevent and treat
AIDS "it could be very damaging to scale up
antiretroviral" programs, Ms. Schonning said in the
Coalition leaders said they planned to meet with
"The delivery of antiretroviral therapy will only
be possible with a
revolution in global public health, which makes primary
care available to those who have never had it
before," the report said, and success in AIDS
"will pave the way for treatment of many other
diseases that are now left untreated."
The report is available online at
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Education Can Be Creative, Say Experts
LUMPUR, Nov 20 (IPS) - Many Asian countries now have
sexual health education in schools, but teachers often
focus on health and biology and leave out the very issue
they need to address -- sexuality, said experts at a
regional conference here, this week.
Teachers are wary of talking about sex with young people
because they are uncomfortable with the subject or fear
encouraging-- or being seen as encouraging-- youngsters
to have sex at an early age, says Hathairat Suda, senior
programme assistant with the Bangkok- based Programme
for Appropriate Technology on Health (PATH).
"(But) If you wait to talk about sex with your
children it might be too late, since your children might
be already at risk of reproductive health and sexual
health problems," Hathairat said at the 3rd
Asia-Pacific Conference on Reproductive and Sexual
Health, that ended Sunday.
Early education on reproductive and sexual health --
especially during adolescence-- was widely discussed
here, given that young people in Asia are having their
first sexual experiences earlier than ever and
information is needed to protect them from risky
However, in many Asian societies, sex is taboo for
public discussion, due to social, cultural and religious
Yet, groups are trying innovative ways of getting across
messages on reproductive health. In Malaysia, there are
television shows promoted by Marina Mahathir, daughter
of former prime minister Mahathir Mohamad, in the
Philippines there is the use of theatre and in Indonesia
there is lobbying by progressive religious groups.
It is about creativity and pragmatism. Indonesia’s
Jery Lohy says the programme he is involved with conveys
sensitive information about safe sex to Christian
youngsters but "we can’t say the word
‘sexual’, we just say biological or reproductive
In Sri Lanka, the United Nations Population Fund (UNFPA)
is trying out a pilot project on teaching sex education
to children from the first grade and building on these
sex-education messages in an appropriate fashion for
each grade level, thereafter.
"We start with health issues like cleanliness for
grade one and then add more messages in the upper grades
and finally talk about safer sex," said Asela
Ramjet Kakugampitiya, UNFPA’s monitoring and
evaluation officer. "However, we are not sure
whether we can talk directly about safe sex. Sex
education is a controversial issue in our country (Sri
When a candid teen manual on sexuality was published a
few years ago in Thailand, it drew the wrath of
conservatives, from academics to policymakers, who said
it promoted promiscuity and wrong values.
The furore showed that while it has become an option for
some schools to teach sex education, its implementation
has not always been carried out successfully. Sex
education classes in Thailand emphasise anatomy and
In Vietnam, sex education is part of biology class for
high school students and starting from sixth grade,
students learn about body parts and the reproductive
In Laos, there are no direct lessons on sex education
but biology classes in high school do discuss body parts
and the reproductive system. In Burma, there are no
lessons about sex education at all.
While local beliefs and culture can be a barrier to
intervention on safer sex, statistics cited during the
conference suggest a need for better information on
reproductive and sexual health at a young age.
One million women have died in eight Asian countries
from unsafe abortion, pregnancy or childbirth, according
to a just- released report on progress on the
reproductive and sexual health goals since the 1994,
International Conference on Population and Development (ICPD)
held in Cairo.
Millions more have suffered due to unsafe abortion and
childbirth and lack of access to quality health
services, added the study by the Kuala Lumpur-based
Asia-Pacific Resource and Research Centre for Women
(ARROW), covering Cambodia, China, India, Indonesia,
Malaysia, Nepal, Pakistan and the Philippines.
The failure of sex education is one of the causes of
unsafe abortion and other problems, says Rashidah
Abdullah, co-founder of ARROW and a member of its board
People need to understand that sex education is not only
about sexual intercourse and safer sex, but also about
life and reproductive health, campaigners stressed.
Haithairat listed six factors in sex education:
discussion of organs involved, relationships with
partners and other people, communication skills,
understanding of the socio-cultural context, acceptance
of the diversity of human behaviour and sexual
orientation and prevention and health care.
"All points should come together. If you know how
your body works and how you can protect yourself from
disease but you don’t know the level of your
relationships and don’t know how to communicate with
your partner for safer sex, it is not useful at
all," Haithairat added.
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ED: AIDS: The Strategy Is Wrong
Holbrooke, 29 November: Thursday is the 18th annual
World AIDS Day, a time for countless statements of
concern and commitment from world leaders, thousands of
commemorations and remembrances, and reams of
statistics. One important article has already appeared
on this page, by Jim Yong Kim, the highly respected
director of the HIV-AIDS Department of the World
Health Organization [Nov. 23]. After recounting the grim
3 million deaths in the past year alone, 5 million new
year, rising infection rates in nearly every part of the
world and an
admission that "good news is hard to find in the
new U.N. report"
Kim wrote that he was nonetheless "optimistic that
the epidemic can be stopped."
I respect Kim and admire his commitment, as well as that
of every foot soldier in this war. I share that
commitment. With respect, then, to my friends and
colleagues in the field -- most far more qualified than
I am I must nonetheless mark World AIDS Day with a word
of pessimism that they will not necessarily welcome. We
have to face the truth: We are not winning the war on
AIDS, and our current strategies are not working. Every
year since the first World AIDS Day, the number of
people affected has increased. The very best that can be
said is that we are losing at a slightly slower rate.
The huge, and very expensive, international effort has
saved the lives of a growing number of people. I have
seen some of the beneficiaries of these efforts
firsthand in places as remote as rural eastern
Uganda and it is inspiring. The international
assistance effort must be continued, indeed increased.
But as Kim acknowledges, "fewer than one in five
people at risk of HIV infection has any access to HIV
prevention information," and this must be addressed
with larger internationally supported programs. (But
remember, once a person is on the drugs, it's for life;
to stop taking them is to be hit with a mutant of the
original virus.) Until a vaccine is found -- and that is
probably more than a decade away we must focus on
prevention and treatment. Providing treatment is
essential, of course, but it is also a bottomless pit as
long as the disease continues to spread so fast.
As a strategy, losing more slowly is simply a recipe for
ever-more-expensive, disastrous and deadly failure,
which will require more anti-AIDS drugs at ever-greater
cost -- a modern version of the old story of the boy
with his finger in the dike. Moreover, as Kim points
out, current policies require "building and
strengthening health care systems in the developing
world." This is an essential long-term task with or
without the AIDS crisis, but one so daunting that
linking it so closely to stopping the spread of AIDS
only compounds the odds against reaching either goal.
Only effective prevention strategies can stop the spread
of AIDS. Yet it is precisely here that current policies
have failed most seriously.
In the long chain of actions required to stop the spread
attack on all fronts is necessary. But on one vital
front, the world
health community has been shamefully quiet for two
decades: testing and detection. Because of legitimate
concerns about confidentiality and the risk of
stigmatization, testing has always been voluntary, and
it has been systematically played down as an important
component of the effort.
The results are predictable and fatal: According
to U.N. figures,
over 90 percent of all those who are HIV-positive in the
world do not know their status. Yet there has never been
a serious and sustained campaign to get people to be
tested. That means that over 90 percent of the roughly
12,000 people around the world who will be infected
today just today! will not know it until
roughly 2013. That's plenty of time for them to spread
it further, infecting others, who will also spread it,
and so on. No wonder we are losing the war against AIDS:
In no other epidemic in modern history has detection
been so downgraded.
When I first suggested, about three years ago, that
detection was the weak link in the strategy against
AIDS, I was
sometimes criticized for ignoring human rights. Having
support of human rights for more than three decades, I
understand this issue and the passion it arouses. I have
met monogamous women who were thrown out of their homes
for a disease they got from their husbands, and people
who lost jobs and friends once their condition became
But the spread of the disease cannot be stopped, and we
cannot offer drugs to those who need them, unless people
know their status. That knowledge changes people's
behavior; many who learn that they are HIV-positive
behave more carefully, and they can act on the
information to save themselves and their family members.
Isn't this the most important human right of all?
Quick and reliable saliva and blood tests, which give
20 minutes, are available, increasing the opportunity
confidentiality. Some companies, such as the South
African diamond giant DeBeers SA and its affiliated
mining company, Anglo-American Corp., have started to
strongly encourage testing, using these quick and
confidential methods. But governments have been slow to
use the tests. In an important breakthrough, three small
countries in Africa Botswana, Malawi and
especially Lesotho recently moved from purely voluntary
testing to what is called "opt-out": Testing
becomes routine in certain circumstances unless the
patient opts out by refusing to be tested.
This seemingly small change has had immediate results.
Testing has increased dramatically. And with increased
testing has come increased awareness, less stigma, safer
sex practices and more people on treatment. Without
question, a reduction of the prevalence of HIV-AIDS will
follow. Yet the great and influential international
organizations fighting AIDS have not yet, for the most
part, embraced "opt-out" as part of their core
On this World AIDS Day, many empty words and promises
will be heard. I am gratified that additional money will
be pledged and, as a result, more lives saved. But
unless the current, failing strategy is changed, we will
have to spend even more money later, to treat AIDS
victims who might never have been infected had testing
been more widespread.
Numbers don't lie: Everyone agrees that the number of
people infected is still growing sharply, and not just
in Africa. Widespread testing is not a single-bullet
solution there is none but without knowing
who is HIV-positive and who is not, there is no chance
we can win this war.
The writer, a former U.S. ambassador to the United
president of the Global Business Coalition on HIV/AIDS,
nongovernmental organization, and writes a monthly
column for The Post.
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Breeds on Complacent Attitudes Among Youth
Suvendrini Kakuchi, Tokyo, 30 November: Eri Iwase, 19, a
pretty first year university student, says she is not
worried about being infected with HIV virus that causes
Acquired Immuno Deficiency Syndrome (AIDS), even though
she is sexually active.
''I just feel AIDS is a disease that has nothing to do
with me," she said, explaining that her studies,
part-time work, hobbies and meeting her boyfriend, keeps
her too busy to learn more about the virus that is
believed raging across Japan.
Such a complacent attitude, among sexually active young
people, represents the uphill struggle that Japan faces
in trying to control AIDS in a country where not only
the population but also the government, continues to
ignore the danger of the virus spreading.
Japan has over 10,000 officially known cases of
AIDS/HIV, low compared to other industrialised nations
but troubling because new infections reached a record,
1,165 in 2004 -- making it the only G7 country in which
new infections have been increasing since 1993.
Moreover, government statistics indicate about 40
percent of the new figures represent people in their
teens or twenties --a 24 percent rise from 2003. Condom
use has also decreased 20 percent in 2005, say doctors.
''Despite various programmes, we are finding it really
hard to penetrate the younger generation and already the
statistics show nearly half of 17- year-olds have
experienced sex," says Hideko Fujimori, who heads
Action Against AIDS, a small grass-root organization
involved in promoting protection against AIDS.
Fujimori attributes this situation to various problems.
He cited as key issues poor sex education programmes in
schools, the lack of frank discussion of sex, especially
between parents and children, and low financial support
from the government.
"When I visit schools to talk about HIV/AIDS, there
is a renewed interest among the students but that dies
down a week later. New measures to make it
"cool" to talk about AIDS protection is the
best way to empower children to help themselves,"
Fujimori is planning to launch a new project next April
where high-school students will be trained to develop
programmes geared to raise awareness.
Takuya Togawa, director of the AIDS program at the
Health and Welfare Ministry, acknowledges the lack of
progress in combating HIV in Japan.
''There are barriers in our current projects aimed at
reaching youth. We are requesting a larger budget from
2006 to strengthen AIDS awareness projects that will,
from now on, involve more activists rather than rely too
heavily on doctors and health centres manned by local
municipalities," he said.
Japan's AIDS/HIV budget is around 80 million US dollars
per year. Activists say a large part of the funds is
spent on research and treatment, leaving insufficient
money to finance protection programmes that are geared
specially to youth.
For instance, HIV testing centers manned by
municipalities also cover various other diseases and are
based on appointments restricted to once or twice a
week. Activists say that despite testing being conducted
on an anonymous basis, the formal atmosphere turns young
Dr Masaki Kihara, a well-known AIDS expert, has
developed sex education classes that incorporate social
issues affecting children such as lack of peer support,
problems with parents, and the importance of being able
to develop close and equal intimate relationships with
the opposite gender.
''My research has shown that freewheeling sexual habits
among youth usually stems from their poor personal
relationships. By being able to talk about these social
issues in class, we aim to help children develop
self-confidence that will protect them from risky sexual
Kihara's methods have found support among teachers and
parents who oppose explicit education in schools such as
condom usage, a major problem for advocates who see the
gap between attitude towards sex between he older and
younger generation in Japan as working towards the AIDS
crisis in Japan.
Kihara also hopes to tackle the lucrative sex industry
in Japan that employees young women, some in high
school, which he says is linked to the Japanese AIDS
Police reports this year indicate that the sex-delivery
business--where customers are offered services over
their mobile phones--has now reached more than 2,700
businesses employing around 500,000 people each.
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