AIDS/HIV situation in Bangladesh: A Looming Threat
Mohammad Sorowar Hossain
Research Fellow, National University of Singapore
Email: sorowar@tll.org.sg

Recently, a report on the AIDS cases came out in the daily newspaper According to that report, more than 13 thousand people are carrying HIV in Bangladesh and the experts have classified the AIDS situation as concentrated epidemic. Ironically, the government was downplaying the actual AIDS cases, just informing only 282 and taking credit from the international community! But in reality, the actual figure would be far higher than the reported one. Due to stigma and fear of discrimination HIV infected people are so scared to come forward with their diseases and ask for treatment and health care. It can make people hide their HIV status amidst fear of rejection from loved one. HIV testing is another area where discrimination is evident. Voluntary HIV tests and counseling is often limited, not well known, inaccessible or only in urban areas. People may also be deterred from getting tested because of laws that restrict an individual’s confidentiality. So it is impossible to get the exact HIV status in Bangladesh.

AIDS posing a challenge to the mankind already claimed the lives of more than 23 million, killing more than 3 million people every year. According to WHO report 2002, an estimated 42 million people throughout the globe currently is living with HIV. Another 70 million men, women and children may die of AIDS in the next 20 years and 25 million children will be orphans by 2010.

African human civilization is threatened to extinction due to HIV. 28.5 million people are HIV positive, in which about 30% of the total adult population having this deadly virus and 7000 people is dying every day (BBC report). In South Africa one in nine people are infected with HIV. In Botswana and Namibia about 40% of the total population is fighting with AIDS. In the Bahamas 60% of deaths among children under the age of five are from AIDS and in Zimbabwe the corresponding figure is 70%. AIDS is shaking the very foundations of the African progress. East African universities has reported that an average of 2 to 3 deaths occurs per month among the faculty members while university of Nairobi reported an average death rate of 2 stuff members per week. In Batswana, 35-45% of all teachers are infected. HIV also infects the African economy. A study of African countries suggests that for countries with HIV/AIDS prevelance levels above 20%, GDP is estimated to be 2.6 percentage less per year. Recently it has been reported that last six months 220,000 people died due to AIDS in China. (Channel NewsAisa, October 4, 2003)

Dr. Robert Gallo first discovered HIV, the causative agent of AIDS in 1984. Nobody knows the origin of HIV. Scientists believe that it might have come from African green money or laboratory accident. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo. How he became infected is unknown. HIV destroys the body’s defense systems so that they can no longer defend the body against infections and other disorders. AIDS patients are severely suffered from at least 29 opportunistic infections, which are rarely seen in healthy people. The life expectancy after acquiring the disease is only up to five years.

There are some myths associated with the transmission of the disease. The HIV infection is not acquired (or transmitted) via mosquitoes, food, water, toilet seats, swimming pools, sweat, tears, clothing and a handshake. HIV is mainly transmitted through sexual intercourse (vaginal, anal and oral) or through contact with infected blood, semen, or cervical and vaginal fluids. This is the most frequent mode of transmission of HIV worldwide. Blood transfusion or transfusion of blood products (e.g. obtained from donor blood infected by HIV) injecting equipment such as needles or syringes, or skin-piercing equipment and mother to child are also the route of transmission. Homosexual activity is one of the most talked about issue for the rapid transmission of AIDS because anal sex (practiced by Guys) can cause the rectal bleeding and thereby allow easy transmission of HIV. At the beginning of the epidemic most AIDS/HIV cases were limited to homosexual people.

The curatives for HIV are still elusive. Scientists are working hard around the clock to devise an effective vaccine against HIV. But the fact remains, however, that virus is so smart, disguising the body’s defense systems by rapidly mutating its genetic material, which foils the vaccine developmental efforts. Currently some antiviral drugs have been marketed which are highly costly and toxic for the body but can not cure the AIDS at all, just lengthen the life expectancy of the patients. For instance, the cost of one treatment of AZT alone is around $8000 per year, which is not affordable to general people.

Why is the HIV situation so alarming in Bangladesh?

We are used to feel proud that we have conservative society where moral climate is better than that of other western countries. But the real scenario is quite terrible, unbelievable. Everything what we call “obscene activities” are going under curtain. Moral values especially among the young generations are aggravating very fast. Although there are only 14 well-established prostitutions (two of which were evicted from Narayangaon) all the residential hotels (ranging from high to low class) in major cities are thriving on sex business. All river ports, seaports are well known for sex affairs. Just after evening all the parks in the Dhaka city are considered to be sex venues for low class people. Important studies of the sex industry identified large numbers (1,70,000 including 8,000 to 10,000 hijra) of generally non-literate sex workers (SWs) whose customers represent all segments of society. Female SWs have an average of 2-5 clients a day, making the number of clients about half a million men a day. In addition, ‘floating prostitutes’ are present in large number but the precise distribution and prevalence are unknown. It is suspected that large numbers of young and mostly single female textile and garment workers may also supplement their low wages by occasional prostitution.

Sex outside marriage might be more widespread than traditionally acknowledged. Documented sexual practices include premarital, extramarital and male-to-male sex particularly among youth. For example, some studies indicated a high percentage of (around 50%) youths to have experience of sex before marriage and occurrences of induced abortions among women. 60% of long distance truck drivers have sex with commercial sex workers about twice a month without any knowledge of HIV/AIDS. Extra-marital sex appears to exist in rural societies and in particular where husbands are absent for long periods.

Police: Sad to say that our law enforcers (police) are very corrupted and morally degraded. It would be wise to include them under high-risk groups for HIV spreading. In Africa, police and armies are badly affected by AIDS. The ministries of defenses of several African countries have provided the UN with values of 20-40% infection rates among the African soldiers, police. In some countries numbers as high as 60% were reported. In our country sex workers are used to allege “they (police) abuse us at night, treat us inhumanely and do not pay money for sexes with them. Threats from HIV/AIDS are not big problems for us. The police violation is the prime concern for us”

Barber shops: in our country it’s a very common practice to use same blade or special type of knife (Khur) repeatedly without sterilization. This practice is also common in our neighboring countries. Even WHO experts are focusing very little on this issue. But this would be one of the major factors, which may increase the risk of spreading of HIV infection where the HIV epidemic is looming at large.

Looks unfamiliar but in reality, homosexual activities are widespread in our conservative society. It has been reported that, Bangladeshis are very active on global gay scene. But those still in the closet oscillate between confusion, guilt and fear. Since some gay activists in Bangladesh are highly educated, once in while, foreign education is being cited as reason for being gay. A gay Australian Professor Garry Dowsett, who wrote a research a paper, Men Who Have Sex With Men In Bangladesh, as part of an HIV-related research project, describes a complex pattern of sexual activity – teenage male prostitution in Dhaka parks, a custom of sex between male cousins and brothers-in-law, a tradition of transvestism. According to Dr Safiul Azam, associate professor of Sociology at Dhaka University, homosexuality is increasing at the rate of 3.5% a year. Demonstration of homosexual tendencies for short periods is quite common in our society. Those practicing are not ostracized, although if caught, are ridiculed. Like in other societies gay relation flourish in dormitories, barracks, labor colonies, prisons (very common) and hostels, and authorities are hard pressed to keep them secret. Male prostitutes are available in most towns. In rural areas, homosexuality is generally considered something that young people do for fun and some elders may do in secret. But almost no discussion can take place on the subject, even with the threat of HIV/AIDS looming over Bangladesh and gays being identified as one of the most vulnerable groups

Sexually transmitted diseases (STDs) are a major factor in the spread of HIV infection and serve as indicators of low condom use and other high-risk sexual behaviors. Studies have shown high rates of STDs in various populations. In 1989, syphilis rates of 56% and 39% were found among floating and institutional SWs respectively. In 1997, 54% of 980 SWs gave a history of present or past symptomatic STDs. Recent reports indicate high levels of STDs amongst various other groups. Condoms are not generally the preferred method of contraception. According to a survey conducted by Governmental organizations, about 98% of the floating prostitutes don’t use condom while 96% of the hotel sex workers. Two third of the rickshaw pullers and truck divers never use condom. Furthermore, knowledge of condoms as a means to prevent STDs is very low. Approximately 200,000 required units of blood is currently largely (70-75%) provided by professional blood donors of whom approximately 20% are positive for hepatitis B and/or syphilis. Available data from Client Monitoring System of Department of Narcotics Control and other research reports shows that prevalence of injecting drug use (IDU) is on the rise. Most injecting drug users (IDUs) in Bangladesh share needles. In some areas the professional injectors use one needle for many IDUs. There are estimated 25,000 IDUs mainly in Dhaka, Rajshahi, and other towns including border areas. Prevalence of STDs is quite high among drug users in general. It’s a matter of great concern that our neighbouring countries- India, Barma and Nepal are considered to be the epicenter of HIV epidemic in this region. Currently, about 4 million people in India are having HIV.The epidemic of HIV/AIDS in India is following the same pattern as that of sub-Saharan Africa in the 1980s and it could become just a devastating unless preventive action is taken now. A report from CIA’s National intelligence Council projects that the number of people infected with HIV in India will jump to 20-25 million by 2010. The Bangladesh economy relies on more than 1.5 million migrant workers mostly from neighboring countries, including truck drivers, businessmen and laborers.These migrants, who spend much of the year away from their families, are known to be at increased risk of contracting HIV

Reasons behind the degradation of moral climate

Religion and the family have immense impact on the nation’s moral, but their influence is declining. Education should have positive effects on morals, but it is failing to fulfill that responsibility. We are the second largest Muslim nation in the world. But what proportion of the Muslim population is practicing Islam? Frankly speaking we are Muslim by name. Only a very few portion of the population is practicing the religion. Islam including all the regions condemns all sorts of illegal sexual behaviors and emphasizes on the moral values. Prophet Muhammad (SWT) has said, “ when sin afflicts people and they publicize it, then Allah sunjcets them to ailments unknown in their forefathers.” (Reorted in Sahi Tirmizi)

In our country moral climate is getting worse mainly due to available Indian movies, cable TV and pornographic films. In major cities educated (school, college and university going) young generation is also badly affected by Internet where pornography is easily available. These days, getting excess to cable TV is very easy and cheap. Most of the channels display filthy programs often targeted to the teenagers and younger children. Even shows touted as “family friendly” are filled with sexual innuendo, moral perversion, homosexuality and every combination of dysfunctional families that you can think of. VCD shops are so wide spread that you can find every nook and corner of the towns and even in the villages. All the shops are usually used to display the Indians VCD but porno VCDs remain under the self. Worth mentioning, last year I went to my village where there is no electricity and most of the people are illiterate. I was agape to see the VCD shop! Our government or political leaders are indifferent about the moral degradation. But leaders of some ASEAN countries (Singapore, Malaysia) have restricted the cable TV and banned porno films. Our government must take bold steps to prevent moral degration otherwise a bleak future is awaiting for us.

Religion is the key to curtailing the HIV epidemic

Only education and awareness will not prevent HIV epidemic. As we know, USA is the most civilized industrial nation in the world. But studies show that HIV infection rate is still high. Moreover, other sexually transmitted diseases (STDs) are also increasing at an alarming rate. The annual incidence of syphilis is 130,000, gonorrhea 1.4 million, chlamydia 4 million, pelvic inflammatory disease 420,000 and genital herpes about 500,000. Muslim societies in love with Western life style are also catching up. Another important point needs to mull over that emphasis on condoms give a false impression about the safety. FDA study showed that new codoms had breakge rates of up to 9% and there was a 38% leakage rate of HIV-size particles (AIDS virus is one-fifth the size of the sperm) in the condom tested. So condoms are not totally risk-free to prevent HIV infection.

As muslims, we are fortunate to have in our culture and way of life the basic essential elements of an effective solution. Decency, modesty and virtuous sexual morality are vital factors in controlling the virus casuing AIDS epidemic and its spread. Figures published by WHO on the spread of AIDS in the world show very clearly that Islamic values and traditions, although not fully adhered to or respcted, represnts a strong and effecive means of prevetion against the spread of the virus in the muslim countries. Rates of infection in muslim countries are far lower than those in non-muslim ones. Infection is also much lower amonst Muslims living in non-Muslim countries. This fact should not prevent us, however, from opening our eyes to see problem that is growing amonst us.

Blaming certain groups also allows societies to avoid responsibility of dealing with the epidemic. This denial can be dangerous. Government may hide cases, fail to gether accurate data or not care for people with HIV/AIDS. Officials may use figures of detected cases rather than estimated cases to downplay the magnitude of the epidemic in the country. People at risk may be denial. They may assure a false sense of security by believing only “ outsiders” or marginalized groups can become infected. Stigmatizing an AIDS patient as being sinful or deserving punishment serves little purpose. Besides the fact that many AIDS patients contracted the disease without being sinful, stigmatizing AIDS patients actually further promotes the spread of the disease.