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HIV/AIDS in Bangladesh
26 November 2010, 18:00 PM
Target of universal access to treatment Is yet to achieve
Dr Md Rajib Hossain
Although the number of people living with HIV/AIDS in Bangladesh is not high, the country has failed to ensure antiretroviral therapy (ART) for the treatment of this small figure. According to a recent progress report by World Health Organisation (WHO), Bangladesh has not moved even closer to achieve the universal access target of ART. Experts identified limited services given only by NGOs, social marginalisation, lack of human resources, diagnostics and other health systems bottlenecks as the key factors behind this.
In order to lessen the prevalence of HIV/AIDS, United Nations member states in 2006 committed to the goal of universal access to HIV prevention, treatment, care and support by 2010. Although there is a 13-fold increase in ART coverage worldwide over six years, only one third of people in need have access to treatment. The coverage of prevention interventions is still insufficient and most people living with HIV remain unaware of their HIV status. Population surveys in ten countries showed more than 60 percent of HIV-positive people did not know their HIV status. As a result, many patients start treatment too late. Around 18 percent of patients initiating treatment were lost to follow-up during the first year, a large proportion of them dying due to late initiation of treatment.
According to the progress report, only eight low- and middle-income countries have achieved universal access target or coverage of 80 percent or higher for ART based on data from end of 2009. Also, there are 21 countries that are moving closer to achieve the universal access target, with coverage rates between 50-80 percent for ART.
In Bangladesh, Ashar Alo Society, Mukto Akash Bangladesh and Confidential Approach to AIDS Prevention (CAP) are the three NGOs working to provide coverage of ART to all people living with HIV/AIDS. Experts opined that along with NGOs, the government should establish more centres and monitor the programme strictly in order to ensure universal coverage. There is urgent need to provide coverage of ART for people who are the most affected by HIV, especially injecting drug users (IDUs) where HIV/AIDS is a concentrated epidemic (more than 5%).
Many high risk low- and middle-income countries have been shown promising ART coverage for most of its affected people. We need to work together to expand the services to make sure that not a single affected individual are left out of treatment services.
E-mail: rajib.hossain@thedailystar.net
Incorporating reproductive health services for young people through the national HIV/AIDS responses
Dr Nizam Uddin Ahmed
One of the characteristics of HIV/AIDS pandemic globally is — it affects young people the most and turns into a generalised epidemic through this segment. As such most of the prevention related regimen are concerned with reducing the vulnerabilities of youth to HIV/AIDS exposure by creating enabling environment for them through availability and accessibility of appropriate services and related information.
There is common assumption that young people do not need reproductive and sexual health related information and service prior to marriage. This exacerbates their susceptibility in fact. Hence at the inception stage of the national programme under the GFATM grants, the human rights perspective for HIV/AIDS prevention, care and support regimen for addressing the neglected areas of reproductive health information and services for youth was established.
Essentially this translated into generating simultaneous thrusts towards diminishing the primary barriers of beliefs, norms, stigma and discrimination. At the initial phase the intervention components focused on mass media campaign, youth friendly health services, life skills education, access to condoms, institutionalising HIV/AIDS information in mainstream education curriculum, advocacy with societal decision makers and religious leaders and developing evidence base for policy and programme
The incorporation between HIV/AIDS and reproductive health has paved the path for establishing youth friendly health services and life skills education that prepares young people to adjust with the emotional and physical changes they experience, analyse critical situation to avoid exposure and the ability eschew peer pressure on premarital sex, substance abuse and early marriage.
So, integration of HIV/AIDS within the existing paradigm of reproductive health and education services is need of the time.
The writer is the Director, HIV/AIDS Sector and South Asia Programme Advisor, Save the Children USA.
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