HIV/AIDS: Low prevalence, high stigma in Bangladesh
Counselling for HIV-positive people organized by the NGO, Asar Alo Society
DHAKA, 31 December 2012 (IRIN) - Even though HIV prevalence in Bangladesh is as low as 0.1 percent of the 160 million population, experts fear that widespread discrimination towards people who test positive for HIV may leave infections unreported.
“It is possible that due to social stigmatization towards HIV-positive people, people with HIV can go unreported,” said Munir Ahmed, a social mobilization adviser at UNAIDS in Bangladesh.
Migrant workers, injecting drug users, sex workers and men who have sex with men are most vulnerable to HIV infections in Bangladesh, according to various medical studies
Despite years of HIV awareness programming by the government and NGOs, a number of people with HIV told IRIN they face unabated discrimination in their homes, communities, jobs and health facilities.
“It’s not possible for me to let my friends, family and colleagues in my workplace know that I am HIV-positive because they will simply oust me from society,” said an HIV-positive male from Noakhali District in southern Bangladesh. He travels 165km monthly to the capital, Dhaka, to receive free anti-retrovirals (ARVs) from local NGO Asar Alo Society (AAS).
Rejection started in the home for Mohammad Ferdous Sikder, 36. “When I let my family know that I was infected with HIV, my father kicked me out,” said Sikher, who was infected when he went to Saudi Arabia to work in 2004. “I requested my father to return some of the money I sent back home from Saudi Arabia, but he replied that you don’t need money to die,” Sikder recalled.
Health facilities were not much better. He waited a year to remove his wisdom teeth because “no doctor in the capital was ready to operate when they knew I was HIV-positive. The pain was unbearable but I had to live with it.”
M. Razibul Islam Razon, a doctor practising in the private sector in the capital, said lack of knowledge about HIV/AIDS among health staff is the main problem. “This is simply unacceptable and it needs to change because such behaviour towards HIV-positive [people] is contrary to the basic principle of the medical profession, which is to serve a patient,” Razon said.
Despite tens of millions of donor dollars
going to HIV prevention and service provider training in recent years, accurate information about the risk of HIV transmission is still scarce.
One problem, said Abdul Waheed, director of the government’s National AIDS/Sexually Transmitted Disease Programme
, has been the government’s messaging.
“We acknowledge that messages used in the AIDS campaigns were put wrongly… For example, we used to propagate AIDS as a predatory disease,” he said, adding that some anti-HIV campaigns warned how people could be infected “due to unethical relationships or through other behaviours… against the moral code of Bangladeshi society.”
As a result, a negative perception about HIV and persons infected by it was created, spurring stigmatization. “We already identified this problem and are working to address this through more thoughtful messaging,” Waheed said.
“If you have HIV/AIDS in Bangladesh, the society here will make sure in every possible way that you feel that you are a dirty person who committed heinous sin,” Sikder said. “I became invisible [with] shame and guilt.”
Experts say stigma suppresses reporting, and as a consequence, treatment and prevention efforts.
“I know I was HIV-positive but I got married because I was lonely,” said Anwara Begum, a former sex worker. “Now my husband is also HIV-positive, but we both are happy as we are not alone.”
Company was poor consolation for China Begum, 23, whose husband knowingly infected her. “How can he do that to me?” China asked.
Stigma hits not only people infected with HIV, but also those who work with them, said Momtaz Parvin Jolly, an NGO social worker who works closely with HIV-positive people. After years on the job, she said friends still say her work exposes her to infection.
“No friends came to attend my baby’s birthday as they think me and my baby might be infected with HIV as we both are friends to many HIV-positive [people],” Jolly said.
As of 2010 there were some 105 voluntary counselling and testing (VCT) centres nationwide operated by NGOs and the government, which offer confidential counselling before and after HIV testing.
But according to Sanwar Hossain, a project coordinator with AAS, many centres fail to protect client confidentiality. “As a result, in the fear of social discrimination, people with HIV might not go to the VCTs,” said Hossain.
Mohammad Ali, a counsellor at a VCT facility in Dhaka, said many counsellors do not understand the importance of protecting clients’ privacy.
The government is considering legislation to protect people infected with HIV from discrimination, said the government’s Waheed. “We are now holding meetings with the lawmakers in this regard.”
According to the most recent UNAIDS estimate
, some 7,700 people in Bangladesh are living with HIV.