Inter Press Service - December 9, 1998
Dev Raj

In fact, the country's foremost expert on HIV/AIDS, Prof Nazrul Islam wonders why the virus has not yet laid the country low given that it has every ingredient for a raging epidemic - low awareness, high-risk behaviour, unscreened blood transfusions and no worthwhile control programme.

Prof Islam, who heads the Virology Department at the Bangabandhu Medical University here, says there is a possibility that a genetic factor may be protecting people in this country, but hastens to add that there is no medical evidence for it.

"Commercial sex workers (CSWs) tested under a targeted surveillance programme for high-risk groups indicate less than one percent sero-positivity for HIV although up to 60 percent were found afflicted with syphilis or other sexually transmitted diseases (STDs)," Islam said.

STDs are a problem with young people as 50 percent of those coming into the clinics for STD treatment in the area surrounding the University were found to be students who said they contracted it from CSWs.

"Such statistics show the high level of ignorance about HIV and its spread even among students - a literate section of people in Bangladesh," Prof Islam said. He said he preferred not to label students as "high-risk".

Apart from unprotected sex there are other reasons why he expects a "wildfire" spread of the virus that often leads to the fatal AIDS over the coming year starting with the fact that blood used in this country is still largely unscreened for the deadly virus.

"Screening is done for syphilis and for blood grouping but practically nothing else," Prof Islam who spent a three-year stint with the United Nations Development Programme (UNDP) here as a consultant said.

Alarm bells began ringing with the 100-odd known HIV positive cases in this country traced to infected blood transfusions from a flourishing business plied by professional blood donors and private unregulated blood banks.

In spite of proximity with known global hotspots for HIV such as Burma, the north-east of India and Thailand, Bangladesh appears to be an oasis against the disease unless the statistics are grossly off or the epidemic is in too incipient a stage to be detectable.

According to David Lockwood, chief of the UNDP, the evidence so far is misleading and the epidemic is certain to surface within a year unless drastic measures are taken without delay.

"It is difficult to get any focus on the problem - but at least we are past the stage of denial," Lockwood said describing official inattentiveness despite the UNDP's extraordinary influence in this aid-dependent country.

Still UNDP has kicked off a modest start by helping Bangladesh to clean up its blood transfusion act and has spent 3 million dollars on screening equipment over the last three years and thrown in another million on training modules and capacity building.

Both Lockwood and Islam say whatever story the statistics tell, the real worry is the spread of HIV transmission as amply demonstrated in neighbouring India, Burma and Thailand, while Bangladesh remains woefully unprepared.

To compound the problem, Islamic conservative Bangladesh is reluctant to resort to awareness campaigns that may involve explicit sex and the state-run electronic media has refused to air programmes dealing with HIV.

Lockwood said when UNDP brought publicity material on condom use from other countries and showed them to Bangladesh officials, they reacted by covering their faces.

Religious orthodoxy is another matter. "We had meetings with religious leaders on condom use after some of them accused us of condoning promiscuity by promoting condoms," Prof Islam said.

Condom use in Bangladesh is estimated at less than 20 percent - one reason being sheer lack of availability and the other male refusal to use them, says Parul, a field trainer working for the Cooperative Agencies for Relief Everywhere (CARE) in Bangladesh.

She said attempts to get CSWs to insist that their clients use condoms failed because they lacked negotiating power and feared losing business. The "mastans" or pimps and musclemen who control the trade, always sided with the clients.

Says Md. Alamgir Hossain, UNDP programme officer, "Even in the 18 recognised brothels in Bangladesh worked by about 7,000 licensed CSWs, condoms are never usedless so among the floating unlicensed ones who may be many times that number."

Hossain is sure that HIV must be making steady inroads into the rural hinterland through truck drivers and migrant labourers who contract the virus in cities and take it to their village.

The surveillance reports, for what they are worth, showed slum dwellers in Bangladesh having 23 percent more sero-positivity than CSWs. (END/IPS/rdr/an/98)

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