PANOS London - Friday, July 1997
Mostaf Kamal Majumder

"If the country and the people take action now, they have the opportunity to save thousands of lives and millions of dollars -- otherwise Bangladesh faces an AIDS epidemic of appalling social and economic proportions."

That was two years ago. Yet it was only in April this year that a comprehensive five-year plan of action was drawn up by the Bangladesh National AIDS Prevention and Control Programme.

The fact that Bangladesh took so long to wake up to the AIDS crisis has mystified some observers and there is scepticism over the plan being implemented in time to avert disaster.

"It's frustrating -- the country has known there's a problem for a long time," says a senior development expert who wishes not to be identified. "They have a moral obligation to do something. All this really should have happened sooner."

HIV is expected to spread faster and kill more people in South and Southeast Asia than anywhere else in the world in the coming decades. Bangladesh's neighbours, India and Burma, are already in the throes of a serious and rapidly worsening epidemic of HIV.

In the past the government argued that the forces behind epidemics in other countries, such as sexual and drug injecting behaviour, are less pronounced in Bangladesh. The new plan is an acknowledgment that this argument doesn't hold water.

Sexually transmitted diseases, which can lead to HIV infection, are common, particularly among the poor.

Blood for transfusion is not systematically screened for HIV.

And, according to the Ministry of Home Affairs, there are 800,000 drug addicts in Bangladesh -- though most inhale and are not at risk of HIV infection, the numbers who inject drugs (and are therefore at risk from contaminated needles and syringes) are increasing.

The Bangladesh economy relies on more than 1.5 million migrant workers, including truck drivers, businessmen and labourers. These migrants, who spend much of the year away from their families, are known to be at increased risk of contracting HIV.

In addition, there are more than 100,000 known sex workers in Bangladesh, most of whom have not received AIDS education and do not use condoms.

If reliable statistics about HIV were available in Bangladesh, it might not have been so easy to ignore the problem for so long. However, the number of HIV positive people in Bangladesh is not known.

Based on the small number of surveys that have been conducted in the past, the World Health Organisation estimated that in 1993, there were 20,000 people living with the virus in the country.

Although the Bangladesh Ministry of Health still quotes this figure, epidemiologists from the World Bank estimate that the true number of infected people may have risen to 112,000 or more by now.

The only way to obtain accurate estimates of the number of infected people is by testing a random sample of the population for HIV.

If the sample is truly random, the fraction of infected people will be the same as that in the general population. This method, known as surveillance, has never been properly tried in Bangladesh, leaving health workers and policy makers guessing.

The new plan recognises that AIDS cannot be attacked in a purely medical way. It acknowledges, too, the difficulty in changing behaviour and attitudes and the need to involve all sectors of society in any strategy.

In particular, the plan aims to implement a reliable surveillance system to educate the public about HIV and AIDS; control sexually transmitted diseases; ensure safe blood supply and provide care, support and counselling for infected people.

Work will be carried out by government ministries and health- related nongovernmental organisations.

Implementation is expected to cost about 40 million dollars, most of which will be sought from overseas donors.

Lisa Messersmith of United Nations AIDS programme (UNAIDS) is optimistic. "The national AIDS Committee will be working on the plan for the next six months," she says. "We expect that an action plan will be ready by the end of November. Finally, it seems that Bangladesh is in a strong position to do something."

The plan is consistent with Bangladesh's long term health goals.

"In the past, Bangladesh health policy was focused on child survival -- now there is a trend to focus on issues of adult and reproductive health that have been neglected for a long time," says Sarada LeClerc of the Canadian International Development Agency.

Years of bureaucratic inefficiency and denial may finally be over. But some are taking a wait-and-see ttitude.

"The government hasn't yet said how the plan will be implemented, and nothing has happened on the ground yt" according to a senior official in an international agency.

"However, the newln does recognise that there has to be more coordination between the policy makers and the implementers, and that's a good sign," the official added.(END/PANOS/MKM/DDS/97)

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