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HIV/AIDS has created a major global health crisis. The UNAIDS and the World Health Organization (WHO) Epidemic update (December 2002) reflected a grim reality-the estimated number of people living with HIV/AIDS by the end of 2002 was 42 million. Nearly two-thirds of them live in Sub-Saharan Africa, where in the two hardest hit countries HIV prevalence is almost 40%. The global HIV/AIDS epidemic killed more than 3 million people in 2003 and there are emerging and growing epidemics in China, Indonesia, Papua New Guinea, Vietnam, several Central Asian Republics, the Baltic States, and North Africa.

The impacts of HIV/AIDS on a country are tremendous. AIDS kills millions of people, thus weakening the workforce, fracturing and improvising families, and leaving millions of children orphaned, with concomitant effects on the whole political, social and economic fabric of a country.

Country Situation

Bangladesh is still considered as a low HIV/AIDS prevalent country. However, it is at a critical moment in the course of its AIDS epidemic. It is estimated that there are 13,000 HIV-positive people in the country and that HIV prevalence in the adult population is less than 0.01%. However, the country's vulnerability is very high. National HIV surveillance indicates that the rate of HIV infection among street-based sex workers in central Bangladesh is high compared with sex workers in other parts of South Asia. HIV among injecting drug users is already 4%.

The presence of covert multi-partner sexual activity and denial, the low level of knowledge and low condom use, unsafe professional blood donations, lack of a desirable environment and violation of Human Rights, all contribute to the spread of HIV in Bangladesh.

Current WHO Support

School Health Education (Teachers)
The awareness of HIV/AIDS in the Bangladeshi population remains quite low. One recent survey found that "Only 19 percent of ever-married women and 33 percent of currently married men had heard of AIDS." As a low HIV prevalent country, that has interventions for highly vulnerable populations supported by other agencies, WHO considers creating awareness on HIV/AIDS as a priority intervention at school level. Family life education in Bangladesh is still at its infancy. As a first step the WHO is supporting the National STD/AIDS Programme to orientate teachers on HIV/AIDS. A series of programmes started through out the country with the first workshop being held in the office of the Sirajgong Civil Surgeon in August 2003 with an encouraging 90% female teacher participation.

In this project, teachers are exposed to the basic facts about AIDS and the HIV Virus, the HIV/AIDS situation in Bangladesh, how AIDS is spread, how AIDS is not spread, the window period, the difference between being HIV positive and having AIDS, how to protect oneself from AIDS including the use of condoms and the need to respect the Human Rights of persons affected by HIV/AIDS and other vulnerable populations.

School Health Education (Students)
The majority of parents here are not at ease to talk about sensitive issues such as sexuality and HIV/AIDS to their children. At the same time teachers are still not comfortable to talk on these issues. But in reality, students are curious and have a lot of questions in their minds related to the physiological and emotional changes during adolescent age. They can get wrong information from their peers and friends if parents and teachers fail.

As the teaching of family life education has not gained the desired momentum through the formal education system, WHO is supporting awareness programmes for students on HIV/AIDS.

Blood safety
Blood safety is one of the priority issues for prevention of HIV/AIDS, especially in Bangladesh as professional donors are still one of the significant groups of donors. There is also evidence that many drug users are also professional blood donors.

WHO in Bangladesh supports the training of doctors on blood safety. In addition to transfusion medicine related issues such as the screening of Transfusion Transmitted Infections, the programme emphasises the need to reduce unnecessary transfusions through the appropriate clinical use of blood including the use of intravenous replacement fluids and other simple alternatives to transfusion, wherever possible.

WHO is also working on the detailed work plan related to blood safety which the Ministry of Health and Family Welfare is proposing to implement using credit it has received from the World Bank.
In the biennium 2004-2005 this will be a key activity of WHO.


Voluntary Counselling and Testing
WHO has been supporting the VCT programme of the ICDDR,B since July 2003. Under this project ICDDR,B continues to provide VCT services for HIV in Dhaka. In addition it will also be starting new services in collaboration with other organisations in Chittagong and Sylhet.

Other activities include providing training for counselling to other organisations as and when requested by them, providing a supportive environment for people who identify themselves at risk for HIV, documenting the HIV prevalence among people who identify

themselves at risk for HIV and submit same in the form of a report to WHO and National Partners and the development of a comprehensive and ethical procedure of referral and care for HIV positive people are other activities that are planned.

WHO support to the GFATM proposal on HIV/AIDS

The GFATM proposal which Bangladesh developed with the support of many partners including WHO has secured funding. This project aims to prevent HIV infection in young people aged 15-24 in order to avert a generalised epidemic in Bangladesh. The activities covered in the proposal include providing HIV prevention information to young people through mass and print media, life skills education through youth organisations, and clubs, integration of HIV prevention into secondary schools and higher secondary curriculum and making health services more youth friendly. A social marketing programme for condoms targeted to young people will be introduced in 64 districts. Advocacy and sensitisation programme will target religious and community leaders, parents, and policy makers. The proposal will also cover the much-needed research to generate the strategic information that is required to respond to the epidemic.

WHO provided support to this project during its designing in the beginning. It also supported the Ministry of Health and Family Welfare during the grant negotiation stage.

HIV Care and Support:

WHO is currently convening the HIV/AIDS Care and Support subgroup of the UN Extended Theme Group on HIV/AIDS.

This Group which was formed in July 2003 will play an advisory role to the UN Theme Group related to issues that concern persons living with HIV/AIDS (PLWHA) including the need for a comprehensive programme for PLWHA that includes clinical and nursing care, socio-economic and psychological support and protection of human rights and legal support.
3 by 5 is a global initiative of WHO, where WHO will provide Anti Retroviral Therapy (ARV) to 3 million people within 2005. WHO, Bangladesh will also work under this programme in the 2004-2005 biennium.

Key Documents

i. National HIV policy
ii. National Strategic Plan
iii. WHO supported Workshop on log frame Development for HIV programmes
iv. WHO supported School Teacher training programme- August 2003

Related Links

i. 3 by 5 initiative of WHO
ii. ARV guideline
iii. 3 by 5 Strategy




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