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Introduction
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.
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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
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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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