A grim tale of disease, distress

"Apa, are you sure you will not write my name in your report? If anyone could understand that I am [HIV] positive, I will not find clients anymore and will die of hunger," said 38-Year-old Ruma (not her real name), an HIV positive sex-worker while speaking to this newspaper yesterday.

Ruma has been living on the streets, mostly in the Gulistan area of the capital, since she was 12, around when she came into notice of a man who was involved in sex trade.

Soon she found herself dealing with no less than 20 clients a night. At a young age, she also learned to inject drugs into her system after seeing others do it.

Although she would prefer using condoms to avoid sexually transmitted diseases (STDs), most of the clients would demand unsafe sex for which they would pay an extra amount. "I could not say no sometimes," she said.  

Ruma came to know she was HIV positive in 2017, after screenings at a drop-in-centre (DIC), run by a local NGO, for those who inject drugs.

Even today, Ruma depends on sex trade for a living. She hides her HIV status and insists on using condoms so that her clients do not get infected by her.

"Nowadays I can only work twice or thrice a week for my expenses. From a single client, I get around Tk 100 and with that, I buy whatever I need. My husband doesn't always live with me and I don't get much support from him."

Asked what she does for treatment, Ruma said it is not possible for her to take the medicines required every day. "I can take medicines from the DIC. The staff there even wrote the names of the tablets and when to take them. But I cannot maintain my routine due to my drug habit," she added.

According to Save The Children, five of the 21 DICs for drug users and 26 of the 29 DICs for street sex workers, were temporarily closed due to the Covid-19 pandemic, for which services such as HIV screening, Methadone and Antiretroviral (ARV) distribution, HIV prevention education, and treatment were heavily disrupted.

The ARV drugs are free and distributed at six major hospitals around the country, including Bangabandhu Sheikh Mujib Medical University (BSMMU) and Infectious Diseases Hospitals (IDH) in Dhaka.

Ruma said she was not able to not get the medicine from BSMMU when Covid outbreak began as she did not wear a mask and gloves.

"A woman asked me to tell her what my problems were from afar. But I did not want others to hear me, so I left without the medicine."

She was suffering from fever, diarrhoea and fatigue at the time.

Shamima (not her real name), 35, who is in sex trade to fend for herself and her seven-year-old daughter, is also HIV positive. She said she too would receive the medicine from a DIC at Chankharpul but was unable to after the service was disrupted when the Covid-19 outbreak began.

She, however, sent a male relative to buy medicines on her behalf. "He used to take Tk 100 for four pills," she said, adding that she later learned he had been charging money even though she is supposed to get the medicines for free.

According to Md Akhtaruzzaman, senior manager, National AIDS/STD Control Programme (NASP) of the Directorate General of Health Services DGHS, there was a disruption to hospital services at the beginning of the pandemic.

"However, we have sent the medicines to our respective patients through couriers [SA Paribahan] and Uber Moto, based on their locations. Besides, the enlisted patients can also send their authorised person to collect the medicines as they cannot always come in person," he said.

In some cases, the medicines have been handed over to a patient's nominated person after a verbal permission from the patient taken by the peer counsellors at the centre over the phone.

"But since this is not just about the medicine and every patient needs to get a follow-up, they must visit in person at least every six months," he added.

According to NASP data, the total number of HIV cases as of October 2019 is 7,374. Of them, 1,242 resulted in death. Of the patients who are fighting the disease, 70 percent are taking ARV treatment regularly, while the remaining 30 percent, including those living out of the country, prefer taking treatment abroad.

On the other hand, according to Save the Children, the number of HIV positive sex workers till September this year is 36. Of them, four have already died.

The organisation worked with 18,500 sex workers around the country until yesterday, and from today, they will be covering 30,000 sex workers.

Save the Children's Dr Shahrear Farid, deputy director, measurement and evaluation, HIV/AIDS Programme, told this correspondent that the DICs for street sex workers work on building awareness related to HIV and STDs, and they do so both on the field and inside the centres with the assistance of their peer educators. They also distribute lubricant and condoms and refer a medical assistant if symptoms of STDs or other health related issues are found.

During and after the lockdown (till September), the outreach workers rarely found sex workers at the hotspots due to a lack of clients. 

The number of screenings, however, increased and the organisation is focused on that under the community leadership. Those who are found to be positive are connected to ART services.