Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are global public health challenges, with millions affected worldwide. Though Bangladesh remains a low-prevalence country, HIV/AIDS has steadily emerged as a concern due to various socioeconomic and health factors.

As of the latest reports, Bangladesh has an estimated 14,000 to 16,000 people living with HIV, with around 1,300 new infections annually. The prevalence rate remains below 0.1%, making it a low-prevalence country by global standards. However, certain key populations, such as intravenous drug users (IDUs), men who have sex with men (MSM), transgender communities, and sex workers, show higher infection rates than the general population.

Causes and transmissions

High-risk behaviours, such as unprotected sex and shared needles, contribute significantly to the spread of HIV in Bangladesh. Lack of awareness about safe sex practices, coupled with limited access to sexual health education, increases the vulnerability of certain communities. Migrant workers, who often face challenging conditions abroad and engage in risky behaviours, are another vulnerable group.

While HIV transmission from mother to child remains relatively low, it is an area of concern. Without proper medical interventions, the risk of transmission during pregnancy, childbirth, or breastfeeding can be significant.

Efforts in prevention and control

The government of Bangladesh, in collaboration with international agencies like UNAIDS, WHO, and UNICEF, has implemented several measures to curb the spread of HIV. Bangladesh's national AIDS/STD program (NASP), established in 1985, plays a pivotal role in prevention, awareness, and treatment initiatives. They include:

HIV testing and counselling (HTC): Expanding access to HIV testing services across the country is critical. NASP has increased testing facilities, particularly targeting high-risk populations.

Needle exchange programmes (NEPs): NEPs are crucial in reducing transmission among IDUs. By providing clean needles and syringes, the risk of infection through shared equipment is significantly reduced.

Education and awareness campaigns: Numerous campaigns have been launched to increase awareness of HIV/AIDS. Public health messages are spread through mass media, social media, community outreach programs, and workshops targeting at-risk groups.

Antiretroviral therapy (ART): ART is available free of charge through government-supported facilities. Early initiation of ART has been instrumental in reducing morbidity and mortality rates among people living with HIV (PLHIV).

Collaboration with NGOs: Organisations like Save the Children, BRAC, and Marie Stopes International are integral in reaching marginalised communities with prevention, care, and treatment services.

Challenges

Despite these efforts, several challenges continue to hinder the effectiveness of HIV/AIDS programs in Bangladesh:

Social stigma: A significant obstacle is the stigma attached to HIV/AIDS. Many individuals avoid getting tested or seeking treatment due to fear of societal backlash.

Limited resources: While international agencies provide support, Bangladesh's healthcare infrastructure lacks the necessary resources to adequately address the growing number of HIV cases. There is a need for more funding to expand HIV prevention, treatment, and education programmes.

Migration and mobility: Bangladesh has a large population of migrant workers, particularly in Middle Eastern countries. Many of these workers return home with HIV, contributing to the rise in cases. Comprehensive programs to target migrant populations are still underdeveloped.

Access to services: Geographic disparities in healthcare access are a major concern. While cities like Dhaka have better HIV-related services, rural areas often lack the necessary infrastructure to provide proper care.

The road ahead

To address the HIV/AIDS situation in Bangladesh effectively, there needs to be a multi-faceted approach. Continued collaboration between the government, international agencies, and local NGOs is essential for scaling up prevention and treatment programs. Expanding ART access, reducing stigma, and increasing awareness about HIV transmission and prevention are critical steps to curbing the spread of the virus.

Moreover, integrating HIV/AIDS services with other healthcare services, such as maternal health programs, will be crucial for reaching broader populations and reducing mother-to-child transmission. With sustained efforts and comprehensive strategies, Bangladesh has the potential to manage its HIV epidemic and improve the quality of life for those affected by the disease.

The writer is the associate professor of the Dept. of Reproductive & Child Health (RCH) at the Bangladesh University of Health Sciences (BUHS).