Know your status

Shirajul Islam was trying hard to stay awake. In between yawning, he was scratching his scruffy beard, not knowing what to say.

It was Wednesday; 2:00pm to be exact. He looked tired.

This correspondent waited patiently for the 40-year-old to start speaking. He opened his mouth but words just did not seem to come out.

“I was… I was in prison for a year for carrying drugs,” he finally said in between stuttering. “I left my wife and daughter in 2008; I don't know where they are.”

“I mostly spent my nights on footpaths,” Shirajul said. He slowly raised his arm towards his worn-out shirt. He left his hand there as if he forgot what he was planning to do or say.

Shirajul has been doing drugs for a long time. He could talk very little about his life, that too with coherence.

This correspondent was speaking with him at a rehabilitation centre in Dhaka's Chankharpool area.

Though it's quite impossible to say how it started, the officials at the centre said Shirajul told them that his addiction was a result of peer pressure.

As the addiction became worse, he was injecting drugs and soon started sharing needles with other addicts living on the streets.

A few months back, he was spotted by some NGO workers, who brought him to the rehabilitation centre and got his blood tested.

All the years of injecting drugs took a toll on him. His blood test came out HIV (human immunodeficiency virus) positive.

He now takes medication suggested by the doctors at the centre to control the virus. At the same time, to control his addiction, he takes prescription opioids as part of his therapy.

At the rehabilitation centre, this correspondent met many others who have tested positive for HIV and come to the centre for medication. This centre mostly deals with drug abusers, many of whom pose a threat of spreading HIV.

This correspondent also spoke to two other HIV positive persons.

Abida sold flowers for a living. The 35-year-old also lived on the streets and eventually under influence of others, started injecting drugs. An NGO recently brought her to the centre.

Her condition is better than Shirajul as her infection was detected early.

Mohammad Ujjal, on the other hand, had been diagnosed with HIV around 20 years ago. He comes to the centre regularly for his medication. “Early detection of the virus helps me control it,” said the 45-year-old Dhaka resident. “I don't do drugs anymore and try to maintain a healthy lifestyle such as avoiding narcotics, eating well and getting enough rest.”

Ujjal currently owns a business in the city.

PWID

Like the three, People Who Inject Drugs (PWID) are being detected through blood tests and medical check-ups by NGO workers with support from the government.

Not just them, sex workers and others from groups vulnerable to the virus are also being tested.

According to the authorities concerned, the more people with HIV are being detected the better, as it helps identify them and take proper preventive measures.

They also opine that increase of HIV detection does not mean increase of HIV/AIDS cases. Instead, it means the capacity of reaching out to more people has increased.

Dr Belal Hossain, deputy director of Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare, said, “We are working towards enhancing our ability to increase HIV detection. However, the prevalence of AIDS is still low in the country.”

According to the Safe Blood Transfusion Act, no one can test blood of a person without their consent, he said. “So, we need to create more awareness among people.” 

In this regard, Lima Rahman, chief of party (HIV/ AIDS programme) of Save the Children, said, “We could not detect the majority of the HIV cases yet. Social stigma and a lack of awareness among people still prevail.”

“It is important to test your blood, to know your status for proper treatment, so that husband does not infect wife or wife does not infect her child,” she added. 

INITIATIVES

The government has adopted the Fast Track Strategy of the Joint United Nations Programme on HIV and AIDS (UNAIDS) and is determined to achieve the 90-90-90 goals by 2020.

Under this strategy, at least 90 percent of HIV cases have to be detected, 90 percent of patients have to come under proper treatment and 90 percent of patients' HIV has to remain under control.

To make that happen, the government is working with different development partners.

There are also 25 HIV test and counselling centres across the country.

Moreover, Dr Belal Hossain said, “HIV affected persons can avail free treatment at six government hospitals.”

Besides, The Global Fund, a non-profit organisation, is providing fund to run HIV-related programmes by Save the Children under the monitoring of DGHS. At present, Save the Children and icddr,b are the two organisations in the country, who are working with PWID, sex workers and other HIV affected persons.

With the support of the government and Save the Children, there are also 50 rehabilitation centres, also known as drop centres, across the country for PWID and sex workers. Other than free medication, the centres also conduct training and awareness campaigns and distribute free contraceptives and syringes.

According to UNAIDS data (2018), there are estimated 13,000 HIV affected persons in the country. Of them, only 5,586 had been detected so far, while 3,265 of them are receiving free medication.

ANTIRETROVIRAL, METHADONE

Antiretroviral and Methadone are also given by the government through the centres for free to HIV patients and PWID.

Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV.

Methadone is a powerful synthetic analgesic drug similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin addiction.

HIV IN BANGLADESH

The first-detected case of HIV was in 1989 in the country, but a national committee on AIDS had been formed in 1985 for early detection of AIDS.

According to UNAIDS data (2017), Bangladesh stood at the 10th position in HIV deaths among Asian countries whereas Indonesia stood first.

In 2016, Bangladesh lost around 1,000 people due to AIDS. AIDS claimed 62,000 lives in India the same year, the highest in Asia.

Around 36.9 million people were living with HIV in 2017, which was 36.3 million in 2016, according to the UNIAIDS data (2018).

WORLD AIDS DAY TODAY

The theme of this year's World AIDS Day is “Know Your Status” as getting tested gives a person the knowledge needed to protect themselves and their partners.

Also, according to officials and development workers, if one learns that they are HIV-positive, they can start treatment that will help them stay healthy, live longer and take steps to reduce the risk of passing HIV on to others.

(Names of the HIV-positive individuals mentioned in this report have been changed)