The National AIDS/STD Programme (NASP) is one of the wings of Directorate General of Health Services (DGHS) under the Ministry of Health & Family Welfare (MOHFW) responsible for coordinating with all stakeholders and development partners involved in HIV/AIDS programme activities throughout the country.
HIV/AIDS: Bangladesh Situation
In Bangladesh the first case of HIV was detected in 1989. Till December 2008, there were 1495 reported cases of HIV and 476 cases of AIDS, among them 165 died. By definition Bangladesh is a low prevalence country (The last surveillance conducted in 2007 found national prevalence of HIV < 1%), but there are significant level of risky behavior that makes our country vulnerable to HIV/AIDS.
Photo:World AIDS Day 2008 Rally
HIV/AIDS in Bangladesh (Since 1989)
Identified Cases
2008
Total
oHIV Cases
288
1495
oAIDS Cases
111
476
oAIDS Death
42
165
Estimated HIV cases: 7,500 (Source: NASP 2008, Government of Bangladesh)
HIV prevalence in Bangladesh is low (< 1%) among the general population, even within the vulnerable population it continued to be low other than certain sections of injecting drug users. There is consensus that there are risk factors for the spread of HIV in Bangladesh which are: formal and informal commercial sex trade, low levels of condom use, increasing injecting drug use, and rising prevalence levels among injecting drug users. Over the period of 1999 -2008, HIV prevalence in central Dhaka showed rapid increase of HIV prevalence. The 8th Serological surveillance shows that the HIV rate has crossed the concentrated epidemic among IDUs. Rates in Central Bangladesh rose from 1.4% to 7% since 1999, up to as high as 11% in one neighborhood of Dhaka. Hepatitis C prevalence among IDUs reached 83%, indicating that needle sharing is common. Data also show that 44 percent of female IDUs are also sex workers.
Large number of man continues to buy sex in greater proportion than elsewhere in the region (average number of client of female sex workers ranges from 8-61/week (7th round BSS). Moreover, most of these men do not use condom in their commercial sex encounters and female sex workers report lowest condom use in the region (0-12 % with new client by different groups of female sex workers).
In Bangladesh, there are significant population of sex workers based in brothel, street, hotel and residence. They are composed of both male and female. An estimated 54,000 – 90,000 female sex workers (brothel, street and hotel based) and 40,000 – 150,000 MSM and male sex workers and 10,000 – 15,000 hijras are involved in high risk sexual behaviour and sex trade. The consistent condom use by female sex workers with new client past week improved significantly but still it less than 50% for all population across the country, further low by hijras and by men having sex with men (MSM).
NATIONAL RESPONSE TO HIV/AIDS
In response to HIV/AIDS prevention GOB formed the National AIDS Committee (NAC) with patronage of the His Excellency President of Bangladesh. It has a full-fledged Technical Committee (TC-NAC) comprising national expert from different discipline. In 1997, protocol for safe blood transfusion was formulated. There are 98 blood screening centers established for screening HIV, Syphilis, Malaria, HBV & HCV. With support from GOB, the NGOs have set up STD/AIDS Network with more than 250 members working in the field of HIV/AIDS.
As nodal body for HIV/AIDS activities National AIDS/STD Programme (NASP) has been formed under DGHS of MOHFW which is functioning from 1998. The major roles of NASP comprise policy, information, coordination and regulation and implementation where necessary.
The intervention among the vulnerable population in Bangladesh evolved over a period of more than ten years stretching from 1997-2008. Initially started and led by NGOs, later there developed a strong partnerships among Government, NGOs, civil society and donors, to facilitate comprehensive interventions targeted at the most vulnerable and bridge groups in the population. These groups include female sex workers and their male clients, IDUs, men who have sex with men, hijras and transport workers. In general these intervention packages included condom promotion, STI management, needle/syringe exchange, detoxification, peer education, health education / counseling, resting/recreation facility, community awareness and local level advocacy.
ACHIEVEMENTS SO FAR
National AIDS Committee (NAC) formed in October, 1985
HIV/AIDS intervention started during 1994-1996 with support from UNDP.
Protocol for safe blood transfusion formulated in 1997. So far 114 blood screening centers established for screening HIV, Syphilis, Malaria, HBV & HCV
The “National Policy on HIV/AIDS and STD Related Issues” developed and approved by the cabinet in 1997.
Five-year National Strategy (1997-2002) developed and adopted in NAC for effective implementation of HIV/AIDS Interventions.
Second five-year “National Strategic Plan for HIV/AIDS 2004-2010” developed, approved and being implemented.
National Mapping of brothels in Bangladesh has been completed.
Size estimation of the Most-At-Risk population groups done in 2004.
Eight rounds sentinel surveillance on HIV and Syphilis completed and 9th round is ongoing.
Effective interaction with different ministries to support the NASP initiated and 17 Ministries and focal points identified.
Increased partnership with NGOs through HAPP, HATI and GFATM (Round 2 and 6). A total of 104 NGOs involved in HIV/AIDS prevention in 3 major programs.
650 billboards constructed and placed at different towns across the country. TV spots on HIV/AIDS developed and broadcasted.
Facilitated forming a network of PLWHA and provide them care & support with ARV
Task force on HIV/AIDS and Human Rights formed.
106 Voluntary Counseling and Testing Centers (VCTC) have been established in different institutions throughout the country.
Observation of World AIDS Day every year to increase mass awareness and create enabling environment for HIV/AIDS programs.
100% Targeted Intervention coverage for brothel based sex workers
34 million young people addressed through mass media under branding campaign
50,000 gate keepers and local influential persons sensitized
HIV/AIDS and related information incorporated in school and college curriculum
Through the text book incorporation 13,438,291 female and male students received information on HIV/AIDS
3,570,100 booklets titled ‘Nejeke Jano’ on HIV/AIDS distributed to young people
4booklets on HIV/AIDS for 4 major practicing religions in the country are published
20 million people who adhere to religious values are targeted for HIV information
Workplace policy on HIV/AIDS developed and endorsed by BGMEA
660,000 garment factory workers targeted for Life-Skills Education (LSE)
HIV/AIDS prevention, care and support related information incorporated within the training curriculum of 5 different ministries
ARV made available for 314 HIV infected people
Training provided to 492 doctors and nurses on STI, ART and counseling
Through 184 Youth Friendly Health Service (YFHS) centers services provided to 647,233 adolescents and youth
323,334 young people provided with Life-Skills Education (LSE) through 195 enlisted youth organizations throughout the country
Orientation given to 45,000 community elites and 12,500 police personnel through advocacy workshops
256 Drop-in-Centers (DICs) established across the country to provide essential services to high-risk population groups
A number of important national documents have been prepared which are:
ØNational Strategic Plan 2004-2010ØNational Advocacy and Communication Strategy 2005-2010ØNational ART Guideline, 2006ØNational STI Management Guideline, 2006ØNational AIDS M & E Framework 2006-2010ØHarm Reduction Strategy for Drug Users 2006-2010ØTraining Module for Health Managers on HIV/AIDS, 2006ØBangla Handbook on HIV/AIDS Prevention, 2007ØNational Baseline Survey of Youth and Adolescents in Bangladesh, 2006ØNational Standard for Youth Friendly Health Services (YFHS), 2006ØTOT Manuals on Mainstreaming HIV/AIDS for NGOs and 5 Key Ministries.ØNational Guideline on Management of OIs, 2009ØHIV Counseling Manual, 2009ØStandard Operating Procedures (SOP) for Services to PLHA, 2009ØCaregivers’ Training Manual to Provide Services to PLHA, 2009ØCounseling Training Manual for PLHAØPeer Educators’ Training Manual, 2009ØDoctor’s Handbook on Clinical Management of HIV and AIDS, 2009ØTechnical Report on Behavioral Surveillance Survey 2006-07, 2009
