Responding to HIV and AIDS in
Bangladesh
Why we should invest in a
Low Prevalence Country
Dan O. Odallo
UNAIDS Country Coordinator
Bangladesh
RST UNAIDS; Slide 1
Outline
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Controversy
Definitions
Global figures
National Figures
Brief History
AIDS in Bangladesh
Potential for spread
Enduring Risk factors
Rationalizing the investment in AIDS prevention
Conclusions
RST UNAIDS; Slide 2
Controversy
• Many schools of thought:
– Zoonotic theory (contact with animals, polio
vaccine, malaria research)
– Conspiracy theory (CIA, Soviet Plot etc)
– Divine intervention theory—God’s punishment
• July 3, 1981: "Rare Cancer Seen in 41
Homosexuals.“ The New York Times headline
article.
RST UNAIDS; Slide 3
What is HIV and AIDS
• HIV- Human Immunodeficiency Virus the virus that
causes AIDS
• AIDS (Acquired immunodeficiency syndrome) is the
final and most serious stage of diseases resulting
from HIV numerous opportunistic infections
• Candidiasis (thrush)
• Herpes simplex
• Malaria
• TB
• Pneumonia
RST UNAIDS; Slide 4
Global summary of the AIDS epidemic, December 2007
Number of people living
with HIV in 2007
People newly infected
with HIV in 2007
AIDS deaths
in 2007
RST UNAIDS; Slide 5
Total
Adults
Women
Children under 15 years
33 million [30 – 36 million]
30.8 million [28.2 – 34.0 million]
15.5 million [14.2 – 16.9 million]
2.0 million [1.9 – 2.3 million]
Total
Adults
Children under 15 years
2.7 million [1.6 – 3.9 million]
2.3 million [1.3 – 3.4 million]
370 000 [330 000 – 410 000]
Total
Adults
Children under 15 years
2.0 million [1.8 – 2.3 million]
1.8 million [1.6 – 2.1 million]
270 000 [250 000 – 290 000]
National Sero-Surveillances:
HIV Prevalence Rates Over the Rounds
Surveillance
Round
Year
Numbers Tested
HIV (%)
1st Round
1998 – 1999
3886
<1% (0.4)
2nd Round
1999 - 2000
4634
<1% (0.2)
3rd Round
2000 - 2001
7063
<1% (0.2)
4th Round
2002 - 2003
7877
<1% (0.3)
5th Round
2003 - 2004
10445
<1% (0.3)
6th Round
2004 – 2005
11029
<1% (0.6)
7th Round
2005 - 2006
10368
<1% (0.9)
8th Round
2006-2007
12786
<1% (0.7)
RST UNAIDS; Slide 6
6
Brief History
1959
•Virus thought to have jumped from animal to man in early 50s
1981
•Emergence of Kaposi's Sarcoma and Pneumonia among gay men in
New York and California.
• CDC calls it "GRID" (gay-related immune deficiency. However,
cases started to be seen in heterosexuals, IDUs and people who
received blood transfusions
1983
•Researchers at the Pasteur Institute isolate the virus
•International consensus that it should be called Human
Immunodeficiency Virus --HIV.
•Rapid spread of HIV across the world, especially Africa
•Fear and confusion over the virus—stigma and discrimination
1998
•First vaccine trials begin
RST UNAIDS; Slide 7
Brief History
1996
•UNAIDS is created to lead the Global Response to HIV and AIDS
1998
•First vaccine trials begin
2001
•The United Nations organizes a special session on AIDS
(UNGASS) and adopts the Declaration of Commitment on
HIV/AIDS
2005
•The world begins to wake up to the reality of a global epidemic
with multidimensional implications and consequence
•More resources made available to fight HIV.
•Better surveillance of HIV and AIDS globally
2006
onwards
•More attention paid to the so-called low prevalence countries
•Greater role of science in responding to AIDS
•Multi sectoral consensus
RST UNAIDS; Slide 8
Experience to date
• Encouraging news in infections and death but we’re
far from defeating HIV and AIDS
• AIDS death was two million in 2007, a fall of
200,000 compared with 2000
• Annual new infections were 2.7 million, 300,000
less than 2001.
• Treatment increased by 43%
• Outside of sub-Sahara Africa, HIV disproportionately
affects injecting drug users (IDU), men who have sex
with men (MSM)
RST UNAIDS; Slide 9
HIV PREVALENCE IN DRUG USERS, ROUND VIII (2007)
8
6508 drug users sampled from 28 cities
HIV found in six cities only
7
7
7
6
4.9
5
4
%
4
4
3
2
1.7
2
1.4
1
19992000
IDU-Dhaka
IDU-Chandpur
IDU-Ishwardi
RST UNAIDS; Slide 10
1.1
0.8
0
20002001
1.8
1
0.8
0
0
0
0
2002
20032004
20042005
2006
IDU-Narayanganj
IDU-Teknaf
Heroin smokers-Dhaka
1.7
1 0.9
0.8
0.6
0.3
0.2
2007
IDUs buying sex from FSW in the last year, using condoms and
having STIs
70
60
50
40
30
20
10
0
Dhaka
Rajshahi
Chapainawabganj
Buying sex from FSW last year
Used condom during last sex with FSW
Consistently used condom with FSW in last year
STI symptoms last yr
Active syphilis
RST UNAIDS; Slide 11
Chandpur
Potential spread of HIV from MARPs to the general population in
Dhaka, Bangladesh
2% married
10% married
MSW/HIJRA
Rickshawpullers
73% married
MSM
22%*
89%
10%*
27% IDUs are rickshaw pullers
72%*
MSM
28%
11%*
9.6%*
IDU
57%*
2-3%*
1-3%*
42% married
*figures
referSlide
to last
RST UNAIDS;
12 year
47% married
FSW
76%*
Truckers
16% married
18 - 23% of female SW mentioned
their clients or non-commercial
partners are IDU
54% married)
IDU
FSW
Client
MSW
MSM
New infections in thousands
New infections show various populations influence the
epidemic over time
30
Clients
25
20
Husband->Wife
15
Lo-risk men
Lo-risk
women
10
5
IDU
FSW
MSM
0
0
RST UNAIDS; Slide 13
+2
+4
+6
+8
+10
+12
+14
+16
+18
Enduring Risk Factors
• Large Commercial Sex Industry. Often hidden and complex:
There are over 105,000 male and female sex workers.
• Low condom use all-round
• High level of Sexually Transmitted Infections (Syphilis)
• Needle-sharing among Injecting Drug Users
• High level of stigma associated with people living with HIV.
• Limited access to health care for MARPS
• BUT…still very low prevalence…
RST UNAIDS; Slide 14
Why investing in HIV prevention- Impact
on Health Services
•
AIDS illnesses generate a disproportionate share
of total health care demand.
•
Increase in disease burden due to increased cases
of illnesses such TB, malnutrition,
diarrhoea,meningitis, pneumocystis carinii
pneumonia (PCP) in the form of opportunistic
infections associated with HIV infection
•
(It is widely accepted that HIV/AIDS drives the
incidence of TB.)
RST UNAIDS; Slide 15
Why investing in HIV prevention- Impact
on Health Services
• Prohibitive cost of treatment cannot be sustained in a
resource poor country such as Bangladesh
• AIDS may increase demand for third-party payment
for health care. This may take the form of private
insurance, or public insurance.
• AIDS introduces additional Risk to Health Care
Workers
– “HIV/AIDS has increased our exposure to the virus
and we fear contracting it,”
RST UNAIDS; Slide 16
Why investing in HIV. Impact on Mobility
1.
2.
High mobility
between Bangladesh
and other countries
in the region and
beyond means that
infection can come
from outside the
borders as well as
spread within the
country.
Cross border
mobility for sex
work exposes
populations to
different
RST UNAIDS; Slide 17
• HIV among Sex
Workers
•
•
•
•
•
Dhaka
Khulna
Hili
Barisal
Jessore
0.2%
0.4%
2.7%
0.3%
0.5%
(casual)
Impact of AIDS
(household level )
• Reduced income if household head is sick
– (India-unemployment rate for HIV+ is 14.2% and for
HIV- it is 4.3%)
– selling of family property (45% families with AIDS patient
in India borrowed money compared to 27% non-AIDS
families)
• Early orphanhood (increased likelihood is 1.0% by
age 17) Loss of income earner means that
mothers must enter the labour market and reduce
childcare.
• Stigma and discrimination and shame against the
family, community rejection and destitution
RST UNAIDS; Slide 18
ROLE OF GOVERNMENT
• Public policy has proved to be an
effective weapon in containing the
HIV/AIDS epidemic. Governments
can have the greatest impact by
providing incentives for those
most likely to spread HIV to adopt
safer behavior (Ainsworth 1998) .
RST UNAIDS; Slide 19
AIDS Transition
RST UNAIDS; Slide 20
WAY FORWARD- Comprehensive Response
RST UNAIDS; Slide 21
What it all means…
Retaining clear evidence-based focus on priority groups and scale up
access to high quality interventions for priority groups (MARPs).
Strengthen support for the reduction of vulnerability to HIV infection.
•
vulnerable women and children
•
reducing vulnerability associated with cross-border travel and
undocumented migration; reducing vulnerability to HIV infection in
prisons;
•
reducing vulnerability among ethnic groups;
•
increasing access RTI/STI) services.
Ensuring that universal precautions in the health sector.
Increasing access to care and support services for people living with
HIV and AIDS (PLHA).
Reducing stigmatisation and discrimination of people living with HIV
and AIDS (PLHA).
•
.
RST UNAIDS; Slide 22
• Th
RST UNAIDS; Slide 23
23-Mar-16
nk You