Abstract
Bangladesh initiated an early response to the HIV epidemic starting in the mid-1980s. Since then, the response has been enhanced considerably, and many HIV-prevention interventions among the most at-risk populations and the general youth are being undertaken. Alongside prevention activities, gathering of data has been a key activity fostered by both the Government and individual development partners. This paper reviews available sources of data, including routine surveillance (HIV and behavioural among most at-risk populations), general population surveys, and various research studies with the aim to understand the dynamics of the HIV epidemic in Bangladesh. Available data show that the HIV epidemic is still at relatively low levels and is concentrated mainly among injecting drug users (IDUs) in Dhaka city. In addition, when the passively-reported cases were analyzed, another population group that appears to be especially vulnerable is migrant workers who leave their families and travel abroad for work. However, all sources of data confirm that risk behaviours that make individuals vulnerable to HIV are high--this is apparent within most at-risk populations and the general population (adult males and youth males and females). Based on the current activities and the sources of data, modelling exercises of the future of the HIV epidemic in Dhaka suggest that, if interventions are not enhanced further, Bangladesh is likely to start with an IDU-driven epidemic, similar to other neighbouring countries, which will then move to other population groups, including sex workers, males who have sex with males, clients of sex workers, and ultimately their families. This review reiterates the often repeated message that if Bangladesh wants to be an example of how to avert an HIV epidemic, it needs to act now using evidence-based programming.
Highlights
The first case of HIV in Bangladesh was detected in 1989
It is known that an effective needle/syringe programme (NSP) can reduce HIV transmission among injecting drug users (IDUs) and safer behaviours have been documented in IDUs who have participated in the Bangladesh NSP [20]
The findings showed that a large proportion of married men who had travelled either within Bangladesh or abroad reported sex with female sex workers (Fig. 5)
Summary
The first case of HIV in Bangladesh was detected in 1989 Even prior to this first case, the Government of Bangladesh (GoB) had become active and formed the National AIDS Committee (NAC) in 1985 in anticipation of an epidemic. Surveillance data: The national HIV surveillance system set up by the GoB has been active since 1998 It is based on the UNAIDS/WHO guidelines for a revised ‘2nd generation HIV surveillance’, a key priority of which is to improve the monitoring of developing epidemics like that in Bangladesh [2]. In accordance with the UNAIDS/WHO guidelines, HIV surveillance in Bangladesh has focused on selected groups of individuals known to be most-atrisk for acquiring HIV infection They include sex workers, injecting drug users (IDUs), males who have sex with males (MSM), and Hijra (male transgenders). In each of the past seven annual surveillance rounds, the pooled level of HIV prevalence was
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