Composite Awareness Programme (CAP) on HIV/AIDS - Bangladesh

Female Sex worker in Bangladesh is vulnerable of HIV/AIDS

Mohammad Khairul Alam
plusbangla@yahoo.com
HIV/AIDS researcher
Rainbow Nari O Shishu Kallyan Foundation

Bangladesh, with a population of 144,319,628(July 2005 est.), had about 2,500 – 15,000 adults and children living with HIV infection at the end 2003(UNAIDS 2003 Report), According to the National AIDS/STD Programme (NASP) the estimated number of people living with HIV (PLHIV) was around 7500 as of end 2004. Significant underreporting of cases occurs because of the country's limited voluntary testing and counseling capacity and the social stigma, which leads to the fear of being identified and detected as HIV positive.

The HIV-prevalence rate among adults between the ages of 15 and 49 is still relatively low, at 0.1 percent of the population. As expected, rates are higher in specific groups, such as injecting drug users who have left treatment (1.7 percent) and commercial sex workers (0.5 percent), according to a national behavioral and serological surveillance undertaken in 2001.

Although overall HIV prevalence is low, behavior patterns and extensive risk factors that facilitate the rapid spread of the infection are prevalent, making Bangladesh highly vulnerable to an HIV/AIDS epidemic. These risk factors are gender discrimination, A large commercial sex worker/ brothel sex worker, a large number of hidden/residence sex worker, Lack of basic sexual knowledge, Lack of proper knowledge of sexually transmitted diseases(STDs/STI) etc.

There are fourteen government reputed brothel in Bangladesh, where roughly 40,000 sex workers live in there, the number of per sex worker’s client/customer is 18.8 per week, and 44 clients per week for hotel-based workers. And non countable client meet to residence sex workers or street sex worker, who are very vulnerable for HIV/AIDS. Significant prevalence of sexually transmitted diseases (STDs) among sex workers in Central Bangladesh. About 43 percent of female sex workers and 18.2 percent of male sex workers have syphilis. This and other STDs facilitate the spread of HIV infection and serve as indicators for low condom use and other high risk sexual behaviors. The majority of brothel-based sex workers report at least some sex without condoms with their clients. Among the clients, such as rickshaw pullers and truck drivers, about 83 percent have never used condoms when buying sex.

Now a day Injection Drug Users are increasing all over in Bangladesh. In Central Bangladesh, among 93.4 percent of over 500 injecting drug users, needle sharing is routine. These drug injectors are not an isolated population—they are often married and sometimes sell sex to customers and their own blood to hospitals and clinics.

Lack of knowledge may be creating most problems for Bangladesh of HIV/AIDS epidemic in future. While knowledge of HIV is nearly universal among sex workers and their clients, it is extremely low among the general population. In 1996-97, only 19 percent of women who have been married and 33 percent of men had ever heard of AIDS. In 2001, many still could not identify the basic routes of HIV transmission.

By keeping South Africa outside, India has the largest number of people living with HIV, estimated at 5.1 million (range: 2.5 million – 8.5 million) in 2003. Most infections are acquired sexually, but injecting drug use is playing a bigger role than previously thought. It is also a great threat for Bangladesh, because every day a large number of people are going to India for various reasons. Bangladesh has twenty custom and immigration point in the border with India, and Indian track crosses of this border every day with loaded goods. But Indian track drivers are highly infected HIV/AIDS. So it is also creating the scope of scattering HIV/AIDS in Bangladesh.

Stop AIDS, Keep the Promise, is it possible in Bangladesh?

-Md. Ismail Hossain-
-Assistant Director-
-Bangladesh Bank-
-banglaplus@yahoo.com-

Fortunately fact that overall HIV prevalence rate in Bangladesh is low, but we don’t declare, full of coolness that we are free from this epidemic. Because the risky behavior of infection of the disease is such high, the HIV/AIDS may spread at an alarming rate in the country at any time. On the other hand, since the first case was detected in 1989, till December 2005, only 7,500 cases were officially reported. Of these, 465 have developed AIDS, and 64 have died (National AIDS/STD Program –NASP).

The health care system is low in Bangladesh. Thousands of people die in every year by several common diseases. Although some health or prevention knowledge would lessen this fatal mortality. Capital city’s health care system in upgraded in some extent but district level health care system is nominal. Several NGO’s are working on HIV/AIDS prevention sector. But we found that there is a massive need of facilities and manpower to deliver comprehensive HIV care and laboratory facilities to support and monitor the therapy. There is a similar lack of medical personnel with enough knowledge of antiretroviral therapy. Possibilities for drug distribution to remote corners are limited and storage facilities are often insufficient.

AIDS surveillance specialist Mr. Parvez Sazzad Mallick said, “There are so many cultural values and socio economical systems are responsible for this increasing like this dieses, poverty and illiteracy is also responsible for this increasing. This indicator is not fully responsible but it helps to change behavior on so that. So if we want to prevent of this at first we have to emphasize to try to change sexual behavior. We did success to find out our vulnerable target groups and why they become vulnerable�. (Senior Technical Officer- Family Health International -FHI)

The HIV/AIDS programme specialist Mr. Mohammad Khairul Alam said, “several social norms and immature behavior fueled of this disease to scatter rapidly. There are several social components link to develop this harmful situation. Poverty-behind to force it, Gender discrimination plays a vital role; Frustration & risk behavior help to sink humanity resulting infection. The link between poverty & gender discrimination are help to decline socio economic prosperity. This link creates several anti social poisonous issues also. Such as trafficking to prostitute, sell sex for earn or living, break down family norm to create frustration and driven drug point. We notice easily that Illiteracy is the main watchword of all circumstance. So it is not easy to remove it from the society, several programs & strategies are needed to gain sustainable position�.

HIV/AIDS researcher Dr. Salim Ahmed said ‘91 per cent of the adolescents of the country have no knowledge of sexually transmitted infections (STIs). According to the NASP report, 50 per cent of the adolescents of the country are living under the ominous shadow of HIV infection’. (Program Manager, National AIDS/STD Program- NASP)

The ‘Rainbow Nari O Shishu Kallyan Foundation’ identified four major approaches in a groundbreaking study on spread out HIV in Bangladesh. This study undertook by comparing of social-economic norm, family pattern, economic dependency, cause of mounting sex industries, gender discrimination status & global analysis fact. There are four factors that appear to play a crucial role in HIV transmission in Bangladesh: Injection/ intravenous drug use (By sharing needle), female sex work (Due to lack of safe sex knowledge), gender discrimination (which indirectly force females commercial or non-commercial sex), Same sex/ homosexually/ Hizra (Due to lack of HIV/AIDS information, because they act invisible in this society). Poverty & illiteracy fueled it proportionally.

Mr. Md. Alauddin, (Ex- Procurement Consultant, IDA/DFID funded HIV/AIDS Prevention Project) said, “HIV/AIDS is not just a health issue in our society. It is also a social, economical, developmental, ethical and psychological issue. Some of our policy makers including civil servants, few members of civil societies are confident regarding spread of HIV virus as because they think our nation is a Muslim moderate nation and its society is Muslim majority religious society where moral character is better than that of other non-Muslim nation. This type way of thinking also allows our societies to avoid responsibility of dealing against the widespread of HIV virus. This attitude can be dangerous for the future of Bangladesh. HIV virus knows no social, religion, racial, boarder or cultural barriers. But if we follow some preventive measures or change some sexual behavioral pattern in our life, if we avoid sharing needles, if we can ensure safe blood, this virus is still not harmful.�

Women will carry on HIV/AIDS epidemic. Women in Bangladesh, largely getting sexual experience within marriage and for the most part, premarital sexual contact is mostly confined to their future husband or Lovers. Nowadays-sexual behavior among Bangladeshi women is changing. Adolescent girls may not stay in the traditional sex of previous generation and casual sexual behaviors are mounting. This may take Bangladesh in an alarming position.

Commercial Sex Workers are vulnerable for HIV/AIDS in Bangladesh

Mohammad Khairul Alam
plusbangla@yahoo.com
HIV/AIDS researcher
Rainbow Nari O Shishu Kallyan Foundation

The over all HIV/AIDS epidemics situation is low in Bangladesh. But it is increasing very high in some heterogeneous group who are actually vulnerable of HIV/AIDS. HIV/AIDS spread out very quickly in all over the population. There are many ways in Bangladesh to HIV/AIDS increasing issue.

The cause of poverty, gender discrimination, low prevalence of health facility, lack of reproductively knowledge, illiteracy and high risky behavior may be called epidemic in future of Bangladesh. The atmosphere, which is needed to spread HIV as epidemic of HIV/AIDS, those are present in Bangladesh.

It seems that there are three issues that are appearing to play a crucial position in HIV transmission in Bangladesh: female sex work substance use, Intravenous drug use, professional blood donor and mobility. Female sex workers and their clients have been a major factor in the heterosexual transmission of HIV. Separate but unstable epidemics have been seen in some IDU populations in Dhaka city. And mobile populations, particularly at national borders are at higher risk of HIV acquisition due to the fact of being away from home, community and the anonymity and loneliness of traveling. The following three segments focus on the monitoring of the HIV epidemic in these vulnerable populations.

Commercial/Professional sex workers operate in all over the country. But it is important to know how large the sex-worker population may be to adequately interpret surveillance results. It is hypothetical that in some region, rapid increases in the absolute numbers of sex workers have resulted from significant political, social or economic changes. The nature of sex work and the profile of sex workers vary enormously within and between countries. There are most female sex workers, and those that work full-time, part-time or seasonally. Sex workers may operate in variety of settings such as brothels, riverbanks, bars, parks, under contraction buildings, street corners, hotels, etc. Sex work does not consider in Bangladesh, expect 14 reported brothels. Some HIV/AIDS or social workers suspected that brothel sex worker in Bangladesh is limited, near about 35,000 to 45,000, but other category sex workers is no countable, it is suspected more then 1,00,000. Dhaka city, for example, has approximately 5,000-15,000 female sex workers--an estimate (Source: Rainbow Nari O Shishu Kallyan Foundation). In most Cities, however, validated estimates of the numbers of sex workers are almost non-existent.

All estimates require regular updating and validation but these two approaches are worthy of repetition in other settings. Neither method can work without the trust and involvement of commercial sex workers themselves.

Frequency of exposure to HIV infection through sexual intercourse is the key factor for transmission of HIV among sex workers. For example, there are many countries; a significant proportion of sex workers is infected with HIV. The rates might vary from less than 1 percent to 40 percent or higher in some settings.

Even where HIV infection has not yet increases extensively, STD infection is often very high among sex workers. For example, in one brothel area in Bangladesh, 95 percent of 466 sex workers tested positive to antibodies for genital herpes virus and 60 percent for syphilis, although HIV was not detected among any of them. With the sequence of the epidemic, HIV tends to increase where other STDs are present.

There are many aspects to the nexus of drug use and HIV infection, In most of Bangladesh, people who choose to use drugs (Smoking-drug, morphia, heroin, hashish, Medicare-drug some kinds of sleeping pill, cold syrup, injections etc) that are not all socially sanctioned are treated as entirely outside society, enemies even of the social structure. The factor of Injection/ intravenous Drug Users (IDUs), which is directly can influence of HIV/AIDS, STDs/STI. For the majority of injecting drug users (IDUs), it means that lip-service is paid to the principles supposedly learned through the course of the epidemic: in relation to IDUs and the risks of HIV transmission, issues such as human rights, peer education, community participation, and legal and social change are unachievable fictions.

Besides, better estimation of populations at risk (i.e., those currently injecting drugs, or sex partners of IDUs and populations coming to be at risk), and a better understanding of the dynamics of drug utilization and social association of drug use are all necessary for targeting interventions efficiently.

Populations in Bangladesh are moving across land and sea borders in increasing numbers. International trade supports this growth in population mobility, international border between India and Bangladesh; more than 500 trucks come daily. Also occurring in Bangladesh are high levels of maritime trade, and seamen on fishing vessels travel widely in the region, enabling the transmission of HIV to populations in areas where the virus was previously unfamiliar.

Crossing land or sea borders often requires overnight stays, leaving the individual with idle time and opportunities to visit drinking and gambling establishments and brothels. HIV surveillance data for female sex workers, male STD clinic patients and young males at two sea ports – Cittagong & Mongla --show a clustering of high prevalence sites.

Source: Rainbow Nari O Shishu Kallyan Foundation

Make no mistake; China's AIDS epidemic is growing.

Ms. Muslema Khan Bulon
AIDS researcher
bulon@email.com

AIDS cases were first identified in 1981,in the United States. Researchers have traced cases back to 1959. There are millions of diagnosed cases worldwide, but there is no cure. There are about thirty million people in the world who are currently infected with HIV. China is the world largest population country in the world. Potentiality, manpower & security were able to attract world famous investor. Many foreign investor, invest in here. So China plays an important role in the world markets.

By the way, AIDS epidemic is knocking the door. UNAIDS, WHO and Government, the study estimated that 650,000 people have HIV/AIDS in China, down from the government's 2003 estimate of 840,000 cases. The revision is due mainly to the earlier study's overestimation of the number of people infected through blood-buying schemes, said Deputy Health Minister Wang Longde.

The HIV/AIDS programme specialist Mr. Mohammad Khairul Alam said, “several social norms and immature behavior fueled of this disease to scatter rapidly. There are several social components link to develop this harmful situation. Poverty-behind to force it, Gender discrimination plays a vital role; Frustration & risk behavior help to sink humanity resulting infection. The link between poverty & gender discrimination are help to decline socio economic prosperity. This link creates several anti social poisonous issues also. Such as trafficking to prostitute, sell sex for earn or living, break down family norm to create frustration and driven drug point. We notice easily that Illiteracy is the main watchword of all circumstance. So it is not easy to remove it from the society, several programs & strategy are needed to gain sustainable position�.

UN officials said the new figure is more accurate than past estimates in part because more surveillance sites have been set up during the last two years. The figure is within an estimated range of 540,000-760,000 HIV/AIDS cases, UN officials said.

Of the 25,000 people who died of AIDS in China last year, 10,000 acquired their infections through blood-buying schemes, said the Health Ministry. The high mortality comes despite estimates that those infected through blood-buying, mostly poor farmers, comprise a small proportion of total AIDS cases in China.

"Make no mistake, China's AIDS epidemic is growing," said Hank Bekedam, WHO's chief China representative. "With an estimated 70,000 new infections in 2005, the epidemic here shows no signs of abating." "The new numbers should not mask the fact that HIV infections are on the rise. we fear the number of new infections this year will be even higher and this trend could continue in the future," Bekedam said.

The Rainbow Nari O Shishu Kallyan Foundation identified four major approaches in a groundbreaking study on spread out HIV in Asia. This study undertook by comparing of social-economic norm, family pattern, economic dependency, cause of mounting sex industries, gender discrimination status & global analysis fact. There are four factors that appear to play a crucial role in HIV transmission in Asian Countries: Injection/ intravenous drug use (By sharing needle), female sex work (Due to lack of safe sex knowledge), gender discrimination (which indirectly force females commercial or non-commercial sex), Same sex/ homosexually/ Hizra (Due to lack of HIV/AIDS information, because they act invisible in this society). Poverty & illiteracy fueled it proportionally.

About half the 70,000 new infections were sexually transmitted, while most others were acquired through intravenous drug use, the study said. The number of sexually transmitted cases exceeded the number of cases through IDU, worrying officials that the epidemic has moved into the general populace, and it has killed many people. So people need to be more aware and protect themselves so they don't become another statistic, because HIV and AIDS are serious, deadly, and they will be with us for a long time. There will not be a cure found anytime soon, but hopefully there will be a cure found. We have to think AIDS couldn’t backward the present development in China.

References: Agence France Presse, Rainbow Nari O Shishu Kallyan Foundation.

Don’t Mistake India is going to HIV/AIDS epidemic.

Ms. Muslema Khan Bulon
AIDS Researcher
bulon@email.com

HIV/AIDS is mounting in every country in the world. If we compare with other disease, it is only AIDS that will get significantly worse in every year. Other problems don't grow but AIDS will overcome the medical alliance. The HIV/AIDS programme specialist Mr. Mohammad Khairul Alam said, “several social norms and immature behavior fueled of this disease to scatter rapidly. There are several social components link to develop this harmful situation. Poverty-behind to force it, Gender discrimination plays a vital role; Frustration & risk behavior help to sink humanity resulting infection. The link between poverty & gender discrimination are help to decline socio economic prosperity. This link creates several anti social poisonous issues also. Such as trafficking to prostitute, sell sex for earn or living, break down family norm to create frustration and driven drug point. We notice easily that Illiteracy is the main watchword of all circumstance. So it is not easy to remove it from the society, several programs & strategy are needed to gain sustainable position�.

These findings are of concern when viewed against the general awareness levels of HIV/AIDS in India. For example, while close to 90 percent people in urban areas have heard of AIDS, only about 72 percent of people in the rural areas know about it. Tellingly, the study also highlights low awareness levels of HIV/AIDS in heavily populated states as a "danger signal". About three out of four rural women in Bihar, Gujarat and Uttar Pradesh had never heard of HIV/AIDS.

The ‘Rainbow Nari O Shishu Kallyan Foundation’ identified four major approaches in a groundbreaking study on spread out HIV in Asia. This study undertook by comparing of social-economic norm, family pattern, economic dependency, cause of mounting sex industries, gender discrimination status & global analysis fact. There are four factors that appear to play a crucial role in HIV transmission in Asian Countries: Injection/ intravenous drug use (By sharing needle), female sex work (Due to lack of safe sex knowledge), gender discrimination (which indirectly force females commercial or non-commercial sex), Same sex/ homosexually/ Hizra (Due to lack of HIV/AIDS information, because they act invisible in this society). Poverty & illiteracy fueled it proportionally.

With regard to preventive measures, three out of ten men and five out of ten women were not aware of the condom’s protective value. Less than 30 percent of women in rural areas of Bihar, Gujarat, Uttar Pradesh and West Bengal were aware that HIV/AIDS could spread through blood transfusion. Only about 66 percent of women in urban areas but less than 50 percent in rural areas were aware of dangers of HIV-infected mothers breast feeding their children and possibly passing the infection on to the child.

The most significant recent shift in drug use patterns in the region, as well as in India, is the move from smoking or chasing to injecting drug use. Heroin, buprenorphine (tidigesic/tamgesic) and dextropropoxyphene (spasmo-proxyvan) are the most commonly injected drugs in India.

A Rapid Assessment Survey (RSA) of drug users in 14 cities collected and collated street-based information on drug use and drug-related HIV. In-depth thematic studies of drug use in the border areas, female drug users, drug use in rural areas and patterns of drug use in prison populations were also launched. A National Household Survey having a sample size of over 40,000 males in the 12-60 age group, documenting the extent, patterns and trends of drug use in India was a major part of the research collaboration.

RSAs conducted in Jamshedpur, Hyderabad, Bangalore, Shillong, Dimapur, Thiruvanthapuram, Goa, Ahmedabad, Imphal, Chennai, Mumbai, Delhi and Kolkata indicate that 43 per cent of clients interviewed had injected at some point. Needle sharing was reported by 53-85 per cent of injectors. Non-cleaning of needles/syringes was common and knowledge of modes of HIV/AIDS transmission was limited. Consequently, risk-perception of HIV was low. Significantly, women drug users also reported injecting drug use. Clearly, there is need to extend interventions and prevention activities into areas other than the north-eastern states and particularly the metropolitan cities of India where injecting drug use is a problem. There are over 100,000 estimated injecting drug users in India outside of the north-eastern part of the country.

References: SHYAM, Rainbow Nari O Shishu Kallyan Foundation

-AIDS is spreading alarmingly in India-

-Ms. Mahmuda Begum-
-Health & Nutrition Researcher-
-Mahmuda.Dhaka@gmail.com-

India is the country with second largest population of HIV-infected individuals. First case of HIV was detected in 1986 in Chennai. Current estimates of HIV infection among the adults between the age 15-49 years is 0.7 %. HIV is increasingly being diagnosed among the housewives and pregnant women and not among the high-risk groups.

AIDS researcher Mr. Mohammad Khairul Alam said, “HIV/AIDS is a three dimensional disease. It spreads out by three major causes:- such as unconscious or unsafe sexuality, blood exchange(needle) /transfusion for patients, infected mother to child. HIV/AIDS direct by impact on the human body - it paralyze the physical condition, psychological morbidity and destroy social value. It also wipes out three things, such as it affects adults in their productive prime, severely hampers economic growth of person, and hampers his family, at last by rotation it destroys country’s progress. Every one can protect it by avoiding risk behavioral sex (multi-partner sex, unsafe sex practice etc), by avoiding injectable drug (needle sharing is a burning cause of it), by avoiding getting blood without test. Nation wide programme is also needed to take three major strategies:- top to bottom awareness programme of HIV/AIDS, gender discrimination programme to ensure girls and women rights, poverty reduction programme�.

India is experiencing rapid and extensive spread of HIV. This is particularly worrisome since India is home to a population of over 900 million. As a single nation it has more people than the continents of Africa, Australia and Latin America combined. There are an estimated 5.1 million people infected with HIV in India today, and 70,000 to 100,000 cases of AIDS may have already occurred in the country. The Rainbow Nari O Shishu Kallyan Foundation identified four major approaches in a groundbreaking study on spread out HIV in Asia. This study undertook by comparing of social-economic norm, family pattern, economic dependency, cause of mounting sex industries, gender discrimination status & global analysis fact. There are four factors that appear to play a crucial role in HIV transmission in Asian countries: Injection/ intravenous drug use (By sharing needle), female sex work (Due to lack of safe sex knowledge), gender discrimination (which indirectly force females commercial or non-commercial sex), Same sex/ homosexually/ Hijara (Due to lack of HIV/AIDS information, because they act invisible in this society). Poverty & illiteracy fueled it proportionally.

HIV prevalence among drug users in India indicates a differential epidemic characterized by unacceptably high levels in certain areas (Manipur with a reported HIV prevalence of 80 per cent), high prevalence rates (above 5 per cent) in many cities of India with a concentrated IDU population (Chennai, Mumbai, New Delhi), and low level prevalence in certain areas like Calcutta (2% HIV seroprevalence for the past seven years). In some areas of India, the population segments at risk for drug use and high-risk sex overlap. In Manipur, the transmission of the HIV virus from injecting drug users (IDUs) to their spouses has been established, and a study found that 45 per cent of the wives of HIV-infected IDUs were also HIV-positive.

The most rapid and well-documented spread of HIV has occurred in Bombay and the State of Tamil Nadu. In Bombay HIV prevalence has reached the level of 50 percent in sex workers, 36 percent in STD patients and 2.5 percent in women attending antenatal clinics. Certain regions, such as eastern India (Calcutta area) and northern India (New Delhi region), still show a lower prevalence of HIV (1 to 2 percent) among sex workers.

HIV is rapidly spreading to rural areas through migrant workers and truck drivers. Surveys show that 7 to 10 percent of some truck drivers in the country are infected with HIV. An estimated 1 to 2 million cases of tuberculosis occurs in India every year. In Bombay 10 percent of the patients presenting with tuberculosis are HIV-positive. Tuberculosis is the presenting symptom of AIDS in over 60 percent of AIDS cases.

Contrary to traditional belief, sexually transmitted diseases and sex with multiple partners are common in the country, both in urban and rural areas. An estimated 3 to 4 percent of some rural populations have a sexually transmitted disease. Injecting drug use is a problem in Manipur, which is in the North East region, where 55 percent of drug users are HIV-infected and 1 percent of women attending antenatal clinics are infected with HIV.

References: Rainbow Nari O Shishu Kallyan Foundation, UNAIDS

AIDS is a three dimensional disease

- Al-Haz Dr. M. A. Matin -
- Principal Section Officer -
- Institute of Social welfare and Research -
- Dhaka University -
- motin.dhaka@gmail.com -

After Twenty years, the first clinical evidence of acquired immunodeficiency syndrome (AIDS) was reported, AIDS has become the most harmful disease humankind has ever faced. Since the start of the epidemic, more than 60 million people have been infected with the HIV. Some worst effected region of sub-Saharan Africa where HIV/AIDS is now the leading cause of death.

The environmental closeness of Bangladesh to Myanmar and consequently, the Golden Triangle drug trail has made it a major transit route for drug smuggling and its easy availability in the area. However, the transmission route of HIV/AIDS in Bangladesh is no longer confined to the IDUs but spreads further to the female sexual partners of IDUs and their children. This is not surprising as women are mostly vulnerable to HIV infection and other sexually transmissible diseases because of geographical and socio-cultural factors including economic, educational and legal discrimination and unequal gender relations.

Women are disproportionately affected by HIV/AIDS. Biology and gender inequality conspire to drive the spread of the disease, and forces women to bear the brunt of the social and economic costs. ‘Rainbow Nari O Shishu Kallyan Foundation’ have found that male to female transmission appears to be 2 to 4 times more efficient than female to male transmission, because semen contains a far higher concentration of HIV than vaginal fluid. Young girls are particularly vulnerable. Their immature cervixes and low vaginal mucus production presents less of a barrier to HIV, all of which have been seen in many settings to be contributing factors to the rapid spread of HIV.

People with AIDS are mainly prone to developing various cancers, particularly those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more harmful and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.

Children with AIDS may get the same opportunistic infections, as do adults with the disease. In addition, they also have severe forms of the bacterial infections all children may get, such as conjunctivitis (pink eye), ear infections, and tonsillitis.

In children younger than 13 years, the definition of AIDS is similar to that of adolescents and adults, except that lymphoid interstitial pneumonitis and recurrent bacterial infections are included in the list of AIDS-defining conditions.

In many developing countries, where diagnostic facilities may be minimal, epidemiologists employ a case definition based on the presence of various clinical symptoms associated with immune deficiency and the exclusion of other known causes of immunosuppression, such as cancer or malnutrition.

Many people are so debilitated by the symptoms of AIDS that they cannot hold steady employment nor do household chores. A small number of people first infected with HIV 10 or more years ago have not developed symptoms of AIDS.

AIDS researcher Mr. Mohammad Khairul Alam said, “HIV/AIDS is a three dimensional disease. It spreads out by three major causes:- such as unconscious or unsafe sexuality, blood exchange(needle) /transfusion for patients, infected mother to child. HIV/AIDS direct by impact on the human body - it paralyzes the physical condition, psychological morbidity and destroys social value. It also wipes out three things, such as it affects adults in their productive prime, severely hampers economic growth of person, and hampers his family, at last by rotation it destroys country’s progress. Every one can protect it by avoiding risk behavioral sex (multi-partner sex, unsafe sex practice etc), by avoiding injectable drug (needle sharing is a burning cause of it), by avoiding getting blood without test. Nation wide programme is also needed to take three major strategies: - top to bottom awareness programme of HIV/AIDS, gender discrimination programme to ensure girls and women rights, poverty reduction programme�.

References: Rainbow Nari O Shishu Kallyan Foundation, UNAIDS

Physiological, Behavioural And Social Factors Make Adolescents More Vulnerable than Adults to HIV/AIDS

- Mohammad Khairul Alam -
- Executive Director -
- Rainbow Nari O Shishu Kallyan Foundation -
- Rainbowngo@gmail.com -

Globally, the rate of sexually transmitted infections (STIs) among young people is soaring. One-third of the 340 million new STIs each year occur in people under 25 years of age. Each year, more than one in every 20 adolescents contracts a curable STI. More than half of all new HIV infections occur in people between the ages of 15 to 24 years. The sexual health needs of adolescent girls are generally overlooked and stigma and vulnerability affect particular groups of men as well as women. Although men generally have more access to information on sexual issues than women, and more decision-making power regarding sexual behaviour, access to information, and treatment for other infections which facilitate the transmission of HIV and onset of AIDS, including sexually transmitted infections, are limited because of weak public health services, health workers' negative attitudes, and the high cost of treatment.

If the adolescents are informed and thought about their sexual and reproductive health, they might take the decisions about it independently. The physiological, behavioural and social factors make adolescents more vulnerable than adults to STDs/STI. It has been observed who that girls have a large mucosal surface area and have not yet developed mature mucosal defence systems, are more exposed to infection. The cells that line the opening of the cervix are particularly susceptible to chlamydia, gonorrhoea and HIV.

Social powerlessness, poverty and economic dependence contribute to the vulnerability of adolescent girls. The HIV/AIDS epidemic has been fuelled by gender inequality. Unequal power relations, sexual coercion and violence is a widespread phenomenon faced by women of all age-groups, and these have an array of negative effects on female sexual, physical and mental health. The study of HIV/AIDS infection reveals the disastrous effects of discrimination against women on their health and on the socio-economic structure of society.

Recently, “Rainbow Nari O Shishu Kallyan Foundation� has focused mostly on three types of work on HIV/AIDS in Bangladesh -- community mobilisation for prevention through promotion of fidelity, condom-use and abstinence; advocacy on access to affordable treatments, targeted at medicine producers and international donor organisations; and work to ensure “mainstream� support to AIDS-affected individuals and communities for integration on poverty mitigation work. HIV/AIDS has good relation with poverty and gender inequality. Without decline in gender discrimination and poverty, all efforts to prevent HIV/AIDS or sustainable development in this sector will fail.

Usually, girls do not have the same educational and employment opportunities as boys, and they face family and societal pressure for early marriage and childbearing. Early marriage and early childbearing are the norms in Bangladesh. However age at marriage is rising now. Finally, there is evidence that an increasing proportion of unmarried adolescents are sexually active.

Currently as age at marriage is increasing, this raises its own issues and concerns. Sometimes late marriage increases premarital sex. Sex outside marriage is normally considered immoral and adolescents who engage in it particularly girls are strongly condemned.

In many societies, people from groups associated with high incidences of HIV infection -- including drug users, men who have sex with men, and commercial sex workers are subjected to a culture of fear and punishment when their HIV status is suspected.

References: UNAIDS, World Bank, Rainbow Nari O Shishu Kallyan Foundation

ARC a Project Solid Management

Sir,
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Your's

Mohabbat alom Bidduth.
ED
Palli Mukti Sangstha (PMS)
Sirajgonj,Bangladesh.
edpms08@yahoo.com