A precarious time lies ahead for the country’s HIV-positive and AIDS patients as international donors organisation providing preventive measures for HIV infection, as well as treatment and rehabilitation for HIV-positive and AIDS patients, are pulling out their operations in Bangladesh.
Agencies like USAID and Save the Children have already stopped their operations concerning HIV/AIDS patients, including medical treatment, since the government announced in 2009 that it would provide all necessary treatment to HIV patients from 2012, to be funded by the World Bank. However, it has yet to put such mechanism in place in the country.
The HIV patients will face serious crisis when the Global Fund to Fight AIDS, Tuberculosis and Malaria stops their project at the end of this year, followed by the Swiss Red Cross which will end their project next year.
Since starting their operation in Bangladesh in 2004, the Global Fund has invested around $131m in Bangladesh to continue HIV prevention and AIDS control efforts. The Swiss Red Cross started their activities in 2000.
Three local NGOs – Ashar Alo Society, Mukto Akash Bangladesh and Confidential Approach to AIDS Prevention (CAAP) – are also currently working for the HIV patients and provide them with free medicine and other necessary treatment. They are funded by the aforementioned donor agencies and will struggle to provide their services when the donors stop their funding here.
As the government has no proper institutional support for these patients, they will have nowhere to go for the free medical treatment, counselling, physical and mental health support and other services once the NGOs shut down. The Dhaka Tribune talked to UNAIDS Country Director Leo Kenny, who said: “Bangladesh treats all people who need Antiretroviral Therapy (ART) free of charge. But we are facing a situation where the government has agreed to take over procurement and distribution of ART treatment from the Global Fund. We are facing procurement delays and this needs to be sorted out immediately.”
Delay in government initiative
Despite the announcement in 2009, it was in 2013 when the National AIDS/STD Programme (NASP) started working on a project titled “Comprehensive care, support and treatment of PLHIV (people who are living with HIV)” to provide treatment and other services in collaboration with NGOs directly involved with this particular field.
The plan was approved by The Ministry of Health and Family Welfare in August last year and by World Bank in October. But the NASP later informed the government that the plan needed to be revised.
“We found that it was not possible to implement the plan with direct collaboration with the NGOs and it required revision,” NASP Line Director Dr Husain Sarwar Khan told the Dhaka Tribune. “It has been delayed due to the whole process of reviewing the plan and other formalities. We hope that the government will implement the plan very soon.”
Gaps and challenges
According to government statistics, 3,241 people have been diagnosed with HIV infection in the country between 1989 and 2013, 1,299 of whom contracted AIDS and 472 died from it. 370 new HIV-positive patients were identified in the country last year.
UNAIDS data says that the estimated new infections have increased by 25% in Bangladesh since 2001 and the reported new infections has increased 1.5 times over the past five years.
The number has been especially increasing in some key population, such as sex workers, people who inject drugs, transgenders, etc.
There are more than 9,000 people in the country living with HIV, two-thirds of whom did not know their status, according to an estimate by the UNAIDS last year. The most updated scenario will be announced today, on the occasion of the World AIDS Day.
There have been many challenges regarding the detection and treatment of HIV patients, despite their low number compared to the country’s total population. Talking to the Dhaka Tribune, several HIV/AIDS patients said they preferred going to the NGOs where they can get proper treatment by keeping their identity secret, as well as proper counselling.
In addition patients and NGO officials alike claimed that the government had not created a friendly environment for HIV/AIDS patients in government and private hospitals, and the patients have to suffer fear, social stigma and discrimination.
Leo Kenny said: “The main reason people do not access testing is stigma and discrimination, so we need to address this. Repealing the punitive laws and policies will be a big step in the right direction.
“There are important capacities which need to be built especially at a district and upazila level. Bangladesh has good guidelines and algorithms for prevention, treatment care and support, but for them to be fully implemented major capacity building needs to ensue.”
Amitabh Sharma, the newly-appointed country representative of Swiss Red Cross in Bangladesh, said the main challenge is the lack of institutional support and a strong institutional structure from the government.
“It is high time that the government should take the leading position. We do not lead; we can only provide support. We, the donors, can never be the substitute to the government,” he told the Dhaka Tribune.
Habiba Akhter, executive director at Ashar Alo Society, said: “The government should bring all vulnerable people under the HIV identification process, otherwise there is no guarantee to prevent further infection.
“We only find HIV patients when they become weak and are continuously suffering from diseases and infections. To bring these people under the identification process, a fair and supportive environment should be ensured at all levels of society.
“The sooner people come to test for HIV infection, the sooner they can get treated in case of infection,” she told the Dhaka Tribune.