Lives of others: HIV/AIDS in Bangladesh

"As anaesthesia was kicking in, and the doctor and nurses were getting ready for the c-section, I heard someone say, ´If I was her, I´d never bring this baby into the world.´ For the first time in my life I loathed myself, I felt ashamed, as if I was scum of earth," Salma (not her real name) breaks down in tears, the only time she did so throughout the interview.

Talking to Salma and her husband Munir (not real name either) at the CAAP (Confidential Approach to AIDS Prevention) centre in Banani, Dhaka, one understands why confidentiality is crucial to people living with HIV/AIDS in our country. Social stigma and being discriminated virtually everywhere are the primary reasons that haunt people with HIV/AIDS. As Salma points out, "Why blame the nurses and the attendants when the doctor´s attitude was anything but kind?"

According to Munir, he had to clean the room in the clinic where his wife stayed for four days as the staff at Marie Stopes Clinic in Banshbari refused to do it. And though Munir pointed out that his wife was not receiving free services, the attitude of the staff did not change much.

Munir found out that he is HIV positive ten years ago, when he had to have a medical check-up. He was planning to go to Saudi Arabia for work and had paid his ´adam byapari´ (recruiting agent) Tk 70,000. Following the check-up, the agent told Munir that there was some "irregularity" in his blood but did not disclose what exactly was wrong. Munir, an auto mechanic, was not that concerned initially, as he did not feel "sick."

It was not until he had more comprehensive check-ups done at other medical facilities, that he was convinced he was HIV positive. But the reality of the consequences would take years to settle in.

"I was nonchalant. My family members were confident (apparently they still are) that the medical reports were wrong. I looked healthy, I felt healthy; how could I be ill? I bumped into a relative at PG Hospital who figured out that I was getting tested for HIV. He didn´t approach me directly regarding the issue but after a while suggested that I go to the CAAP centre. He said that I might find the staff at the centre helpful. Eventually I did and I´ve been going through counselling at CAAP since 1999," says Munir.

CAAP Hotline has been functioning since 1996. The centre has an open-door policy of providing anonymous care and counselling. It also offers free HIV-test. A team of trained counsellors -- university graduates in Psychology and with two to three years experience working in health-related fields -- accommodate the clients at the centre. Since 1999, the centre has helped 184 clients. Counsellors discuss the disease, its progression, the issues that may develop and what to do about them, good hygiene, when to report for medical help and how to avoid infecting others. The centre is run by Dr Halida Hanum Khandaker. Currently the centre also provides ART (Antiretroviral Therapy) that includes lifesaving drugs, to its clients and refers them to medical facilities including IDH (Infectious Diseases Hospital) at Mahakhali, Dhaka for treatment.

With no visible sign of guilt or remorse, Munir agrees that Salma contracted HIV from him. Husbands infecting wives with the virus is not an uncommon case in South Asia. Asked how he contracted HIV, Munir goes mute for minute and then says he is unsure but suspects it has something to do with an accident he endured while working at a soap factory, when he was ten. His right hand was badly cut. He says he remembers being admitted to Dhaka Medical College Hospital.

Certain things in that story do not add up and Salma was not aware that her husband is HIV positive when they got married five years back. It was not an arranged marriage; the couple had known each other for a while before they decided to take the next step.

Munir disclosed his HIV status to Salma three years after their marriage. She was given the impression that it is an "irregularity" in blood, the same perception Munir had initially. Like others from uneducated, lower middle-class families, Salma was left in dark about the risks of having unprotected sex with an HIV positive individual. Munir also admits that he was engaged in substance abuse, on and off.

Munir decided to bring Salma at CAAP for counselling only after she was pregnant, though his counsellor had repeatedly warned him about the risks of an HIV positive mother transmitting the virus to her baby during pregnancy, labour and delivery, and through breastfeeding. Apparently the pressure from family members -- even those who are aware of Munir´s HIV status -- to have a child was overwhelming for the couple.

This nonchalance, carelessness and ignorance are not limited to the uneducated or underprivileged class. The couple´s counsellor, Suriya Islam (PW and Adherence Counsellor), who has been working at the CAAP centre since 2001, says that men from upper middle-class and educated families have infected their wives and often left them in the dark. She recalls a case (without disclosing the identity of the individual) where the HIV positive husband divorced his wife, whom he infected, and then remarried, without disclosing his HIV status to his new bride.

Another client once told Suriya that he deliberately infected his wife so that she won´t leave him.

Explaining the antiretroviral therapy, Suriya says, "According to WHO guidelines, HIV infected adolescents and adults should start antiretroviral therapy when they have clinical AIDS, regardless of CD4 count. People with stage III or IV HIV should be offered treatment. When CD4 counts are available, all HIV infected people with less than 200 CD4 cells should be offered treatment.

"The drugs that are used include Triovix, Diavix, Avifanz and Avilam and monthly medical expense runs between Tk 4,000 and 7,000. Clients receive these lifesaving drugs free of cost from CAAP. This initiative is funded by SRC (Swiss Red Cross). SRC also funds CAAP´s voluntary counselling and testing programmes."

According to an official government report, as of December 31, 2006, 874 cases of HIV/AIDS have been reported. 240 cases of AIDS have been detected and 109 people have already died.

Many people living with HIV/AIDS are unwilling to get tested. Among the high-risk groups HIV test is also challenging as they have their right to give consent and nothing can be done against their will.

A survey among adolescents and young people (15-24 years) in 2005 revealed that only one out of three males in urban and one out of four in rural areas, was somewhat knowledgeable about HIV/AIDS. Nearly 59 percent of married women and 42 percent of men (age 15-54) have no idea as how to avoid HIV.

Statistics on sex workers also shows that these women have every intention of using condoms and understand the risk of unprotected sex. In most cases, however, their clients refuse to use condoms.

There is concerning evidence of increasing new HIV infections despite prevalence rate said to remain low. Bangladesh has been identified as one of the five countries in the Asia-Pacific region where HIV/AIDS infections are rising. It was revealed at the recent 8th International Congress on AIDS in Asia and the Pacific (ICAAP8) in Colombo 2007.