DHAKA, 19 February 2008 (IRIN) - Insufficient data, coupled with the lack of a coherent HIV prevention policy, are undermining Bangladesh's national AIDS programme, say health experts.

"We need to gather stronger empirical data and relate all problems faced by HIV/AIDS, with a special emphasis on the use of condoms by all who need them," said Dan Odallo, country coordinator of UNAIDS in Bangladesh.

Among intravenous drug users (IDUs), HIV has already become a concentrated epidemic - when five percent or more members of any high-risk group are infected.

"In more than one IDU cluster in Dhaka [the capital], 7.5 percent HIV-positive cases have been diagnosed recently," said Dr Mohammad Hanifuddin, director of the government's project to combat sexually transmitted infections (STI) and HIV.

Most of Bangladesh's more than 150 million inhabitants are largely unaware of the risk factors; moreover, many seldom practice safe sex, including condom usage, warned Prof Nazrul Islam, head of the department of virology at the Sheikh Mujib Medical University in Dhaka.

Poor official statistics

Although there are only 1,207 officially confirmed HIV-positive cases, national estimates put the number of people living with HIV in the world's eighth most populated nation closer to 7,500 but the real number could be several times higher.

"Most of these people do not go to the laboratories for a test," said Shahnaz Begum of Durjoy Mohila Shongho, a national NGO working with street-based commercial sex workers, citing the social stigma associated with the disease. "They only go to the labs when they are either compelled or enticed to. The official statistics are just the tip of an iceberg."

Islam noted that "The biggest problem facing the country's HIV/AIDS prevention and control programme is scanty statistics," and no one really knew what the true facts were.

Inept national AIDS programme

Despite that, the government's national AIDS/STI programme lacks the necessary strength and capacity to respond. "A large portion of the budget has been contracted out to UNICEF [the UN Children's Fund] and Save the Children USA to implement the government's programme. These organisations are not contracting firms; Bangladesh should do its job itself," said Islam, who is also a member of the country's national AIDS committee.

Although the number of voluntary counselling and testing centres in the country had increased, there was an agonising absence of HIV treatment facilities near them. "Hospitals, doctors, paramedics, government health workers and all of society need to be brought into the de-stigmatisation process," he suggested.

The national programme also continued to neglect the issue of hundreds of thousands of migrant workers in the country - many of whom are potential importers of HIV - while the country's porous borders with India and Myanmar made the risk of the virus spreading even greater.

"More than 80 percent of the diagnosed HIV-positive people are migrant Bangladeshi workers and their wives," the leading HIV expert confirmed, adding that the care and support of HIV infected people remained unsatisfactory.

Few data and fewer condoms

Odallo said more rigorous efforts were needed in data collection and breaking the barrier of condom use only for family planning purposes. "There is a very wide range of variation in data, which makes it very hard for us to know whether our interventions are having any impact or not," he complained.

"Family planning is on one side of condom use and HIV is on the other; we, the public sector, are in the middle. Condoms are distributed only for child spacing, rather than STI/HIV control."

When the government stated that couples eligible for family planning did get condoms, it failed to ensure that other sexually active people were protected against the risk.

"Condom use occupies only 10 percent of the social marketing - whatever figure we get is confined within this 10 percent of the sexually active people. The rest - 90 percent - don't have access anyway. You cannot keep ahead of the epidemic unless you overcome the above two obstacles," Odallo insisted.

Bold steps needed

Another problem is the lack of a clear policy on the social protection of HIV-infected people and those of different sexual orientations. "People living with AIDS are voiceless. The fact that people with AIDS and MSM [men who have sex with men] suffer stigma and discrimination drives the whole AIDS debate underground, so we do not know whether we are making any progress," the UNAIDS official said.

He felt there should be a complete policy revision of public sector condom programming, and that sub-district or community heads should be able to distribute condoms not only to eligible couples, but also to others who needed protection against sexually transmitted infections and HIV.

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