Bangladesh 2014

disciplines relevant to the prevention and control of HIV and sexually transmitted diseases (STDs). With
political support from the National AIDS Committee and technical support from the TC-NAC, the task force
led the process of developing a national policy on HIV and AIDS, which was endorsed by the Cabinet in
1997 (NASP and MOHFW 2008). In 1997, the protocol for safe blood transfusion was formulated. Today
there are 211 blood screening centers established for screening HIV, syphilis, malaria, hepatitis B virus
(HBV), and hepatitis C virus (HCV). With support from the government of Bangladesh, non-governmental
organizations (NGOs) have set up an STD/AIDS network with more than 250 members working in the field
of HIV/AIDS. As the nodal body for HIV/AIDS activities, the National AIDS/STD Program (NASP) was
formed under the DGHS, and has functioned since 1998. The major role of the NASP is to formulate policies,
coordinate information, and regulate the implementation of the HIV/AIDS prevention efforts in the country.
The NASP is implementing HIV/AIDS prevention activities through a coalition of three functionaries, the
NAC, MOHFW, and DGHS. The NASP is also responsible for coordinating activities of all stakeholders
and development partners involved in HIV and AIDS program. Bangladesh has adopted its third National
Strategic Plan (2011-2015), with the following objectives: to implement services to prevent new HIV
infections; to provide universal access to treatment, care, and support services for people infected and
affected by HIV; to strengthen coordination mechanisms and management capacity at different levels to
ensure an effective multi-sector HIV/AIDS response; and to strengthen the strategic information systems
and research for an evidence-based response (MOHFW 2012). Most HIV-related activities are based on
prevention among most-at-risk populations, because Bangladesh is a country with low prevalence of HIV.
HIV intervention programs targeting the vulnerable population in Bangladesh evolved over a period
of more than 10 years, from 1997-2008. Initially, programs were started and led by NGOs, and a strong
partnership developed with the government, civil society, and donors, who worked to facilitate
comprehensive interventions for the most vulnerable groups. These groups included female sex workers and
their male clients, injecting drug users (IDUs), men who have sex with men, transgendered persons (hijras),
and transport workers. In general, intervention packages included condom promotion, STI management,
needle/syringe exchange, detoxification, peer education, health education and counseling, resting/recreation
facilities, community awareness, and local level advocacy. In addition, the Government of Bangladesh,
under the direct supervision of NASP, has taken the initiative to provide optimum care and management to
people living with HIV through care, support, and treatment services at government and NGO facilities. An
AIDS Epidemic Model analysis conducted to examine the impact of interventions concluded that early
response to HIV/AIDS helped to maintain a low prevalence in Bangladesh. The analysis demonstrated that
up to 2014 the ongoing interventions have averted a total of 141,225 HIV infections and saved 3,841,000
Disability Adjusted Life Years (DALYs) and 19,545 lives (MIS 2015).
Bangladesh has been conducting serological surveillance and behavioral surveys since 1999. These
surveys provide data to better understand and address the HIV situation at both the national and sub-national
levels. They thereby aid in the design of prevention, treatment, care, and support programs. Since 1998,
serological surveillance surveys of most-at-risk groups have been conducted approximately every two years.
According to the latest Serological Surveillance (NASP 2012) in Bangladesh, HIV prevalence among
persons who use drugs, female sex workers, male sex workers, men who have sex with men, and hijras is
0.7 percent with IDUs in Dhaka city have the highest prevalence (5.3 percent). A recent study also observed
that the number of HIV cases among IDUs in Dhaka city is increasing rapidly (NASP et al. 2014).
Bangladesh has been implementing HIV prevention programs through awareness-raising activities
since 1987, a time when there were no identified cases of HIV in the country. Over the years, the HIV
program has grown in size and quality and has involved a wider network of stakeholders. The program has
increased its coverage of most-at-risk populations, which now include young people. There have been
various efforts to prevent HIV transmission, such as public health education through the media and program
activities by both government and NGOs, particularly with groups considered to be at high risk for
transmission of HIV/AIDS. In addition, adolescent and young people age 11-24 have been targeted through
providing life-skills training to peer leaders. Integrating life-skills based education in secondary school
curriculums is a major accomplishment to reach adolescents with messages on HIV/AIDS prevention.
176 • HIV/AIDS-related Knowledge, Attitudes, and Behavior