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 increase 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

-Mohammad Khairul Alam, HIV/AIDS Programmme Consultant

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