RST UNAIDS; Slide 1

Why we should invest in a Low Prevalence Country

Dan O. OdalloUNAIDS Country Coordinator

Bangladesh

Responding to HIV and AIDS in Bangladesh

RST UNAIDS; Slide 2

Outline

1. Controversy2. Definitions 3. Global figures4. National Figures 5. Brief History 6. AIDS in Bangladesh 7. Potential for spread 8. Enduring Risk factors 9. Rationalizing the investment in AIDS prevention 10. Conclusions

RST UNAIDS; Slide 3

Controversy

• Many schools of thought:

– Zoonotic theory (contact with animals, polio vaccine, malaria research)

– Conspiracy theory (CIA, Soviet Plot etc)– Divine intervention theory—God’s punishment

• July 3, 1981: "Rare Cancer Seen in 41 Homosexuals.“ The New York Times headline article.

RST UNAIDS; Slide 4

What is HIV and AIDS

• HIV- Human Immunodeficiency Virus the virus that causes AIDS

• AIDS (Acquired immunodeficiency syndrome) is the final and most serious stage of diseases resulting from HIV numerous opportunistic infections

• Candidiasis (thrush)• Herpes simplex• Malaria• TB• Pneumonia

RST UNAIDS; Slide 5

Global summary of the AIDS epidemic, December 2007

Total 33 million [30 – 36 million] Adults30.8 million [28.2 – 34.0 million]

Women 15.5 million [14.2 – 16.9 million] Children under 15 years 2.0 million [1.9 – 2.3 million]

Total 2.7 million [1.6 – 3.9 million]Adults 2.3 million [1.3 – 3.4 million]Children under 15 years 370 000 [330 000 – 410 000]

Total 2.0 million [1.8 – 2.3 million]Adults 1.8 million [1.6 – 2.1 million]Children under 15 years 270 000 [250 000 – 290 000]

Number of people living with HIV in 2007

People newly infected with HIV in 2007

AIDS deaths in 2007

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Surveillance Round

Year Numbers Tested

HIV (%)

1st Round 1998 – 1999 3886 <1% (0.4)

2nd Round 1999 - 2000 4634 <1% (0.2)

3rd Round 2000 - 2001 7063 <1% (0.2)

4th Round 2002 - 2003 7877 <1% (0.3)

5th Round 2003 - 2004 10445 <1% (0.3)

6th Round 2004 – 2005 11029 <1% (0.6)

7th Round 2005 - 2006 10368 <1% (0.9)

8th Round 2006-2007 12786 <1% (0.7)

National Sero-Surveillances: HIV Prevalence Rates Over the Rounds

RST UNAIDS; Slide 7

Brief History

1959

•Virus thought to have jumped from animal to man in early 50s

1981

•Emergence of Kaposi's Sarcoma and Pneumonia among gay men in New York and California.

• CDC calls it "GRID" (gay-related immune deficiency. However, cases started to be seen in heterosexuals, IDUs and people who received blood transfusions

1983

•Researchers at the Pasteur Institute isolate the virus •International consensus that it should be called Human Immunodeficiency Virus --HIV.

•Rapid spread of HIV across the world, especially Africa•Fear and confusion over the virus—stigma and discrimination

1998

•First vaccine trials begin

RST UNAIDS; Slide 8

Brief History

1996 •UNAIDS is created to lead the Global Response to HIV and AIDS

1998 •First vaccine trials begin

2001 •The United Nations organizes a special session on AIDS (UNGASS) and adopts the Declaration of Commitment on HIV/AIDS

2005 •The world begins to wake up to the reality of a global epidemic with multidimensional implications and consequence

•More resources made available to fight HIV.•Better surveillance of HIV and AIDS globally

2006 onwards

•More attention paid to the so-called low prevalence countries

•Greater role of science in responding to AIDS •Multi sectoral consensus

RST UNAIDS; Slide 9

Experience to date

• Encouraging news in infections and death but we’re far from defeating HIV and AIDS

• AIDS death was two million in 2007, a fall of 200,000 compared with 2000

• Annual new infections were 2.7 million, 300,000 less than 2001.

• Treatment increased by 43%

• Outside of sub-Sahara Africa, HIV disproportionately affects injecting drug users (IDU), men who have sex

with men (MSM)

RST UNAIDS; Slide 10

1.41.7

4 4

4.9

77

0

1 0.80

1.1

0.60.9

2 1.81.7

0

0.8

0 0.20.30.8

1

0

1

2

3

4

5

6

7

8

1999-2000

2000-2001

2002 2003-2004

2004-2005

2006 2007

%

IDU-Dhaka IDU-NarayanganjIDU-Chandpur IDU-TeknafIDU-Ishwardi Heroin smokers-Dhaka

HIV PREVALENCE IN DRUG USERS, ROUND VIII (2007)

6508 drug users sampled from 28 citiesHIV found in six cities only

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IDUs buying sex from FSW in the last year, using condoms and having STIs

0

10

20

30

40

50

60

70

Dhaka Rajshahi Chapainawabganj Chandpur

Buying sex from FSW last year

Used condom during last sex with FSW

Consistently used condom with FSW in last year

STI symptoms last yr

Active syphilis

RST UNAIDS; Slide 12

FSW

IDU

MSW/HIJRA

72%*

22%*

10%*

57%*

28%

Truckers

76%*

Potential spread of HIV from MARPs to the general population in Dhaka, Bangladesh

73% married

54% married)42% married

47% married

16% married

89%

MSM

11%*

27% IDUs are rickshaw pullers

2-3%*

1-3%*

9.6%*

Rickshawpullers

MSM

*figures refer to last year

10% married2% married

18 - 23% of female SW mentioned their clients or non-commercial partners are IDU

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New infections show various populations influence the epidemic over time

0

5

10

15

20

25

30

0 +2 +4 +6 +8 +10 +12 +14 +16 +18

New

in

fecti

on

s in

th

ou

san

ds

IDU

FSW

Client

MSW

MSM

Lo-risk men

Lo-riskwomen

Clients

Husband->Wife

FSWIDU MSM

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Enduring Risk Factors

• Large Commercial Sex Industry. Often hidden and complex: 105,000 There are over male and female sex workers.

• Low condom use all-round

• High level of Sexually Transmitted Infections (Syphilis)

• - Needle sharing among Injecting Drug Users

• .High level of stigma associated with people living with HIV

• Li mited access to health care for MARPS

• BUT…still very low prevalence…

RST UNAIDS; Slide 15

Why investing in HIV prevention- Impact on Health Services

• AIDS illnesses generate a disproportionate share of total health care demand.

• Increase in disease burden due to increased cases of illnesses such TB, malnutrition, diarrhoea,meningitis, pneumocystis carinii pneumonia (PCP) in the form of opportunistic infections associated with HIV infection

• (It is widely accepted that HIV/AIDS drives the incidence of TB.)

RST UNAIDS; Slide 16

Why investing in HIV prevention- Impact on Health Services

• Prohibitive cost of treatment cannot be sustained in a resource poor country such as Bangladesh

• AIDS may increase demand for third-party payment for health care. This may take the form of private insurance, or public insurance.

• AIDS introduces additional Risk to Health Care Workers – “HIV/AIDS has increased our exposure to the virus

and we fear contracting it,”

RST UNAIDS; Slide 17

Why investing in HIV. Impact on Mobility

1. High mobility between Bangladesh and other countries in the region and beyond means that infection can come from outside the borders as well as spread within the country.

2. Cross border mobility for sex work exposes populations to different

• HIV among Sex Workers

• Dhaka 0.2%• Khulna 0.4%• Hili 2.7%

(casual) • Barisal 0.3%• Jessore 0.5%

RST UNAIDS; Slide 18

Impact of AIDS (household level )

• Reduced income if household head is sick – (India-unemployment rate for HIV+ is 14.2% and for HIV-

it is 4.3%)– selling of family property (45% families with AIDS patient

in India borrowed money compared to 27% non-AIDS families)

• Early orphanhood (increased likelihood is 1.0% by age 17) Loss of income earner means that mothers must enter the labour market and reduce childcare.

• Stigma and discrimination and shame against the family, community rejection and destitution

RST UNAIDS; Slide 19

ROLE OF GOVERNMENT

• Public policy has proved to be an effective weapon in containing the HIV/AIDS epidemic. Governments can have the greatest impact by providing incentives for those most likely to spread HIV to adopt safer behavior (Ainsworth 1998) .

RST UNAIDS; Slide 20

AIDS Transition

RST UNAIDS; Slide 21

WAY FORWARD- Comprehensive Response

RST UNAIDS; Slide 22

What it all means…

Retaining clear evidence-based focus on priority groups and scale up access to high quality interventions for priority groups (MARPs).

Strengthen support for the reduction of vulnerability to HIV infection. • vulnerable women and children • reducing vulnerability associated with cross-border travel and

undocumented migration; reducing vulnerability to HIV infection in prisons;

• reducing vulnerability among ethnic groups; • increasing access RTI/STI) services.

Ensuring that universal precautions in the health sector.

Increasing access to care and support services for people living with HIV and AIDS (PLHA).

Reducing stigmatisation and discrimination of people living with HIV and AIDS (PLHA).

• .

RST UNAIDS; Slide 23 Apr 19, 2023

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