HIV/AIDS in Bangladesh - National Response

National Response

Bangladesh's HIV/AIDS prevention program started in 1985, when the Minister of Health and Family Welfare established the National AIDS and Sexually Transmitted Diseases Program under the overall policy support of the National AIDS Council (NAC), headed by the President and chaired by the Minister of Health and Family Welfare. The National AIDS/STD Program has set in place guidelines on key issues including testing, care, blood safety, sexually transmitted infections, and prevention among youth, women, migrant populations, and sex workers. In 2004, a six-year National Strategic Plan (2004–2010) was approved. The country’s HIV policies and strategies are based on other successful family planning programs in Bangladesh and include participation from schools, as well as religious and community organizations. The AIDS Initiative Organization was launched in 2007 to fund for those without proper medication in order to combat the virus. The National HIV and AIDS Communication Strategy (2006–2010) was also developed and launched.

Since 2000, the Government of Bangladesh has worked with the World Bank on the HIV/AIDS Prevention Project, a $26 million program designed to prevent HIV from spreading within most-at-risk populations and into the general population. The program is being integrated into the country’s Health, Nutrition and Population Program, which is supported by the government and external donors. In 2003, a national youth policy was established on reproductive health, including HIV/AIDS awareness. Since 2006, students in 21,500 secondary and upper-secondary schools have been taught about HIV/AIDS issues. The educational program introduces a "life skills" curriculum, including a chapter on HIV/AIDS drafted with assistance from the United Nations Children's Fund (UNICEF).

Bangladesh developed its first Antiretroviral Therapy (ART) treatment guidelines in 2006, with PLHIV able to buy subsidised antiretroviral drugs from specified pharmacies. Unfortunately, most HIV diagnostic facilities are provided by NGOs based in Dhaka and most rural and cross-border migrants miss out on ART, HIV testing and other associated care and support services. If they seek private care, the cost is often beyond their means.

Currently, the program funded by the Global Fund is leading the national response to fight HIV and AIDS. Bangladesh had received 3 grants on HIV/AIDS from The Global Fund to fight AIDS, Tuberculosis and Malaria- Round 2 from 2004-2009, Round 6 from 2007-2012 and Rolling Continuation Channel (RCC) from 2009-2015. The Round 2 grant focused mainly on prevention of HIV among young people with strategies including- 1. HIV/AIDS prevention messages dissemination through information campaign in mass and print media 2. HIV/AIDS orientation, training and services via Life skills education, Youth Friendly Health services and accessing condom 3. Integration of HIV/AIDS in school and college curriculum 4. Advocacy and sensitization of religious leaders, parents and policy makers 5. Generating information for policies and programs. The main focus of Round 6 grant was on Most at Risk Populations (MARP) and scaling up of the Round 2 project including interventions with vulnerable youth. The interventions for High Risk population and vulnerable young people includes essential services for injecting drug users and female sex workers; treatment, care and support for PLHIV; and awareness and prevention strategy for vulnerable young people including garment industry workers. National level capacity building, strengthening district coordination, support to networks and self help groups are also among the strategies.

Round 2 and Round 6 has been implemented through Public-Private Partnership where Economic Relations Division of the Government of Bangladesh worked as Principal Recipient and Save the Children USA managed the grants as Management Agency in collaboration with Ministry of Health and Family Welfare. Based on the satisfactory level of completion of the Round 2 project, Global Fund awarded Bangladesh with the 6 year fund termed as “Rolling Continuation Channel (RCC)” from 2009-2015, which is consolidated with the Round 6 grant. For high level of performance the Project is appreciated as a” best practice” example in Asia and is rated as “A” by the Global Fund. The program is being implemented through 13 technical packages by 13 consortiums comprising 61 organizations nationwide. Save the Children, as a Principle Recipient of the grant is facilitating implementation through technical and compliance related support to all the consortia. Other Principal Recipients are National AIDS/STD Program and ICDDR,B. The main objectives of RCC Program are-

• A). Increase the scale of prevention services for key populations at higher risk: Injecting Drug Users (IDUs), Sex Workers (FSWs), hijras (transgendered) & Men who have Sex with Men (MSM)
• B). Increase the scale of the most effective HIV/AIDS activities conducted through Round 2
• C). Build capacity of partners to increase scale of national response to the HIV/AIDS epidemic

Some significant achievements of the HIV/AIDS program funded by the Global Fund are-

• 1. Overall HIV Prevalence remains <1%

• 2. HIV/AIDS information is included in text books of secondary and higher secondary level education, from grades VI to XII, in both Bangla and English.

• 3. HIV/AIDS prevention, care & support related information now mainstreamed within the training curriculum of five different Ministries.

• 4. National standards for Youth Friendly Health Services (YFHS) have been established, now practiced in public, NGO & private health service facilities countrywide.

• 5. Standard Operating Procedures (SOP) for services to PLHIV have been endorsed by the government

• 6. Public-private partnership has been proved to be an effective model for fighting AIDS

• 7. Over 300 people living with HIV and AIDS (PLHIV) are receiving anti-retroviral treatment (ARV) per year

• 8. Workplace policy on Life Skills-based Education (LSE) on HIV/AIDS endorsed by Bangladesh Garments Manufacturers’ association (BGMEA)

• 9. Under the Ministry of Religious Affairs, 4 booklets on HIV/AIDS have been published for the 4 major practicing religions in the country