According to the latest government data, more than 250 people died of AIDS in Bangladesh in 2022, and the number of infected individuals has also risen.
The main causes of these alarming deaths and infections have been identified as the reuse of medical items, such as surgical instruments and syringes, international travel, and unprotected sex. To address the situation, the government has expanded the scope of treatment for AIDS patients as part of a long-term plan under its healthcare programme.
The “National Tuberculosis, Leprosy, and AIDS Control Program” of the Directorate General of the Health Services (DGHS) reported that 1,276 new AIDS cases were diagnosed in Bangladesh last year, compared to 947 in 2021. During this period, 266 people died of AIDS, an increase from 232 deaths in the previous year.
The DGHS stated that this is the highest annual count of infections and deaths since the first AIDS case was recorded in Bangladesh in 1989. Analysing statistics from the past 34 years reveals that the total number of AIDS patients in the country stands at 10,984, with 2,086 deaths over the same period.
They reported that the number of people carrying the HIV virus in Bangladesh exceeds 15,000, with a portion of cases undiagnosed. The government hopes that if the programme continues as planned, 95 per cent of AIDS patients will be treated by 2025. It will take a few more years to bring the remaining 5 per cent under treatment.
Analysis of their data shows that 1,118 of those affected are Bangladeshi citizens, while the remainder are Rohingya people residing in various camps in Cox's Bazar.
Among Bangladeshi citizens affected within the year, the highest number—342 patients—were from Dhaka. Additionally, 246 AIDS patients have been identified in Chattogram (158 of whom are Rohingyas), 175 in Rajshahi, 141 in Khulna, 79 in Barishal, 61 in Sylhet, 40 in Mymensingh, and 34 in Rangpur district.
Meanwhile, UNICEF estimated that by 2030, around 3,60,000 adolescents worldwide may die from AIDS-related diseases. Without increased investment in HIV prevention, testing, and treatment programmes, an average of 76 teenagers could die each day.
According to the agency’s report, “Children, HIV and AIDS: The World by 2030,” if current trends in population growth continue, the number of people aged 0–19 living with HIV will reach an estimated 2,70,000 by 2030—about one-third less than current estimates.
According to the organisation, the current AIDS situation in Bangladesh remains largely unchanged. The United Nations aims to bring 95 per cent of people with AIDS under treatment.
Dr Zahidul Kabir, head of the Virology Department at Suhrawardy Medical College Hospital, stated, “Compared to neighbouring countries, Bangladesh has fewer AIDS patients. However, it is important for us to remain vigilant. Otherwise, there is a risk of an increase in AIDS cases in our country.”
“Our country can currently be considered low-prevalence. Essentially, Bangladesh is a high-risk country for HIV. At present, the number of infected people is relatively low, but there is a danger that it may increase at any time,” he added.
Causes of rising morbidity, mortality
The former Director General of the DGHS, Professor Dr ABM Khurshid Alam, stated that while Bangladesh has successfully eradicated or controlled many diseases, it has made only limited progress in controlling AIDS.
“In medicine, we often use reusable items, including surgical tools. It is essential to ensure these items are properly sterilised. Otherwise, innocent patients undergoing procedures like colonoscopies or endoscopies risk infection. Additionally, drug addicts using intravenous injections are also contracting AIDS, leading to a rise in patient numbers,” he noted.
Dr Khurshid Alam called for a stronger emphasis on diagnosis and treatment to eradicate AIDS, stressing the importance of caution to prevent transmission while ensuring that victims are not marginalised. The government provides comprehensive support, including free treatment and medicines for AIDS patients.
DGHS Additional Director General Professor Dr Ahmedul Kabir, discussed the causes of the disease’s spread, noting that increased global travel contributes to the rapid transmission of infectious diseases.
Professor Kabir suggested two possible reasons for the rise in reported AIDS deaths— in the past, some may have died without a clear diagnosis. Now, with improved AIDS control programmes, more cases are identified, allowing deaths previously attributed to unknown causes to be correctly linked to AIDS.
Another reason could be that many people with AIDS in Bangladesh are older, with some deaths occurring naturally. According to DGHS statistics, the majority of new patients are migrant workers and their family members. Previously, new cases were more common among the four high-risk groups, but infections in the general population increased last year.
Data from the DGHS indicate that the risk of HIV/AIDS is highest among four groups—female sex workers, male sex workers, gay men, and transgender individuals. A recent UNAIDS report states that sex workers are 21 times more likely to contract HIV/AIDS than the general population.
There are over 1,00,000 female sex workers in Bangladesh, with adolescents among them being particularly vulnerable, as they often lack access to protective measures when needed.
Remedy
Health experts are urging the government to adopt additional plans and initiatives to address AIDS effectively. They emphasise the need to expand identification testing and coverage, particularly for the Rohingya population, migrants, returnees, and high-risk areas. Similar to Covid-19 testing, some experts have recommended implementing HIV testing for everyone in border areas.
According to UNAIDS, AIDS patients in Bangladesh now represent 0.1 per cent of the total population, with over 15,000 people carrying the HIV virus. However, only 50 per cent of patients are receiving treatment. The latest figures show that 6,104 of the most recently identified individuals are now receiving medical care, while the remainder remain untreated.
The National AIDS/STD Control department of Bangladesh reports that the proportion of diagnosed patients receiving medical care is rising annually. In 2019, 52 per cent of patients were aware of their AIDS status, increasing to 63 per cent in 2021. Two years ago, 65 per cent of patients were under medical care, a figure that has now risen to 77 per cent.
AIDS in Bangladesh
The first HIV patient in Bangladesh was identified in 1989. Since then, between 10 and 200 new cases have been identified each year, rising to 869 in 2018. The first HIV-related death occurred in 2000. In 2021, 729 more cases were detected, including 188 among Rohingya refugees from Myanmar.
Dr ABM Khurshid Alam, former director general of the DGHS and line director of the TB-Leprosy and AIDS/STD Program, noted, “The rate of HIV infection in the country is low, at only 0.1 per cent. However, risks remain due to factors like population density, migration, and low awareness.”
“Additionally, the high HIV rates in neighbouring countries—India, Pakistan, Myanmar, Thailand, Malaysia, and Indonesia—pose further challenges for Bangladesh," he added.
AIDS treatment, services in Bangladesh
A member of the Bangladesh Country Coordinating Mechanism (BCCM) stated that the extent of AIDS treatment and services in the country exceeds current needs. However, due to a lack of awareness at the grassroots level, many government plans are difficult to implement. AIDS treatment services have not yet been introduced in the private facilities.
In Bangladesh, AIDS treatment is provided only through government initiatives. HIV screening is conducted only at 97 blood transfusion centres, including all district and medical college hospitals nationwide. Additionally, screening is available in the blood transfusion departments of private institutions.
The AIDS/STD Control Programme has directed these institutions to establish effective communication and conduct confirmatory testing on all HIV cases identified through initial screening. Medical services are available at 11 centres across the country, and AIDS treatment typically does not require hospitalisation, as most patients receive care at home.
Patients must regularly collect medications from designated centres and stay in contact with their doctors. Oral medication is provided for adults and syrup for children. However, if a patient has other physical complications in addition to AIDS, they may need to be admitted to hospital to receive treatment for those conditions.
Returning expatriates raise concerns
Since 2019, many people who went abroad, both legally and illegally, have returned to the country due to the Covid-19 pandemic. Worryingly, a significant proportion of newly diagnosed AIDS patients are migrants, with high infection rates also observed among their family members.
There is concern that some communities may not be included in testing efforts. Additionally, over the years, some returning migrants have been diagnosed with HIV. Statistics indicate that 30 per cent of new HIV cases identified in the survey involve migrant workers or their family members.
Lack of awareness
Experts believe that awareness about AIDS remains below the desired level, although it is gradually increasing.
They emphasise that further efforts are needed to raise awareness. Officials from the Department of Health's National AIDS/STD Programme report that 50 per cent of people infected with HIV are unaware of their status, and of those who know, over one-third do not seek treatment.
Affected individuals need to take regular antiretroviral medication and undergo blood tests. However, the government only began tracking the health status of those in treatment at the end of 2019.
According to experts, the government is conducting large-scale campaigns to increase public awareness. People are now more informed than ever before; for instance, sex workers and expatriates are much more aware of the risks. Strengthening awareness programmes could further reduce the risk of AIDS.
AIDS: A gender issue
The first case of AIDS was diagnosed in the United States in 1981, with the first five identified cases involving male homosexuals. In Bangladesh, AIDS was initially detected in a man. Thus, both globally and locally, men are seen as the initial carriers of the disease.
However, women are often highlighted as the most vulnerable group; for instance, the slogan for World AIDS Day 2004 was "AIDS: Women at Greater Risk."
This slogan obscures the reality that women are victims within the AIDS crisis. It is often claimed that women are more physically vulnerable to AIDS transmission than men. However, this narrative can imply that female genitalia are the primary sites of all diseases, including AIDS. Such portrayals further marginalise women and perpetuate stereotypes.
Men are the primary transmitters of AIDS to women, possessing most of the known avenues for spreading the disease. Even in prevention and treatment, men play a predominant role. While women are the primary victims, patriarchal society frequently portrays them as being at "higher risk."
Consequently, AIDS is not just a medical issue but a gendered one. Publications related to the disease rarely address men’s responsibility in its spread. Instead, by placing women at the centre of prevention measures, society shifts the focus, despite the greater responsibility lying with men.
