Around 37 per cent of AIDS (Acquired Immunodeficiency Syndrome) patients in Bangladesh remain undiagnosed, with 23 per cent not under treatment. Experts warned that undiagnosed and untreated patients increase the risk of AIDS transmission among the general population.
According to the National AIDS/STD Control Programme (NASP), many infected individuals have left Bangladesh and cannot be reached via their provided contact information. According to the officials of this programme, finding AIDS patients within Bangladesh’s 170 million population is seen as a significant challenge.
To address the issue, the Directorate General of Health Services (DGHS) expanded its efforts to identify and treat patients. Initiatives include opening HIV (Human Immunodeficiency Virus) testing facilities in 25 prisons and increasing the detection and treatment scope through field workers who work with AIDS patients.
This report is followed by another published article by The Business Post titled “AIDS: Bangladesh at high risk.” This report is attempting to provide an in-depth scenario regarding finding and identifying undiagnosed HIV-positive patients.
Despite NASP’s efforts, not all identified patients receive treatment. Currently, 77 per cent of known HIV-positive individuals are under treatment, leaving 23 per cent untreated.
There is a lack of screening at airports and land ports. DGHS data shows that around 30 per cent of those diagnosed with HIV annually are migrant workers returning from abroad.
However, there is no routine HIV screening at international airports, sea ports, or land ports. Experts have highlighted insufficient DGHS and health ministry budgets, suggesting that increased funding is necessary to bring at-risk populations under screening.
As a result, many HIV-positive individuals are unknowingly transmitting the virus. To strengthen HIV control efforts, experts recommend adequate budget allocation.
It is reported that in 2021, DGHS officials held two meetings with the Bureau of Manpower Employment and Training (BMET) to implement HIV screening at airports, but progress remains limited.
DGHS’s NASP Senior Manager Md Akhtaruzzaman explained, “Testing can be done on the spot using rapid test kits, which cost only Tk 150 each. However, despite rising HIV cases, testing facilities remain limited to 23 districts, leading to undiagnosed cases.”
Akhtaruzzaman believes the current budget allocation is insufficient to minimise the risk of HIV transmission effectively.
HIV testing in prisons to find patients
Among general inmates, underserved HIV-positive individuals are at greater risk, often due to drug-related issues. Therefore, the health ministry’s DGHS has implemented an HIV programme across 25 prisons in Bangladesh. This programme, aimed at incarcerated drug addicts and other at-risk inmates, involves two main strategies.
For example, eight prisons (Keraniganj, Kashimpur-2, Narayanganj, Rajshahi, Cox's Bazar, Chittagong, Sylhet) have appointed two staff members each and steps have been taken to increase the skills of the existing staff.
Additionally, satellite HIV testing services are now available in 17 more prisons, managed by Medical Technologists (MTs) and counsellors from district sadar hospitals.
DGHS’s NASP Line Director Dr Md Khurshid Alam said that HIV-positive inmates are often deprived of medical care, posing a risk of transmission within the prison population. He explained, “Health services related to AIDS among prison inmates aim to control the spread of this disease. Police cooperation is essential in managing infection risks among this population.”
According to the NASP, eight essential services are available in these prisons, including HIV testing, treatment with antiretroviral (ARV) drugs, continued OST (Oral Substitution Therapy) for drug users, early detection and treatment of hepatitis C, sexually transmitted diseases, and tuberculosis, and awareness programmes led by peer educators from among the inmates.
The programme officials said that they are trying to trace the infected patients. The country's first National AIDS Committee (NAC) Member Secretary Virologist Nazrul Islam said, "Increasing detection rates by testing at-risk populations and ensuring access to treatment are essential."
The 95-95-95 target
To combat AIDS, UNAIDS has established a 95-95-95 target by 2025 where 95 per cent of people with HIV should know their status, 95 per cent of those diagnosed should receive treatment and 95 per cent of those treated should achieve viral suppression, thereby reducing transmission risk. Bangladesh's progress is currently at 63-77-93.
Nazrul Islam emphasised the importance of testing at-risk groups and ensuring treatment access. To aid this, the programme coordinates regularly with other government agencies.
The Gulf Approved Medical Centres Association (GAMCA) certifies Bangladeshi expatriates travelling to the Middle East, a process which includes HIV testing. Each year, 700,000 HIV tests are conducted at GAMCA-authorised centres. The NASP maintains contact with GAMCA to store and treat all positive cases identified.
Field workers among AIDS patients
In 2022, DGHS appointed an HIV-positive individual in each of the 12 HIV/AIDS treatment centres to encourage others to seek treatment. AIDS/STD Programme Senior Manager Md Akhtaruzzaman said, “When an HIV-positive patient shares their experience of living healthily on treatment, it motivates others to seek care.”
He noted that Rohingya refugees in Bangladesh have an HIV prevalence rate of 0.8 per cent, higher than Bangladesh’s rate of less than 0.01 per cent. Vulnerable populations in areas like Dauldia are also at risk.
HIV testing and counselling services
Through DGHS, supported by NASP, The Global Fund, Save the Children, and icddr.b, HIV testing and counselling are provided free for vulnerable populations, the general public, and immigrants through 103 drop-in centres.
According to the Safe Blood Transfusion Act 2002, HIV screening is mandatory for blood transfusion. A total of 97 blood transfusion centres including all district hospitals and medical college hospitals of the country under government management are conducting HIV screening.
Apart from this, HIV screening is also done in the blood transfusion department of private institutions. The NASP of DGHS has directed that all HIV cases received through screening be included in the confirmatory test to establish effective communication with these institutions and conduct final testing.
As a result, the report containing the data of infected patients received from the Safe Blood Transfusion Department will take the HIV case detection programme a step further.
