The presence of covert multi-partner sexual activity and denial, the low level of knowledge and low condom use, unsafe professional blood donations, lack of a desirable environment and violation of Human Rights, all contribute to the spread of HIV in Bangladesh. The prevalence of the disease is drawing attention but the denial, discrimination, stigma are still the obstacles to handle the national burden. Programmes addressed by various government and non-government organisations are helping to improve the situation but HIV/AIDS is still a taboo. As a result, the service providers remain behind the curtain.

The programmes are mainly working for the advocacy on HIV/AIDS related problems; but people living with HIV/AIDS should also get the attention for maintaining quality life before they die. Social workers are so much interested to work for the people, but a large portion are not interested to work with them -- for their rehabilitation, treatment, nursing, integrated and comprehensive support including mental support.

PLWHA need specific care interventions at different levels such as institutional, community and home-care.

The patients’ sufferings start from the denial from the society which is a common scenario of our society. PLWHA want to live a life like a normal individual. Whereas people who get other sexually transmitted diseases get proper treatment from health care providers, PLWHA lack from the least facilities. In most cases they don’t express their illness and infect other people. The attitude of the society towards PLWHA should be modified to overcome the problem. But positive approach is a must for some specified population specially among healthcare providers. In most cases the PLWHA have to seek the facility very cautiously so that they are not familiar as PLWHA due to fear of being abandoned from the society.

Moreover, there is almost no specified treatment centre in the country for PLWHA. The sufferings of the patients are more miserable specially when they seek treatment facilities in the hospitals of the country. They don’t get even proper care from the hospital stuffs when they are recognised as AIDS patient. The main cause behind the problem is lack of adequate knowledge on HIV/AIDS -- even among the health service providers. This prevents the patients to lead quality life. Even living with HIV/AIDS, leading a quality life is possible if proper care is given -- with drugs and supportive measures.

These people (PLWHA) are forsaken form their families as well in some cases. A patient was under the supervision and treatment at a centre of the capital. He was back to the country from a middle east country. In Bangladesh his aunt was the only relative who did not give necessary support to the patient at the end stage of AIDS. Finally the patient died without his any relative at Samajik Sastho Kendro.

There is not adequate financial help both from the government and non-government organisations to rehabilitate the PLWHA which is an obstacle to handle the patients -- informed Dr Mustafa Abdur Rahim, Executive director of Samajik Sastho Kendro, a non-profit healthcare service centre working with PLWHA from the diagnosis up to the burial of HIV/AIDS patients. He handled near 50 AIDS patients, but his centre is facing severe financial crisis. He urge different concerned level to pay attention for the treatment and rehabilitation of PLWHA in addition to ongoing advocacy programmes. There is almost no help in the sector of treatment facility of the suffering people.

We can do a lot to overcome the existing problems by improving the social perspective, by community participation, family support, by changing the educational system.

There was high stigma and discrimination in Thai society in 1980s. Gradually the stigma was removed from the society. The monks and nuns from Buddhist Temples and Christian Churches came forward in AIDS care work with “meet, come, share and go to the community” strategy. During the period of high stigma, monks sheltered and cared the full-blown AIDS patients. In a religious country like ours, we can do a lot by the leaders of religious community (Imam of mosques) if they come forward to address the social burden. In order to implement to drive specified advocacy programme should run among specified population.

Another important sector of advocacy is badly needed among the health care providers like physicians, nurses and other health stuffs. A pregnant HIV infected woman came at a community clinic for the delivery. As she was HIV positive, the authority called an eminent gynaecologist of the country to perform the delivery. But it is surprising that he refused to perform the delivery. It is noticeable that this renowned gynaecologist has many programmes to reduce the maternal and child health. So advocacy among the doctors should not be neglected, neither it is very necessary to remove the social stigma. The doctors are the first person to consult for the PLWHA. If they are not helpful and cooperative to them, it is not possible to handle the disease burden properly.

Half-way model houses should be established for sharing the views and providing emotional support to PLWHA.

Specified treatment facility centres are also very necessary, because there are scarcity of trained doctors in this field to handle the disease. Multi-disciplinary approach is needed for the end stage AIDS patients. If one centre is established, some others may come forward to address the patients. But some one should come forward first.

The government can be the first stakeholders to establish such a hospital or half-way house.

So it is high time to pay proper tribute, respect to people living with HIV/AIDS by providing badly necessary treatment and rehabilitation to lead a quality life before they die.