AIDS threat looms up: Aggressive surveillance needed

Health officials and concerned citizenry in the country are grappling with the national implications of AIDS crisis that hovers over lands beyond the borders of Bangladesh  and have been trying to come up with means to combat the new threat that it poses to Bangladesh. Experts see clear indications that the disease that once was supposed to be confined to some specific areas is now spreading to wider residential neighbourhoods.
The alarm bell is ringing at the door. Figures so far available in India are restricted to the so-called high risk groups-prostitutes, heterosexuals, drug addicts, truck drivers and migrants. Africa disproportionately bears the burden of the HIV/AIDS pandemic. Although only 11%  of the world's population lives in Africa, roughly 67% of those living with HIV/AIDS are in Africa. In Africa there were 22.4 million people living with HIV and the country recorded 1.9 million new infections in 2008. An estimated 14 million children in Africa have been orphaned as a result of HIV/AIDS.  Officially, no exact statistics are available that speak of the country's middle class becoming AIDS victims as yet.  Reports that pour in from the neighbouring country, India indicate that there are about 5.134 million HIV infected people in India, constituting about 0.6% of the total population.  Although the percentage is small, the numbers are staggering, the highest of any country, overtaking South Africa. All these reports make people genuinely concerned, since in no time, the virus may cross the borders with the traveling people and can play havoc in the country.
On the other hand, that the reported HIV positive numbers in the country still remain relatively quite low, not anything to cause alarm, is no surprise. It reflects the general level of ignorance and a sort of apathy of the people and administration. The actual number infected with the virus may be quite high. The majority of the people who are infected now don't even know they are ill. We are now talking about a generation that will have developed AIDS sometime after the year 2020 or later. And the country simply does not have the wherewithal to deal with any such crisis.
Complacency and ignorance do not always pay as it did not in the CIS (previously USSR)  countries. Unicef reports that abuse of injected drugs accounts for most of the region's infections of HIV, the virus that causes AIDS. However it noted that sexual transmission is on the rise in Belarus and Ukraine. The total number of infections in the region more than doubled from 4,20,000 in 1998 to I million in 2001.  While that is small compared to 28.5 million in sub-Saharan Africa, the rate of infection in some East European and CIS countries is the world's highest.
Most worrisome, the virus now percolates insidiously and afflicts low risk individuals like house wives and children of wealthy people.  Speaking about India, a doctor who heads the Mumbai-based AIDS research and control centre says, “infected housewives and children are a clear indication of just how much the AIDS virus has advanced in India.   He estimated that one out of 10 HIV patients is a housewife.
In our country, the first HIV patient was detected in 1989. Till the end of 1996, the country registered just 79 HIV positive cases, officially known, out of which 15 were female. It was officially known from Health Ministry sources that 82 AIDS- infected persons died last year and the number of deaths so far recorded was 472 in the country.
However, UNAIDS estimates that the number of people living with HIV in the country may be as high as 12,000.
Although still considered to be a low prevalence country, Bangladesh remains extremely vulnerable to an HIV epidemic, given its overpopulation, dire poverty, gender inequality and high level of multiple sexual relationships. UNAIDS estimates that without any intervention the prevalence in the general adult population could be as high as 8% by 2025.  Social researchers grimly say, “In our country with all the economic problems- rising unemployment and drug abuse, only AIDS was missing. Now we, too have not been spared.  If the number continues to rise, it will be especially ominous for the country, since the country does not have medical facilities, physicians or drugs to adequately treat the disease. Noticeably, in the United States, it took more than a decade of massive public education and millions of dollars in research before the appalling number of HIV cases finally stabilized. Speaking about Bangladesh, the country today is so economically weak that it can't even treat the scourge of prevalent disease like diarrhea, malaria,  tuberculosis etc., let alone fund its anti-AIDS effort. “It is, as if, we're standing on the beach, watching a giant wave coming right at us”, says one medical expert in the country. “We know it, we see it, and we can do almost nothing about it.  We are just going to be swept away”.
In our country what we have to be careful is about the possibility of transmission of this deadly scourge through “heterosexual” chains. At least in India as well as our country, that mode accounts for almost two thirds of almost all HIV positive cases. In India as well as in our country, promiscuity is the single most important way by which this scourge has the possibility of spreading. People must know its incubation period,  that keeps the  virus hidden for a long time and after a certain time it explodes in a virulent form almost as an epidemic. The most potent reason for its rapid transmission is because the symptoms take an average of five years to show up. So an infected person can pass the virus unknowingly to scores of people. This is unlike other sexually transmitted diseases where the symptoms appear in the first few weeks or months of infection itself and the other reason is that middle class never believed that they wee vulnerable to the insidious culprit.
Shockingly, the old concept s of societal ethos, mores and morality seem to be breaking down. Most revealing, a recently released research data conducted  by a West Indian based  Institute  on the sexual mores of middle class and upper class Indians reveals that of the 16,154 persons surveyed as many as 43 per cent of them admitted to having had pre-marital sex. Among those who were married, one out of five people said they had extra-marital relations. Most of these people in these groups did not use condoms while having sex since they did never comprehend that such behaviour exposed them to sexually transmitted diseases like AIDS. Experts  attribute this shift in sexual behaviour of the middle or lower  class of working people  as changes in the work place as a major cause. Lack of housing facilities in the work place has spawned a breed of workers who spend half their working lives away from home. At the same time women have become an increasingly visible part in many places away from their homes. All these factors taken together, one can only see the settings for an increasing number of casual sex relationships.  Till recently, many people in our country considered AIDS a scourge of the libertine West that posed no threat to a conservative society like ours based on monogamous marriages. Bangladesh, these days, has hundreds of thousands of sailors, construction workers and other professional groups who work abroad for a time and a continual tide of students and business men returning from overseas. The virus has either spread or is likely to spread from returnees carrying this insidious infection because they were not tested on their arrival.  Most people in the country and the government prefer to ignore it.  Unsurprisingly, the first AIDS case surfaced in the country in 1989 –the carrier being a returnee from abroad.
Social scientists point out that the growing affluence of a certain class of people and the influence of movies have something to do  with the changing moral values. And without contradiction, one can say that the influence of the West is not an escapable factor. Shockingly, we have borrowed the gloss but not the ability to fight a crisis. While in the West, maintaining multiple sexual relationship is now considered a “high risk” behaviour, in our country it has become just a symbol of liberation. At the same time, women are shedding their inhibitions and sexual ambitions of both the groups are running high.
In the face of the impending AIDS threat that is likely to jolt the country by the end of the year 2025, as UNAIDS predict  as the tide of migrant workers returning  home continues to increase, the government from now on, will have to launch an intensive programme to halt the spread of the disease with some practical steps. Health ministry must ensure that hospitals and clinics conduct safe blood transfusion of patients and think seriously about screening those who they thought might be using drugs –focusing mainly on unemployed young men and IV drug users. Lastly, both the administration and people must contend with the fact that AIDS is no longer a medical problem, it is a social problem. And the startling rise in the number of cases of sexually transmitted diseases, health officials contend, is an early warning about the spread of the dreadful AIDS. The National AIDS surveillance programme unveiled in 1997 has done a pretty good job by promoting safe blood supply, rational use of blood and blood products through screening, provision of care and support systems and amendment of laws to prevent discrimination of people living with HIV/AIDS. In most of the countries of the world, the AIDS virus has spread beyond the most vulnerable groups and into the society's mainstream. It robs economies of the workers, families of their support and children of their parents.

The writer is a columnist of The Daily Star.  
E-mail: aukhandk@gmail.com