Epidemic predictions: the growing emergency of HIV in Dhaka

2 March 2006

Mohammad Khokonon is telling a by-now familiar story: he is a regular heroin smoker and is dependent on injecting a popular tranquilizer called bupranorphine.

The 27-year-old has been on drugs for three years.

“The influence of friends is strong here,” he says. “It’s very risky, very hard not to get into taking drugs.”

His mother, Manjur Nesa, is a street cleaner for the local authority, the Dhaka City Corporation, and 12 people live in her windowless two-room house in City Colony - one of a number of slums in central Dhaka.

Mohammad is shamefaced as he explains that his mother’s earnings, and those of his wife, go on his drugs.

At City Colony’s ‘drug hotspots’, where most drugs are bought and sold, dealers give conservative estimates – ‘there are around 200 heroin smokers here’, they say.

But the numbers don’t add up: down the narrow, dark, warren-like alleys in the Colony, many admitl they are on drugs, putting their lives at risk of HIV every time they share a needle.

The HIV prevalence rate across Bangladesh is less than one per cent, but soars to around five per cent among injecting drug users. Research done among 5,000 users by humanitarian and development agency CARE International showed that more than 90 per cent of them shared needles.

Dr. Taslim Uddin, CARE’s HIV programme co-ordinator in Dhaka, makes a grim prediction: “When the HIV prevalence rate reaches 10 per cent, we call it an epidemic. Right now, we are pretty close to a concentrated epidemic with around five per cent prevalence among injecting drug users, and it is rising. It is very alarming – a growing emergency. This could be very dangerous.

“The predictions for the future are that by 2030, Bangladesh will have an eight per cent prevalence rate among all adults, which is enormous. Dhaka is likely to see the first outbreak and the first spike will be with injecting drug users, and the second – in 2010 – will be client-driven, through sex work, especially as many sex workers’ clients are drug users. These groups are at risk not just of contracting HIV themselves, but of passing it on to others.”

CARE International runs 52 drop in centres in Dhaka – some of them through local NGOs (Non Governmental Organisations). Around 10,000 injecting drug users, 50,000 heroin smokers and other drug users – who are at risk of starting to inject – and 20,000 sex workers use them. Recent figures show that these programmes reach 75 per cent of Dhaka’s drug users and more than 85 per cent of its sex workers.

At the centres, there is a trained nurse, HIV support and education, opportunities to detox, peer education sessions, free condoms and a needle exchange programme – which is also available on the streets at so-called ‘drug hotspots’. People can also wash and eat, watch tv, read, or learn a vocational skill.

Faruk Hossain, 25, lives in the Colony and was a drug user. Now he is an outreach worker for CARE, and goes to hotspots to inform users of the dangers of HIV and to explain how they can change risky behaviour. He also exchanges used syringes for clean ones, and hands out condoms.

He said: “There was a heroin spot around my house, with people taking drugs all the time. From my childhood, I saw them, and when I got older, I started taking heroin too.

“But now, in my work, when I see people stop sharing needles, or come off drugs, it is so inspiring – I feel so glad.”

Despite the social stigma associated with drug taking and sex work, many yield to both – risking HIV and other sexually transmitted infections because of a lack of knowledge.

Shanaj Begum is the elected president of a sex-workers’ collective, called Durjoy Nari Shangha – which, translated loosely from the Bengali, means an ‘organisation of women who are hard to conquer’.

Set up as a support group for sex workers in Dhaka in the late 1990s in a climate of institutional and societal oppression, it is now a partner organisation of CARE’s, an official NGO, and offers support to thousands of sex workers through its drop-in centres.

Shanaj Begum explains that Durjoy is an enormous safety net against a growing threat of HIV.

“All of us who are members of Durjoy are ‘floating’ sex workers - we work on the street. Many of us have no shelter, food, or anywhere to wash. Some sleep on the streets and the police beat them.

“But the biggest thing we face is the risk of HIV and sexually transmitted infections. So we have set up drop-in centres where women can rest and wash and eat – as well as learn another job, like sewing – before going to work between 6pm and 10pm. We also have schools, where they can leave their children safely. And we have 10,000 outreach workers among our number who are responsible for going on to the streets to teach sex-workers about proper condom use.

“We started off with 20 women in February 1998, but now have around 2,500 in different areas of the country. We are a social network, we support each other, and our numbers are increasing as the number of brothel evictions – and the demand for sex – increases.

“HIV is growing in Bangladesh. The spread of the disease is not stopping, so we need to prevent it; it is a real and growing emergency and no-one else supports sex-workers in this way, so we need more funding to continue our work.”

 by Sophie Kummer