I was just doing some literature research through FHI reports about the nature of the HIV situation in Bangladesh. Due to the relative lack of knowledge, stigma surrounding these communities, and dense population in Dhaka, injecting drug users and commercial sex workers are at highest risk. HIV rates have reached epidemic proportions among drug users-some communities indicating rates as high at 8.9%. Misti McDowell, the country director of FHI, explained that these high rates can contribute to the concentrating of the disease in the Dhaka area. Commercial sex workers then play the role of dispersing the disease through working with various incoming clients and mobilizing through the country. With regard to commercial sex workers-the heterosexual sex business is the most common and thus bears the highest need for awareness and condom use. However, men who have sex with men (MSMs) and Hijra sex workers are at more risk than other sex workers because they are neglected and difficult to locate and provide treatment. Iâ€™m shocked with how well enclosed these communities are-especially the MSMs. I remember coming home one day from a site visit of an MSM integrated health center (IHC). I was explaining to various family members of how MSMs (most of them expressed being gay) find security and community through these centers. My cousinâ€™s first words were, â€œWhat? Gay people actually exist in Bangladesh?â€ I had a good laugh from that one.
Actually, I canâ€™t blame my cousin or anyone else for that matter for denying this fact. Gay culture and identity does not exist in Bangladesh. First of all, it is haram (forbidden) by the predominant religion. And second of all, it is very difficult to detect because of the little free mixing between boys and girls. It is not considered odd to see two unmarried men spending an unusual amount of time together-itâ€™s actually preferred (as opposed to spending time with a woman). But what frightened me the most was the fact that many of these MSMs were married with families. If they were to practice unsafe sex with another man and then have sex with their spouse, it can propose some difficult problems. The fact that these men arenâ€™t and canâ€™t be open about their practices places them at a higher stake for contracting and transmitting HIV.
Furthermore, itâ€™s virtually impossible to receive treatment from a general doctor. In the case of MSMs-once the doctor sees the evidence of anal sex, he/she will discharge them for being homosexual. I personally believe that there needs to be a behavioral change among all facets of the populations-students, politicians, doctors, sex workers, drug users, clients, etc. But the paper necessitates a behavioral change among the risk groups-â€œThe experience from other Asian countries suggests that behavior change may not be rapid enough to avoid an HIV epidemic, unless there is massive scaling-up of existing interventions among the appropriate vulnerable groups.â€ (page 17)
So in the nutshell, these IHCs are INTEGRAL for preventing Bangladesh from spiraling into an HIV/AIDS epidemic. Bad news? There needs to be more of them AND societal beliefs should start changing.
Good news? FHI Bangladesh just received theyâ€™re 4 year funding from USAID! It was party at the office yesterday!