The UNODC Regional Office for South Asia (UNODC ROSA) is located in New Delhi, India, and covers six countries of the region: Bangladesh, Bhutan, India, Maldives, Nepal and Sri Lanka. Under its Regional Programme for South Asia for the period 2018-2021, UNODC is delivering technical assistance to South Asia under the following five components: (1) Countering transnational organized crime; (2) A comprehensive response to the drug problem (drug trafficking & drugs and health); (3) Countering corruption; (4) Terrorism prevention; (5) Criminal justice and crime prevention.
UNODC is currently implementing a project in Bangladesh with the aim to provide technical support to national stakeholders on drug and HIV/AIDS prevention and treatment, for effective implementation of HIV treatment and awareness-raising programme with People Who Use Drugs (PWUDs). As a part of this project, UNODC will develop a tailor-made Training Curriculum on Drugs and HIV/AIDS for the Bangladesh Police, in collaboration with the Bangladesh Police (Ministry of Home Affairs), National AIDS/STD Programme (ASP) – Ministry of Health and Family Welfare, and other key stakeholders like Save the Children, icddr’b, CARE Bangladesh, National network of People who Use Drugs (NPUD) and others.
The overall objective of this assignment is to advocate with the Bangladesh Police to institutionalize the developed Training Curriculum in order to provide comprehensive and consistent training on Drugs and HIV/AIDS issues to their newly recruited officers, as well as to include it in the refresher training for the officers on board. The aim of the training is to sensitize the law enforcement officers on the drug treatment and harm reduction programmes, in particular, providing information on the context of drugs and HIV/AIDS issues in Bangladesh, and to equip them with understanding and skills to be able to provide their proactive support to stakeholders implementing the drug treatment and HIV/AIDS programmes with key populations, as well as to help prevent violence, harassment, stigma and discrimination at various levels.
Bangladesh is a lower-middle income country with an estimated population of 164.6 million in 2019 (37% urban, 63% rural) and life expectancy of 72.5 years. Bangladesh’s GDP is growing fast at an annual growth rate of 7.9% in 2019; its gross national income was US$ 1,750 per person (in current US$). Government health spending as a proportion of total government spending is still comparably low at 3.4%. Per capita public and private health expenditure is US$ 6.1 and US$ 25, respectively, with the latter mainly out-of-pocket, with total health expenditure per person of US$ 34 in 2016 (extracted from pre-populated Essential data table).
Bangladesh has maintained a low HIV prevalence of <0.01% among its general population since the first case was detected in 1989, however, it is one of seven countries in the region where the epidemic continues to increase [2,5]. Overall HIV incidence rose by 56% and HIV-related mortality by 110% since 2010.
There are an estimated 14,000 people living with HIV in Bangladesh. National programmatic data of the ASP indicates that from 1989 to October 2019, a total of 7,374 HIV-positive cases were detected (52.7%); between November 2018 and October 2019, a total of 919 new cases were detected. Most newly infected people were from Dhaka (381), followed by Chattogram (203), Khulna (90) and Sylhet (59). 105 were Rohingya refugees, referred to as ‘Forcibly Displaced Myanmar Nationals’ (FDMN).
In terms of epidemiological risk factors, 37% of new cases did not belong to any key population; 15% were migrants; and 11% FDMN. Almost a quarter of new cases (24%) were people who inject drugs (PWID), whereas Men who have Sex with Men, Male Sex Workers, Female Sex Workers, and hijra (a Bangla ‘third gender’ category, overlapping with the Western concept of ‘transgender women’) constituted 3%, 3%, 2% and 1% of newly identified HIV infections, respectively. Around three quarters (74.42%) of new HIV cases were aged 25-49; 6.5% of cases were children (0-18 years). About 74% of new infections were male, 25% female, and 1% were hijra. The HIV vulnerabilities of PWUDs, especially PWIDs, are much higher than any other groups due to drug dependency and sharing of needle-syringes, mental health problems, violence and harassment, stigma and discrimination, legal and social factors. Since 1998, the Harm Reduction programme has been implemented with PWIDs by International / National NGOs supported by the Ministry of Health and Family Welfare, however, it is still not fully covered by the laws of Bangladesh, and violence and harassment are common phenomena in the daily life of PWUDs, both from the side of the law enforcement agencies as well as the society. These multifaced problems have been negatively affecting the implementation of the HIV/AIDS and harm reduction programme, making it difficult to reach PWUDs with services, as well as impeding access to services by PWIDs due to fear of legal action, violence, harassment, stigma and criminalization. As the HIV prevalence is increasing gradually among PWUDs and their partners, it became a public health threat leading to increased risk of HIV transmission among general population. Same scenario has been observed in many countries in the world, where ultimately the epidemic could be brought under control introducing interventions by law enforcement agencies, especially the Police, Narcotics Control Department and prison authority. In Bangladesh, the problem still prevails due to lack of effective and evidence-based policy advocacy by CSOs/CBOs, as well as lack of political commitment to transform policies into actions. Against this background, and given its extensive expertise working in the area of HIV/AIDS and drug control and treatment, both globally and in Bangladesh, UNODC Programme Office in Bangladesh aims to develop a tailor-made Training Curriculum for the Bangladesh Police, in consultation with relevant stakeholders, to increase awareness on HIV/AIDS and drug issues and to provide capacity-building in line with international standards and best practices.