Bangladesh is a lower-middle income country with an estimated population of 164.6 million in 2019 (37% urban, 63% rural) and a 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$). Government health spending as a proportion of total government spending is still low at 3.4%. Per capita public and private health expenditure is respectively US$ 6.1 and US$ 25 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. Overall HIV incidence rose by 56% and HIV-related mortality by 110% since 2010.
There are an estimated 14,000 people living with HIV (PLHIV) in Bangladesh. National programmatic data of the AIDS/STD Program (ASP) indicates that from 1989 to October 2019, a total of 7,374 HIV positive cases were detected (52.7%); during Nov 2018 to Oct 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 people, referred to as ‘Forcibly Displaced Myanmar Nationals’ (FDMN).
The HIV vulnerabilities of PWUDs especially PWIDs are much higher than any other groups due to drug dependency & sharing of needle-syringes, mental health problems, violence & harassment, stigma & discrimination, legal and social factors. Since 1998, Harm Reduction programme has been implementing with PWIDs by International / National NGOs supporting by the Ministry of Health and Family Welfare but still it is not legalized by the laws of the People Republic of Bangladesh, as such imprisonment, violence and harassment is a common phenomenon in the daily life of PWUDs both by the law enforcement agencies and the society. It is widely documented that PWUDs who are in prison are more vulnerable to HIV transmission than those who are outside of the prison and other close settings. As the responsible department the national AIDS/STD Programme (ASP), Ministry of Health and Family Welfare has limitation to engage the DNC, Bangladesh Police and Prison authority for effective HIV response due to limited financial and human resources. Therefore, there is a critical need for a multi-sector response for effective HIV programme implementation in Bangladesh, particularly to address the legal and structural factors.
These multifaceted problems have been affecting the implementation of HIV Programme-harm reduction programme to reach the PWUDs with services as well as accesses to services by PWIDs without fear of legal action, violence, harassment, stigma and discrimination. The HIV epidemic is increasing gradually among PWUDs and their partners, which became a public health threat for HIV transmission among general population. Considering the ongoing HIV epidemic and being the responsible agency, UNODC ROSA through its programme office in Bangladesh is planning to identify the needs of stakeholders, especially government counterparts to address the issues affecting the implementation of national HIV Programme-Harm Reduction Intervention and accordingly to provide technical support to government counterparts.
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 ROSA 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 ROSA is currently implementing a project in Bangladesh with the aim to identify the key gaps in the harm reduction programme specially for PWUDs and accordingly to identify key areas for providing technical support to national stakeholders on Drugs and HIV/AIDS for effective implementation of HIV programme with PWUDs (People Who Uses Drugs). As a part of this project UNODC will conduct a Need Assessment Study to find out the gaps in HIV response among PWUDs following UNODC mandates.