CAT-S Key Findings

Bangladesh

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Country Report

Key Findings


Average self reported baseline CD4 count was 280.2 cells/mm3

Only 0.5% of respondents received a viral load test 

Majority of HIV test was either refereed by a clinician or due to diagnosis of HIV among immediate family member. 

The average duration between HIV diagnosis and first CD4 test was 8.4 months (median: 3.6 months, range: 0-14 years)

48.6% of those taking ART had experienced some delay in treatment initiation.

40.7% of respondents had poor treatment literacy

25.5% respondents reported having been sick within the 6 months prior to the interview and 42.5% of them required hospitalisation 

Average cost of treatment was 12,335 BDT (158.8 USD)

Only 59.2 % of participants reported being able to get condoms whenever they needed.

3.8% of participants reported having had their HIV status disclosed by a health care professional without their consent. 

Among 52 PWID interviewed, 19.2 % had no steady partner but 60% of those without a steady partner were sexually active and only 66.7% always used condoms.  

Among PWID with steady partners, only 11.9% were known to be HIV positive. Only 40% always used condoms.

22.4% of respondents or their spouse were pregnant since their HIV diagnosis and 23.9% of these were unintended.

46.5% were advised not to have children. 43.5% reported being coerced to terminate pregnancy due to HIV status of the mother

None of the respondents were on stavudine

Study Outline


 Since 2001, the Asia and the pacific region, has seen a 20% drop in the new HIV infections. In that same time the number of people living with HIV/AIDS who have access to ART has tripled. Despite this progress, access to ART, remains very low, with over 60% of PLHIV not having access to treatment. Overall, the East, South and South East, Asian region has some of the lowest levels of access in the world. For many years PLHIV groups were raising voice against a lack of rigorous research and information on the barriers and enablers to access to treatment, care and support. Historically studies in the region have been ad-hoc, and not representative of the needs and experiences of those affected by the disease.

Study Objectives 


 The overall objective is to monitor and document the issues related to PLHIV’s access to HIV treatment, care and support services in Asia and the Pacific region. The specific objectives of this study is to assess the HIV treatment-related issues such as access to pre-ART care, ART, ART adherence, treatment literacy, high risk behaviours, mental health status, health seeking behaviours, etc. and, to monitor changes in key issues in community access to treatment, care and support services.

Country Context 


 HIV in Bangladesh has continued to remain at relatively low levels among key population. There is, however, a concentrated HIV epidemic among persons who inject drugs (PWID) in some parts of central Dhaka, primarily due to sharing of unclean and used syringes. As a result, the rate of new infections is still on the rise. The latest round of serological surveillance in Bangladesh (2011) showed that HIV prevalence among all key populations remained below 1 percent with the exception being among PWID. Although the overall prevalence of HIV was 1.2% among PWID in 2007/08, there is a concentrated epidemic among male PWID in central Dhaka. The prevalence of HIV in this cluster increased from 4% in 2002 to 7% in 2007/08, and then fell slightly in 2010 to 5.3%. In Bangladesh as in other countries of the region, HIV risk arises mainly from unprotected paid sex, sharing of unclean and used syringes by PWID, and unprotected sex between men who have sex with men (MSM) and Transgender (Hijra) people. Recent data suggests that HIV prevalence among PWID in Dhaka has started increasing, rising to 7% in 2007/08 in one neighborhood. 

 

Methods  


 Screen Shot 2014-07-18 at 11.37.19 AMSample size was determined using proportionate sampling method with error allowance of 0.0035 and a target of 600 people living with HIV was set for Bangladesh. The sample size was then distributed based on geographical caseload reported by National AIDS Program. Risk-group and gender specific seeds (initial respondents) were recruited, using convenience sampling. Thereafter, a snow-ball sampling technique was used to enrol study respondents with seeds recommending their peers to the study.

Respondents were recruited from seven health service centres one each from Shyamoli, Banani, Chittagong, Banani, Sylhet, Khulna and two centres in Mohammadpur. A structured questionnaire was used to collect data. There were 14 sections and an interview in an average took 71 minutes to complete. A total of 15 data collectors were used. Ethical clearance was obtained from the Bangladesh Medical Research Council (BMRC). All respondents were provided standard information on the study and a written consent was obtained. Data collection was carried out between 26th November 2012 and 30th April 2013.

Soco-Demographics


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The mean age of respondents was 36.1 years.

57% of respondents were male, 42.3% female and 0.7% TG. 

73.5% live in a rural area, 11.7% live in a small town and 14.8% in a large town or city. 

66% of respondents had a partner or spouse and were living with that person, 33.8% were single, divorced or widowed.

The average household size for all respondents was 5 people. 

The most common self-identified risk group was international migrant workers (40.8%), there were 52 self identified persons who inject drugs in the study.

50.8% of respondents were either illiterate or could only read and write. Only 6% had a higher secondary or college level education.  59.3% of respondents earned some form of income, on averaged 7,954.5BDT (102.4 USD) per month.  99.5% of all respondents reported being members of NGO or CBO and 6.7% did work in a HIV program

 

HIV Diagnosis and Pre-ART Care


Screen Shot 2014-07-18 at 12.18.35 PMThe most common reasons given for going for a HIV test was due to being referred by a doctor due to suspected HIV related symptoms or being sick (27.7%), followed by husband/wife/child tested positive (27.2%).

The most common place for getting a HIV test done was in a NGO run VCT centre (60.7%).

91.8% of respondents reported having had a CD4 test done.

Less than one percent of respondents (0.5%) reported having had a viral load test done.

The average self reported baseline CD4 count was 280.2 cells/mm3

Majority (87%) of the study respondents sought NGO clinic for HIV consultation while 8.2% went to  private hospital/clinic

The average duration of time that CD4 test was done after HIV diagnosis was 8.4 months (median: 3.6 months, range: 0-14 years)

Health Seeking behaviour and associated costs


84.3% reported visiting their doctors, nurses or health workers at least once a month while 8.4% visited only when they are sick.

25.5% respondents reported of being sick within 6 months prior to the interview and 42.5% of them required hospitalisation

Average cost of treatment was 12,335BDT (158.8 USD).

22.2% of those who were sick and hospitalised mentioned that they received some sort of subsidy and 55.6% reported that they paid out of their pocket for their treatment. 

2% had received home-based care services

Stigma and Discrimination


Only 14.7% of respondents had disclosed their HIV status to someone other than their spouse, close family member or health care worker. 

32.9% of respondents who disclosed their status had been forced to change their residence or were unable to rent accommodation because of their HIV status.

Less than one percent of respondents reported having been denied health services due to their HIV status. 

3.8% of respondents reported having had their HIV status disclosed by a health care professional without their consent. 

50.3% of respondents were confident that their medical records were being kept completely confidentially.

 

Relationship with Health Care Provider


5.8% of respondents on ART agreed or strongly agreed that they were sometimes insulted when talking to their HCP. 87.8% of respondents on ART agreed or strongly agreed that their HCP made them feel comfortable when discussing any issues. 93.8% of respondents on ART agreed or strongly agreed that their HCP had told them of the possible side effects of their ARVs. 87.4% of respondents on ART agreed or strongly agreed that their HCP had told them of the changes to expect in their health when taking ARVs.

 

HIV Risk Behaviours


28 respondents reported to be current injecting drug users.

89.3% of PWID reported that they were able to get access to clean syringes whenever they needed them.

54.9% of respondents with a spouse or partner reported that the HIV status of their partner was negative or unknown.

59.2% of respondents reported being able to get condoms whenever they needed them. 7.3% were never able to get condoms.

 

Reproductive Health


83% of respondents have children, of whom 10.6% are known to be HIV positive. 

33.8% of  respondents with a spouse/steady partner had received counselling on child baring since being diagnosed with HIV. 

Only 3 respondents who had a desire to have children reported being coerced into being sterilised. 

22.4% of respondents in a relationship, or their spouses, had become pregnant since being diagnosed.

The majority of those pregnancies were intended (75%)

Treatment of Co-Infections (TB and HCV)


18.8% were diagnosed with TB after being diagnosed with HIV. 

100% of those received treatment and 85% of those had completed treatment. 

10.2% of respondents were provided with information on Hep C. 

Only 2.7% of respondents were offered a HCV test.  

Only 1 respondent was found positive for Hep C and did not receive treatment. 

 

Treatment Literacy


Screen Shot 2014-07-18 at 1.11.26 PMHIV Treatment literacy was measured by respondents answers to 25 questions. The higher score represents a higher knowledge of HIV prevention and treatment.

The mean score for HIV treatment literacy was 15.5. 1% of respondents scored a 0 and 22.3% scored between 1 and 10. 

Only 1.8 % had used the internet to search for HIV related information.

Reproductive Health


The average time on ART was 2.4 years. Of the 452 who were taking ART, 29.7% were taking ART for three years and above. 

13.5% of respondents on ART had changed regimen at least once since starting treatment. 

6.7% of the respondents were not aware of what ART is

48.56% of those on ART had experienced some delay in treatment initiation. 

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75.3% of respondents were on ART and only 1 who was eligible was not currently on ART at the time of the interview. The majority of those on ART were taking Ziudovudine + Lamuvudin + Nevaripine (38.5%)

Long Term Side Effects (self reported)


33.7% of participants on ART experienced at least one of the listed long-term side effects.

11.5%  were told by a clinician that their body fat has changed due to side-effects of ARV

1.1%  reported to have felt numbness in the limbs

3.5 reported to have had problems with the liver

Ashar Alo Society Bangladesh


Website: www.aas.org.bd

Email: info@aas.org.bd

AAS is a society formed by and for people infected with, and affected by, HIV/AIDS, from all over Bangladesh, and those who love them. It was started by volunteers in 1998 to give care and support to PLHIV and their loved ones. in 2000, AAS was formally established as a formal entity of PLHIV under the umbrella of Advocacy Program, CCDB. In 2001, AAS received funding from UNDP Regional HIV and Development program, South and North Asia under it’s greater involvement of people living with HIV/AIDS (GIPA). in 2001 AAS started working as the first independent organisation of PLHIV in Bangladesh.

Vision:


 Ensure quality of life and a discrimination free society for all PLHIV in Bangladesh.

Mission:


AAS as an organization of PLHIV working for those infected with and affected by HIV and AIDS; for improving the quality of life, ensuring rights and services, encouraging greater & meaningful involvement, capacity enhancement of PLHIV group and contributing to HIV prevention in Bangladesh.

Legal status: 


 AAS was registered under the Ministry of Social Welfare (Reg-07153) dated 3rd Sept’2002 & NGO Affairs Bureau (Reg-NGOAB-2181), dated 28th December 2006.

Achievement: 


 AAS is the pioneer, and largest, peer support group of PLHIV in Bangladesh. AAS had been providing ART on a small scale and was subsequently awarded a grant from Save the Children-USA (Management Agency) for implementing the care & treatment project under the GFATM- round 6, as the lead organization in a consortium with other four associate partners. Thus AAS was able to administer ART to PLHIV through Global Fund support. After rigorous advocacy initiatives of AAS, the government of Bangladesh (GOB) has taken over the responsibility of providing ART to PLHIV from December 2012. Although GOB is procuring ARV, it is being supplied and distributed to other organizationz and PLHIV under the leadership of AAS. It is a great recognition/achievement of AAS by the government for its capacity and good work.

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