Raad Rahman explores the difficulty in fighting HIV among South Asian migrant workers.
Sylhet, Bangladesh. March 2014: If you have been to the Middle East in recent years, and particularly to the city of Makkah in Saudi Arabia, you may have admired the labor of one of the thousands of migrant workers who form the anonymous working class of the conservative Muslim countries dotting the region.
Kamal is such a worker. He tested positive for HIV in 2004. At the time he was immediately deported deported back to his native Sylhet, after 22 years of life in the Middle East. Upon returning, he married 25 year old Rokeya. He then fathered three children, never spoke about his disease to his family, until his youngest son Hanif, aged two years, developed a ghastly rash and a severe lymph node flu in 2011.
Doctors in Sylhet were unable to diagnose the problem, and Hanif was rushed to a hospital in Dhaka. Within two short weeks, all five members were diagnosed as infected with the disease, and the reason behind why Kamal was always sick after returning from abroad became known to his wife and her family, even though his family does not know, even today. His wife Rokeya, had to ask her immediate family for help with lifesaving blood transfusions for her children.
“When my older brother found out I had AIDS, he initially slapped me and accused me of sleeping around,” says Rokeya.
It was only in order to save Rokeya’s dignity that Shakib admitted that he knew that he had HIV all along.
“Stigma and discrimination against HIV positive people and other most at-risk populations is widespread,” says Dr. Nadia Rahman of UNAIDS.
It is estimated that approximately 8,000 adults and children were living with HIV in 2013 in Bangladesh, but only 3,241 have been reported.
“Whilst the number of people living with HIV is currently at one percent of the at-risk population, it has increased by more than 25 percent between 2001 and 2011, signifying the high risk of an impending epidemic,” says Dr. Rahman.
“Around 10 million Bangladeshis, mostly young and sexually active, are currently working outside the country and according to the available national data around 50% of recent HIV infections in Bangladesh are linked to returnee migrants and their families,” says Dr. Rahman.
According to statistics collected by Ashar Alo Society of Sylhet, of the 562 recorded cases of HIV in the district, only eight are attributed to male or female sex workers, or IV drug users. The rest of the 556 infected or affected by the HIV and AIDS virus are migrant laborers such as Kamal. Of this number, 231 have already died in Sylhet, including several women and children, who never received any information about their husbands having the virus.
Border cities such as Sylhet, Jessore and Chittagong also have high occurrences of the disease. A crucial impediment to truly capturing all the children who are affected by the virus is because of “inadequate numbers of testing centers across high risk populations, such as those engaging in unprotecting paid sex, and using shared needles,” says Dr. Rahman. “These populations are driving the disease. Only one third of HIV positive people are detected in Bangladesh,” she adds.
Cases such as Kamal’s is common and widespread across the six major cities in Bangladesh. The UNAIDS 2013 Report on the Global AIDS Epidemic calculates that amongst the high risk populations in Bangladesh, only 4 percent of female sex workers, 9 percent of males having sex with males, and 5 per cent of intravenous drug users have been screened in the country.
“One of the biggest tragedies about any child born with HIV is that the disease is very preventable. Anti-retroviral (ARV) medication, if administered in a timely manner, greatly diminishes the possibility of a pregnant mother transferring the disease to their child,” says Tahmina Begum, an aid worker who has been working with Kamal and his family for the last three years.
Aid has ensured that medication is cost effective, and frequent cash transfers to victims ensures that ARV medication, once costing approximately $1000 per victim even ten years ago, now costs $100 for a year’s supply of medication, all of which is subsidized through cash transfers and emergency aid provided to victims.
Begum and her colleagues have helped to ensure that at least 17 children at high risk of contracting the virus were given the medication since 2007 alone, thus ensuring they do not contract the disease. 31 children in Sylhet, however, have not been so lucky.
Several victims have been children, despite concerted efforts across various UN agencies and civil society platforms working to ensure that cash transfers, free testing facilities, and knowledge sharing activities have increased.
“The prevalence of HIV can be reduced with early interventions, but there is a severe stigma associated with even being tested for the disease,” says Tajdin Oyewale of UNICEF. “The effects of the virus can be greatly reduced if medication is taken properly, but in order to do this, the scale of interventions must be significantly increased in Bangladesh.”
Joint efforts across UN agencies has seen a tremendous effort to reduce the stigma behind HIV worldwide, in order to reach the goals of zero new births connected with HIV, zero stigma for HIV victims, and zero transmission to sexual partners by 2015.
Since 2003, the Bangladeshi government has been working with INGO and local grassroots level partners in providing the necessary education to reach the three zeros. As part of the ThinkWise campaign, which has scaled up efforts in promoting awareness of the disease through sports activities and other high profile events, the Bangladeshi Cricket Board, in partnership with local and multilateral institutions, conducted Bangladesh’s first “cricket clinic” in March 2014.
In the weeklong sports retreat held in Gazipur, 80 burgeoning athletes comprising 40 girls and 40 boys, learned first hand about high-risk behavior, randomness of occurrence, and general facts about HIV. Other activities included children infected or affected by the virus meeting key players across several of the participating teams.
Shorobh and his two brothers and sisters, Maya aged six, and Alim, aged seven, met cricket players from the Bangladeshi women’s cricket team in Sylhet. Alim, his older brother, says, “I vomited blood as a child, even if I ran for less than ten minutes. Even today, I get tired very easily on some days, but I can play with my friends in school at least, now that I take my medication. It is amazing to meet my cricket idols and know they care about me.”
“I’ve lived in shame for so long, it is good that someone is finally highlighting that all this has happened through no fault of my own,” says Rokeya, Kamal’s wife.
Dr. Sydur Rahman, national AIDS/STD Program Manager from the Ministry of Health says, “Awareness must arise from the grassroots level. Teaching leaders and adolescents to give back key messages to the community is a renewed promise that the Government of Bangladesh cares for the country’s health.”
Leo Kenny, UNAIDS Country Coordinator for Bangladesh explains that migrant workers, both internal and external, increase occurrences of the disease, raising crucial barriers to protecting the rights of children. Kenny says, “Without government leadership, the response has not been at scale or sustainable in any country of the world, and AIDS is a global issue requiring cooperation. Civil society is critical to the progress of providing sustainable services, and must be given the space by governments to do thus.”