Why young people are more vulnerable ?
Public health has improved markedly in Bangladesh over the past three decades. Life expectancy at birth is approximately 70 years, just above the World Health Organization’s world average of 69 years. Bangladesh faces major health challenges. The national population is projected to grow to between 200 to 225 million over the next four decades.
Communicable diseases are a major cause of death and disability in Bangladesh. While the prevalence of tuberculosis (TB) has declined substantially, Bangladesh still ranks among the top ten countries in the world with the highest TB burden. The disease is found primarily among the poor and least educated populations. Pneumonia and water-borne diseases also are widely prevalent. Pneumonia and other infections are major causes of death among young children.
The toll of non-communicable diseases — chronic diseases, cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases — is increasing in Bangladesh as the population becomes more urbanized. In the first national survey to measure blood pressure and blood glucose, about one in three women and about one in five men age 35 and older has elevated blood pressure and roughly one in ten has elevated blood glucose, an indication of diabetes. Cancer is the sixth leading cause of death in Bangladesh, accounting for more than 150,000 deaths annually.
The first case of HIV in Bangladesh was detected in 1989. The current estimates suggest an HIV prevalence rate of <1% among the most-at-risk population groups. The number of people living with HIV (PLHIV) and deaths from AIDS in Bangladesh are announced on the World AIDS Day every year by the MoHFW, These numbers have been steadily rising. There were 1,207 reported HIV cases and 125 new AIDS cases at the end of 2007. Based on available data, the estimated number of infections in Bangladesh is about 7,500.
In accordance with the UNAIDS/WHO guidelines, HIV surveillance in Bangladesh has focused on selected groups of individuals known to be most-at-risk for acquiring HIV infection. They include sex workers, injecting drug users (IDUs), males who have sex with males (MSM), and Hijra (male transgenders). In addition, particular population subgroups, such as regular partners of sex workers or mobile men, including truckers and rickshaw-pullers, who may eventually be the source of spread of the epidemic into the general population are evaluated. In each of the past seven annual surveillance rounds, the pooled level of HIV prevalence was <1% among all population groups tested (3–14). However, the HIV epidemic in Bangladesh is evolving rapidly. While still a low-prevalence country for overall HIV rates, IDUs in Dhaka city have shown an increase of HIV prevalence from 1.4% to 7% in the past six years, and in one locality, this has now reached 10.5% (14). The surveillance data for each of the population groups will be discussed in the relevant sections.
In Bangladesh HIV spreading Very seriously, there are some important cause as
Bellow :
- Drug injection-sharing behaviours.
- Practising unsafe sex
- Sex with female drug user without knowledge.
- Sex with HIV effected female sex workers
- Male sex with male, in this case Condoms were almost never used during sex. A large proportion of MSM had female sex partners or was married. A qualitative study attempted to understand the nature of the relations of MSM with women. It was found that these men feel societal pressure to marry, become husbands, and become fathers. Since these men were engaging in risky practices, their female partners were also at high risk for HIV and STIs.
- In 1998, a situational assessment of the Chittagong port was conducted to gather information on the behavioural factors contributing to the risk of HIV infection in the port city of Chittagong, Bangladesh, for the immediate objective of designing an HIV and STD-prevention programme. The populations included men from various trades in Chittagong and male and female sex workers. The study demonstrated an extensive clandestine sex trade in Chittagong. Traffickers brought women from Burma and the tribal areas of Bangladesh. Child prostitution was also common. Fishermen, dock-workers, and rickshaw-pullers represented major client groups, followed by local and foreign sailors and truckers. Between 40% (truckers) and 75% (dock-workers) of men reported recent contact with sex workers.
This study formed the basis of assessing the vulnerabilities of mobile populations in the surveillance system of Bangladesh through which dock-workers, truckers, rickshaw-pullers, and launch-workers were sampled in different rounds from different cities. HIV has not been detected in any of these groups sampled over the different rounds of surveillance with the exception of one rickshaw-puller out of 401 sampled in Dhaka. However, high-risk behaviours for HIV/STIs have been recorded in the surveillance, and other special studies for truckers, rickshaw-pullers, and more recently in boatmen working in Teknaf. The latter study was conducted with boatmen who were aged ≥18 years living in Teknaf and working on boat-sailing from Teknaf in the last six months for trade, fishing, or carrying goods or passengers. Consistent condom-use among truckers and rickshaw-pullers in the last month with different partner types ranged from 1% to 11%. For boatmen, this was assessed over the last month, and it ranged from 0% to 4.7%.
- At least 10% of men from general population are buying sex from female sex workers without
Knowing the health condition of the female sex worker.
- Low condom-use by men, remains one of the largest barriers to prevention of HIV in Bangladesh. Of the studies presented above, two on adult males showed a positive association between knowledge about prevention of HIV and condom-use. However, there are other more complex factors that need to be better understood for developing effective prevention programmes.
- There are some special issues that are closely related to the HIV epidemic, including issues of migration, gender, and stigma. Although certain most at-risk populations have been the focus in the active surveillance, most cases identified through clinics have, in fact, acquired HIV while working abroad, or from their spouse who worked abroad. To date, 371 people attending the ICDDR, B’s VCT Unit (Jagori) have been identified as infected with the virus. Of them, 54.2% are returnee-migrants, suggesting that migrants working away from their families may be particularly vulnerable to HIV.
Migration for work abroad is very common in Bangladesh. In two ICDDR, B surveillance areas in Mirsarai and Abhoynagar 1,200 (10.8%) of married women of reproductive age have a husband living abroad. Return from working in a high-prevalence country is one of the ways HIV is introduced into low-prevalence countries.
Reaching returnee-migrants for surveillance is difficult because they become part of the general population and do not form a special group. While they have special needs, targeting them might lead to stigmatization. Also, there was uncertainty as to their behaviours while abroad and when they return. A study was, therefore, undertaken among married couples to ascertain whether migration enhanced the vulnerability to HIV in both men and women. This was a cross-sectional survey of knowledge, behaviour, and practice among married men and women conducted in two ICDDR, B surveillance areas. The surveillance data allowed identification and sampling of subgroups of married men and women who had not lived apart from their spouses, were currently living apart, or had lived apart in the last five years. The findings showed that a large proportion of married men who had travelled either within Bangladesh or abroad reported sex with female sex workers (Fig. A few men used a condom during sex with a sex worker (24-31%), or with their spouse (28-31%).
- There are limited care and support provisions for PLHIV in Bangladesh. Antiretroviral drugs (ARVs) are not available through the public healthcare systems yet. At present, the GoB focus on care for HIV and AIDS patients is primarily through NGOs, although a few dedicated doctors have taken this up on their own initiative. There is a considerable need for improving support from the medical establishments and improving the training to handle AIDS patients.
There is much good news in relation to HIV for Bangladesh. The prevalence remains low, certainly lower than the neighbouring countries. There has been strong government support for surveillance—both serological surveillance and behavioural surveillance—and the Government and NGOs have used these data to build the national programmes.
Why young people are more vulnerable ?
Half of all new infections worldwide occur in young people aged 15-24. Young people are more at risk of HIV because they become sexually active at a young age but often do not settle with one partner early on, nor do they use condoms regularly. Young people are also more likely than any other age group to experiment with drugs, including injection drugs, which further increases their risk of HIV.Each day, nearly 6,000 young people between the ages of 15 and 24 become infected with HIV.
More than two decades into the epidemic, the vast majority of young people remain uninformed about sex and sexually transmitted infections (STIs). Although a majority have heard of AIDS, many do not know how HIV is spread and do not believe they are at risk. Those young people who do know something about HIV often do not protect themselves because they lack the skills, the support or the means to adopt safe behaviours.
For biological, behavioral, and cultural reasons, young people are at especially high risk of contracting STDs, including HIV.
Sizable numbers of adolescents are sexually active. In some countries, sexual activity begins in early adolescence, either within or outside of marriage. Young age at first intercourse is a strong risk factor for STDs.
A study in Bangladesh found that 88 per cent of unmarried urban boys and 35 per cent of unmarried urban girls had engaged in sexual activity by the time they were 18. In rural Bangladesh, those figures were 38 per cent for boys and 6 per cent for girls.in this situation lacking the necessary knowledge and skills, younger adolescents are less likely to protect themselves from HIV than young people in their early 20s.
Their immature reproductive and immune systems make adolescents more vulnerable to infection by various STD.
Adolescents, especially young girls, are less able to refuse sex and/or less able to insist on adequate protection. Sometimes sexual activity involves abuse or coercion which, in turn, is linked to young age at first intercourse and to more than one sexual partner—both HIV risk factors.
Girls are particularly vulnerable to being exposed to HIV where gender inequalities, embodied in national law or cultural or religious practice, create an economic and social dependence upon men. This dependence, generated by less access to education and economic opportunity, the inability to inherit or own property, and lack of legal protections, often limits women’s power to refuse sex. Women and girls may be subject to gender-based violence, abuse, coercion or contractual sex for goods or money and are often unable to adequately protect themselves against these sources of risk to exposure to HIV.
Conditions such as poverty, homelessness, political strife, and dislocation, which are increasingly common among young people in developing countries, are associated with sexual abuse or with sexual intercourse exchanged for money or support for basic needs.
Young people are ill-informed about STDs, their symptoms, the need for treatment, and where to obtain treatment. Combined with many adolescents’ fear of the medical system, these circumstances often result in avoidance and delays in seeking health care. Untreated STDs result in increased susceptibility to HIV infection.
Reproductive health service providers tend not to welcome adolescent clients. Studies in Bangladesh have found health facilities where adolescent clients are denied privacy and confidentiality, and in which the staff are often rude or moralizing.
Potential of sexual transmission of HIV is even more likely in incidences of rape than during consensual sexual intercourse, due to an increased likelihood of blood-to-blood contact.
Sexual abuse/forced or coercive sex includes:
*rape within marriage or dating relationships
*rape by strangers
*unwanted sexual advances or harassment
*forced marriage, or denial of the right to use measures to protect against
sexually transmitted infections (STIs) including HIV
*trafficking of people for the purpose of sexual exploitation
*Childhood sexual abuse
*Child marriage
While it is true that not all situations on the list above will necessarily put a woman at direct risk of HIV transmission, being subject to sexual abuse in any of these ways increases the likelihood of a woman finding herself in a situation where she is unable to negotiate sexual behavior in the future, thus increasing the risk of HIV.
Educating young people about HIV, and teaching them skills in negotiation, conflict resolution, critical thinking, decision-making and communication, improves their self-confidence and ability to make informed choices, such as postponing sex until they are mature enough to protect themselves from HIV.
Written by Farhana Newaz, Asian University, Malaysia.
