It’s very difficult to truly grasp the scope of the HIV epidemic in Bangladesh. The first case of HIV in Bangladesh was detected in 1989 and by all accounts the numbers of infected individuals have been rising since that time.
If one is to go by reports, most of them now several years years old, the percentage of the total population living with HIV is less than 1%. As would be expected, percentages are higher in at risk populations, including a population of drug users in Dhaka where 10% were found to be infected.
The latest numbers from the Government of Bangladesh, as of December 2012, confirmed 2,871 cases of HIV in the country. This number has increased over time: the number of confirmed cases in, for example, 2009, stood at 1,745.
But these numbers likely belie the true extent of the epidemic: UNAIDS estimated that as many as 16,000 people in Bangladesh were living with HIV in 2011 (estimated range of 4,900 to 16,000).
Now, some fiver years later, in all likelihood the numbers are higher.
The clinical situations on the ground, from what I can tell after only a small amount of time spent in an HIV clinic in Dhaka, is sobering.
Based on what I was told, hospitals do not routinely send HIV tests. Diagnostic facilities are generally provided by NGOs based in Dhaka, leaving more rural and less connected locations with limited testing and associated care and support services.
Doctors working in the clinic told me how they had struggled getting their patients to surgeries, cancer care, even dental care because other hospitals and providers refuse to treat HIV positive patients.
They were only able to list one hospital where they felt they could get surgical care for their patients — that one several hundred miles and a days journey away. Because of this, physicians in the HIV ward often find themselves creatively providing services, like dental work, that they are not set up to provide.
According to the doctors I spoke to, hospitals might charge a patient several times more for services once they learn that he is HIV positive. Or they might claim that they do not care for HIV patients and send the individual away.
If this is true, it is tragic for a number of reasons. Obviously it is a human tragedy: for the patients struggling — against what seems to be a stigma in both the medical community as well as the wider community at large — to get the care they need.
If the medical community refuses to care for HIV patients, it seems likely that patients would refuse testing if offered or would hesitate to reveal their HIV status knowing that they will be charged extra or turned away.
And in the end these things get in the way of understanding the extent of disease and, perhaps most importantly, create barriers to HIV control and prevention.
And all of this is important because, although the number of people living in Bangladesh with HIV may currently be small, Bangladesh represents a huge — in a country of over 150 million people — vulnerable population. This population living in dire poverty and many out of reach of medical services.