AIDS crisis looming: A disaster waiting to happen?

According to UN estimates, 25 million of the 34 million infected people in the world live in Africa. In absolute terms South Africa has the most cases; 4 million or about 20 percent of its adult population is now HIV positive. Thirteen million Africans have already died of AIDS and 10 million more are expected to die within five years. In Botswana, the rate of infection is 1 in 3, in Zimbabwe, it is 1 in 4. According to the US Census Bureau, AIDS related deaths will slow population growth in some of these nations to zero, and the population in Botswana, Zimbabwe, and South Africa will actually start to decline. Life expectancy by the end of the decade would normally have been 70 in this part of Africa; as a result of AIDS it will plummet to 30.

The Census Bureau's Karen Stanecki said at the 13th International AIDS Conference: "It is hard to comprehend the mortality we will see in these countries." People talk rhetorically of waging war on diseases. But in the case of AIDS, the rhetoric could hardly match with the measures taken, and the effects of AIDS-illness on human populations are similar to those of war. Most infectious diseases tend to kill infants and the old, but AIDS, like war, kills those in the prime of life. Indeed, in one way it is worse than war. When armies fight, it is predominantly young men who are killed. AIDS kills young women, too.

The destruction of young adults means that AIDS is creating orphans on an unprecedented scale. There are 11.2 million of them, of whom 10.7 million live in Africa. On top of that, vast numbers are infected as they are born. True, children are rarely infected in the womb, but they may acquire the virus from their mother's bodily fluids when they are born or from breast milk. It is now known that more than 5 million children have been infected in this way and almost 4 million of them are already dead.

Leaving aside Africa, Asians now risk an unprecedented pandemic. In India, already some 3.7 million people are living with HIV, and the disease has a significant grip on the urban population in the south and the west. But in the northeast, infection takes a specific pattern, spreading from drug users to their wives and wider community. "It is not just a medical problem but a social and developmental problem," says P. L. Joshi of the National AIDS Control organization. Large migrant populations, grinding poverty, low literacy rates, and repressive attitudes toward women hamper the fight to curb the spread of HIV. The most poignant revelation has come from Dr. Rohto Sob, a consultant for the WHO in Delhi, who disclosed that a majority of infected Indians are between the ages of 17 and 25. "This is your working population," he says. "In the long run, industrial population will be hit as it has been in Africa."

AIDS experts urge officials in developing countries where till now the infection rate is low to take cue from some African countries like Uganda and Senegal and a single Asian country, Thailand. Their strategies seem to have worked. Their contrasting experiences serve both as a warning and lesson to other countries in the world, particularly those in Asia that now have low infection rates, and may be feeling complacent about them. The warning: act early, or you will be sorry. The lesson: it is, even so, never too late to act.

Senegal began its anti-AIDS programme in 1986, before the virus had got a proper grip. It has managed to keep its infection rate below 2 percent. Uganda began its programme in the early 1990s, when 14 percent of the adult population was already infected.

Now the figure is down to 8 percent and gradually falling. Thailand's rare success story in its fight against AIDS is also encouraging. Pragmatic awareness campaigns have helped bring down the infection rate which was once as high as one in every 60 people. In contrast, in Myanmar, the military regime maintains that the very idea of an AIDS outbreak is a propaganda fabricated by "destructionists" intent on ruining the nation's image.

UN experts have indicated that in the Asian region, including India, Myanmar, Nepal, Philippines and last of all Bangladesh, a disaster is waiting to happen. There are some 5 million new cases each year, of which 58 percent are people under 25. About 7.2 million Asians have either HIV or full-blown AIDS, including 5 million in India, and about a million in Thailand. India's impending status as the AIDS capital of the world is a shock to the Indians but also a grim warning to Bangladesh.

Till recently, many people in our country considered AIDS a scourge of the libertine west that posed no threat to a conservative society like ours based on monogamous marriages. But Bangladesh also has hundreds of thousands of sailors, construction labourers, and other professional groups who work abroad for a time, and a continual tide of students and businessmen returning from overseas. Villages in Bangladesh, to say nothing of the cities and towns, are not, in fact, the bastions of sexual probity they are quaintly imagined to be, and the country has a huge population of migrant workers moving through cities in pursuit of farming or industrial jobs. Studies have shown that Bangladeshi society, long considered so conservative, is more footloose and sexually free than is commonly admitted.

As a result of this, HIV is no longer confined to a distinct zone that services long distance truckers. Experts have found clear indications that the killer disease that once prowled the red light areas now stalks the bourgeois neighborhoods.

AIDS is now the fourth leading cause of death globally and the leading cause of death in Africa. In most of the countries of the world, the AIDS virus has spread beyond the most vulnerable groups and into the society's mainstream. It robs economies of their workers, families of their support, and children of their parents. In some African countries, more than 20 per cent of the 15-49 years old population is infected with HIV: 20 per cent in South Africa, a mind-numbing 36 per cent in Botswana. As one estimate by UNAIDS says: within 10 years there will be 40 million AIDS orphans in Africa.

Public health officials in India warn of a six-fold increase in infections in the next three years -- about 20 million adults. In other words it means that India is teetering on the brink of becoming another sub-Saharan Africa. It is like a fire, says Dr. Salim Hubayeb, the World Bank's lead public health specialist for South Asia. In the beginning it is easy to control because you can go to the source.

But, intervention seems dauntingly difficult either in India or Bangladesh, because Asian societies like to keep the source under wraps, a vice that stems from ignorance and lack of proper education. Sex in our societies is not a subject of polite conversation. Public health officials have long despaired of this taboo because it makes the task of raising public awareness of sexually transmitted diseases more difficult. Marriages are often arranged and sex education is non-existent.

But in truck stops that dot the country and in cities and towns where migrant labourers toil far away from their families an underworld of illicit sex supports a vast cohort of sex workers. Moreover the virus has either spread or is likely to spread from the returnees carrying this insidious infection because they were not tested on their arrival. Most people in the country and the government prefer to ignore it. So when the first AIDS case surfaced in the country in 1989 -- the carrier being a returnee from abroad -- the officials in government circles argued that AIDS was a western disease that would not affect our uniquely moral society. Out of 219 people diagnosed to be carriers of HIV virus till 2002 at BSMMUH at Dhaka, 111 were returnees from abroad, 26 of them later developed full blown AIDS, and 20 of them died.

It was a big mistake, and complacency of this sort will make us pay a heavy toll in the future. Insidiously the disease has spread and continues to spread into high risk populations -- floating sex workers, IV drug users, patients with sexually transmitted diseases, and through blood supply and shared needles to the countryside even. Protection and extreme precaution are badly needed at every stage. Say, for example, in southern Tamil Nadu province, tests revealed in 1992 that only one quarter of the blood supplies were tested for the virus and that 15 per cent of the cases reported were caused by contaminated blood. Since then, with financial and equipment help from abroad, NACO (National AIDS Control Organization) has started providing kits to donate blood. The popular practice of professional blood selling was banned and hundreds of unregulated privately run blood banks were shut down.

In our countryside, where more than half of the people live, many still have not heard of AIDS. Part of the reason is Bangladesh's culture of denial. Many people still downplay the existence or significance of AIDS. Even today, some officials argue that measles, TB, diarrhea, or hunger are more pressing problems to be tackled. Understandably, the growing number of HIV cases in India and Myanmar, our closest neighbours, calls for stepping up efforts to halt the spread of the disease in our country through cross-border transmissions. The most worrying aspect is the trafficking of teenage girls to India, who, after being coerced into sex trade in the cities of India, eventually come back to Bangladesh carrying with them HIV infection, and spread the disease without their knowledge.

Perhaps the most disturbing fact is growing evidence either in India or in Bangladesh of what HIV experts call "transmission chains" in which the virus percolates insidiously through social substrata and afflicts low risk individuals like housewives and children, mostly belonging to middle class poor families. A report carried by The Daily Star on March 20 that 38 construction workers in Khulna have been found to be carriers of HIV is most alarming. Most worrisome, as the report indicates that women workers in the adjoining fish processing factories are also suspected of being infected by HIV. This should serve as a wake up call for the government that is still apathetic about this dreaded disease. What is needed other than viral testing of the vulnerable group is a campaign that reaches every corner of Bangladesh.

Md. Asadullah Khan is a former teacher of physics and Controller of Examinations, BUET.