PLHIVs stare at uncertain future

People living with HIV and AIDS say “uncertainty” looms over their treatment from January as the government is yet to pass their new care and support plan.

They shared their apprehension with bdnews24.com on Sunday, a day before World AIDS Day.

The relevant government authority, however, said they had “nothing to be worried”.

With less than 0.1 percent prevalence among the general people, Bangladesh is considered a low HIV prevalent country.

But experts warned against complacency as the stigma related to the disease is so profound that, according to a UN report, up to 20 percent people suffering HIV infections avoid seeing a doctor for fear of being ostracized in Bangladesh.

Habiba Akter who is the President of a Network for the People living with HIV (PLHIV) told bdnews24.com their fear grew as the government could not take over the charge of their treatment and management even after two years of announcement in 2012.

She said the donors supported treatment project would end in December, but the government did not pass the ‘Comprehensive Care, Support & Treatment of PLHIV’ plan that it decided to take up.

The plan kept the provision of ‘direct contracting’ to organisations for buying drugs for the needy in a public private mechanism.

The World Bank also issued its no objection certificate (NOC) for this direct contracting under which some fixed organisations run by the people living with HIV would buy and supply those drugs, instead of open tendering.

But Akhter said instead of passing this plan, the ministry of health was now planning to change the plan making it an ‘open tendering’ process which would take at least a year for it to come into effect due to lengthy process.

“Where we will get medicines in this one year…after December the donors’ project will end,” Akhter asked.

The government and the World Bank have earlier decided to fix direct contracting considering the need as only drug supply is not enough for people living with HIV.

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They need some associated support which is crucial to maintain their drug therapy known as ART. Those include monitoring and treatment adherence, peer support, community support, health check up, and lab investigation.

Besides, due to stigma those patients will not come out to a public place for taking drugs, that’s why the organisations which are run by them managed their treatment as of today.

Line Director of the National AIDS/STD Programme (NASP) Dr Husain Sarwar Khan acknowledged that the ministry of health had been planning to change its earlier decision.

“But we’ll not put them into distress,” he told bdnews24.com.

“Probably the ministry will pass it (care plan) keeping the earlier provision of direct contracting,” he said.

Government’s apathy

But the people living with HIV cannot garner confidence as government’s apathy to them is “not new”.

At least four out of eight blood samples testing machines for HIV, known as “CD4 Cells” counting machine, lay idle in as many hospitals as the government did not appoint regular technicians and supply testing reagents.

Despite media reports and activists pressure the government could not run those machines properly.

In 2012 when those machines were distributed at public hospitals one of them was sent to the Institute of Public Health (IPH) at Mohakhali where the HIV is not tested.

Later it was found that the machine was supposed to be sent to the Infectious Diseases Hospital (IDH) which is also located at Mohakhali.

Dr Khan who was not the line director at that time said those who took the machine were confused by the name of the hospitals.

“One is IPH and other is IDH. P or D, it confused them,” he said.

Asked why the machine was not shifted later, he said they would do it shortly after launching new beds at the IDH for HIV/AIDS patients.

Explaining the reason for keeping the machine idle, he said some hospitals where those machines were placed did not get many people for testing and reagents expired.

The CD4 cells counting machine helps in the testing of HIV/AIDS blood samples, determine the stage of the infection, guide anti-retroviral drug choices as well as indicate the patients’ response to treatment and disease progression.

Pass the plan quickly

The UNAIDS Country Director in Dhaka believes the government would handle the plight of the people living with HIV in “timely manner”.

“It is important that the care and support package is passed quickly by the ministry of health and family welfare to ensure that people living with HIV do not go without treatment,” Leo Kenny told bdnews24.com on Sunday.

“This is a government responsibility and I am sure it will be handled by the government in a timely manner”.

Triple zero

The theme of the World AIDS Day has been set ‘Three Zeros’ – zero new HIV infections, zero AIDS death, and zero stigma and discrimination from 2011 to 2015.

Experts say addressing stigma can take a country closer to zero AIDS death and zero new HIV infection.

With stigma attached to the disease, UN reports indicate that Bangladesh was unable to detect as many cases as it should because people refused to undergo tests.

The latest government figure released on World AIDS Day last year put the number of people living with HIV at 3,241 in Bangladesh since the first case was detected in 1989.

The number of AIDS patients was 1,299 and 472 people died of AIDS.

However, UN estimates the number to be between 8,000 and 16,000, which means many are left undetected and untreated.