Socio Cultural Problems Faced by People Living in Bangladesh

Socio-Cultural Problems Faced By People Living
In
Bangladesh
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1
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CHAPTER 1
INTRODUCTION
1.1 Introduction
With less than 0.1 percent of the population estimated to be HIV-positive,

Bangladesh is a low HIV-prevalence country. The country faces a concentrated
epidemic, and its very low HIV-prevalence rate is partly due to prevention efforts,
focusing on men who have sex with men (MSM), female sex workers (FSWs), and
injecting drug users (IDUs). In Bangladesh the first case of HIV was detected in 1989.
According to NASP 2008, Government of Bangladesh source, till December 2008,
there were 1495 reported cases of HIV and 476 cases of AIDS, among them 165 died.
Last surveillance conducted in 2007 found national prevalence of HIV < 1%, this
makes Bangladesh a low prevalence country. However, there are specific socio-
cultural conditions that have the potential to increase the vulnerability of the country
to HIV/AIDS1.
HIV/AIDS prevention programs have successfully reached 71.6 percent of

commercial sex workers (CSWs) in Bangladesh, according to the 2005 United
Nations General Assembly Special Session (UNGASS) Country Report. However,
only 39.8 percent of CSWs reported using a condom with their most recent client, and
just 23.3 percent both correctly identified ways of preventing the sexual transmission
of HIV and rejected major misconceptions about HIV transmission. Other factors
contributing to Bangladesh’s HIV/AIDS vulnerability include cross-border interaction
with high-prevalence regions in Burma and northeast India, low condom use among
the general population, and a general lack of knowledge about HIV/AIDS and other
sexually transmitted infections (STIs). Bangladesh also has a high tuberculosis (TB)
burden, with 102 new cases per 100,000 people in 2005, according to the World
Health Organization. HIV infects about 0.1 percent of adult TB patients in
Bangladesh and HIV-TB co-infections complicate treatment and care for both
diseases2
2
Surveillances showed that in central Dhaka HIV prevalence among Injecting
Drug Users (IDUs) rose from 1.4% to 7% (up to 10.8% in a particular locality) during
last four years. Simultaneously recent Behavioural Surveillance Survey (BSS) data
indicate an increase in risk behaviours such as sharing of injecting equipment and a
decline in consistent condom use in sexual encounters between IDUs and female sex
workers. BSS data also indicate that the IDU population is well integrated into the
surrounding urban community, socially and sexually, thus raising concern about the
spread of HIV infection. Over the five surveillance rounds conducted in Bangladesh
between 1998 and 2004, the total HIV prevalence remained below 1%. According to
the data published by National AIDS/STD programme (NASP) on December 1 st 2009,
the current situation of HIV/AIDS in Bangladesh is shown in the table below4:
As of 2008 2009 As of 2009

New HIV 250
Total HIV 1495 1745
New AIDS 143
Total AIDS 476 619
New AIDS Death 39
Total AIDS Death 165 204
Table 1: Bangladesh HIV data 2009
The epidemics in many countries of South Asia are now entering a new phase.
One of the first populations to be affected by HIV in South Asia were injecting drug
users. In areas where drug injection has been long established, such as Manipur in
north-eastern India, HIV prevalence rates of over 40 percent have been recorded for
several years. Several hundred thousand people infected during the explosive start of
epidemics are becoming ill and are undergoing treatment. The treatment of infections
becomes a great burden for the country concerned, because HIV/AIDS requires long-
term and effective medical care, periodical hospital-based care and trained manpower
to provide comprehensive healthcare services. For countries where resources are
scarce, easy access to treatment and care remain very questionable and prohibitive for
many PLWHAs5.
3
In Bangladesh the situation of human rights in relation to PLWHA seems
critical. As PLWHAs are not visible, the reality of the human right situation is
difficult to estimate. To Human Rights Watch, "People living with HIV/AIDS and
those thought to be infected have been imprisoned, assaulted and even murdered. The
stigma of AIDS has taken many lives before the disease itself killed them. But the
reasons behind the suicides and extent of this have rarely come to our knowledge.
Society’s limited understanding of this disease is causing innocent people to pay a
terrible price. Increasingly across the world, there are voices questioning in one angle.
They question the narrow approach to a single disease, especially the huge financing
for AIDS over all else in basic health care. Our approach to this disease needs to
change for the sake of our people, our brothers and our sisters who are fighting
against odds8.
Social factors like discrimination, stigmatization and rejection have pushed

people living with HIV to become desperate and feel hopeless, to the extent of giving
up their life. They face discrimination and lack of support not only from the society
but also from his/ her own family. They are also being confined from friends, scared
for losing their jobs. This made them to live in phobia and their condition become
worse as they need proper and adequate treatment that could provide them with better
life. Most of these people are not getting proper medical and nursing care as stigma is
attached so strongly to this illness that even some well educated people refuse to serve
them. Many are afraid of consulting the doctors as they did not wish other people to
know about their predicament. With the existing treatment, people with HIV can lead
a normal life particularly if they receive good support from their family members,
especially their parents7.
The situation is aggravated by the fact that major percentage of the HIV
positive individuals are Injectible drug users (IDUs), who are marginalized by society
and criminalized by the law. HIV/AIDS has already been concentrated epidemic
among the IDUs. They must be taken under rehabilitation to stop the spread of this
threat. Conditions of women living with HIV/AIDS are dismal. Women are blamed
for carrying the infection, even though they may have got the virus from their partners
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(in most cases husbands). Instances have been reported, where husbands abandon
their ailing wives and children to find another wife. Due to the fear of social and
family desertion, women are hesitant to disclose their HIV/AIDS status. Also,
disclosure may lead to loss of job and reputations. This fear and dithering will make
women an easy target of violence and abuse.
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1.2 Justification of the study
The Government of Bangladesh estimates that there are 7,500 people living
with HIV/AIDS (PLWHAs) in Bangladesh. According to the Joint UN Programme on
HIV/AIDS (UNAIDS), this figure is approximately 13,000 people, or less than 0.2 per
cent of the adult population (2003). National sero-surveillance in 2005 found a low
HIV prevalence (less than 1 per cent) among groups such as female and male sex
workers, men who have sex with men, Hijras (transgenders), heroin smokers, and
some groups of internal migrants. Nevertheless, HIV prevalence among male
injecting drug users (IDUs) in central Bangladesh is rising steadily: at 4.9 per cent, it
is close to a concentrated epidemic. Available data indicates that IDUs are well
connected to the surrounding community, both sexually and through selling blood,
putting the wider population at risk. Young people are also emerging as a key group
vulnerable to HIV infection5.
PLWHAs in Bangladesh, as in many countries of the world, face manifold

socio-economic and cultural problems in society. In the absence of a friendly
environment, most of the identified PLWHAs and their family members have to
confront stigma, discrimination, and violation of human rights. This situation has also
increased the number of invisible PLWHAs, resulting into their non-accessibility to
care, counselling and support. Most of these PLWHAs prefer to live without
disclosing their status because of fear and shame, or they simply are not aware of the
available facilities for care and support. This situation has, however, led a handful of
PLWHAs to build contacts among themselves to form their own organisations and
network.7
As the numbers of people infected with HIV rise, social and economic
vulnerabilities are heightened. Population movements (cross border/rural-urban
migration and trafficking), unprotected sexual activities and injecting drug use are
among the factors that highlight the need to act quickly and effectively. After nearly a
decade and a half of the epidemic, facilities for care and support remain inadequate.
Stigma and discrimination confront people living with HIV/AIDS (PLWHAs). Lack
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of awareness and understanding have been obstacles standing in the way of
prevention efforts, and inappropriate overtones - condemnation and judgment of
infected people - have led to discrimination and even violence against them 8.
This study will explore the socio-cultural problems faced by PLWHAs and
change the attitude and thoughts of the people towards PLWHAs.
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1.3 Operational Definition
 HIV: Human Immunodeficiency Syndrome. A condition in human in which

the immune system begins to fail leading to life threatening opportunistic
infection14
 AIDS: Acquired Immunodeficiency Syndrome. A collection of symptoms
and infections resulting from the specific damage to immune system caused
by HIV virus in human.
 Opportunistic infections: A serious infection with a microorganism
which normally has little or no pathogenic activity but which has been
activated by a serious disease.
 Epidemic: The unusual occurrence in a community or region of disease.

Specific health behavior or event clearly in excess of expected occurrence.
 Discrimination: A practice of treating a particular group in the society less
fairly than others.
 Sexually Transmitted Disease (STD): Sexually Transmitted Disease refers
to disease of genital organs of either sex transmitted through sexual contact.
 Service: Service is an occupation which includes government and private
services.
 Monthly family income:
Upper class- indicates family income is tk.30, 000 per month or more.
Middle class- indicates family income is more than tk.10, 000 but less than
tk. 30, 000 per month.
Lower class-indicates family income is tk.10, 000 per month or less.
 Level of education:
Illiterate- Persons who can not write their name.
Primary level- Persons who write down their name.
Secondary level- Persons who are studied up to class x.
Higher secondary level- Persons who are studied up to class xii.
Tertiary level- Persons who are studied diploma, graduate or post graduate
etc.
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1.4 Research Question
What are the Socio-Cultural Problems faced by People Living With

HIV/AIDS (PLWHAs) in Bangladesh?
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CHAPTER 2
REVIEW OF RELATED LITERATURE
A study titled 'People living with HIV stigma index' conducted on 238 HIV
positive people revealed that 16.8 percent of them decided not to go to a hospital
when they needed to do so because of the discriminatory attitude of most of the health
providers. The study showed that some 84.9 percent of the HIV carriers decided not to
have more children because of their uncertain future, while 70 percent of them feel
ashamed for their HIV status. The social stigma is so deep-routed in the society that
21 percent PLHIV still believes that they should commit suicide. The
recommendations from the study include all HIV prevention interventions should
incorporate psycho-social counselling, especially to handle the internal stigma and
trauma management. Comprehensive training for the health service providers on
stigma and discrimination and its impact on public health management should be
addressed, while mass media campaign addressing stigma is also important9.
HIV stands for human immunodeficiency virus. This is the virus that causes
AIDS. HIV is different from most other viruses because it attacks the immune system.
The immune system gives our bodies the ability to fight infections. HIV finds and
destroys a type of white blood cell (T cells or CD4 cells) that the immune system
must have to fight disease. AIDS stands for acquired immunodeficiency syndrome.
AIDS is the final stage of HIV infection. It can take years for a person infected with
HIV, even without treatment, to reach this stage. Having AIDS means that the virus
has weakened the immune system to the point at which the body has a difficult time
fighting infections. When someone has one or more of these infections and a low
number of T cells, he or she has AIDS. Scientists identified a type of chimpanzee in
West Africa as the source of HIV infection in humans. The virus most likely jumped
to humans when humans hunted these chimpanzees for meat and came into contact
with their infected blood. Over several years, the virus slowly spread across Africa
and later into other parts of the world7.
10
The course of untreated HIV infection can be divided into three phases: the
acute HIV disease, then the latency phase and finally the disease of Aids, ending in
death. The acute HIV disease lasts a few weeks. This period is also known as the
window of vulnerability, and it is characterized by an explosive replication of the
HIV. During this phase, the HIVs invade the organs of the defence system and other
bodily organs and establish themselves there. The latency phase lasts on average 10
years, during which the virus concentration is relatively low. In the Aids phase the
defence system is completely destroyed, as the result of which death occurs after 1-2
years. The defence system (immune system) has two main jobs: as well as combating
outside invaders such as bacteria, viruses, fungi etc., which give rise to so-called
infectious diseases, it also prevents cancer by tracking down and destroying the body's
own damaged or degenerate cells10.
It takes several years before the human immune system is defeated by the HIV
infection. A veritable war goes on between the immune system and the viruses, with
many battles. As early as a few days after infection (during the acute infection stage)
several thousand million new viruses are formed and at the same time thousands of
millions of helper cells are destroyed. Hence, 2-3 weeks following infection, the acute
HIV infection (= primo-infection) can appear, which subsides again after about 6
weeks, when the human immune system has gained the upper hand in the first battle.
Even during the symptom-free latency period, the viruses replicate with extraordinary
vigour. The human immune system kills as many HIV as are produced, maintaining
equilibrium year upon year. When AIDS itself occurs, the immune system becomes
exhausted and the quantity of virus steadily increases. The weakening of the immune
system through HIV infection makes people increasingly vulnerable, especially to
infectious diseases and cancer8.
Diagnosis: HIV can't be diagnosed through a medical examination or via

disease symptoms. Diagnosis is only possible on the detection of the HIV virus or
antibodies in body fluids (e.g. blood). Normally the presence of antibodies is tested.
The diagnostic window: It takes some weeks before sufficient quantities of antibodies
exist in the blood for the test. This period from infection to proof of infection is called
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the diagnostic window. The period varies from person to person and is dependent on
several factors (transmission path, quantity of transferred viruses, immune system
etc.). The diagnostic window can be reduced by an average of 3 weeks with the use of
an antigen (virus) test or a combination of antigen and antibody tests. For most people
the time taken between infection and diagnosis is 3 months but it may take 6 months
before it is possible.
Clinical Stage: The American health authority CDC (Centre for Disease
Control and Prevention) defines 3 clinical stages of the disease and 3 immunological
categories. According to the CDC definition HIV can only be diagnosed with a
confirmed HIV positive test. Stage A covers both the acute HIV illness and the
subsequent clinical latency. The acute HIV illness arises 3-6 weeks after infection for
50-70% with flu type symptoms: fever, skin eruptions, throat inflammation, muscular
pains, lymph node swelling, headache, and nausea. During clinical latency there are
no further complaints although some people have continuous Lymphadenopathie in
the shoulders, back or neck. The clinical latency can last for many years. Stage
B consists of disease symptoms prior to stage C (AIDS), which further weakens the
immune system. Usually these symptoms accompany a general worsening of health.
In addition to long lasting (a month plus) symptoms such as fever, night sweats and
weight loss, many other infections such as Candida infections of the mouth and throat
or viral illnesses like belt rose occur. Stage C is the final phase of the HIV infection,
the actual AIDS illness. It is the collapse of the immune system. The pattern of the
AIDS illness is unmistakable although individual symptoms may vary. Diverse
infections and cancers are common, as are fungal infections of the oesophagus and
special forms of pneumonia (Pneumocystis carinii Pneumonia), also common are
virus illnesses (i.e. retinal inflammation CMV-Retinitis), parasite infection (i.e.
Toxoplasmosis that causes brain abscesses), rare cancer forms (e.g. Kaposisarkom,
Lymphdrüsensarkom, brain tumours) as well as neurological illnesses (among other
things HIV dementia) and strong weight loss (Wasting syndrome).9
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Transmission: HIV is passed from person to person: HIV is found in body
fluids such as blood, semen, vaginal fluids and breast milk. It is passed from one
person to another or transmitted - only in very specific ways. These are:
 Through sexual intercourse between a man and a woman or between two men;
 Through infected blood - for example through contaminated blood
transfusions or unsterilized needles and syringes. ( In most places today blood
transfusions are completely safe because the blood is tested for HIV before it
is used to treat patients); and
 From an infected mother to her baby while it is still in the womb or during
childbirth or during breastfeeding.
HIV does not spread through "casual" everyday contact between people. It is not
transmitted by coughing, or sneezing, or by touching or hugging someone who has the
virus. It is not spread in air, water or in food, or by sharing cups, bowls, cutlery,
clothing, or toilet seats. And HIV is not transmitted by biting insects such as
mosquitoes, because the quantity of blood on their mouthparts is too minute. HIV can
be passed on by infected blood: If blood from a person infected by HIV gets into the
blood stream of another person, it will infect them also with the HIV. This can
happen: If contaminated instruments are used to pierce the skin during:
 injections
 circumcision
 scarification
 ear piercing
 tattooing
 acupuncture
Infection can be prevented if the equipment used is brand new, or is carefully

sterilised each time it is used. From a blood transfusion with infected blood: Blood
transfusions may be necessary
 after a bad accident, if someone has lost a lot of blood;
 during a hospital operation;
 after childbirth, if the mother has lost much blood; or
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 If a person is anaemic due to bilharzias, hookworm or malaria parasites.
If the blood or equipment used is contaminated with HIV, this will be

transmitted to the person receiving the blood, and so they will also become infected.
All equipment used for blood transfusions should be sterilised before it is used. In
some countries all blood which has been donated is tested for HIV infection, and only
non-infected blood is used. More and more countries are now trying to do this. There
is no risk in donating blood if the equipment is new or properly sterilised10.
In addition to the risk of infection from sexual contact, HIV can be transmitted
through transfusion with HIV-infected blood or blood products, or from a needle stick
injury involving a needle used by an HIV-infected person. The most common form of
transmission of HIV by needles occurs when persons using illegal injecting drugs
share needles. It is also possible to become infected when infected blood, or a bodily
fluid containing infected blood, comes in contact with mucous membranes or skin that
is broken or open. Universal precautions have been recommended for anyone who
might come in contact with blood or body fluids. These precautions apply also to
body fluids that contain blood and to certain body fluids that are not generally found
outside the body, for example, vaginal secretions, semen, and cerebrospinal fluid.
Bodily fluids to which universal precautions do not apply (unless blood is present in
them) include faeces, tears, sputum, saliva, nasal secretions, vomits, and urine.
However, these fluids can contribute to the spread of infections other than HIV, so
some precautions should be taken in handling them11.
Testing: If someone has been at risk of contracting HIV, testing is the only
way to find out whether or not they have become infected. The test should be
combined with comprehensive counselling by a doctor. The HIV infection has, within
the space of only a few years, developed into a pandemic (worldwide epidemic). It is,
therefore, important for all persons to know whether they are infected or not, since in
this way each one of us can contribute towards preventing the further spreading of this
fatal disease. Deceptive calm: As a rule an infected person notices nothing (with the
exception of an occasionally occurring influenza-like illness within the first weeks) of
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the HIV infection for several years – a deceptive calm. In this symptom-free period,
which lasts on average ten to twelve years, the infected person is already a transmitter
of the disease. Whether one has become infected or not can only be ascertained by
making an HIV test. Those who have themselves tested are behaving responsibly both
towards themselves and towards others.
The test always makes sense: Let us assume that the person in question is not
infected at all, i.e. HIV negative. The negative test result indicates the absence of an
infection with a high degree of certainty – provided that the recommended waiting
period before the test has been observed (see below). Any uncertainty and any
unnecessary fears can now be assuaged. In this situation, combined with competent
counselling, a responsible pattern of behaviour (with avoidance of risk situations) can
be developed for the future. Let us assume, on the other hand, that someone is
infected, i.e. HIV positive. This person will, as a rule, do everything possible not to
spread the disease further. No-one would like to infect his/her partner, the person
he/she loves most, or cause the birth of an HIV positive child. On the other hand only
those persons can profit from timely therapy (which can postpone the terminal stage
AIDS), who know that they are HIV positive. In many of the complications
accompanying AIDS, early recognition plays an important role. Such manifestations
can be treated in time, and much suffering can be prevented. An HIV positive person
who places him/herself under competent medical care, can live longer and better than
someone who delays until the onset of AIDS9.
The test performed by a doctor in whom you have confidence, so that

comprehensive counselling can follow. Treat immediately and correctly: When an
HIV positive person falls victim to other infections, this contributes to the
proliferation of the virus, and thus to further weakening of the immune system.
Basically harmless diseases – e.g. shingles – can take a very severe course. Many
diseases, e.g. diarrhoea, must therefore be treated at an early stage. It is essential for a
doctor to know whether his patient is HIV positive or not. Only then can he make a
correct diagnosis and initiate correspondingly effective therapy. For example in the
most frequent type of pneumonia encountered in HIV positive patients,
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Pneumocystis-Carinii-Pneumonia (PCP) completely different drugs have to be
employed than in "normal" pneumonia. At the time when PCP was treated as normal
pneumonia almost half of the patients died. But now, with early diagnosis and
appropriate therapy, less than five per cent of these patients die.
In patients known to be HIV positive a virus disease of the eyes (CMV

Retinitis), which frequently occurs in AIDS patients, can be diagnosed at an early
stage and treated, preventing them from going blind. Anyone who keeps putting off
the decision to submit him/herself to an HIV test, will, if infection is present, lose
valuable treatment time. There are also other reasons why a test should be made: in
the case of certain inoculations, e.g. before travelling overseas, the doctor has to adopt
a different procedure in the presence of an HIV infection to ensure that the patient
comes to no further harm. The same applies to major operations which, as everyone
knows, represent an exceptional strain on the immune system. In the interest of the
patient the nature of the operation must be considered very carefully13
Medical advice: Only if HIV positive individuals know that they are infected
can they take specific precautions to safeguard their health. How many people are
aware that birds in the apartment can, with their excrement, because dangerous fungal
diseases in HIV infected persons, or that cat toilets and the soil in flower pots can
hold similar risks? Alcohol, cigarettes and drugs are even more harmful for HIV
positive persons, since they weaken the immune system additionally. Raw meat and
other foodstuffs likely to be contaminated with salmonella should be strictly avoided,
as should raw fish, oysters and other sea foods. Mayonnaise and sauce or gravy that
have been left standing too long can also be dangerous. In contrast, healthy nutrition
rich in calories and vitamins is to be recommended. Contacts with carriers of
pathogens (germs) – whether children’s' diseases (e.g. chicken pox) or tuberculosis –
can become dangerous. Travelling to countries with a low standard of hygiene –
above all tropical countries – may involve above-average dangers of infection. The
taking of medicines without first consulting the doctor should be avoided due to
possible side effects or weakening of the immune system. And, what many people do
not know, severe physical strain or stress, as well as sun-bathing in the open air or in
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the solarium, can also affect the immune system, and thus accelerate the outbreak of
AIDS. In the interests of all infected persons, all the points mentioned speak in
favour of an HIV test. But there is also a further reason: for several years now the
medical world has been in possession of virus-inhibiting medications12.
When a test should be made:

 In the event of a previous way of life involving risk (e.g. drug dependence or
frequent change of partners)
 Both partners at the beginning of a sexual relationship
 Partners wanting a child
 Women at the beginning of a pregnancy
 Before inoculation with living vaccines
 If blood transfusions were received before autumn 1985
 Prior to major operations
The test should be taken at the earliest two to six weeks after a possible infection and,
in the event of a negative result, repeated after three months. The test no longer makes
sense for persons who already know that they are infected.
Antiretroviral therapy (ART): The current therapy for HIV infection

is called HAART (Highly Active Antiretroviral Therapy) and consists of a
combination of at least three different active ingredients. There are more than 20
different drugs in use. A successful HAART suppresses the viral load (concentration
of HIV in the blood) below the detection threshold and indirectly increases the
number of T-helper cells. Due to these drugs, an HIV infection changes from a fatal
illness into a chronic illness. This way it is possible to prevent the appearance of
symptoms, and also to significantly reduce the risk of infection. The drugs all prevent
replication of HIV via various mechanisms, by interrupting the replication cycle.
However, these drugs can only work over the long term, if they are taken daily, 365
days a year. Thanks to antiretroviral therapy (ART), people infected with HIV
are living significantly longer and have a better quality of life. But ART cannot
completely eliminate the HIV in a person and it is not a cure. The drugs must be
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taken for a lifetime, which is a heavy burden on the patient. As soon as the drugs
are stopped, the viruses replicate again explosively. Sometimes the drugs are not
tolerated or the HIVs are resistant to these drugs, which therefore do not work
any longer.13
Currently, the drugs available to combat HIV infection are the reverse
transcriptase inhibitors and the protease inhibitors. The reverse transcriptase
inhibitors indirectly prevent the viral genome from becoming incorporated in
the DNA of the human host cell, as these drugs block an important enzyme for
DNA synthesis – reverse transcriptase. The protease inhibitors block protease, a
central enzyme responsible for forming new viruses. Nowadays the two types of
drug are used in combination. Both help to keep down the level of virus in the
blood and lymph nodes and in this way they slow down the progress of the
disease. Huge advances have been achieved in the treatment of HIV infection in
the last few years. In the early nineties, antiviral therapy was used only in the
advanced stages of HIV infection. Nowadays treatment is begun early in the
hope: (1) of stopping further proliferation of the virus and destruction of the
immune system, thus halting the progress of the disease; (2) of suppressing the
formation of resistant HIV variants; (3) of reducing proneness to infection.
Studies have shown that in HIV-positive pregnant women, the risk of
transmitting the virus to the baby can be greatly reduced by use of antiviral
therapy. Nowadays therapy is begun with two different reverse transcriptase
inhibitors and one protease inhibitor. Reverse transcriptase inhibitors include
AZT (Retrovir®), Lamivudin (3TC®), ddI (Videx®) or ddC (Hivid®). Protease
inhibitors are Indinavir (Crixavan®) or Nelfinavir (Viracept®14).
Drugs for Prophylaxis in cases of AIDS: Prophylaxis is aimed at

preventing or at least delaying onset of typical infections (opportunistic
infections) in the AIDS stage. It only combats the symptoms and does not cure
the HIV infection, nor is it a way of halting the destruction of the immune
system. The precise procedure for prophylaxis against opportunistic infections
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depends on the stage of the disease. Various drugs are used: e.g. Baktrim® for
prophylaxis against Pneumocystis carinii pneumonia. Post-exposure prophylaxis
(b) For several years now, medical and nursing staff exposed to the risk of HIV
infection by an injury at work – from a used syringe, for example – have been
treated for two to four weeks with one or more anti-HIV drugs. This has reduced
the risk of transmission by 80%. Since 1997 this "treatment" has been available
in Switzerland also to persons who may have become infected through
unprotected sexual contact with an HIV positive partner. But little is known at
present about the effectiveness of the "treatment", except that it should be
started as soon as possible, ideally within a few hours, but not later than 72 hours
after the infection risk situation, otherwise the HIV will already have spread in
the body. These drugs must be taken for two to four weeks and have strong side-
effects. The decision to carry out PEP needs careful consideration by a doctor in
a central hospital, as nothing is yet known about long-term damage through
antiretroviral therapy on healthy individuals.
What you one know about the test: The test used to ascertain whether
someone has become infected with the AIDS Virus, HIV, is called the HIV
antibody test (e.g. the ELISA). What is looked for is not the virus itself, but the
products of the human defence system (immune system) in the blood, i.e. the
antibodies. The HIV test is one of the surest tests in medicine. The time from the
moment of infection until the appearance of antibodies in the blood
(seroconversion time, diagnostic window) varies, and is dependent on various
factors (route of transmission, number of virus particles transmitted, etc.). As far
as we know today, antibodies appear at the earliest after two to six weeks and, in
the majority of people within three months, and therefore testing are effective at
the earliest two to six weeks after exposure to risk of infection. If the result is
then negative, the test should be repeated 3 months later15.
There are various tests, and these complement each other. The ELISA is
used as an HIV antibody detection test. Since other antibodies may also interact,
"positive" results are always rechecked. For confirmation or correction the
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Western Blot Test is used. It is more time-consuming and expensive than the
more sensitive ELISA. To exclude possible sample switches in the laboratory, in
the event of a "positive" result a second blood sample is to be
recommended. Antigen tests, which demonstrate viral components directly, are
less sensitive than the HIV antibody test, and give no essential shortening of the
diagnostic window. The antigen test is important in identifying those newly
infected with HIV. The PCR test (gene probes, with which even traces of genetic
material of the virus can be detected) is, because of its complexity, used only by
specialists and when test results are unclear e.g. in early diagnosis in infants and
uncertain cases of infection with HIV. The PCR Test is nowadays used to
measure the effectiveness of therapy13.
Only people who are aware of their infection can behave responsibly towards
themselves and others.
 Infected persons should, in principle, inform all previous sexual partners about
the existence of the infection, so that they can also have themselves tested at
once and receive medical counselling. In this way can it be ensured that they
profit at an early stage from the medications available today, and that they do
not unwittingly transmit the infection further
 Infected persons must inform their present sexual partner about the infection.
Safe protection means abstaining from sexual intercourse and the exchange of
body fluids. Condoms reduce the risk of infection, but they do not exclude it
completely. Someone who does not want to change his/her risky pattern of
behaviour should always protect him/herself with condoms.
 In sexual intercourse between infected persons it is worthwhile using condoms
to reduce the risk of infection with other pathogenic organisms (syphilis,
herpes, hepatitis etc.) or with a particularly "virulent" HIV strain.
 Infected persons must inform doctors, dentists and nursing staff about the
infection, so that the latter can act accordingly.
 Blood, organ and sperm donations from infected persons are forbidden.
20
All the points set out here ought to be obvious as ground rules of caring and
considerate behaviour.
Injecting drug users, sex workers and men having sex with men are considered
most at-risk groups to HIV infection in Bangladesh. Between 20,000 - 40,000 people
in Bangladesh inject drugs, 57% borrow needles and only one in three used sterile
equipment. This percentage is much higher in female injecting drug users (74%).
More than half (57%) of injecting drug users (IDUs) are married and most IDUs are
sexually active (with an average of two partners). In Dhaka, the HIV rate among IDUs
is 6.4%5. Commercial sex work occurs in Bangladesh as it does in other Asian
countries. Most married men who have unprotected sex with sex workers continue to
have unprotected sex with their wives, exposing them to infection with HIV and other
sexually transmitted diseases. Low condom use, risky behaviour and general lack of
understanding about HIV is not limited to clients of sex workers. In fact these traits
are widespread and heighten the chances of a HIV epidemic in Bangladesh. Although
many people have heard of HIV, their knowledge is limited in regards to how it is
transmitted and how they can protect themselves. Nearly one in five ever-married
women who had heard of AIDS did not know if there was any way to prevent it. This
was lower for men, at 6%6. Men having sex with men are largely hidden due to the
powerful stigma and discrimination they face in Bangladesh. Many men who have sex
with men are bi-sexual and do not necessarily identify themselves as such. Men
buying sex from other men rarely use condoms and many continue to have sex with
their wives20.
Migrant workers are another important group identified as a priority in the

Bangladesh National Strategic Plan for HIV and AIDS 2005-2010. Approximately
250,000 people leave Bangladesh for employment every year. The risk is that they
will get infected during their stay abroad and return to Bangladesh where they may
transmit the virus to others especially their wives who could in turn transmit infection
to their babies. Migrant workers account for a significant number of HIV cases in
Bangladesh, primarily because they are subjected to mandatory HIV testing.
According to the International Centre for Diarrhoeal Disease Research (ICDDR), 47
21
of the 259 cases of people living with HIV between 2002-2004 were infected as a
result of migration. Of these, 29 were males returning from abroad, seven were wives
of migrant workers, and four were children of HIV positive migrant workers. In 2004,
data from the National AIDS/STD (Sexually Transmitted Disease) Programme
showed that 57 of the 102 newly reported HIV cases were among returning migrants.
According to the recent Children and AIDS, Third Stocktaking Report 2008 published
by four UN agencies, only 16% of girls aged between 15 and 24 have a
comprehensive knowledge of HIV in Bangladesh. There is a high level of
misconception among youth. More than half believe that HIV/AIDS can be spread by
coughing or sneezing and 50% believe that HIV can be spread through sharing food
or water with a HIV infected person17.
Although young Bangladeshis are at risk of HIV very few believe so - 22% of
unmarried males reported having premarital sex, almost 60% of whom had never used
condoms. This has impacted on the rate of STIs; almost one in five men, and two in
five adolescent boys, reported having at least one symptom of a sexually transmitted
infection (STI) in a 2004 health survey. Women also require special attention in HIV
interventions in Bangladesh, given their social, economic and political status. Women
are four times more likely to contract HIV than men.
Women's lower social and cultural status also causes them to have less access
to education, employment opportunities and health care, including opportunities for
HIV tests, counselling and medical care. Women are often subjected to early
marriage, sexual abuse and violence in intimate and marital relationships. An
increasing number of women are forced to sell their bodies as the only way to survive
and provide for their children. Men who buy sex from women are often reluctant to
use condoms. Because women have little negotiating power, even within their
marriages, they may have unprotected sex with their spouses who might be engaging
in one or more high-risk behaviours and be exposed to HIV18.
The HIV prevalence among the general public is not fully known; currently
available surveillance data only covers high risk groups. This ambiguity is partly
22
because voluntary and confidential counselling and testing (VCT) services are not
widely available in Bangladesh. While HIV tests are available in some private health
settings, in many cases there is no counselling support and no confidentiality
guarantee. Many HIV positive people tested both in private and government facilities
have seen their names and other personal details published in the local or national
media. Social values, lack of adequate information, the stigma attached to HIV and
AIDS, and the lack of confidentiality are not conducive for people, especially the
younger population, to seek out HIV tests.
All of these factors are compounded by unsafe blood transfusions and the
reuse of injection syringes; an increased rate of external and internal migration by
people seeking work or a better economic environment; and the fear, stigma and
secrecy attached to STIs.
HIV positive people are ignored in the society in Bangladesh. There are a lot
of cultural stigma and misconception about them. Positive people have been treated
generally as a criminal. They are isolated from the society, family and friends. But
they have all rights to live as a normal citizen of the country. The positive person can
come in the open and speak in their own voice and play active role in making the
problem visible to the policymakers, care givers, media people, staff of DHARA and
the general people. If we could ensure it and break their silence, life of the PLWHAs
would be changed dramatically28.
Stigma and discrimination: Stigma and discrimination is widespread over

the region. Bangladesh. Lack PLWHA networks, and still have to overcome a deep-
rooted stigma before PLWHA feel secure enough to step forward. In Bangladesh
there are examples of HIV positive people being thrown into jail or isolated lockups.
Eight positive people have got together in Dhaka and are trying to form a network of
PLWHAs. There are numerous incidents across the region of rejection of PLWHAs
by doctors and paramedical staff and refusal to requests for treatment. This can be
attributed to the fear of contracting the infection from PLWHAs, especially in places
that do not have the facilities to enable the doctors to practice universal precautions.
23
Just getting rid of irrational fears of infection by the dissemination of information is
not going to reduce discrimination and stigma, if these originate from reasons other
than lack of information, the voices of HIV positive people are rarely heard and their
faces seldom seen in pubic. People living with HIV/AIDS cannot come out and live
positive lives without fear of having their future shattered in light of the pervasive
climate of denial, stigma and discrimination that exists. This lack of an enabling
environment seriously jeopardises the efforts to bring a halt to the epidemic and
mitigate its human, social and economic costs19.
Legislative measures to protect vulnerable groups Groups targeted by NASP

are susceptible to police excesses, because criminal laws are in direct conflict with
HIV policies. So far, no legislative measures have been adopted to repeal these laws
and protect the interests of the vulnerable population. Stigma, discrimination and
denial Stigma continues to be a major barrier to working with HIV-positive people. A
major cause of stigma is the association of HIV with sexual promiscuity and immoral
behaviour. Awareness-raising programmes tend to focus on how HIV is spread; there
is very limited discussion on human rights and AIDS, discrimination and stigma
issues. There are very few education programmes among the medical community. As
a result, public perceptions of PLWHAs and members of vulnerable populations are
very negative. Incidences of stigma and discrimination against PLWHAs by the
medical community are also common, which prevents a large section of PLWHAs
from accessing public or private health services.
Socioeconomic and social – cultural factors: Unfortunately, a low level of

awareness on HIV/AIDS still prevails among the general population as well as the
high-risk behaviour groups. The 1999-2000 Bangladesh Demographic and Health
Survey found that over 90% of rickshaw pullers could not identify a single correct
method of HIV prevention. Only 31% of married women and 50% of currently
married men had heard of HIV/AIDS. Yet, in a survey on premarital intercourse,
Population council found that 29% of women nineteen years and older and 69% of
married men in rural and urban areas had engaged in premarital intercourse. In a
population based study of 1541 slum dwellers the mean age at first sexual intercourse
24
for men was 19 and for women was 14.75 years. In in-depth interviews with 120 of
these respondents, most women reported their partners to be their husbands, while
most men reported their premarital partners to be CSWs, women who they pretend to
love, women who they did love, and 8.5 % of the 540 male survey respondents
reported male sexual partners. The evidence is mixed as whether there is a class
differential in premarital sexuality. One study found the incidence of premarital sex to
be higher in the lower socioeconomic class than in the higher class. However, a 1997
Population Council survey reported no major differences between the people living in
poor or well-off areas20.
Based on this information, we see that the ongoing efforts in Bangladesh

require a paradigm shift from a health response to addressing HIV/AIDS as a human
development issue. This requires action to deal with the socioeconomic and cultural
factors that render individuals and communities vulnerable to HIV/AIDS
Availability and accessibility of services: Issues related to care cannot be

dealt with in isolation. Some of the issues touched upon here are as much a part of
Stigma & Discrimination or Human Rights. In theory no government in the region has
denied that people living with HIV/AIDS also deserve health care – and that their
need for this is often more acute than that of others. But the reality is that PLWHAs
are often denied access to necessary health services, all over the region. In some
countries, there is such complete denial that there is no expectation from PLWHAs of
receiving any medial support.
Human Rights: In Bangladesh the situation of human rights in relation to

PLWHA seems critical. As PLWHAs are not visible, the reality of the human right
situation is difficult to estimate. To Human Rights Watch, "People living with
HIV/AIDS and those thought to be infected have been imprisoned, assaulted and even
murdered. The stigma of AIDS has taken many lives before the disease itself killed
them. But the reasons behind the suicides and extent of this have rarely come to our
knowledge. Society’s limited understanding of this disease is causing innocent people
to pay a terrible price. Increasingly across the world, there are voices questioning in
25
one angle. They question the narrow approach to a single disease, especially the huge
financing for AIDS over all else in basic health care. Our approach to this disease
needs to change for the sake of our people, our brothers and our sisters who are
fighting against odds21.
Social factors like discrimination, stigmatization and rejection have pushed

people living with HIV to become desperate and feel hopeless, to the extent of giving
up their life. They face discrimination and lack of support not only from the society
but also from his/ her own family. They are also being confined from friends, scared
for losing their jobs. This made them to live in phobia and their condition become
worse as they need proper and adequate treatment that could provide them with better
life. Most of these people are not getting proper medical and nursing care as stigma is
attached so strongly to this illness that even some well educated people refuse to serve
them. Many are afraid of consulting the doctors as they did not wish other people to
know about their predicament. With the existing treatment, people with HIV can lead
a normal life particularly if they receive good support from their family members,
especially their parents.
The situation is aggravated by the fact that major percentage of the HIV
positive individuals are Injectable drug users (IDUs), who are marginalized by society
and criminalized by the law. HIV/AIDS has already been concentrated epidemic
among the IDUs. They must be taken under rehabilitation to stop the spread of this
threat. Conditions of women living with HIV/AIDS are dismal. Women are blamed
for carrying the infection, even though they may have got the virus from their partners
(in most cases husbands). Instances have been reported, where husbands abandon
their ailing wives and children to find another wife. Due to the fear of social and
family desertion, women are hesitant to disclose their HIV/AIDS status. Also,
disclosure may lead to loss of job and reputations. This fear and dithering will make
women an easy target of violence and abuse22.
Level of Involvement of PLWHAs: It has been found that there is an absence

of effective involvement of PLWHAs at every level of the initiatives against
26
HIV/AIDS throughout the region. PLWHAs have to be included at all levels of
programme planning and implementation. Their views have to be solicited from the
initial stages of the dialogue and they have to be included in the team that plans the
objectives and activities. Including them in the monitoring and evaluation is also
essential. PLWHAs are unique in possessing a special insight in and commitment to
the success of the programmes. Moreover, since there are a number of organisations,
especially NGOs, which have PLWHAs working for them, there is a pool of
PLWHAs who possess the know-how of planning, implementation, monitoring and
evaluation, and others with the potential to learn the same. It has been demonstrated
by smaller efforts such as Counselling Centres, Care Homes, etc that clients respond
best to fellow PLWHA, thereby increasing the chances of the programme's success.
Another way of involving the PLWHAs and building their capacity is for all
organisations working in this field to employ PLWHAs and include them in all their
activities25.
Networking: The total number of PLWHAs who are known to have disclosed
their status is not more. Of them one positive woman committed suicide recently. The
PLWHAs have no registered organisation in Bangladesh. Nevertheless there is an
initiative to form a self help group of people living with HIV/AIDS under the name of
Ashar Alo (Light of Hope). The group wants to get their organisation registered with
the appropriate government ministry. With support from a group of NGOs another
initiative has been taken by positive people who formed a National Network of
PLWHAs in Bangladesh on 20 January 2001 Taking stock of their situation, they have
developed objectives for their network, as below.
Objectives of the National Network of PLWHAs in Bangladesh

 To protect the rights of PLWHAs.
 To establish and enhance contact with support organisations and national,
regional and international networks.
 To ensure participation in policy making and implementation of the
HIV/AIDS programme at national level.
27
 To co-operate with the government and non governmental organisations in
their HIV/AIDS prevention programmes.
 To provide necessary information, counselling and services to HIV positive
people.
The PLWHAs and their organisation/network, most of them had never heard
of the Paris Declaration. Nevertheless, their activities aimed at reaching the goal of
"greater involvement" in response to the HIV/AIDS situation in the country with the
effective assistance of the NGO Support Network. PLWHAs Network and supportive
NGOS would be a first step in increasing the influence of PLWHA. The PLWHAs
expressed the need for skills to advocate for their concerns at various local, national
and regional forums. All agreed that to respond to the HIV/AIDS epidemic in
Bangladesh, it would be necessary to involve PLWHAs and other marginalised
communities in policy and programme development, implementation and evaluation,
management and administration. The PLWHAs organisations and individuals would
also have critical contributions to make in the creation of a supportive environment
for all HIV positive people in society23.
28
CHAPTER 3
RESEARCH METHODOLOGY
3.1 Conceptual framework
Independent Variables Dependent

Variable
Socio –demographic factors:
 Age, Gender, Marital status

 Level of education, Religion
 Family size/ No. of Family members
 Occupation
 Income
Education and Knowledge related factors:

 Education and knowledge related to
HIV/AIDS
Factors related to Mode of Transmission: Socio-Cultural Problems

 Mode of transmission of HIV/AIDS
ssBehavioural Pattern Factors:

 Faced from family
 Faced from society
29
Access to Media:
 Access to information
 Access to treatment
3.2 Study Objectives
3.2.1 General objective
 To explore the Socio-Cultural Problems faced by People Living With

HIV/AIDS (PLWHAs) in Bangladesh.
3.2.2 Specific objectives
 To describe the socio demographic factors associated with the Socio-cultural

problems faced by PLWHAs in Bangladesh.
 To explore the level of knowledge related to HIV/AIDS in relation to the
Socio – cultural problems faced by PLWHAs in Bangladesh.
 To asses the mode of transmission of HIV/AIDS to identify the Socio-cultural
problems faced by PLWHAs in Bangladesh.
 To demonstrate the behavioural pattern faced by PLWHAs from their family
and society to identify the Socio-cultural problems faced by PLWHAs in
Bangladesh.
 To asses the access to media for information and treatment of PLWHAs in
relation to the Socio-cultural problems faced by PLWHAs in Bangladesh.
30
3.3 Study Design:
My study design was a Descriptive Cross Sectional Study.
3.4 Study Population:

People Living With HIV/AIDS in Bangladesh
3.5 Study Area:

Organizations dealing with PLWHAs:
Ashar Alo, CARE Bangladesh,

C/o CCDB (Christian Commission for House No. 66, Road 7/A,
Development in Bangladesh), Dhanmondi, Dhaka-1209,
88, Senpara Parbatta, GPO Box-226
Mirpur-10, Dhaka-1216.
CAAP (Confidential Approach to CCDB (Christian Commission for

AIDS Prevention), Development in Bangladesh),
House no 63, Block-D, Road 15, Banani, 88, Senpara Parbatta,
Dhaka-1213. Mirpur-10, Dhaka-1216
HASAB ( HIV/AIDS&STD Alliance SHISHUK(Shishuk Shastha Unnayan

Bangladesh), Karzkaram),
4/1, Iqbal Road,Mohammedpur,Dhaka- 7/1,Block-A, Lalmatia, Dhaka-1207
1207
IDHRB (Institutional Development of Rotary Club Dhaka ,

Human Rights in Bangladesh), 168/C, Green Road, Dhanmondi, Dhaka-
House No. 500/h, Road 8, 1205
Dhanmondi R/A, Dhaka-1205
3.6 Study Period:
31
My study was carried out from November 2010-February 2011.
3.7 Sample size:

Due to minimum number of AIDS patients identified in our country and from
them limited patients are corresponding with the organizations dealing with People
Living with HIV/AIDS (PLWHAs) therefore, my sampling technique was purposive
and my sample size was dependent on patients available in the organizations. My
sample size was 100.
3.8 Inclusion criteria

 The study was conducted with only PLWHAs.
 The study was conducted only PLWHAs with the mentioned organizations.
 People who were normal in sense and able to provide information.
3.9 Exclusion criteria

 People who were unable to give information.
 People who refused to give consent.
 People who were absent in interview time.
3.10 Sampling technique:

Sample was selected purposively considering the inclusion and exclusion
criteria.
3.11 Data collection tools and technique
There were the following data collection procedures.
 A semi structured questionnaire was designed and pre-tested to collect the
information on socio-demographic, Socio-economic, knowledge and attitude
related factors.
 Focus Group Discussion (FGD).
3.12 Data management and Analysis plan:
32
After collection of data, this was checked and verified for consistency and
reduction of errors. Thereafter these data was transferred to a suitable master sheet for
processing and subsequent analysis. Data was entered to the computer and saved in
Statistical Package for Social Sciences (SPSS) ver 16.00 by the Research. Quality and
reliability of collected data were re-checked. Appropriate statistical analysis,
calculation and test were carried out to relate variable according to the objectives of
the study.
3.13 Ethical considerations
 Right to refuse and withdraw from the study at any time was accepted.
 Respondent was told that the collected data from the interview would be kept
confidential and would be used for the study purpose only.
 All interviews were conducted with the prior consent of the respondents.
 No incentives would be given to the respondents.
3.14 Limitations of the Study
 The first limitation of this study was the cross-sectional nature of the design
thats why my study sample size was smaller.
 All the PLWHAs did not give consent.
 Few PLWHAs refused to continue interview after the starting of the process.
 I had done this study with PLWHA who were available with the
corresponding organizations; this might not accurately predict the situation of
the country.
33
CHAPTER 4
RESULTS
This was a descriptive cross sectional study conducted among the HIV/AIDS
patients in Dhaka City. Samples from November 2010 to February 2011 was taken
and studied. All data were taken, managed and analyzed.
Table: 1 Distribution of the respondents by their age (n=100)
Age Frequency Percent

Up to 20 years 25 25
21 years-30 years 35 35
31years -40 years 25 25
above 40 years 15 15
Total 100 100
Table 1 indicates that out of 100 HIV/AIDS patients 25% were up to 20 years
of age, 35% were age of between 21-30 years , 25% were aged between 31-40 years,
15% were aged above 40 years.
Table: 2 Distribution of the respondents by their sex (n=100)
Sex Frequency Percent

Male 60 60
Female 40 40
Total 100 100
Table 2 indicates that out of 100 HIV/AIDS patients 60% were male and 40%
were female.
34
Table: 3 Distribution of the respondents by their occupation (n=100)
Occupation Frequency Percent

NGO worker 38 38
Service 20 20
Unemployed 13 13
Students 10 10
Others 9 9
Housewife 10 10
Total 100 100
Table 3 indicates that out of 100 respondents 38% were NGO workers, 20%
did service, 13% were unemployed, 10% were students, 10% were housewife and 9%
did other types of work.
Table: 4 Distribution of the respondents by their marital status (n=100)
Marital Status Frequency Percent

Unmarried 33 33
Married 27 27
Divorced 22 22
Separated 13 13
Others 5 5
Total 100 100
Table 4 indicates that out of 100 respondents 33% were unmarried, 27% were
married, 22% were divorced, 13% were separated and rest 5% had others status.
35
Table: 5 Distribution of the respondents by route of transmission of HIV (n=100)
Route of transmission Frequency Percent
Sexual transmission 22 22
Blood transmission 27 27
Mother to baby transmission 20 20
Do not know 31 31
Total 100 100
Table 5 indicates that out of 100 respondents 22% thought their route of
transmission of HIV was sexual, 27% thought it was due to blood transfusion, 20%
thought for their mother and rest 31% did not know how they got HIV.
Table: 6 Distribution of the respondents by their knowledge on HIV/AIDS (n=100)
Knowledge on HIV/AIDS Frequency Percent

Yes 67 67
No 33 33
Total 100 100
Table 6 indicates that out of 100 respondents 67% had knowledge on

HIV/AIDS and rest 33% did not have knowledge on that.
Table: 7 Distribution of the respondents by their knowledge on VCT and ART

(n=100)
Knowledge on VCT and ART Frequency Percent

Yes 57 57
No 43 43
Total 100 100
36
Table 7 indicates that out of 100 respondents 57% had knowledge on
Voluntary Counselling and testing (VCT) and Antiretroviral Therapy (ART) but 43% did
not have idea on it.
Table: 8 Distribution of the respondents living with their family (n=100)
Living with family Frequency Percent

Yes 33 33
No 67 67
Total 100 100
Table 8 indicates that out of 100 respondents 33% HIV patients were living
with their family and 67% were not living with their family.
Table: 9 Distribution of the respondents leaved by their family because of HIV

positive (n=100)
Leaved from family Frequency Percent

Yes 44 44
No 56 56
Total 100 100
Table 9 indicates that out of 100 respondents who were not living with their
family 44% were leaved by their family because of their HIV status and 56%
respondent’s family did not do that.
37
Table: 10 Distribution of the respondents facing stigma and discrimination because of
HIV positive (n=100)
Stigma and discrimination Frequency Percent

Yes 82 82
No 18 18
Total 100 100
Table 10 indicates that out of 100 respondents 82% faced stigma and
discrimination because of their HIV status and 18% of them did not face stigma and
discrimination.
Table: 11 Distribution of the respondents facing verbal abuse by the people (n=100)
Verbal abuse Frequency Percent

Yes 80 80
No 20 20
Total 100 100
Table 11 indicates that out of 100 respondents 80% faced verbal abuse and
because of their HIV status and 20% of them did not face such.
Table: 12 Distribution of the respondents facing physical abuse by the people (n=100)
Physical abuse Frequency Percent

Yes 33 33
No 68 68
Total 100 100
Table 12 indicates that out of 100 respondents 33% faced physical abuse and
because of their HIV status and 68% of them did not face such.
38
Table: 13 Distribution of the respondent of getting fairly treatment by the health care
provider (n=100)
Treated fairly by health care

provider Frequency Percent
Yes 72 72
No 28 28
Total 100 100
Table 13 indicates that out of 100respondents 72% of them were treated fairly
by the health care provider and 28% did not get fairly treatment by the health care
providers.
Table: 14 Distribution of the respondent by their opinion of disclosing of their HIV

status (n=100)
Agree of disclosing HIV status Frequency Percent

Yes 22 22
No 78 78
Total 100 100
Table 14 indicates that out of 100 respondents 22% of them thought that they
should disclose their HIV status and 78% respondents thought they should not
disclose their HIV positive status.
39
CHAPTER 5
DISCUSSION
“Socio-Cultural Problems faced by People Living With HIV/AIDS (PLWHAs)

in Bangladesh” was a descriptive cross sectional study. The study population was 100
HIV/AIDS patients who were seeking treatment from selected NGOs in Dhaka City.
It was found that out of 100 HIV/AIDS patients 25% were up to 20 years of
age, 35% were age of between 21-30 years, 25% were aged between 31-40 years, and
15% were aged above 40 years. Among 100 respondents 60% were male and 40%
were female. Out of 100 respondents 38% were NGO workers, 20% did service, 13%
were unemployed, 10% were students, 10% were housewife and 9% did other types
of work. In case of marital status of the respondents 33% were unmarried, 27% were
married, 22% were divorced, 13% were separated and rest 5% had others status.
Among all the respondents 22% thought their route of transmission of HIV was
sexual, 27% thought it was due to blood transfusion, 20% thought for their mother
and rest 31% did not know how they got HIV. Though all the respondents were
seeking treatment from different NGOs in Dhaka City but still they did not have clear
idea and knowledge on HIV/AIDS. Among 100 respondents 67% had knowledge on
HIV/AIDS and rest 33% did not have knowledge on that.
It was revealed that out of 100 respondents 57% had knowledge on Voluntary
Counselling and testing (VCT) and Antiretroviral Therapy (ART) but 43% did not have
idea on it. Among all (n=100) 33% HIV patients were living with their family and
67% were not living with their family. We found that 67%( 67) respondents were not
living with their family and among that 100 respondents 44% were leaved by their
family because of their HIV status and 56% respondent’s family did not do that.
The study identified that out of 100 respondents 82% faced stigma and
discrimination because of their HIV status and 18% of them did not face stigma and
discrimination. Among all 33% faced physical abuse and because of their HIV status
40
and 68% of them did not face such, and out of 100respondents 80% faced verbal
abuse and because of their HIV status and 20% of them did not face such. 72% of the
total respondents were treated fairly by the health care provider and 28% did not get
fairly treatment by the health care providers. Out of 100 respondents 22% thought that
they should disclose their HIV status and 78% respondents thought they should not
disclose their HIV positive status.
CHAPTER 6
41
CONCLUSION
HIV-related stigma and discrimination severely hamper efforts to effectively

fight the HIV and AIDS epidemic. Fear of discrimination often prevents people from
seeking treatment for AIDS or from admitting their HIV status publicly. People with
(or suspected of having) HIV may be turned away from healthcare services and
employment, or refused entry to a foreign country. In some cases, they may be forced
from home by their families and rejected by their friends and colleagues. The stigma
attached to HIV/AIDS can extend to the next generation, placing an emotional burden
on those left behind.
Today, HIV/AIDS threatens the welfare and wellbeing of people throughout

the world. At the end of the 2008, 33 million people were living with HIV with two
million having died from AIDS-related illness that year. Combating stigma and
discrimination against people who are affected by HIV/AIDS is a vital ingredient for
preventing and controlling the global epidemic.
No policy or laws can alone combat HIV/AIDS related discrimination. Stigma

and discrimination will continue to exist so long as societies as a whole have a poor
understanding of HIV and AIDS and the pain and suffering caused by negative
attitudes and discriminatory practices. The fear and prejudice that lie at the core of the
HIV/AIDS discrimination need to be tackled at the community and national levels,
with AIDS education playing a crucial role. A more enabling environment needs to be
created to increase the visibility of people with HIV/AIDS as a 'normal' part of any
society. The presence of treatment makes this task easier; where there is hope, people
are less afraid of AIDS; they are more willing to be tested for HIV, to disclose their
status, and to seek care if necessary. In the future, the task is to confront the fear-
based messages and biased social attitudes, in order to reduce the discrimination and
stigma of people living with HIV and AIDS.
42
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Socio-Cultural Problems Faced By People Living

With less than 0.1 percent of the population estimated to be HIV-positive,

HIV/AIDS prevention programs have successfully reached 71.6 percent of

As of 2008 2009 As of 2009

Table 1: Bangladesh HIV data 2009

Social factors like discrimination, stigmatization and rejection have pushed

PLWHAs in Bangladesh, as in many countries of the world, face manifold

 HIV: Human Immunodeficiency Syndrome. A condition in human in which

 Epidemic: The unusual occurrence in a community or region of disease.

What are the Socio-Cultural Problems faced by People Living With

REVIEW OF RELATED LITERATURE

Diagnosis: HIV can't be diagnosed through a medical examination or via

Infection can be prevented if the equipment used is brand new, or is carefully

If the blood or equipment used is contaminated with HIV, this will be

The test performed by a doctor in whom you have confidence, so that

In patients known to be HIV positive a virus disease of the eyes (CMV

When a test should be made:

Antiretroviral therapy (ART): The current therapy for HIV infection

Drugs for Prophylaxis in cases of AIDS: Prophylaxis is aimed at

Migrant workers are another important group identified as a priority in the

Stigma and discrimination: Stigma and discrimination is widespread over

Legislative measures to protect vulnerable groups Groups targeted by NASP

Socioeconomic and social – cultural factors: Unfortunately, a low level of

Based on this information, we see that the ongoing efforts in Bangladesh

Availability and accessibility of services: Issues related to care cannot be

Human Rights: In Bangladesh the situation of human rights in relation to

Social factors like discrimination, stigmatization and rejection have pushed

Level of Involvement of PLWHAs: It has been found that there is an absence

Objectives of the National Network of PLWHAs in Bangladesh

3.1 Conceptual framework

Independent Variables Dependent

Socio –demographic factors:

 Age, Gender, Marital status

Education and Knowledge related factors:

Factors related to Mode of Transmission: Socio-Cultural Problems

ssBehavioural Pattern Factors:

3.2 Study Objectives

3.2.1 General objective

 To explore the Socio-Cultural Problems faced by People Living With

3.2.2 Specific objectives

 To describe the socio demographic factors associated with the Socio-cultural

3.4 Study Population:

3.5 Study Area:

Ashar Alo, CARE Bangladesh,

CAAP (Confidential Approach to CCDB (Christian Commission for

HASAB ( HIV/AIDS&STD Alliance SHISHUK(Shishuk Shastha Unnayan

IDHRB (Institutional Development of Rotary Club Dhaka ,

3.6 Study Period:

3.7 Sample size:

3.8 Inclusion criteria

3.9 Exclusion criteria

3.10 Sampling technique:

3.12 Data management and Analysis plan:

3.13 Ethical considerations

3.14 Limitations of the Study

Table: 1 Distribution of the respondents by their age (n=100)

Age Frequency Percent

Table: 2 Distribution of the respondents by their sex (n=100)

Sex Frequency Percent