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STRATEGIC PLAN OF THE NATIONAL AIDS PROGRAMME OF BANGLADESH
1997-2002

The first patient with Acquired Immunodeficiency Syndrome (AIDS) was diagnosed in Bangladesh in 1989. Until 1999 ten AIDS cases and 126 persons with HIV infection have been reported (17 were reported through 1998-1999 national surveillance). Currently available data show that HIV prevalence is still low. However, the paucity of data calls for a cautious appraisal. Indeed, many factors suggest that HIV may spread rapidly in the near future. These include high rates of sexually transmitted diseases (some studies show, based on syndrome, rate of up to 50-60% among sex workers) and hepatitis B; significant number of commercial sex workers; evidence of high-risk behaviours (pre- and extra marital sex, and low condom use); a large international and national migrant labour force; an essentially unscreened blood supply system derived mostly from professional blood donors, approximately 20% of whom test positive for hepatitis B and syphilis; and rising injecting drug use. The present HIV situation could, therefore, evolve rapidly into an impending and escalating epidemic. This window of opportunity of existing low prevalence should, therefore, not be missed to initiate primary preventive efforts.

The national response has included establishment in 1985 of a National AIDS Committee (NAC), and Technical and Co-ordination Committees at central level and committees at various peripheral levels. A number of activities have been implemented by the NAC, the Ministry of Health and Family Welfare (MOHFW) as well as by the Directorate General Health Services (DGHS). A well-established NGO network carries out various HIV/AIDS related prevention and care interventions. However, in spite of a substantial amount of work already done, the level of response has been neither adequate nor satisfactory. The Government expression of commitment to AIDS prevention has to be translated into action at the ground level.

This Strategic Plan provides a framework for a national response to AIDS and defines Bangladesh's strategies and priorities for STD/AIDS prevention and care for the next five years (1997-2002) in line with National Policy. The plan builds on work already done and emphasizes a multi-sectoral response to the AIDS problem to include enhancing the involvement of various Governmental Ministries, NGOs, the private sector and the community; and outlines programme management aspects including monitoring and evaluation. This strategic plan also provides a guide for further planning and for the development of sector-specific work plans, which will follow.

The broad strategies and interventions included in this strategic plan take into consideration the present epidemiological situation and the likely future scenario. The priority strategies, therefore, include:

• Establishing and keeping a NAP management team effective at central, district and upazila levels.

• Preventing transmission of HIV through expansion of interventions targeted among individuals with high risk behaviours including sex workers and their clients, truck drivers, injecting drug users, etc.; strengthening STD case management to include syndromic approach; increasing availability, accessibility and use of quality condoms; promoting responsible sexual behavior of young people both in and out of school; information, education and communication (IEC) activities targeted at policy makers and the general population; enabling legislation and the use of the media, and above all creating an enabling environment for people in general and for those afflicted in specific which would include making information and care available to them.

• Improving a safe blood supply through promoting voluntary blood donation and banning professional blood donation;

• Rational use of blood/blood products and a thorough screening of donated blood for HIV and other pathogens;

• Provision of counseling and other support including expansion of voluntary testing facilities targeted at pregnant women or women contemplating pregnancy and breast feeding mothers;

• Provision of care and support systems including counseling services; implementing activities to include legal amendments to counter discrimination against people living with HIV/AIDS and vulnerable groups, towards improving community acceptance;

• Establishing HIV/AIDS and STD surveillance to determine present and future magnitude of the problem and to monitor HIV/AIDS and STD programmatic interventions and their effects;

• Strengthening capacity for diagnosis of STD/HIV/AIDS;

• Mobilising and supporting various Government, private and non-government sectors.

To guide activities related to these strategies and interventions, the NAC recently approved a policy document on STD/HIV/AIDS, which has been accepted by the Government. Moreover, the Government is now fully committed to combat AIDS in Bangladesh and has accorded priority to STD/AIDS prevention and control. This is reflected by the Government commitment to establishing a National AIDS Programme (NAP) in the DGHS with full time staff to co-ordinate the overall national response and to provide technical and operational support to all sectors including NGOs and the private sector. Moreover, Government plans to ensure that all activities are planned and carried out within the framework of this strategic plan. The NAP will assist in coordinating HIV/AIDS prevention activities in various sectors, and facilitate decentralization of activities to upazila and district levels. To do so, the NAP will establish links with upazila, district and division level AIDS committees and focal points in other relevant ministries and assist them in planning and implementing activities. The NAP activities will be monitored by committees established at various levels, through regular reporting from peripheral to central level, and through field visits by the programme staff. External reviews of the NAP will occur every 2-3 years. To assess the progress made, indicators have been identified and targets set.

To carry out various strategies and interventions included in the strategic plan, financial support would be needed. The Government of Bangladesh has committed required number of full-time staff to work at the national level and plans to set aside funds as a part of the 5-year plan. Additional resources would be mobilized from multilateral and bilateral agencies. The total budget requirements for the planning period (1997-2002) are as follows:

• Taka – Lakh

US$ - Million