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HIV/AIDS, a worldwide epidemic, also has an impact on Bangladesh, not only among the high risk groups but also the general population. Unsafe practices among injecting drug users (IDUs), particularly needle sharing and unprotected sexual behavior among high risk groups, such as MSM and commercial sex-workers have caused an increase in the number of HIV infected people (UNAIDS, 2006a; Islam & Conigrave, 2007). The number of HIV/AIDS cases has been increasing steadily since 1994, although Bangladesh had numerous prevention programs including epidemiological surveillance among high risk groups even before the first case was detected in the country in 1989 (NASP and Save the Children USA, 2006). Prevalence of HIV cases in 2005 among the certain risk groups in Bangladesh were:- less than 0.1% in adults, about 4.9% in IDUs and less than 1% in both MSM and female sex workers (USAID, 2008), even though there was a HIV prevention policy from 1997. While only 363 HIV positive cases were reported by the end of 2003, the number of new cases in 2007 raised to 1,207 (National AIDS/STD Programme (NASP)/Ministry of Health and Family Welfare, 2008). According to the estimation of National AIDS/STD Programme (NASP) by the end of 2005, around 7,500 adults and children were living with HIV in Bangladesh and by the end of 2007, UNAIDS estimated a higher total of 12, 000 HIV/AIDS cases (UNAIDS, 2008).
A periodic survey for serological surveillance by Azim, Hussein, and Kelly (2005) revealed an increase in HIV prevalence among the IDUs from 1.4 to 4 percent from 1999 to 2004. According to the USAIDS survey report, HIV prevalence among the IDUs was 4.9 in 2005. Another survey in 2006 reported that the prevalence of HIV among IDUs increased to 7.0 percent in Dhaka City and to 10.5 percent in one of the neighbourhoods in comparison to 2000 (Azim, Khan, Haseen, Huq, Henning, & Pervez, 2008; NASP/Ministry of Health and Family Welfare, 2008). However, MSM and sex workers are reported to have prevalence below 1.0 percent since the beginning of the epidemic (Islam & Conigrave, 2007; NASP/Ministry of Health and Family Welfare, 2008). This prevalence may be due to incomplete data collection from high risk groups (NASP/Ministry of Health and Family Welfare, 2008). Because of the limited facilities in the country for sentinel surveillance and voluntary counseling and testing (VCT), the real incidence of HIV cases are underestimated. Stigma and discrimination attached to HIV are also important factors for under reporting in Bangladesh.
Another major factor contributing to Bangladesh’s HIV/AIDS vulnerability is cross-border interaction with high-prevalent countries such as Burma (Myanmar), India and Nepal (NASP/Ministry of Health and Family Welfare, 2008). Worldwide evidence suggests that the epidemic can spread easily and rapidly to other high risk groups, including sex-workers, MSM and their families and ultimately to the general population (NASP/Ministry of Health and Family Welfare, 2008).