HIV response affected by stigma: UNAIDS

If we can solve that one thing (stigma), we can get closer to zero (AIDS) deaths and zero new (HIV) infections,” Leo Kenny told bdnews24.com in an interview on Sunday, when the world is celebrating the World AIDS Day.

This year's theme is to achieve the 'Three Zeros' – zero new HIV infections, zero AIDS deaths and zero stigma and discrimination.

A new UN report recently showed Bangladesh was one of the few countries in Asia and the Pacific that could not control a fresh wave of HIV infection in the last decade, despite overall low prevalence.

The report also found that AIDS related deaths did not drop and a huge stigma that went with the disease made it difficult to generate an adequate response.

Up to 20 percent people suffering HIV infections had avoided seeing a doctor for fear of being ostracized.

Kamal Hossain, 36, (not his real name) was one of those unfortunate who had to hide along with his wife in a far off place when both were detected as HIV positive

The clinic told his work managers and the couple were asked him to quit. His landlord also asked them to leave.

"They (doctors) told me you will die soon. Fulfil whatever dreams you have. Your wife will also die,” is how Hossain recounted his ordeal after being detected HIV positive.

The UNAIDS coordinator Kenny said Bangladesh needed to ponder “very seriously” how to detect more HIV cases.

“One of the reasons is people don’t come for voluntary testing for fear of stigma,” Kenny said.

He listed some ways to increase the number of people being tested and urged the government to invest in “prevention” -- rather push for “treatment as prevention” of the HIV virus.

“One way is to make available voluntary testing and counselling centres and another way is to integrate this into the existing maternal, child and sexual reproductive health services so that you can test it anywhere, in any health facility”.

He suggested involving the community people and broached an idea of “providers’ initiated” testing and counselling.

“It means every pregnant mother is offered a test, if she seems at risk. It’s not mandatory but a healthcare providers' initiative to do it."

“But you have to make available the latest rapid testing facilities. It’s easy. Somebody will come and get the test results within 20 minutes and start treatment if needed”.

Kenny said it takes three to five days in the conventional testing procedure with the Western Blot and Elisa method to get results and “people do not come back to get the results so you lose them, they don’t go for treatment”.

Government statistics suggest Bangladesh has less than 3,000 people living with HIV on World Aids Day last year -- and less than 1,000 having access to the government supplied expensive drugs.

But UN estimates the number to be between 8,000 and 16,000, which means many are left without treatment.

Kenny, however, said research indicates starting treatment early worked as prevention.

He said new guidelines suggest starting drugs much ahead of the CD4 cells earlier cut off counts 350 cells/mm3.

Now World Health Organisation recommends starting the drugs when the count is 500 cells/mm3, which is the lower range of the normal ranges from 500–1,000 cells/mm3.

CD4 cells act as army in body’s immune response system, detecting intruders like virus and bacteria.

Kenny said the latest guideline, if followed, would double the number of people on treatment. “We have to find money and we have to make sure we have the technical capacity to double the number of people on treatment”.

He mentioned benefits of starting early treatment.

“In some cases the treatment can be stopped at some point when it does not appear that the HIV is coming back. It does not cure. But it does indicate that the sooner you put people on treatment, the better it is”.

He said it also reduced the chances of passing on the virus.

“In many people who start early treatment, the viral load of HIV in the blood becomes so low that they don’t pass the virus on, not as easily anyway.

“So this is the advantage of treating early that we call ‘treatment as prevention’”.

But he cautioned there is “no substitute” for prevention itself at the end.

“It’s easy to prevent the virus, the correct and consistent use of condoms, educating young people, all the old things we know work very well involving communities and all that. Now we have to do it”.

He said Bangladesh made commitments in the United Nations General Assembly in 2011 about 10 targets.

But to achieve those targets like cutting down by half the number of new infections among the injecting drug users or the infections by sexual transmission, and to make ‘close to possible’ universal access to treatment, investments should be made.

“Across the region Bangladesh’s own resources in the (HIV) response is one of the lowest. We have to think about it”.

He said UNAIDS showed that “It's much cheaper to invest in prevention and treatment than it is to have to treat many more people”.

He, however, credited Bangladesh for its early initiative soon after the first case was detected in 1989.

“The government started early, they involved very vibrant civil society and they did the hard work on injecting drug users and sex workers and they have kept the epidemic from exploding”.

“It can explode any time, and then it will be costly,” Kenny warned.

Bangladesh made has ‘wonderful’ achievements on many health indicators.

“So let not let AIDS undermine those achievements”, Kenny said.