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HIV/AIDS

Making Parliamentarians Partners for Prevention and Control

by Tasneem Mosadeq
THE initial response in all the countries to HIV/AIDS was that of denial. It was pushed back as a problem affecting only the homosexuals. But from a few isolated cases among margina lised segments it has now become the pandemic of the century. Young and old even children irrespective of gender, caste, religion, sexual orientation and geographical habitat, are exposed to it. The global status of HIV infection as of 1 January. 1996 portrayed a grim picture of its relentless expansion. An estimated 30.6 million people are infected with HIV worldwide, out of which 27.4 million are adult (men-15.8 and women-11.7) and 3.2 million are children. An estimated 10.4 million people developed AIDS from the beginning of the pandemic until 1 January, 1996.
Since its discovery epidemiologists. sociologists, communities and governments have developed various approaches to address the problem that is HIV/AIDS. Innovative methods for awareness, counselling and clinical management were implemented from health perspective. Because HIV is infectious, fatal and has no cure or vaccine for prevention as yet available the complexity of the !>roblem has multiplied in erms of its impact on socioeconomic structures.
A significant observation is that AIDS and poverty intrinsically chase each other in a vicious circle. A community's ability to alleviate its poverty is directly affected by AIDS and in
turn poverty increases a community s vulnerability to HIV infection. Therefore, it is evident that HIV/AIDS prevention, control and management is a development issue. At the root of HIV/AIDS spread lies the most personal and private behaviour of individuals. The key factor therefore, for addressing this problem is behavioural change at the personal, family and community level which can only be achieved by creating an environment of empowerment for ensuring the right:
• to seek, receive and impart information
• to freedom from discrimination
• to care and support • o security of person * to freedom of opinion and expression
* to share in scientific advancement and Us benefit
• to take part in and influencing the government
In some parts of the world AIDS epidemic is maturing while in others it is surfacing. Because of this phenomenal eruptions the epidemic situation is getting worse; from nearly 10 million HIV infections in 1990 to over 27 million in 1996. A further proof of it is that since the beginning of the pandemic the large majority of HIV infections, 93 per cent have occurred in the developing world. The number of HIV infected people in Southeast Asia is now more than three times the total number of infected people in the entire industrialised world.
In this context the vulnera-
bility of Bangladesh to HIV/AIDS because of its geographical proximity to the areas like India. Myanmar and Thailand where it is erupting now with rapid fire spread consequences can no longer be ignored. According to the government endorsed surveillance 83 HIV Infected cases have so far l>een detected in Bangladesh out of which four have resulted In full blown AIDS and eventual death. Although, the figures may look very insignificant compared to the estimated 3 million HIV Infected cases in India. Yet the fact that all the factors which contribute to the spread of HIV abound in this country and the infra-structure required to prevent, control and care is almost non-existent gives us an extremely short lease of life.
Bangladesh now has a na-tional policy on STD/HIV/AIDS endorsed by the cabinet. Subsequently, a draft strategic plan for five years for the national AIDS programme was developed. For strengthening it a two-day workshop to review the draft 5-year strategic plan was organised by the Bangladesh AIDS Prevention and Control Programme on 28 and 29 April. 1997. Representatives from NGO's, relevant GOB sectors, multi and bilateral donors and private sectors participated in the session. One of the key elements that emerged from the dialogue and in-depth discussion -was the multi-sectoral thrust for effective inter-
vent ion lor the prevention and control of HIV/AIDS In Bangladesh. In this context a presentation was made by ACTIONAID Bangladesh (AAB) in collaboration with Christian Commission for Development in Bangladesh (CCDB) a local organisation.
Finalisation of national strategic plan incorporating relevant feedback from the consensual workshop Is under process. We now require concerted, comprehensive and flexible plan of action Involving all sectors not only for today but for tomorrow because the effect of HIV/AIDS will become evi-
dent then. With this view and to reiterate the multi-sectoral response ACTIONAID Bangladesh (AAB) in collaboration with the Bangladesh AIDS Prevention and Control Programme (BAPCP) supported two workshops organnised by the Centre for Advocacy and Social Mobilisation (CASM) for the Honourable Members of Parliament. The theme of the workshop was "Developing Social Commitment With The Lawmakers To Control HIV/AIDS".
To enact a policy we require the endorsement of the legislators. And the multi-sectoral approach involving different government and private sectors can become a reality when the representatives of the people are directly involved because they work for the people. They are the pivot around which the community moves. The objective of the workshop was to
Taineritarians and identify the ‘atedfs for fuhii* cpllabpratidn * tt was with a lot of trepidation that the programme was planned and executed. We were not sure of the response and reaction of the respected Members of Parliament and their partic Ipation especially on a sensitive and controversial issue of HIV/AIDS. The two workshops were held in the Pan Pacific Sonargaon Hotel on 27 September and 11 October, 1997, respectively. We were very encouraged to find that the MP participation was 50 per cent.
The Honourable Minister for Health and Family Welfare, Mr Saiahuddin Yousuf inspite of his busy schedule participated
in both the workshops and actively guided the working session. In his closing speech he reiterated government's commitment for accelerating the country-wide intervention on HIV/AIDS and pledged his Ministry's involvement and sup-Eart. The interaction among the onourable MPs. activists, private sector participants and media people in the working session was extremely cordial. It was at once noticeable that the law makers were not knowledgeable about HIV/AIDS transmission, prevention, high risk behaviour, care and socioeconomic and political im'pact. But throughout the session they were like eager students trying
to learn and assimilate. There were debates which resulted in pro-active feedback.
The highlight of the second workshop was the presentation by the Peer Educators from the SHAKTI project of CARE in the Tangail brothel. The peer educators are sex workers of the brothel. The MPs intently absorbed their presentation which focused on their life, their vulnerable position, exploitation. their children and the std/HIV/AIDS prevention programme through condom promotion and linking up of the local power structure. The response of the MPs to the presentation was humane, compassionate and positive. They agreed that eviction of sex workers was not the solution for addressing HIV/AIDS. Some of them felt that as decision makers they have an obligation to attend to the most neglected) abused and condemnen com-snunhy ' without becomlSi judgements, The presentation) of all the working groups emphasized the need that a problem of such immense magnitude must draw national attention and discussion in the parliament but prior to that the legislators must be informed of all the activities that are taking place at the government leveL The law makers expressed their desire to move away from the eush surrounding of a five-star itel and into the field for realistic intervention. Although, in both the session resentment was voiced towards lack of information flow from sectors involved In intervention and the overbearing role of the
NGOs but at the end efforts of these sectors were recognised and the exposure that the workshop provided was unanimously appreciated.
The most important aspect of the workshop was the open and congenial atmosphere where everyone felt at ease to speak about sensitive Issues like sexually transmitted diseases. sexual behaviour, high risk behaviour group, social mobilisation ana community empowerment. All the MPs agreed that appropriate support in caring for people with AIDS is a priority witn the aim to contain the spread: It was encouraging to find that the MPs in their ■earnestness rose above
their political affiliation, social dogmas and personal prejudices to accept the changes that were proposed for intervention in the identified core group.
But it was rather disappointing to find virtual absence of representation from the business community. The economic impact of HIV/AIDS will first be felt by the private sector at the micro level. In a few countries of Africa some banks and industries are facing closure due to the increasing mortality rate because of AIDS. Therefore, the business community here must not feel complacent that it is not their problem. They must be aware that HIV/AIDS prevalence is highest among the 15 to 45 years age group which is the most productive oeriod in an mdiviauars life. The accompanying cost of HIV/AIDS in terms of-absentism. lower pro> ductivity. depletion of skilled. I llnanpower. high staff turn over" and health insurance will cre-‘hte tremendous pressure on the private enterprises with a spill over effect on the macro economy of the country.
However, the bottomline is that the MPs as people s representatives work for the people, the NGOs work in the community with the people and the government as the caretaker of the democratic system is established by the people so where is the room for any disparity? We must Join hands to combat against the scourge of HTV/AIDS.
The writer is Head of Disability and AIDS Coordination Unit. ACTIONAID Bangladesh.