Effective HIV & SRH Responses Among Sex Workers and other Key Populations Module 1: National Data

Objectives Review Country HIV status Know where we are in regards to SRH health needs for KAPs

Bangladesh Situation First HIV case in the country was detected in 1989. Bangladesh still a low prevalent country in the region:* Prevalence rate - <0.1% Prevalence rate among key populations – <1% Concentrated epidemic (5.3%) among people who inject drugs (PWID) in Dhaka 0.1% of young people aged 15–24 who are living with HIV Estimated number of HIV infected people is 9,000 * Source: 9th round National HIV Serological Surveillance 2011

Bangladesh Situation by New Cases of HIV and AIDS Related Deaths Total New Cases in 2014 New HIV 433 AIDS Deaths 91 Cumulative Cases 1989-2014 HIV 3,674 Total AIDS Deaths 563

Estimated and Reported Cumulative Number of People Living with HIV, 1989-2014

Gender Distribution of New Cases: 2014 Number Male 298 Female 131 Transgender 4 Total 433

Age Distribution of New Cases: 2014 No of cases 0-5 years 15 6-9 years 8 10-18 years 5 19-24 years 42 25- 49 years 323 50> 40 Grand Total 433

HIV prevalence over the rounds of HIV surveillance Source: NASP, 2011

HIV prevalence among female sex workers, 2011 Street, Female sex workers Hotel, Female sex workers Casual, Female sex workers Residence, FSW Combined residence and hotel, female sex workers

Prevalence of HIV and active syphilis over time: Dhaka P<0.05 for MSW and hijra Active syphilis Source: NASP, Surveillance reports & GF RCC project icddr,b, 2010, 2013

Prevalence of active syphilis among female sex workers, 2011

Bangladesh’s approach to the HIV epidemic Target key populations – people who inject drugs (PWID), female sex workers, males who sex with males (MSM) including male sex workers (MSW) transgendered people (hijra) PLHIV Other population groups – migrants Young people

HIV targeted interventions in Bangladesh – landmark events Targeted interventions among hijra started Further scaling up in all groups including MSM and hijra 1st case of HIV 1989 1995-98 2000 2004-2009 2009-15 Scaling up in all groups except MSM & hijra Targeted interventions among FSW, PWID and MSM started

Drug Use and HIV Infection Wives and girlfriends of clients Wives and girlfriends of Substance users Clients of FSWs Substance Users Female Sex Workers IDUs Husbands and boyfriends of FSWs HIV RISK RINGS

HCV prevalence among PWID, 2011 Note: Combined PWID/HS refers to the combined group of PWID and heroin smokers. Numbers in brackets refer to the total numbers of PWUD sampled in each site Source: NASP, 2011

Active syphilis prevalence among PWID, heroin smokers and combined PWID & heroin smokers, 2011 Note: Combined PWID/HS refers to the combined group of PWID and heroin smokers. Numbers in brackets refer to the total numbers of drug users sampled in each city Source: NASP, 2011

Reaching with HIV Prevention Intervention Reached with HIV Prevention Programme 7.5 % of female sex workers 65.9% of male sex-workers 70.7% of transgendered sex workers 29.2% of MSM

Received an HIV test in the past 12 months and know their results 4.1 % of female sex workers 39.4% of male sex-workers 41.1% of transgendered sex workers 15.9% of MSM who have 0.27% of HIV testing coverage at ANC

Where about Condom Use? Percentage of sex workers reporting the use of a condom with their most recent client 66.8 % of female sex workers 58.8% of male sex-workers 45.3% of transgendered sex workers 49.6% of MSM who have

Where we are? Evidence from A study in six countries in the region: 33% of women living with HIV in Bangladesh reported their most recent pregnancy was unwanted. FSW in Bangladesh found that 60% had an unmet need for family planning compared to 16.8% of married women ages 15–49 (survey)

Service delivery model: Implemented by NGOs Field based outreach activities Community development & mobilization Education and awareness BCC session & material distribution Condom, lubricant/needles and syringes distribution On-site educational sessions Referrals DIC based activities (Drop-in-services) Social gathering, rest & recreation Group education session Counseling: psycho-sexual & psycho-social Audio-visual learning Condom and lubricant demo. & distribution Clinical services at DIC STI syndromic management & treatment, counseling abscess management General health treatment VCT Referral - VCT, care & support, complicated STI & other health complications, drug detoxification Capacity building Peer education training Life skill training Vocational training /income generation Local level advocacy Project/DIC Facilitation Team to sensitize lawyers, journalists, Sensitization meeting with religious leaders, Health Service Providers & local elite Sensitization meeting with law enforcement agency Legal support through referral linkage