<%-- Page Title--%> Special Feature <%-- End Page Title--%>

<%-- Volume Number --%> Vol 1 Num 153 <%-- End Volume Number --%>

May 7, 2004

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Branded Untouchables

Azfar Aziz

She doesn't die, even though condemned to death. Shrouded in black, she stands stuck between life and death, utterly confused, shaken to the very root of her being. "If the government had established a hospital for us, gave us work, we could at least live decently the few years we're left with," she demands. "If not, why doesn't it hand us some poison so that we could die and find peace at last?"

"Was it a crime that I was born poor, that I tried to earn a better living for my family, my children?" the burkha-clad woman breaks down sobbing. She doesn’t expect any answer. And who is there to answer her? Being HIV positive, an AIDS survivor, she belongs to the class of modern untouchables.

She was a poor village woman, a mother of two. She spent Tk 85,000 to book a job as a cleaner at a women's madrasa in a Middle Eastern country, at least that is what she was led to believe. She took it as a God-sent opportunity in answer to the years of prayers for a better future. She consulted her husband and relatives and won their consent to accept the offer, which came from a local acquaintance.

To raise the passage money and the recruiting agent's commission, the woman had to sell the only piece of land she inherited from her mother and borrowed the rest of the sum on high interest. Eventually, one morning she left family, home and country for the Middle East in quest of a dream.

But, upon reaching the new land she was confronted with her worst nightmare. Instead of a madrasa, she was confined to a hotel -- a brothel in disguise. Initially, she screamed, rebelled, fought hard the pimps but there's a limit how long and how far a human being can endure brutal physical and mental torture. The brothel-keepers know this very well and are experts in breaking the spirit of recruits who end up as sex slaves.

For the next two years, she and her colleagues,also trafficked from many other countries, had to cater to the sexual whims of men who were predominantly Arab Muslims. Her passport and other documents were seized and she never got paid. When she asked for money, the pimps told her they had to buy her for Tk 300,000 and wouldn't pay her any until that 'investment' was recovered.

After two years, one day the brothel was raided by police and she was arrested. In jail, she faced interrogation and torture again. It was then that she came to know that she was infected with HIV and was hastily sent back home without any money at all.

Upon her return to her village home, she confided in her husband about her plight. Her husband and relatives virtually kicked her out of the house along with her two children.

She now runs a small grocery shop on a footpath in Gulshan, Dhaka. Her son is working at an auto-workshop for a daily wage of Tk 10. She can't tell her children of her disease and needs at least Tk 50,000 as dowry to get her daughter married.

Life is a daily struggle for this woman, who asks between sobs whether it was her fault that she was poor, orphaned at an early age, and that she had only wanted to bring good days to her family by working abroad?

IF you live in Dhaka, you can't have possibly missed it, though you may not have grasped its full implication. The bright-red bodies of BRTC's Ashok Leyland double-deckers carry the message loud and clear through the main wayfares of the city day in and day out in large, bold letters in Bangla of the vernacular, 'AIDS <>ekti maarattak rogue. Ei roger kono chikitsa nei. AIDS roge mrittu abodharito<>.' This apparent awareness-raising message means: 'AIDS [Acquired Immunity Deficiency Syndrome] is a fatal disease. There is no treatment for it. An AIDS patient is sure to die.'

We don't doubt the intention behind this public notification was one of welfare and awareness raising. However, due to information and understanding of the communicators it has virtually turned into a death sentence for the HIV positive people. The myths generated by ignorant propaganda have so stigmatised the AIDS patients as to reduce them into a new sect of untouchables, not unlike that of the lepers in the middle ages. Only, in case of the people living with HIV and AIDS, the stigma is more cruel, the social boycott more complete, superstition of its association with sin almost universal and the shroud of myths and misconceptions harder to destroy.

Speaking on the issue in a plenary session a couple of months back, Professor Dr M Nazrul Islam, chairman of Virology Department of Bangabandhu Sheikh Mujib Medical University, termed the attitude towards AIDS patients as simply insane.

He narrated a few incidents that he experienced during his day to day work that sketch a shocking picture of the apathy towards the HIV/AIDS patients even among the physicians and nurses.

Professor Islam referred one of his patients, an HIV positive girl, to a friend of his, also a specialist physician. The next day that friend phoned him, sounding rough and angry, "Why did you send her to me? To waste my time? These people should die anyway." Thus, even the healer refused to deliver his Hippocratic oath.

An expatriate Bangladeshi, who worked in a Middle Eastern country, built a house for his mother with his earnings. He became infected with HIV. Eventually his mother came to know of the nature of his disease. After his death, the mother didn't let his wife and children enter the very house built by his hard-earned money. They were evicted from their home for the crime of being the children and wife of an AIDS patient.

During a visit to a hospital, Professor Islam found the doctors and nurses on duty were not giving intravenous saline to an HIV positive patient, though there was expressed advice for that. When he asked why, the doctors indifferently replied, what was the benefit in giving him saline? He would die anyway.

The virologist said doctors at Dhaka Medical College Hospital morgue even refused to carry out autopsy on dead bodies of HIV positive people. "Due to lack of acceptance of this disease among the doctors and nurses, AIDS patients have to be kept in hospitals showing false ailments," he said, adding that only one NGO-run hospital in the city was admitting and treating HIV positive patients without any discrimination.

Echoing Professor Nazrul, T I M Zahid Hossain, an HIV/AIDS activist working with ActionAid Bangladesh, cited two such anecdotes further illustrating the extent of discrimination against the people living with HIV and AIDS. In one instance, he quoted some AIDS survivors as saying in a condolence meeting of a recently departed fellow patient: “None of the hospitals in the city agreed to give him a space. Doctors and nurses refused to attend. It will happen to us. We are scared.”

In the second case, "a hospital authority refused to provide medical support to an HIV positive woman in delivering her child. Finally, she was taken to a rural dispensary where no proper medical support was available at the time of delivery."

According to Professor Islam, HIV positive people in many cases victimise themselves thinking their lives have no worth anymore, whereas symptoms of this disease can be controlled. Due to negative-publicity and mis-reporting, many HIV positive people think they will die very soon. This wrong idea has to be eliminated so that HIV infection doesn't bring in panic with it, he said.

Zahid Hossain, too, described how at a South Indian hospital, recognised to be one of the best AIDS testing and treatment centres of the country, a number of patients committed suicide, being deprived of counselling and suffering trauma from being suddenly informed of their infection. He also said, "Over the last 15 years, a number of cases have been reported in which people living with HIV have been criminally charged, sometimes with very harsh penalties imposed."

The people living with HIV and AIDS are stigmatised, isolated and deprived of care, despite the fact that the UN Commission on Human Rights has confirmed that "Discrimination against people living with HIV/AIDS, or those thought to be infected, is therefore a clear violation of their human rights." This declaration has been signed and ratified by all member countries including Bangladesh.

According to Hossain, in countries like Bangladesh, the violation of the rights of these modern-day untouchables has three basic features: "Firstly, as the majority of the people living with HIV and AIDS lack access to testing facilities, they are deprived of information and relevant cares. Secondly, even if they are informed, they are deprived of counselling and lifeline of drugs and care. Thirdly, they are secluded and exposed to social scrutiny and stigma without any legal protection."

In Bangladesh, they are not even getting any antiretroviral drugs, which are essential for treatment of AIDS, to buy in the market, he added.

Just a decade ago, treatment for HIV/AIDS did not exist. A positive HIV test meant certain and imminent death. But, with the development of anti-retroviral drugs, the treatment of AIDS and HIV has progressed significantly over the years. It's now no more fatal than any other severe disease, e.g. diabetes, cancer, tuberculosis, etc. It also isn't necessarily rooted in or associated with sin or vice, as the image portrayed by the public awareness-raisers.

Recent interventions in some African countries have proved that a therapy relying on the anti-retroviral drugs which attack the virus that causes AIDS can transform the sure death sentence into a more chronic condition, enabling those suffering to live much longer, healthier lives. Technically, anti-retroviral therapy is feasible throughout the world. The cost of the medicines has also come down dramatically.

WHILE the Bangladeshis -- including the leaders, governors, judges, gurus, priests, teachers and even the healers -- are persistently deluding themselves by believing that the disease will not be of much significance in a predominantly Muslim country and it is not only fuelling ignorance but also impeding new detection of case in the country. Meanwhile the possibility of an epidemic is flourishing on the myths, living unchecked in the shadows of oblivion. There is every sign and probability of its pounding all of a sudden on the nation unprepared and ill-equipped to combat it. By harbouring negligence and apathy we are creating our own future hell.

According to the UNAIDS 2003 Fact Sheet, world-wide over 60 million people have been infected with HIV since it was first diagnosed 20 years ago. While these numbers are shocking, what is more frightening is the experts' estimate that between 2000 and 2020, over 68 million people will die of AIDS prematurely in the 45 countries most affected by the disease.

Luckily, the prevalence in Bangladesh is still low -- 13,000 as of April 2001, estimates the UNAIDS and the World Health Organisation. But experts believe the actual figure to be much more than that.

In one region of Bangladesh, HIV prevalence among injection drug users (IDUs) jumped from 1.7 percent in 2001 to 4 percent in 2002. While HIV prevalence in the overall population is reportedly still low, the country's poverty, gender inequality, and proximity to raging epidemics in India and Southeast Asia point to the possibility of an AIDS explosion. Globally, reaching 5 percent in any high-risk group is seen as an epidemic. Experiences from Indonesia, Thailand and India show that HIV among the IDUs can increase sharply from 4 per cent to 50 per cent within as few as four years.

About 33 percent of the IDUs in Bangladesh visit female sex workers. Seventy percent of rickshaw-pullers visit female sex workers and have wives at home. The spread of HIV/AIDS from IDUs to sex workers and rickshawallas would be very fast unless it is effectively prevented. Men having sex with men also have sex with female sex workers. This is how it could make inroads into the general population.

Dr Habibullah Choudhury, HIV/AIDS coordinator of Bangladesh Red Crescent Society, reported in October 2002, "Experts are predicting that the AIDS pandemic could be set to explode in Bangladesh. According to official figures, there were 182 HIV-positive men and 35 HIV-positive women in the country at the end of last year. However, no one knows the actual figure.

"Many people living with HIV/AIDS are unwilling to be tested and even though there are private and public laboratories carrying out HIV testing, the results are not sent to the national AIDS/sexually transmitted diseases (STD) programme."

Dr Choudhury observed, “The plain truth is that we cannot afford to be complacent, especially as, according to a recent Unicef report, 96 percent of girls and 88 percent of boys don't know how to protect themselves.”

"Twenty-two confirmed HIV-positive cases were reported during the last six months and experts believe that new cases of HIV infection might be double this year compared to last year's total of 31. Of the 22, 18 are migrant workers and four are housewives. Officially detected cases are only the tip of the iceberg, but this sudden rise in the detection rate indicates a rapid increase in transmission rates which should set alarm bells ringing."

Vivek Maru, a researcher of the Human Rights Watch, reported on August 20 last year, "Bangladesh is brutalising exactly the people it most needs as allies if it is to avoid a severe AIDS epidemic. Violence against at-risk people traumatises them and drives them out of reach of HIV prevention services, which can increase their risk of infection."

In his 51-page report "Ravaging the Vulnerable: Abuses Against Persons at High Risk of HIV Infection in Bangladesh," Maru records rapes, gang-rapes, beatings and abductions by both police officers and mastans. Their targets -- sex workers, men who have sex with men and injection drug users -- are both at high risk of HIV infection and the people most capable of bringing AIDS information and services to their peers. In a direct blow to the fight against AIDS, some of the abuses are committed against AIDS outreach workers.

Alluding to the sheer rise of HIV prevalence among the IDUs from 1.7 percent to 4 percent in 2002, Maru said, "This is a critical situation. Strong intervention now could save countless lives, but time may be running out.”

(The writer is Senior Sub-editor of the Daily Star)



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