Bangladesh's new HIV worry: returning migrant workers

  • Tuesday, 10:10 Date 16/06/2015
  • Overseas workers bring valuable remittances to the economy, but often return with a deadly secret 

    hiv bangladesh
    People rally in Dhaka during World AIDS Day in December 2014 (Photo by Stephan Uttom)

    In 1989, Albert Rozario* joined a tide of young Bangladeshi migrant workers seeking prosperity outside the country’s borders. He landed in neighboring India, working as a hotel cook in Mumbai for more than US$250 a month — a relative fortune at the time.But with the newfound cash came the biggest disaster of his life.Albert dove into a life of pleasure, frequenting the city’s red light districts, where he engaged in unprotected sex. He contracted HIV there, he now believes, though he wouldn’t learn of his condition for another three years.By then, he had found a wife, started a family and moved to Oman. A standard medical test at his new employer revealed the truth.“I was diagnosed HIV-positive,” Albert recalled during a recent interview. “I came to know it as a dangerous disease and my employer sent me back home.”When he returned, he decided that revealing his health status outside his own family was no option.“People in society consider AIDS a curse and look down upon the patients,” he said. “So, I decided to hide my disease.”Albert would have been among the earliest known cases of HIV in Bangladesh, which recorded its first case in 1989. More than a quarter-century later, Bangladesh is considered a low prevalence country for HIV — official Ministry of Health data recorded 3,664 people in Bangladesh living with HIV/AIDS last year, though UNAIDS pegs the number higher, at around 9,500 people.But Bangladesh is now seeing an alarming shift in the types of people who are affected by the virus. And this change is the result of the country’s sizeable migrant labor force — people like Albert.Bringing HIV homeUsually, those most likely to suffer from HIV have come from so-called most-at-risk populations — injection drug users, sex workers and men who have sex with men, for example. Now, that trend is shifting, says Dr M Ziya Uddin, an HIV/AIDS specialist at the Bangladesh office of the UN Children’s Fund, or UNICEF.“In the last three or four years, we are observing a transition to what we call low-risk women, like pregnant women from the general population and the spouses of migrant workers — those who do not have many high-risk behaviors,” he said in an interview. “Most of these infections are from the migrant population, either directly or through their spouses.”This is where the danger lies for Bangladesh, a country with an estimated eight million migrant workers abroad at any one time. Last year, migrant workers sent home roughly US$15 billion in remittances, according to data from Bangladesh Bank, the central bank. But when migrant workers bring home HIV, the effects can permeate through entire families.James and John Corraya were brothers who lived similar lives. Both had a wife and two children, both found work abroad — James to Mumbai, John to Singapore — and both later contracted HIV and died.Annie, James’s wife, said she married her husband and gave birth to their children not realizing he had the virus. Long after her husband’s death, the effects of HIV continue to affect the family.“We knew about the cause of his death and we tried to hide it, but failed,” said Annie.“Some people came to know it from the death certificate and it was the beginning of social stigmatization for the family.”She said other families in her village never invite hers to social events, like weddings, and rarely even speak to them.“Once, we applied for a loan from the local cooperative society, but we were denied. Even the local parish priest and nuns have refused to assist us, but spread the news of our infection among the people,” Annie said. “They think we are bad, cursed people and say bad things about us. We have been forced into an isolated life.”Now, Annie worries how HIV will affect the next generation of her family. Both her children were also born with HIV, she said.“When they reach marriageable age, we are likely to face serious trouble if it is revealed our children are also HIV-positive,” she said. CursedBangladesh is a socially and religiously conservative Muslim-majority nation of about 160 million people. The Catholic Church’s social service agency, Caritas, helps more than 40 Bangladeshi Christians living with HIV.“Like non-Christians, most of the Christian HIV/AIDS patients hide their disease in fear of social humiliation,” said Dr Edward Pallab Rozario, head of health services at Caritas. “We try to help them with monetary support and counseling, but the mindset of the people in society is still negative toward them.”This sort of discrimination toward people with HIV poses a challenge for combatting the virus. For two years, the Bangladesh government has provided free anti-retroviral medication to people with HIV. But there have been allegations of mismanagement in drug distribution, while overall discrimination means many people who have HIV don’t want to get tested.“People often don’t know where they can test for HIV or get medicine,” said Abdur Rahman, an official with Ashar Alo (Light of Hope) Society, a Dhaka-based organization that helps people living with HIV.“Many people still think HIV/AIDS is a curse. They don’t think it is a disease. Sometimes, the patients isolate themselves and don’t report cases,” he said.The government, he said, must take a more forceful role.“Although people are more aware now, the awareness campaign is largely led by some NGOs. That’s not enough. The government needs to intervene strongly, both in treatment and awareness-building.”Dr Ziya, the UNICEF specialist, worries that Bangladesh’s relatively low HIV prevalence rate may hide a concentrated problem that can “flourish” without warning. With the scale of international funding for HIV efforts in question beyond this year, Bangladesh may well see a decrease in program coverage, he said.“The donors think HIV is not a big problem for Bangladesh and are diverting the funds elsewhere,” he said. “They also are not interested in funding to check HIV among migrants. So, this will be a big challenge for Bangladesh.”Any new health policies for migrant workers will come too late for Albert, the former hotel cook who contracted HIV in India.He passed on HIV to his wife, who died in 2002.“My wife knew about my disease but she never hated me. Instead, she loved me until her death,” Albert said.Today, Albert said he faces no discrimination because of his health, but only because he still hides his HIV status.“I still have a hassle-free life because people don’t know I’m HIV-positive,” he said. “If they knew, they would have hated me, and my family could be socially ostracized.”*Names of people living with HIV in this story have been changed to protect their identities.Stephan Uttom and Rock Ronald Rozario, DhakaBangladesh

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