Profile of an HIV Testing and Counseling Unit in Bangladesh: Majority of New Diagnoses among Returning Migrant Workers and Spouses

Abstract

IntroductionAnalysis of data from HIV testing and counseling (HTC) services provides an opportunity to identify important populations for targeting of HIV prevention efforts. Our primary aim was to describe the demographics of clients presenting to HTC in Bangladesh, a low HIV prevalence country. Our secondary aim was to determine the risk factors for HIV positivity among returning migrant workers who were tested.MethodsWe performed a cross-sectional study of data collected between 2002 and 2010 from the first HTC service established in Bangladesh, located in three large cities.Results8973 individuals attended HTC services, with 558 (6.2%) of clients testing positive for HIV, including 33 children. The majority of those who tested positive were aged 25–44 (71%), male (70%), and married (68%). Key populations considered at increased risk of HIV, such as female sex workers, people who inject drugs, and males who have sex with males accounted for only 11% of adults who tested positive. Notably, 75% of adults testing positive had a history of migrant work or was the spouse of a migrant worker. In multivariable logistic regression of those with a migrant work history presenting for HTC, we found rural residence, working in the Middle East, and longer duration of migrant work to be independently associated with testing positive, and female gender and higher level of education to be negatively associated.ConclusionsThese data suggest that in Bangladesh, in addition to targeting traditional key populations, HIV prevention efforts should also focus on migrant workers and their spouses.

A comprehensive analysis of trends and determinants of HIV/AIDS knowledge among the Bangladeshi women based on Bangladesh Demographic and Health Surveys, 2007–2014

“…However, sex-related risk behaviors are practiced in the real world scenario disregarding the Islamic codes by the Muslims [36]. For instance, the migrant workers, especially, men often practice unsafe sex with non-spousal partner in the foreign country and pose a great threat of HIV/AIDS infection/transmission when they return back to Bangladesh and resume to unprotected sex with their spouses [37]. This provides counter evidence on the lower level of knowledge and awareness among the Muslim women in Bangladesh.…”

Extent of Knowledge about HIV and Its Determinants among Men in Bangladesh

“…In South Asia, the prevalence ranges from as high as 0.3 in Nepal to as low as <0.1% in Bangladesh and Sri Lanka (3). The comparatively lower prevalence is attributed to the geographical detachment from the place of origin of the HIV virus, a low rate of in-migration, and HIV-testing regulations for long-term travelers and returning nationals (4). …”

“…According to UNAIDS 2012, in Bangladesh, the rate of HIV has increased by about a quarter over the last decade (>25%) (4). In addition to that, the South Asian population shares an elevated risk of HIV morbidity due to high rates of tuberculosis (5).…”

“…Several contributing factors to the upward trend of HIV in the country includes increase in intravenous drug users (IDUs), commercial sex workers (CSWs), and men who have sex with men (MSM) (4, 5). IDUs and CSWs tend to be un- or undereducated, which make them more challenging populations for effective health education (13).…”

Migrant Workers and Physical Health: an Umbrella Review

“…Moreover, migrant workers exhibit demographic characteristics that would put them at high risk for heterosexual HIV transmission, such as unstable family and work situations, ease of access to high-risk (including commercial) sex and lack of access to HIV treatment and prevention programs [62,63,64]. Rural residence, longer duration of migrant work to be independently, physical isolation, alcohol use, human rights violations are associated with testing positive; female gender, higher level of education, policy reforms and workplace interventions to be negatively associated [65,66].…”