A man injects himself with drugs on a Dhaka street. Reuters file photo. Rafiqur Rahman
In the slums of Bangladesh&${esc.hash}39;s capital, drug use and prostitution are fuelling an HIV/AIDS emergency that threatens to become a full-blown epidemic, reports Sophie Kummer of CARE International.Mohammad Khokonon has been on drugs for three years, smoking heroin and injecting a popular tranquiliser called bupranorphine bought in the narrow alleyways of City Colony, one of Dhaka&${esc.hash}39;s biggest slums.
&${esc.hash}39;The influence of friends is strong here,&${esc.hash}39; he says, speaking in the windowless gloom of the two-room home he shares with 12 others, including his mother and wife. &${esc.hash}39;It&${esc.hash}39;s very hard not to get into taking drugs.&${esc.hash}39;
Even in the dark, it&${esc.hash}39;s obvious his mother is biting back disapproval as her 27-year-old son tells his story: how the money she makes cleaning streets goes to fund his addiction, how his wife&${esc.hash}39;s earnings also go to buy drugs.
Outside in one of City Colony&${esc.hash}39;s "drug hotspots", where drugs are bought and sold on street corners, dealers estimate conservatively that about 200 local slum-dwellers are regular heroin smokers. But the real number may be much higher.
Down the dark, warren-like alleys of the Colony, many admit they are on drugs, putting themselves at risk of HIV/AIDS every time they share a needle.
The HIV prevalence rate across Bangladesh is less than one percent, but it soars to around five percent among injecting drug users. Research done among 5,000 users by humanitarian and development agency CARE International showed that more than 90 percent of them shared needles.
"When the HIV prevalence rate reaches 10 percent, we call it an epidemic," said Taslim Uddin, CARE&${esc.hash}39;s HIV programme co-ordinator in Dhaka. "Right now, we are pretty close to a concentrated epidemic with around five per cent prevalence among injecting drug users, and it is rising.
"It is very alarming &${esc.hash}39; a growing emergency. This could be very dangerous. The predictions for the future are that by 2030, Bangladesh will have an eight percent prevalence rate among all adults, which is enormous.
"Dhaka is likely to see the first outbreak and the first spike will be with injecting drug users, and the second &${esc.hash}39; in 2010 &${esc.hash}39; will be client-driven, through sex work, especially as many sex workers&${esc.hash}39; clients are drug users. These groups are at risk not just of contracting HIV themselves, but of passing it on to others."
Needle exchangeCARE International runs 52 drop-in centres in Dhaka &${esc.hash}39; some of them through local non-governmental organisations. The centres are used by about 10,000 injecting drug users, 50,000 heroin smokers and other drug users - who are at risk of starting to inject - and 20,000 sex workers.
Recent figures show these programmes reach 75 percent of Dhaka&${esc.hash}39;s drug users and more than 85 percent of its sex workers.
Each centre has a trained nurse, HIV support and education, opportunities to detox, free condoms and a needle exchange programme. People can also wash, eat, watch television or learn a vocational skill.
Former drug user Faruk Hossain, 25, who lives in the Colony, is an outreach worker for CARE, visiting hotspots to tell users about the dangers of HIV and explain how they can change risky behaviour. He also exchanges used syringes for clean ones and hands out condoms.
"There was a heroin spot around my house, with people taking drugs all the time," he said. "From my childhood, I saw them, and when I got older I started taking heroin too.
"But now, in my work, when I see people stop sharing needles or come off drugs it is so inspiring &${esc.hash}39; I feel so glad."
Some of Dhaka&${esc.hash}39;s prostitutes have also set up their own support group which is helping tackle the threat of AIDS.
Shanaj Begum is the elected president of a sex workers&${esc.hash}39; collective, called Durjoy Nari Shangha &${esc.hash}39; which, translated loosely from the Bengali, means an "organisation of women who are hard to repress".
Set up in Dhaka in the late 1990s, it is now a partner organisation of CARE&${esc.hash}39;s and offers support to thousands of sex workers through its drop-in centres.
Shanaj Begum says Durjoy is a vital safety net against the growing threat of HIV.
"All of us who are members of Durjoy are &${esc.hash}39;floating&${esc.hash}39; sex workers - we work on the street," she said. &${esc.hash}39;Many of us have no shelter, food or anywhere to wash. Some sleep on the streets and the police beat them.
"But the biggest thing we face is the risk of HIV and sexually transmitted infections. So we have set up drop-in centres where women can rest and wash and eat &${esc.hash}39; as well as learn another job, like sewing &${esc.hash}39; before going to work between 6pm and 10pm.
"We also have schools, where they can leave their children safely. And we have 10,000 outreach workers among our number who are responsible for going on to the streets to teach sex workers about proper condom use.
"We started off with 20 women in February 1998, but now have around 2,500 in different areas of the country. We are a social network, we support each other, and our numbers are increasing as the number of brothel evictions &${esc.hash}39; and the demand for sex &${esc.hash}39; increases.
"HIV is growing in Bangladesh. The spread of the disease is not stopping, so we need to prevent it. It is a real and growing emergency and no one else supports sex workers in this way, so we need more funding to continue our work."
Any views expressed in this article are those of the author and not of Reuters. Captions for non Reuters pictures: 1) A Dhaka slum. 2) Shanaj Begum(in pink)and members of Durjoy. Both by Sophie KummerOur Standards: The Thomson Reuters Trust Principles.
