HIV/AIDS interventions in Bangladesh: what can application of a social exclusion framework tell us?
Bangladesh has maintained a low HIV prevalence (of less than 1%) despite multiple risk factors. However, recent serological surveillance data have reported very high levels of HIV infection among a subgroup of male injecting drug-users (IDUs). This suggests that an HIV/AIDS epidemic could be imminent in Bangladesh. Although biomedical and behavioural change projects are important, they do not address the root causes of observed risky behaviours among 'high-risk' groups. In Bangladesh, these groups include sex workers, IDUs, males who have sex with males, and the transgender population-hijra-who are all excluded groups. Using a social exclusion framework, this paper analyzed existing literature on HIV in Bangladesh to identify social, economic and legal forces that heighten the vulnerability of such excluded groups to HIV/AIDS. It found that poverty and bias against women are major exclusionary factors. The paper presents areas for research and for policy action so that the social exclusion of high-risk groups can be reduced, their rights protected, and an HIV epidemic averted.
Khosla
Nidhi
N
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. nkhosla@jhsph.edu
D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D011287:Prejudice; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work / Q000331:legislation & jurisprudence; D019529:Sexuality; D012962:Sociology, Medical; D019966:Substance-Related Disorders / Q000453:epidemiology