People living with HIV/AIDS in Bangladesh are set to brace for far worse days when the free supply of expensive drugs needed for their 'healthy survival' will stop and so will the programmes that help them to take life-long medication.
Health-rights activists hold the government responsible for the deepening cloud of 'uncertainty' over the drug supply and support programmes. They say it did not take early steps to write to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to continue with funding even after June 2012 when the project ends.
The relevant government agency National AIDS/STD Programme (NASP), however, does not see an immediate danger since the authorities argue that they have set aside money in the next five-year plan for buying drugs even after exhausting donors' funds.
But experts working with HIV/AIDS are not convinced. They argue that only distributing drug will not be enough.
"They need additional support like counselling, CD4 cell counting to see progress and training of family and caregivers so that they can keep taking the drugs until death," says Habiba Akter, executive director, Ashar Alo Society, which works on HIV-positive people.
Nearly 600 patients currently depend on free drugs and support programmes that started in Dec 2008.
Prof Nazrul Islam, a virologist, says the drug – anti-retroviral – helps decrease viral load in patients to non-detectable levels, giving them better immunity against others infections.
They need to take it all their life, he said, furthering the argument and added that it even lowers the chance of transmission.
Studies in Sub-Saharan Africa, an HIV epidemic region, suggest patients may fail to adhere to anti-retroviral medication because of socioeconomic factors.
Habiba says many of them receive second-line drugs that cost even Tk 15,000 each month. It is even beyond the means of many of the middle-class patients, she says. If they buy, that will impoverish them anyway.
"We urged the authorities time and again to write to the Global Fund, but they did not," Habiba said and added they had no idea why the government 'neglected' the issue.
Prof Nazrul, who was in the team that detected the first HIV-positive case in Bangladesh in 1989 at then the Institute of Post-Graduate and Research (IPGMR) laboratory, say the government does not attach priority to HIV/AIDS issue.
And he is critical of the National AIDS/STD Programme administrators. "They are being deputed when they are about to retire. They spend six months to one year and retire from here. They do not care to take any steps," he alleges.
The Programme manager, Dr SM Idris Ali, however, said: "It's not a red signal. We have a second line of defence."
"We are ready. Tk 450 million has been kept in the budget of the next five-year sector plan (HPNSDP). When necessary, we can buy drugs."
"But," says Habiba, "the plan does not have any guidelines on giving supportive care to the patients." They (NASP) would not be able to offer counseling, follow-up and caregivers support.
The NASP chief Dr Md Abdul Waheed told on Wednesday that they wrote to the Global Fund a week back, though he did not explain why the delay.
"We are not worried. We will be able to manage," he said, but would not elaborate on how they would offer supportive care to the HIV-positive patients once the project stopped.
Dr Lima Rahman, deputy director of Save the Children's HIV/AIDS programme, suggested that the health minister to write to the Global Fund to extend the project by a year. "And then the government should formulate management plan for HIV positives within that one year, if extended," she says.
She also suggests robust public-private partnership in managing HIV patients like in India where over 2.3 people live with HIV/AIDS.
"In government set-up they get drugs along with other supportive care in collaboration with NGOs."
Government records as of Dec 1, 2010, the latest figures available, show there are 2088 confirmed HIV positives in Bangladesh and 850 AIDS patients, of whom 241 have died.
Despite less than 0.1 percent prevalence, experts always keep Bangladesh on HIV-alert as it shares a large porous border with India and the number of high-risk behavior people like sex workers and drug users is on the rise
