HIV transmission in Bangladesh: an analysis of IDU programme coverage.

Background: Sentinel Surveillance found HIV had increased to 7% among street-based injection drug users (IDUs) in Central Bangladesh in 2006-2007, indicating the urgent need to increase prevention. In 2004, size estimation of groups vulnerable to HIV was done by an expert committee under the National AIDS/STD Programme, making programme coverage estimates possible for the first time.

Methods: Appropriate multipliers were applied to size information to estimate a total of 20,000-40,000 IDUs throughout the country. Data from 2003 onwards from the major needle-exchange programmes (NEPs) and detoxification services were analysed to estimate programme coverage as the proportion of the total IDU population reached by interventions, and to assess the proportion of safe injections.

Results: An estimated 31-61% of the upper and lower national size estimates of IDUs, respectively, were in contact with any HIV prevention effort by 2006, with an increasing trend evident over the years. Of these, 24-49% were enrolled at NEPs, and 8-16% had been through detoxification. Although there was a marked improvement over the years, it appears NEPs only provided 160 days of safe injections for every IDU reached in 2006 in the North and Southeast, and 50 days in the South and Southwest, assuming IDU inject twice daily with new needles. If all IDUs reached by programmes in the North and Southeast injected every day, 44% of injections were covered by new needles, and 14% in the South and Southwest.

Conclusion: Within the context of an HIV epidemic among some IDU, and high levels of needle-sharing and risky sexual behaviour, the implications of the low level of programme coverage are alarming, and it is clear Bangladesh needs to take action to improve it in order to control the spread of HIV.