HIV AIDS And The Taboos Of Bangladesh.
By nine o’clock in the morning this curious and wretched place had burst in to life. Every ally way lined with women of all ages dressed in the brightest of saris. Their make up bold, their gold facial jewellery bright and gaudy and wearing smiles that had been well-practiced as they patiently waited for clients.
This was more than just a brothel; this place in Tangail city is a hive of industry, a place to live and breathe and to end your days. Small shops line the narrow paths only wide enough for two people to pass, twisting their way through this maze and eventually leading to one of the many small rooms where these women live and work. Families without fathers or husbands spend their days. Daughters carry on in their mother’s footsteps while their children play in the narrow streets. Over seven hundred prostitutes work and live here and every day sees as many as twenty more joining this surreal world. Some attracted by the money and others brought in forcibly by pimps or fathers (as they are referred to by some). At over a hundred years, it is one of the oldest brothels in Bangladesh but by no means the largest. The sex industry here is thriving as it is all over the country and it would seem that there is nothing to stop it growing ever larger.
Walking through this world can leave you feeling more than sad as old women, once prostitutes themselves, sit pathetically and watch as their daughters carry on the family tradition. As children run through the ally’s playing, do they realise their fate? Yet as you wander through this labyrinth and watch the clients come and go there are no feelings of awkwardness generated. Both parties take the whole experience in their stride. The deed is just a formality. For the clients, ranging from government officials to the many truck and rickshaw drivers, it is just a way of life. Earnings for the girls are relatively high for such a poor country. The equivalent of one dollar will provide satisfaction and a whole night will cost anything up to fifteen. When you compare this to an average wage for many, of only one dollar a day for hard and backbreaking jobs, it’s no wonder it attracts so many new girls.
Bangladeshi society is riddled with prejudice, especially towards sex and drug abuse. Few people talk about such subjects outside its walls. Many charitable organisations such as Care, have taken up the challenge of informing and educating these people about the dangers of sexually transmitted diseases especially HIV AIDS. Classes are held within the brothel and every girl has a health card and is regularly checked and blood tested by a resident doctor.
It is claimed that as yet, in this particular brothel there have been no instances of the disease. One of the reasons for this could be that eighty percent of the prostitutes insist their clients use condoms. The other simply that many things go undetected in this environment. The figures for condom use seem a little strange, when you consider that over half the women have children. There are many girls here that work for themselves or their own families. As their children enter the profession their needs are attended to by the eldest member, who is often their grandmother and in some cases great-grandmother. The majority of prostitutes, are under the control of the many Madams and Pimps who are the ones that really hold the reins in this environment.
Their acceptance of aid workers and resident doctors is purely selfish but extremely sensible. Healthy clean girls mean more money. The terrible sadness of this world is one thing. The retired old women usually found lying in heaps and begging. The children playing, unknowingly waiting for the inevitable and the abuse that so often occurs within a place like this. The desperate poverty pushes many of the people in to such desperate situations. Drug abuse, mainly heroin and prostitution is on the increase and reaching levels unseen in many other countries. Here sits the one of the most over populated countries in the world with an environment so perfect for the spread of HIV AIDS, it could be said that it is only a matter of time before the inevitable happens and this country suffers an epidemic.
Bangladesh, though, has so far managed to escape any major out break. In 1999, it was thought that out of a population of one hundred and eighty million people, all living on a landmass about the same size as England. Only twenty-one thousand adults and children were infected with HIV and only seventeen AIDS cases had been reported since 1997. Today the numbers have more than doubled with over one hundred reported cases of full-blown AIDS. Still this in comparison to all other developing countries is very low, even when you consider the fact that for every case uncovered there is said to be many more that go unreported.
Since HIV AIDS was first recognised within our world over fourteen million people have died from this disease and it is thought that up to and over sixteen thousand people are infected worldwide every day. It is the largest infectious cause of death in the world and the fourth leading cause of death overall.More than ninety percent of people infected live in developing countries and two-thirds of them are in Sub-Saharan Africa.
In Asia though the numbers are rising rapidly and it is thought that the number of people living with HIV AIDS within this region is in excess of eight million people. It could be said that Bangladesh has a unique opportunity to reduce what many people see as the coming onslaught. May be, if its government acts decisively. With the help of the many charitable organisations working here and takes notice of all the problems and pain experienced in the rest of the world, it has a chance of keeping the devastating social and economic effects this disease will bring, to a minimum. Prostitution though is only one part of the problem.
The number of clients to the sex workers is huge and. There are over 100,000 long distance truck drivers, who all have a truck driver’s mate who helps with direction and unloading. It is said around 50% have sex on every journey. Then there are the rickshaw drivers. It is difficult to really know how many there are of this group but in Dhaka alone there are over 300,000. It could only be a guess but there may be 1,000,000 altogether and it is estimated over 65% will visit sex workers daily. There are the dock levers or workers. There are said to be many thousands and over half will visit with sex workers during their time in port. Lastly there is a very large migrant work force, about 80,000, who stay away from Bangladesh on a long-term basis.
As well as the brothels there are thousands of street prostitutes, male and female, plus a very large community of Trans gender sex workers. All these groups are riddled with the problem of drug abuse at frightening levels. In Dhaka alone CARE organisation monitor over 8,000 injecting drug users with nine drop in centre’s and many field staff (All working very hard to provide information, teaching and education on its dangers). For the drug users they are able to reach, they provide disposable needles and syringes. Field workers provide information on safe practice while injecting as well as educating them on the dangers of sexually transmitted diseases including HIV/AIDS and the importance of condom use.
A synthetically produced opiate, Buprerorphine, is supplied to the drug users and is administered under the supervision of field staff. This is a practice considered illegal by the government, so it has become a constant battle for CARE to keep up their work, continually having to engage in dialog and explain the reasons for their approach with a police force ill-equipped to cope or understand the situation and a government with no programs in place to deal with this ever-increasing problem. A blind eye is turned but this does not stop the senseless beating and harassment by police handed out to many of the drug users. This forces many to go underground putting them back at risk from dangerous cocktails of drugs and most importantly HIV/AIDS. After all their work in gaining these people’s trust it puts them back at the beginning.
Most of the heroine available on the streets is referred to as brown sugar. A very impure form, sometimes mixed in to a cocktail of different substances. This alone, can have devastating effects on its victim. Causing terrible and very painful ulcers that manifest themselves when the drug users practices, are unclean and inject in to muscle instead of the vein. Another cause of these ulcers can be the injecting of air bubbles. If before injecting the syringe is not held upright and lightly tapped, releasing any trapped air, It can cause the same excruciating effect.
The majority of the Transgender population are sex workers, and again are a particularly vulnerable group who receive much resentment and prejudice from the mainstream population. It would seem that most societies treat groups of similar form with much bigotry but there is no doubt that in Bangladesh, hatred towards them is quite extreme. Many have experienced violent attacks on the street and it is unlikely that their families know about their hidden life. Most transgender’s go through with their arranged marriages to create a facade, for there is little to no understanding of their ways.
Their problems go deeper than the ever-present social issues. Unlike Transgender people in the western world, they have no way to physically change themselves. There are no sex change operations available and there is no hormone therapy. These poor people have to spend every day; tortured by the fact they will never be able to be who they really feel they are. It is hard enough for trans-genders anywhere but in a third world country things are near impossible. They meet every week to discuss any issues and problems they have. They hold their own meetings and educate themselves on the dangers of drug abuse, sex without protection and their personal difficulties. As a group they are probably the most at risk.
Many attempt their own sex change operations and help with the castration of each other. No detail is necessary but it is correct to assume this type of desperation breed’s disaster. Most earn their living as prostitutes as there is little else for them until there is more tolerance and understanding. All the teaching and information that is being provided, across this country, seems to be having many positive effects and beginning to change the attitude of the sex workers and drug users at least. It is though so very important for the government to begin implementing programs within all the communities of this country. Education within the mainstream population is so important. Crushing the intolerance and prejudice that breeds such ignorance is going to be a difficult task.
There are many cases where suspected sufferers of HIV AIDS are forcibly taken to medical facilities and handcuffed to their bed or confined to the immediate area until blood test results are final. During this time it often happens that the press will publish the picture of a suspected sufferer. The affect of this on the victim can be devastating, turning his or her community and family against them. Many will be beaten, harassed and tormented all due to ignorance. Being forced to leave whether or not they are found to have this disease.
Bangladesh has a common and porous border with India and Myanmar and with the majority of goods crossing the border by trucks in their thousand every day, one can only guess to what effect this is having on the spread of HIV AIDS. Especially when India is a country with a rapidly rising HIV AIDS problem itself. With a major port at Chittagong, open to the rest of the world and providing a main artery, the Meghana river, straight to the small but busy docks in Dhaka. It would seem an impossible task to monitor and stop the looming spread of HIV AIDS in Bangladesh.
Health care in this country is in a desperate state. If HIV AIDS were to hit, there would be little it could do apart from watch its population die. It is ill prepared to look after its already ailing population and has so many other problems to cope with as well.
AIDS is devastating many other countries. The far-reaching and crippling effects, social and economic, would devastate Bangladesh. For the people of this country whether they are part of the high-risk groups or not it is essential that they change their attitude. Which will begin with the government and the education of the young. Adequate programs and authorities that are capable of dealing with this situation respectfully and with grace are essential. Acceptance is everything in a country where poverty rules.
Every day though, life carries on. Brothels get larger, more and more young girls line the streets and the number of injecting drug users expands at an ever-increasing rate. What will happen next? Maybe Bangladesh will carry on being lucky. The worst might never happen.
Photography and writing by Thomas W Morley