Health, Hardship and HIV: Reaching Vulnerable Populations in Chittagong
Family Planning Assocation of Bangladesh (FPAB)

Hasan drives a truck on the long, lonely roads of Bangladesh, and he always looks forward to pulling into Chittagong. The 31-year-old man only gets to see his family a few days a month, and while he’s away from home “he still needs to enjoy himself.” He sometimes visits sex workers in Chittagong, but he only has sex with young women who ‘look clean’. When he gets a sexually transmitted infection (STIs), he usually just visits a pharmacist for medicine.

Chittagong is a densely populated industrial port city in south-east Bangladesh. Life is hard – Chittagong has one of the country’s largest and fastest growing slum areas. The population of the slums is growing at a rate of more than four per cent, more than double the growth rate in the country as a whole. As a result, a large proportion of its residents are young people – most of them illiterate and many unemployed or working in low paying jobs as day labourers or rickshaw pullers. They have little access to any form of recreational activities and limited access to information and health services, especially concerning STIs and HIV/AIDS.

The city is also a major transport hub, with a busy truck interchange, bus terminal and city railway station. These facilities all attract large numbers of people arriving from rural areas to seek work in Chittagong City as well as long distance truck drivers, day labourers and rickshaw pullers. As a result, Chittagong has a significant sex industry with more than 3,000 sex workers, and neighbouring Daulatdia has the largest brothel within Bangladesh. Despite the vulnerability of these groups to sexually transmitted infections and HIV/AIDS, very few prevention services are available.

HIV/AIDS awareness is relatively low in these communities, with more than one third of people having little or no knowledge of the infection. There is also little understanding of the modes of HIV transmission and the ways to prevent infection. In a survey conducted by the Family Planning Association of Bangladesh (FPAB), one third of those sampled had not heard of HIV/AIDS; only 43 per cent were aware that it could be fatal; and only around half of respondents were aware that HIV can be transmitted through sexual intercourse, the sharing of injecting equipment, blood transfusions or from mother-to-child. When questioned on prevention, only 36 per cent were aware that condoms could prevent transmission and only 24 per cent said they used condoms whenever they had sex.