Partnering to Address HIV/AIDS: Bangladesh

Interpersonal communication featured prominently in fostering partnership - the core strategy underpinning this effort to develop a health services programme that would meet the needs of the transport union workers while building the capacities of participants (the trade union and its members). This objective was built on the understanding that a participatory intervention for social change would generate knowledge and raise consciousness among participants about their own concerns (rather than the project's) and help them take steps to address these concerns.

Specifically, during the project's initial period, CARE-Bangladesh staff worked to develop a trusting relationship with union leaders by engaging in discussion, advocacy, and the sharing of information. The project also depends on collaboration with the community - especially the active involvement of the transport union and members in decision-making and program activities. Peers - who are transport workers themselves - help identify areas for outreach, ensure cultural appropriateness of the prevention message, and serve as outreach workers. (CARE helps the union recruit these personnel from the group of workers).

As the partnership grew, the union and its leaders contributed to and took responsibility for programme activities such as day-to-day management of the "drop-in centres" (DICs), committee governance, monitoring of project activities (including the activities of peer outreach workers), sharing of union office staff to look after the DIC activities, motivation of transport owners and agencies to support the intervention, monitoring of the social marketing of condoms, and attendance at peer training opening and graduation ceremonies. [According to organisers, "[u]nion leaders give time and moral support during the opening and graduation ceremonies of the Volunteer Peer Educator training course. Peer educators are motivated to participate more actively in the training process after they hear a union leader praise their role and contribution; receiving a certificate from their union leader also bestows a sense of prestige."]

HIV/AIDS.

According to CARE-Bangladesh, "[w]hile HIV prevalence in Bangladesh is still very low - well below one percent - data show that it is rising significantly, with the number of HIV–positive individuals increasing from 363 to 465 in one year alone. These numbers do not reflect undetected cases, nor those identified at private clinics. UNAIDS [The Joint United Nations Programme on HIV/AIDS] estimates that there are 2,400–15,000 adults in Bangladesh living with HIV/AIDS..."

A baseline behaviour survey conducted by CARE-Bangladesh in 2000 to assess the risk of transport workers acquiring and transmitting STIs, including HIV, found that most workers had little information on HIV transmission and prevention. Almost 50% of the transport workers surveyed had bought sex from female sex workers in the previous month, and almost 10% had paid for sex from transgender sex workers. Condom use was very low, while intravenous drug use was high, and the prevalence of STIs was significant. In the majority of cases, men had visited traditional healers, villagers who are unqualified health care practitioners ("quacks"), and non-trained pharmacists, resulting in re-infection and serious complications.

In the words of a one CARE staff member: "During the whole of 2000 we did advocacy with union leaders to convince them of their moral responsibility to look after the health of their members. We tried to convince them that this project will bring benefits to them, so for their own interest they should be involved in the project activities....We told them we could run the project on our own, but as elected representatives they should run it in the long-term. But interestingly, as the project gained such an excellent reputation, union leaders in many places approached us and requested that we start the program in their working areas."