Women's Feature Service



Bangladesh: Imams Join the Fight Against HIV/AIDS


By Pamela Philipose



Dhaka (Women’s Feature Service) - Bangladesh has a very low HIV/AIDS prevalence. Successive sero-surveillance rounds conducted since 1998 by the National AIDS/STD Programme (NASP) have registered a prevalence level of less than one per cent. But the medical authorities in a country with a population of 156 million know that they cannot afford to be complacent despite this low figure.


Senior Dhaka-based Imam, Mufti Mohammed Abbas Ali Rabbani
feels that Imams play an important role in society and that they can
teach people to desist from wrong-doing and follow the right path.
(Credit: WFS)


Dr Md Abdul Waheed, Line Director, National AIDS/STD
Programme, remarks: "How can we afford to take the threat lightly? We
have a 156 million population of whom over 40 per cent are in the
reproductive age group." (Credit: WFS)


Asks Dr Md Abdul Waheed, Line Director, NASP, “How can we afford to take the threat lightly? We have a 156 million population of whom over 40 per cent are in the reproductive age group.”


What worries Dr Waheed particularly are the many risk factors that exist, including low condom use among the most-at-risk population, a high rate of needle sharing among injecting drug users (IDUs), the higher prevalence of HIV in countries bordering Bangladesh and significant levels of internal and external migration – around eight million people work abroad.


Recent evidence, according to Dr Waheed, suggests that the geographical coverage of IDUs and female sex works has almost doubled. In Dhaka city, HIV/AIDS prevalence among IDUs is estimated around seven per cent and, according to the latest NASP figures, new cases have risen from 250 in 2009 to 343 (till November) in 2010. “It will be difficult for Bangladesh to achieve its Millennium Development Goals target with regard to HIV/AIDS if we do not achieve 100 per cent coverage of those most at risk.”


Recognising the challenge, the Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) has been providing financial support to the NASP since 2004, and has invested a total of approximately USD 131 million into initiatives that will carry on until 2015. This is helping Bangladesh to presently dispense Antiretroviral Treatment (ART) drugs to 400 patients.


One of the prime focus areas of the GFATM has been on prevention services for the most-at-risk groups, especially through the scaling up of information dissemination, even among children. Interestingly, information on HIV/AIDS has been incorporated into school textbooks from Class Seven. “Initially, we found the teachers reluctant to talk about HIV/AIDS, but after some orientation efforts and training, most have come on board,” informs Dr Hasan Mahmud, Deputy Programme Manager, NASP.


All this is being done through public-private partnerships between the Government of Bangladesh and Save The Children Fund USA, which in turn partners other NGOs in the country.


An innovative strategy that evolved from the process was to involve religious leaders in the effort to raise awareness Dhaka-based Padakhep Manabik Unnayan Kendra was chosen by Save The Children to anchor this process. Says Iqbal Ahammed, Padakhep's executive director, “The idea is to get religious institutions in a conservative country like Bangladesh to take ownership of the campaign to prevent the spread of HIV/AIDS and end the stigma that those living with it have to face. This is being done in partnership with the government.” The first phase of the intervention was to involve the various stake-holders in joint discussions. They included the Ministry of Health and Family Welfare, the Ministry of Religious Affairs, the Islamic Foundation, the Ramakrishna Mission, the Bangladesh Buddhist Federation, and the Christian Bishops Conference of Bangladesh. Since information dissemination was seen as a key strategy, an advisory committee, led by the director general of the Islamic Foundation, decided to produce a series of four booklets in Bangla that talked about the HIV/AIDS challenge within the context of the four major faiths in the country: Islam, Hinduism, Buddhism and Christianity. The content of the booklets was decided during a specially-convened national conference.


Reveals Ahammed, “It took over a year, in fact, to produce the booklets, each of which reflected the teachings of the respective religions in the context of HIV/AIDS, and in ways that were sensitive and which had impact. These booklets are now being disseminated to the four religious communities through their respective institutions.” Ahammed's organisation has plans to eventually cover 2,22,000 mosques, 25,500 temples, 2000 pagodas and 500 churches in the country, as part of this strategy.


But while the general effort was to bring all religions on board, clearly the fact that 90 per cent of Bangladesh's population is Muslim is an overriding factor. Says Moniruzzaman Siddique, Team Leader, Padakhep Consortium, “Bangladesh is at a critical juncture in its attempts to address HIV/AIDS. If we fail now, it will be a big setback. We realised that if religious leaders, especially those from the Muslim community, consented to be a part of this effort, it would be a huge gain. So we decided then to reach out to individual 'imams' (spiritual leaders), and convince them about the issue.” Imams have, in the normal course of their duties, many opportunities to interact with the larger community, whether it is through face-to-face interaction, or through more formalised ways like the Friday sermon, the 'milad' – special occasions within the community, like marriage ceremonies – or during Ramadhan, when several connected events take place.


What made a senior Dhaka-based imam like Mohammed Abbas Ali Rabbani get involved in such an intervention? Sitting in the Padakhep office in the crowded downtown area of Mohammadpur in Dhaka, Rabbani, who is recognised as a Mufti (Islamic scholar), puts it this way, “Imams play an important role in society. The Prophet has entrusted upon us the responsibility of taking the message to the people – of desisting from wrong-doing and following the right path.”


Says Shamim Rabbani, team leader of the IDU intervention at Padakhep, “The key messages we want conveyed to the community are basically this: ‘Understand what causes HIV, protect yourselves against it, and end discrimination against those living with it’. The challenge, of course, is to get the imams to put these messages out to the community in ways that we would like them to, but they often modify the message as they think fit.”


To get the imams to be on the same page as the NASP is, therefore, often difficult and Padakhep tries to do this through advocacy work and orientation programmes with the imams.


According to NASP's Dr Mahmud, these leaders are generally ready to adopt the policy of the government, but have their constraints. “For instance, they would not want to be seen as endorsing promiscuity, so they prefer to keep silent on a sensitive issue like condom use.” He adds, however, that most imams do not pose hurdles if others talk about condoms in their presence, “This could be considered an indirect endorsement of the need for people to understand how they can protect themselves.”


Mohammed Toslim Uddin seems to bear this out. A young imam from Manikgonj in northern Dhaka, he speaks of the great curiosity among the youth in his congregation on issues like HIV/AIDS. He says, “After receiving orientation on HIV/AIDS from Padakhep, I have held discussion with many youngsters in my mosque. They demand educational materials and want to know more. We have had very animated conversations. Sometimes they come to me with problems like sexually transmitted infections, and I advise them on the importance of seeking medical help.”


According to Imam Toslim Uddin, while many imams use the television and radio to communicate with their audiences, inter-personal communication is the need of the hour. “You can listen to TV or the radio, but you cannot clear your doubts. You can do this only through direct communication,” he observes. Of course, given that imams generally interact directly only with the men in the community, getting the message across directly to women would certainly be more difficult.


But despite the constraints, Padakhep's Siddique believes this initiative is unique. “We have been successful in motivating religious leaders to join in this effort. Some attempts like these have been made in Indonesia and Malaysia, but in South Asia, I believe, this programme is unusual and could emerge as a model,” he says.


As the message is taken further and further into the community, there is also a need to keep the National HIV/AIDS Programme up-to-date and effective. This is where WHO, Bangladesh, comes in. Dr M.K. Zaman Biswas, National Professional Officer (Epidemiology), WHO, Bangladesh, explains, “WHO provides technical assistance to the programme. We are presently developing a strategy for equitable access to antiretroviral drugs in partnership with other stakeholders.” Equitable access, especially within the high-risk groups, is vital if Bangladesh is to keep its prevalence rate low.


Finally, this is all about life. As one of the slogans used in the campaign goes, 'AIDS kee? Banchte Hole Jante Hobe (What is AIDS? It is about learning to live).'