Simply No Room

In Interviews on January 14, 2010 at 11:36 pm

AIDS Outreach in Pakistan and Bangladesh

Meghan Houser, Staff Writer

At an international forum this September, UNAIDS director Michel Sidibé spoke out against the criminalization of homosexuality for hindering global efforts against AIDS: “We have to remove these laws as they reflect deep-seated stigma and prejudice…Gay people are the ones who brought attention to HIV and AIDS but as we moved on to generalizing services for people with the virus, we forgot them.”[1]

80 countries worldwide consider homosexuality illegal. There are movements across the globe to overcome these sanctions, often led as much by public health and AIDS relief groups as human rights advocates. These advocates have gained major recent victories, such as a decriminalization ruling in India in July, a decision Sidibé dubbed a huge victory because “removing laws that criminalize and discriminate herald a new framework and new commitment and a new movement to universal access to health and human rights.”[2]

Some activists hoped that India’s “new commitment” to discrimination-free access to AIDS services would spread beyond its borders. But in some of these nations, antihomosexuality laws seem hopelessly entrenched through complexes of government denial and cultural phobia.

Islam is the state religion of Bangladesh and Pakistan—two nations that share British India’s old penal system—and while these countries do not necessarily invoke Sha’aria (under which the penalty for sodomy is death), their cultural climate grievously complicates any effort to decriminalize homosexuality.

Until the legal tide turns, how can HIV treatment for homosexuals be promoted in these countries? National approaches range from near total denial of the issue in Pakistan to promising cooperation with NGOs in Bangladesh. This has produced varying results in the treatment and containment of the epidemic.

In Pakistan, where an official in the National AIDS program stated in 2005 that “our better social and Islamic values” keep AIDs prevalence lower in the country,[3] the epidemic is undeniably growing: the first case was reported in 1987, which had grown to 1913 cases by 2002, and ballooned to 96,000 by 2007.[4] In 2006, a full seven percent of HIV positive individuals in Pakistan were gay men, a figure most likely underestimated due to difficulties in data collection.[5]

The paradox of Pakistan’s handling of the AIDS crisis is that at-risk groups such as homosexuals are the ones most often bereft of outreach driven underground by Pakistan’s strict Islamic moral and behavioral codes. “If my family found out they would kill me, I mean really kill me,” says Shelley, 23, a sometime male sex worker from Rawalpindi. “There is simply no room for what we are in Islam, which is very difficult for me as a Muslim and a gay man to live with.”[6] This taboo makes even finding volunteers for treatment difficult. Abid Atiq, program director of a sexual health NGO called Interact Pakistan, notes, ““We have to find them [homosexuals at risk] because they cannot find us…there’s a lot of distrust … They want to know who we are. Are we the police? Will we arrest them?”[7]

Pakistani officials also refuse, in large part, to endorse preventative sexual health education—a sentiment reflected in cultural perceptions as much as law. “When I go home at night I simply can’t talk about the work I do with my wife, my parents, my brothers or sisters,” says Atiq. “99% of families in Pakistan can’t even begin to discuss the issue. Not won’t but can’t.”[8] While there have been advertisements to promote AIDS awareness since 1993, words such as “sex” and “condom” are often ommitted. Even possessing a condom is discouraged: A male sex worker interviewed in 2005 cited fear of law enforcement as his main reason to go without.[9]

Unsurprisingly, a UNAIDS sur vey in 2007 found that around 90% of male sex workers had unprotected anal sex on a regular basis. It has been estimated that only about 20% of sexually active gay men were being reached by any sort of AIDS prevention program.[10]

Though Bangladesh shares Pakistan’s religion and British India’s Penal Code, the outlook for HIV management among homosexuals seems brighter. The Bandhu Social Welfare Society, an NGO that has provided more than 76,000 gay men with sexual health education, is expanding with government support.[11]

Interestingly, Bangladesh often centers AIDS awareness drives around mosques. Since 1998, some 20,000 Bangladeshi imams have been coached to spread the word about high-risk practices and resources for treatment. ‘’They can easily overcome the social taboo against discussing HIV/AIDS,’’ says Syed Ashraf Ali, director general of the Islamic Foundation Bangladesh. ‘’An imam addresses a familiar cohort, one that he meets every week.’’[12]

These and other widespread, state-advocated AIDS initiatives have led to a more hopeful statistical picture for Bangladeshi homosexuals: a UNAIDS study in 2005 found that almost 80% of homosexual men were reached by prevention programs, and more than 45% of sexually active gay men reported using a condom at their last intercourse.[13]

Some admissions must be made in comparing these two profiles. Bangladesh still has a long way to go in addressing the AIDS epidemic among its homosexuals, and maintaining the illegality of same-sex relations can only hamper further efforts by keeping the homosexual community silent. It is equally true that Pakistan’s government is not wholly in denial about the need to address AIDS among homosexuals: the government recently developed an “Enhanced HIV & AIDS Control Program” targeting high-risk groups.[14]

Whether one focuses on the clouds or their silver linings in Pakistan and Bangladesh, one can only hope that Mr. Sidibé’s “new movement” towards universal human rights and healthcare is truly afoot, leaving prejudice by the wayside.


1 IGLHRC, “India: Government Defers Decision on 377 to Supreme Court,” International Gay and Lesbian Human Rights Commission, September 18, 2009, http://www.iglhrc.org/cgi-bin/iowa/article/takeaction/resourcecenter/974.html#

2 Ibid.
3 Laura M. Kelley and Nicholas Eberstadt, “Behind the veil of a public health crisis: HIV / AIDS in the Muslim World,” National Bureau of Asian Research, June 2005 (NBR Special Report), 4.
4 2007 AIDS Epidemic Regional Update Summary: Asia. UNAIDS, 2007. <http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2007/default. asp> (Accessed 17 Oct 2009)

5 “Pakistan: Progress towards Universal Access and The Declaration of Commitment on HIV/AIDS.” UNAIDS country factsheet, 2007. <http://cfs.unaids.org/country_factsheet.aspx?ISO=PAK&gt; (Accessed 17 Oct 2009)
6 Nicholas Harvey. “An Inconsistent Truth.” Fyne Times, 2008, 2-6, <http://www.nickandmaggie.com/article/An_Inconsistent_Truth,_Fyne_Times.pdf&gt; (Accessed 17 Oct 2009)
7 Ibid. 3.
8 Ibid. 1.
9 Alefiyah Rajabali et al., “HIV and Homosexuality in Pakistan,” The Lancet Infectious Diseases (vol.8, issue 8), August 2008, 511 – 515.
10 “Pakistan: Progress towards Universal Access and The Declaration of Commitment on HIV/AIDS.” UNAIDS country factsheet, 2007.

11 2007 AIDS Epidemic Regional Update Summary: Asia. UNAIDS, 2007.
12 Qurratul Ain Tahmina, “Bangladesh: Anti AIDS /HIV Efforts Follow Men To the Mosques,” Inter Press Service, November 15, 2002. <http://ipsnews.net/interna.asp?idnews=13898&gt; (Accessed 17 Oct 2009)
13 “Bangladesh: Progress towards Universal Access and The Declaration of Commitment on HIV/AIDS.” UNAIDS country factsheet, 2007. <http://cfs.indicatorregistry.org/country_factsheet.aspx?ISO=BAN&gt; (Accessed 17 Oct 2009)
14 “Pakistan: Progress towards Universal Access and The Declaration of Commitment on HIV/AIDS.” UNAIDS country factsheet, 2007.


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