An assessment of vulnerability to HIV infection of boatmen in Teknaf, Bangladesh

Abstract

BackgroundMobile population groups are at high risk for contracting HIV infection. Many factors contribute to this risk including high prevalence of risky behavior and increased risk of violence due to conflict and war. The Naf River serves as the primary border crossing point between Teknaf, Bangladesh and Mynamar [Burma] for both official and unofficial travel of people and goods. Little is known about the risk behavior of boatmen who travel back and forth between Teknaf and Myanmar. However, we hypothesize that boatmen may act as a bridging population for HIV/AIDS between the high-prevalence country of Myanmar and the low-prevalence country of Bangladesh.MethodsMethods included initial rapport building with community members, mapping of boatmen communities, and in-depth qualitative interviews with key informants and members from other vulnerable groups such as spouses of boatmen, commercial female sex workers, and injecting drug users. Information from the first three stages was used to create a cross-sectional survey that was administered to 433 boatmen.ResultsOver 40% of the boatmen had visited Myanmar during the course of their work. 17% of these boatmen had sex with CSW while abroad. There was a significant correlation found between the number of nights spent in Myanmar and sex with commercial sex workers.In the past year, 19% of all boatmen surveyed had sex with another man. 14% of boatmen had participated in group sex, with groups ranging in size from three to fourteen people. Condom use was rare {0 to 4.7% during the last month}, irrespective of types of sex partners. Regression analysis showed that boatmen who were 25 years and older were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the boatmen aged less than 25 years. Similarly deep-sea fishing boatmen and non-fishing boatmen were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the day long fishing boatmen adjusting for all other variables. Boatmen's knowledge regarding HIV transmission and personal risk perception for contracting HIV was low.ConclusionBoatmen in Teknaf are an integral part of a high-risk sexual behaviour network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection due to cross border mobility and unsafe sexual practices. There is an urgent need for designing interventions targeting boatmen in Teknaf to combat an impending epidemic of HIV among this group. They could be included in the serological surveillance as a vulnerable group. Interventions need to address issues on both sides of the border, other vulnerable groups, and refugees. Strong political will and cross border collaboration is mandatory for such interventions.

Group sex events amongst non-gay drug users: An understudied risk environment

“…Very few studies have been conducted of group sex and drug use in settings outside the USA other than those studying sex among men who have sex with men or the sexual behaviors of sex workers. Studies of Kenya (Njue, Voeten, & Remes, 2009) and of Bangladesh-Myanmar border boatmen (Gazi et al, 2008) suggest that research on group sex events and drug use might usefully be conducted in many countries.…”

HIV and AIDS in Bangladesh

“…HIV has not been detected in any of these groups sampled over the different rounds of surveillance with the exception of one rickshaw-puller out of 401 sampled in Dhaka during the 5 th Round of the serological surveillance (2003–2004)(12). However, high-risk behaviours for HIV/STIs have been recorded in the surveillance, and other special studies for truckers (30), rickshaw-pullers, and more recently in boatmen working in Teknaf (31). The latter study was conducted with boatmen who were aged ≥18 years living in Teknaf and working on boat-sailing from Teknaf in the last six months for trade, fishing, or carrying goods or passengers.…”

A comprehensive analysis of trends and determinants of HIV/AIDS knowledge among the Bangladeshi women based on Bangladesh Demographic and Health Surveys, 2007–2014

“…There are many potential factors that are attributable to this increased risk of HIV infection and/or transmission: geographical and cultural proximity to India and Myanmar-two severely affected countries [8, 11], poverty, gender inequity, high levels of transitional sex [12], mobility of boatmen across the border area [13], and especially, the low-level knowledge about HIV/AIDS. With the vision of reducing the risk of HIV infection and transmission, we should concentrate on these potential factors, however, many of these factors are often linked with the country’s health, demography, economy, politics, etc., which are not malleable enough to change or improvement.…”