One of Fulcrum Aid’s objectives is to be able to respond quickly and efficiently when we hear of an opportunity to interrupt extreme inequality. However sometimes it just doesn’t work that way. The exploration of a program to support HIV affected children in Bangladesh is a classic example. After five years of conversations, research and stakeholder meetings, we are now just beginning to prepare a proposal for a HIV program with our Bangladeshi partners.

It started in November 2012. I was in Dhaka meeting with Dr Peter Halder, the Founding Director of Bangladesh Youth First Concern (BYFC), when he shared his concern for a small number of children living on the streets who had lost their parents to AIDS. This was long before Fulcrum Aid was formed, but I promised Peter I would support him.

In 2014 I returned with Angela Stewart and Shila Yukuli Phopo to explore the project, and then went again in 2016 for a consultation hosted by BYFC and including major stakeholders such as the national HIV department, UNAIDS, peer-to-peer service providers, and Dhaka University. I was impressed with the collaboration and mutual respect between the agencies, however there were different opinions about the proposed model of intervention which hindered the development of a project.

Bangladesh Youth First Concern (BYFC) initiated the consultation to guide the process of establishing a program for isolated HIV infected children in Bangladesh. The Chief Guest, Dr Md Anisur Rahman, representing the National AIDS/STD Plan, stressed the need for models of care based on best practice, and a coordinated strategy of all service providers.

The keynote presentation by Dr Saima Khan (Acting National Director of UNAIDS) provided current global and national data on HIV/AIDS. She noted that the global HIV infection rate of children fell by 58% from 2000 to 2014, with 32% accessing treatment - a significant improvement from just 14% in 2000. The prevalence of HIV infection remains low in Bangladesh with less than 0.1% of the population being HIV+. Amongst drug users who inject, the prevalence rises to 5.3% and other high risk sectors of the population include fly-in-fly-out workers. Dr Khan reported there were no recorded cases of mother-to-child infections in the past 12 months. The number of HIV+ children in Bangladesh remains low – currently estimated to be about 300 – however Dr Khan warned that these children face high risk of social isolation, stigma, deprivation from health care, education and basic needs such as food, shelter and emotional support. In several cases relatives had claimed the land belonging to children whose parents had died of AIDS.

Despite the risk of stigma and abuse Dr Khan strongly advised that children orphaned through HIV/AIDS should be cared for in their communities wherever possible. Ms Habiba Akter, the founding Director of Ashar Alo Society agreed, saying HIV+ children shouldn’t be given the “double trauma” of being taken from their communities, having already experienced severe losses. However she noted that declining resources were making their task increasingly difficult.

Dr Peter Halder and Mr Apurba Sarker presented the plan of BYFC to establish a program for isolated children infected with HIV who are not being catered for under current programs. Children who have fled or been driven from their communities face extreme risk and will be the highest priority for BYFC’s program. Fulcrum Aid is partnering with BYFC and will provide research, support in project design, advocacy and fundraising.

Photo: From left, Steve Blacket (Fulcrum Aid), Dr Md Anisur Rahman (NASP), Dr Ratu Saha (BYFC) & Dr Saima Khan (UNAIDS).

Bangladesh Youth First Concern (BYFC) will host a conference in Dhaka on February 22nd to consult with the key stakeholders, including UNICEF, WHO, UNAIDS, BRAC, Dhaka Medical College, about 20 local organisations involved in HIV, and Fulcrum Aid from Australia. It is hoped that the conference will map a strategy to establish the program that will ensure vulnerable children affected by HIV/AIDS have a safe home, plus access to education, medical treatment and psychological support.

Dr Peter Halder (pictured) Director of BYFC, reports it will be the only program of its kind in Bangladesh.

Fulcrum Aid has made a commitment to support the project and is working with staff from Flinders University and professionals from the Bangladesh community in Adelaide to provide research that will be used to design the model of care provided.

Dr Julie Robinson, Senior Lecturer in the School of Psychology at Flinders University, has supplied initial research outlining best practice for nurturing the development and well being of disadvantaged children in developing countries.

Dr Shahid Ullah, Senior Biostatistician at the South Australian Health and Medical Research Institute (SAHMRI) says “Fulcrum Aid is a great milestone of working with adults and children from extreme inequality to alleviate their suffering and to improve their lives. As a Bangladeshi national, I am so delighted to see the Bangladesh project "HIV affected children - Bangladesh” and raised my sincere appreciation to those who have taken initiatives of working with vulnerable HIV children in Bangladesh. It is my great pleasure to become part of Fulcrum Aid and work for disadvantaged children and adults in Bangladesh and the world."

Joining Dr Shahid Ullah and Dr Julie Robinson on our research team are Asma Akther (PhD candidate in Developmental Psychology), Shila Phopo (Fulcrum Aid Project Manager and DrPH candidate) and Dr Lillian Mwanri, (Senior Lecturer in Public Health, Flinders University).