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Title: Geographies of HIV/AIDS in Bangladesh : vulnerability, stigma and place
Author: Paul, Alak
ISNI:       0000 0004 2674 0699
Awarding Body: Durham University
Current Institution: Durham University
Date of Award: 2009
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HIV / AIDS is one of the most complex health and socio-economic problems which leads to adverse impacts on individuals, communities and societies. It becomes increasingly concentrated mostly among marginalized populations in the developing countries like Bangladesh. In south Asia, Bangladesh is a predominantly Muslim country, where it might be thought that HIV (by sexual and drug use activity) is not likely to be a problem because of traditional and conservative mores. But different surveillance rounds results have show Bangladesh to be at risk of an HIV epidemic. There are many risk and vulnerability factors such as geographical location, trans-border mobility, poverty, stigma and discrimination etc. which favour the spread or transmission of HIV / AIDS. Most studies in Bangladesh on HIV are medical in approach and generally ignore the socio-economic, cultural or geographic linkages of HIV. Many research works have been carried out on sexuality, STDs, drug use and awareness related to HIV infection, but few investigations have contributed to understanding the 'lifeworlds' of vulnerable people, and stigma of marginalized communities. In addition, few research projects have attempted to see the role of place and mobility in relation to HIV risk in Bangladesh. This negligence has left planners poorly equipped to design and implement HIV prevention strategies. The present research intends to bridge this gap in understanding health risk behaviour in relation to prejudice, place and policy points of view by exploring the issues of vulnerable and marginal people's lives which put them at risk of infection and also their adopted coping strategies and how are these played out. Apart from this, the aim is also to gain an understanding of the local civil society, people and policy planners' perceptions in explaining the vulnerability of people to HIV and its mitigation measures. This research takes a qualitative approach as a methodological research strategy which recognizes that people make a difference and places make a difference. In other words, the researcher has tried to explore the issue from a socio-geographic point of view along with health and policy planning in the field work in Jessore, Khulna and Dhaka. The location of both Jessore and Khulna has 'geographical value' as they have ports, brothels, opium dens, large transport terminals and slums. This research has been carried out on three social groups. First, I worked with people vulnerable and marginalized to HIV infection (i.e. sex workers, drug users, HIV positives and transport workers including Indian truckers). Second, I talked with local elites or people in civil society (i.e. journalists, NGO personnel and local government officials). Finally, I worked with key personnel and policy planners (i.e. high GOB and NGO officials) in Dhaka. Regarding the sampling frame, beside the NGO beneficiaries, I managed this challenging work by developing contact with marginalised people through 'snowball' sampling. Despite it being a sensitive issue, this research did not negatively impinge on my respondents from any ethical or moral point of view. To fulfill the research objectives, the work is fully based on qualitative methods for data collection (i.e. indepth interviews, focus group discussions, participant observation and naturalistic observation) and data analysis (i.e. discourse analysis and grounded theory). The researcher used flexible conversational techniques for questioning the participants in convenient places. The evolving HIV/AIDS pandemic has shown a consistent pattern through which marginalization, discrimination, stigmatization, and, more generally, a lack of respect for human rights and dignity of individuals and groups heighten their vulnerability. In particular, due to this social, economic and legal context, sex workers and drug users are subjected to harassment which can increase their 'everyday' vulnerability to sexually transmitted diseases and make them 'victims' to violence. Most HIV positive participants felt loss of self image and self-esteem, uncertain and unpredictable future and distressing emotions. Discrimination against them has also been increasing. The qualitative information in this research demonstrates the real health risk to HIV/AIDS of the vulnerable people through their 'lifeworlds'. This research also managed to highlight or distinguish the geographically significant places like port areas of Bangladesh in relation to STDIHIV/AIDS. It makes a relationship between geographic space and health risk particularly with drug users and sex workers through 'risk bridging'. Apart from women trafficking and Indian truckers, this research has also found much evidence that many vulnerable people including sex workers, drug users and transport workers are falling into health risk due to their high mobility and the role of risky and non-risky places. However, a transparent and accountable mechanism is needed to ensure stronger coordination of activities on HIV and to ensure that commitments to HIV prevention and control are effectively translated into action. The government must formulate and implement programs to reduce stigma and discrimination so that people living with HIV, and particularly members of vulnerable groups, can access services for prevention, care and support. Hopefully, this research will ultimately lead to a better understanding of the social and geographical context of HIV/AIDS and provide a better foundation for health planning. In addition, this research develops a methodology of investigation for the study of a complex health and social environment in Bangladesh.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available