Correspondence
In Sindh province, different
regu­latory bodies are working in
isolation, including the Sindh Blood
Transfusion Authority, the Sindh
AIDS Control Program, and the
newly established Sindh Healthcare
Commission. These bodies should
have developed a roadmap to
monitor medical practitioners and
to stop quackery. Additionally, in dire
scenarios such as that in Larkana,
federal government should step in to
facilitate the provincial government
by ensuring the continuous supply of
WHO-recommended HIV screening
kits and medicines. A door-to-door
campaign should start in Larkana
city, as a collaboration between
federal and provincial governments
and the private sector. International
monitoring agencies should also
support the poor health-care system
of the province.
We declare no competing interests.
Muhammad Zaid, Muhammad Ali,
*Muhammad Sohail Afzal
sohail.ncvi@gmail.com
Department of Life Sciences, School of Science,
University of Management and Technology, Lahore,
Pakistan
1 Zaid M, Afzal MS. HIV outbreak in Pakistan.
Lancet Infect Dis 2018; 18: 601.
2 The News International. WHO declares HIV
outbreak in Larkana as ‘Grade 2 Emergency’.
https://www.thenews.com.pk/latest/481688-
who-declares-hiv-outbreak-in-larkana-as-
grade-2-emergency (accessed June 10, 2019).
3 Khan MH. HIV cases in Larkana put a question
mark on Sindh’s healthcare system.
Dawn News; May 5, 2019. https://www.dawn.
com/news/1480257 (accessed May 8, 2019).
HIV infection in
Rohingya refugees in
Bangladesh
The Rohingya people face discrimin­
ation, detention, violence, and
torture in their native Myanmar, as
a result of the government’s denial
of their citizenship.1 Nearly 1 million
individuals have fled to refugee
www.thelancet.com/hiv Vol 6 July 2019 e419
camps in Cox’s Bazar, Bangladesh.2 By
Aug 28, 2018, 273 cases of HIV had
been officially recorded, increasing to
319 as of March 8, 2019, with more
undiagnosed cases likely. 3 Among
the 319 HIV cases, 277 were taking
medication and 19 had died.3
The situation demands attention
for several reasons. Prevalence of HIV
is high in the background population
of Myanmar. 4 Rohingya women
and children face sexual violence,
including gang-rapes, in Myanmar 1
and the incidence of sexual violence
has increased among the refugees.1
An absence of basic living facilities
during humanitarian crises places
girls and women at particularly high
risk of exploitation and exposure to
HIV and other sexually transmitted
infections.2,3 The prevalence of HIV
among injection-drug users in
Bangladesh is 1·1%, 2 and because
Cox’s Bazar is well known for drug
trafficking, both the general and
refugee population are at risk of
drug abuse and HIV exposure.
Finally, the diagnostic and treatment
infrastructure for HIV/AIDS is
poor in Bangladesh. Only 3900 of
12 000 people living with HIV are
aware of their status and only 1800
are on antiretroviral treatment. 2
This gap in the identification
and management of HIV within
Bangladesh makes Rohingya refugees
more vulnerable to HIV. Furthermore,
HIV affects the quality of life among
infected individuals and their
families, while contributing potential
sources of accrued infections among
sexual partners and children.
Although Bangladesh’s National
Strategic Plan for HIV and AIDS
has taken up the task of expanding
programme coverage to the Rohingya
refugees, this remains insufficient.4
Under the leadership of the AIDS/STD
Programme, the health sector has
convened stakeholders to strengthen
and update the HIV response
framework.5
To prevent the crisis getting
worse, there needs to be initiation
of extensive behavioural change
communication programmes to
increase the Rohingya population’s
awareness of HIV, alongside allied
preventive measures, such as provision
of social protection to vulnerable
women and children, promotion of
barrier methods of contraception
among sexually active women, and
strengthening of measures to prevent
drug use and forced prostitution in
the Cox’s Bazar district. Moreover,
existing health-care providers should
be empowered to identify and to
treat people with HIV. Finally, all
relevant international agencies should
recognise HIV as a priority to prevent
the negative health and socioeconomic
consequences of this latent epidemic.
We declare no competing interests.
*Kamrul Hsan, Mark D Griffiths,
David Gozal,
Mohammad Azizur Rahman
kamrul.phi.ju@gmail.com
Department of Public Health & Informatics,
Jahangirnagar University, Dhaka, Bangladesh (KH),
Institute of Allergy and Clinical Immunology of
Bangladesh, Dhaka, Bangladesh (KH), Humanitarian
Response Organization, Dhaka, Bangladesh (KH),
International Gaming Research Unit, Department of
Psychology, Nottingham Trent University,
Nottingham, UK (MDG), Department of Child
Health, University of Missouri School of Medicine,
Columbia, MO, USA (DG), Department of
Biochemistry and Molecular Biology, Jahangirnagar
University, Dhaka, Bangladesh (MAR)
1 Islam MM, Nuzhath T. Health risks of
Rohingya refugee population in Bangladesh:
a call for global attention. J Glob Health 2018;
8: 020309.
2 Hossain MM, Sultana A, Mazumder H,
Munzur-E-Murshid. Sexually transmitted
infections among Rohingya refugees in
Bangladesh. Lancet HIV 2018; 5: e342.
3 Ukhiya News. 319 Rohingyas affected by
AIDS. http://en.ukhiyanews.com/by-aids
(accessed March 30, 2019).
4 WHO. Bangladesh: Rohingya Refugee Crisis
2017–2018. http://www.searo.who.int/
mediacentre/emergencies/bangladesh-
myanmar/public-health-situation-analysis-
may-2018.pdf?ua=1 (accessed April 19, 2019).
5 WHO. Emergency type: Rohingya Refugee
Crisis–Weekly Situation Report #52. http://
www.searo.who.int/bangladesh/
weeklysitrep52cxbban.pdf?ua=1&ua=1&ua=1
(accessed April 19, 2019).