Baseline Report RPDO

Baseline Report of RPDO Consortium 1
Baseline Survey
On
Knowledge, Attitudes & Behaviours

regarding HIV/AIDS Among
Hotel & Residence Based High Risk
Group
ACKNOWLEDGEMENTS
We would like to thank the following people and organizations for their support in
this survey.
- The National Department of Health, STI & HIV Prevention. A number of staff
of this department were assist us to conduct the study including planning
and administration issues, assistance and support in data collection and
reviewing the data and report.
- The consortium Team leaders, who was involved in most of the stages of
planning of the survey. He assisted the research team in each district by
supporting the data collection process and liaising with facilities as
required.
- The consortium DIC staffs, who contribute immensely through assisting the
data collecting team during data collection.
- Mr. Tofael of UNICEF who advised on the sampling methodology and also
supported the survey and encouraged the research team from its earliest
stages.
And last but not least,

- The data collectors, who participated in the survey and the in particular the
respondents who assisted the research team in the collection of data.
CONTENTS
Acknowledgements............................................................ 2
List of Abbreviations........................................................... 4
Foreword......................................................................... 5
Executive Summary ............................................................ 6
1 Introduction ................................................................... 7
1.1 STIs and HIV in Bangladesh ...................................... 7
1.2 Justification of the study...................................... .. 7
1.3 Objective of the study........................................ .. .. 8
1.4 Methodology ................................... ............ 8
1.5 Sampling Frame ...................................... ............ 10
2. Limitations ........................................................................ 12
3. Baseline Survey Results.................................................... 13

3.A Socio-demographic Profile of the respondents 13
3.B Income & Savings .........................................………….. 15
3.C Sex work & Condom Use........................................... 19
3.D Knowledge & Perception on HIV................................... 23
3.E STI Related Issues ........................................... .......... 27
3.F Harassment /Abuse/Violence.............................. .......... 29
4. Recommendation ........................................ .......... .......... 31
5. Conclusion ........................................ ........ ........ ........ 32
5. References .................................................. .......... .......... 33

List of Abbreviations
AIDS Acquired Immune Deficiency Syndrome
CI Confidence Interval
DFID Department for International Development
EDL Essential Drug List
FC Female Condom
HIV Human Immunodeficiency Virus
IEC Information, Education and Communication
NGO Non-Government Organization
NASP National AIDS/STD Program
STI Sexually Transmitted Infection
USAID United States Agency for International Development
VCT Voluntary Counseling and Testing
WHO World Health Organization
RPDO Rural Poor Development Organization
AASARR Association for Social Advancement & Rural Rehabilitation
ORA Organization For Rural Advancement
CDWF Community Development Welfare Foundation
UNICEF United Nations Children’s Fund

Foreword
It gives us a great pleasure to be able to present this summary report of the results
of the first baseline assessment of RPDO Consortium. It lays out a wealth of data;
the success stories and the challenges that confront us as we strive to improve the
delivery of care for HIV/AIDS & Sexually Transmitted Infections. This can serve as
an entry point for prevention services that stand to reduce the rates of both HIV
and other sexually transmitted infections.
I would like to take this opportunity to thank all those involved in this massive
task, especially a core group from the consortium, and the STI & HIV Prevention
Unit of the Government. Without their tireless commitment this survey would not
have been successful.
I am confident that these findings will make a positive contribution to improving

the quality and sustainability of STI & HIV services in public sector facilities in
Bangladesh.
Md. Fazlul Karim Chowdhury

On behalf of the research team
Executive Summary
There is a paucity of data available in Bangladesh on the management of sexually

transmitted infections (including HIV) in public sector primary health care (PHC)
facilities. Hence, a comprehensive national baseline survey of HIV prevention and
Sexually Transmitted Infection (STI) and management services was conducted in
collaboration with the UNICEF and on behalf of RPDO Consortium between
November 2004 to January 2005.
The primary objectives of the survey were to ascertain the current status of the
HIV/AIDS epidemic and the risk of behaviors among the Hotel & Residence based
High risk population in a aim to increasing access to STI/HIV prevention services,
and reducing new HIV infections. Furthermore, it is anticipated that findings will
inform the selection of measurable indicators for ongoing monitoring and
evaluation of the national STI programme. Data were collected by a pre-set
questionnaire which was tested in four locations (district) of Bangladesh. Detailed
information on specific aspects of the HIV and STI prevention and management
was obtained by interviews with 343 respondents at national and provincial levels.
This survey estimates that:
- Local Administration plays a vital role in this context. 37.8% of the
respondents say that the police mostly harass them.
- Most of the respondents are primarily literate (i.e. 83.4%)
- Average age of the respondents are 23.59 years
- Average daily income of the targeted population of this survey is Tk. 166
- Very poor attitude of savings. 73.2% have no savings and
- Due to the financial crisis most of them choose this profession
- 98.5% know about the primary information of HIV/AIDS but in major
- they know, condom is the only way to prevent STD & HIV
- 38.5% of the respondent know proper use of condom but only 6.7% of them
use condom in the last week
- Usually the clients dislike to use condom
- Most of them do not want to take any suggestion from any physician
regarding STI treatment
A number of interventions have been identified to strengthen STI/HIV management

and prevention services in public sector. These include in-service training and
transfer of skills to health care providers, and the implementation of systems for
monitoring and evaluation of key activities, for support and supervision, and for
human resources management, to ensure that opportunities to provide prompt and
effective treatment for STIs, and for prevention of HIV infection are not missed.
1. INTRODUCTION
1.1 STI AND HIV IN BANGLADESH
Sexually transmitted infections (STIs) have become a global burden; the World
Health Organization (WHO) estimates that about 340 million new cases of curable
STIs occur each year in people aged 15-49 years. The low knowledge on HIV and
STI that are seen in the selected districts are associated with the possibility to
spread of HIV in the region.
STIs constitute a major public health challenge to Bangladesh. It is estimated that
approximately 13000 thousand Bangladeshis were infected with HIV at the end of
2003. STIs are associated with transmission and acquisition of HIV infection.
Several studies have shown that treatment of curable STIs reduces HIV
transmission. Prevention and early treatment of STIs is therefore a high public
health priority in Bangladesh.
1.2 JUSTIFICATION OF THE STUDY:
The significance of comprehensive baseline information of a given community is

manifold. Certainly baseline information is, in extreme instances, the only
agreeable reference to project's achievement or failure against the stated goal
and purpose of the project. Thus, primarily, to measure the progress made by the
project over a period and finally, evaluating the project's achievement at the end
of the project, baseline information is required to compare to determine the
quality and magnitude of progression made by the project. Even beyond the
project life, baseline information is critical to appraise the project impact over
the life of the beneficiaries.
Another dimension of baseline information is to serve as a 'benchmark' to project's

regular monitoring systems aiming at providing the project with required
management information that is expected to roll-on the project on right track
towards achieving project's goal and purpose. Using similar kind of parameters, the
monitoring data, as compared against the baseline information, can guide project
management to see whether the project intervention and strategies are adequate
and effective in achieving the project purpose and goal or there is a need for
redefining the strategies or interventions.
Thereupon, a comprehensive baseline record is essential for the project to help

project management in all the way of project planning, implementation,
modification of project components or strategies, measuring the progress of the
project, determining the success or failure, identifying the backdrops and
evaluating the project impact against the expected project outputs, purpose, and
goal.
1.3 OBJECTIVE OF THE STUDY
The specific objectives of the study are to:

 Measure the socio-economic profile and current livelihood status of the
targeted adolescent groups
 Appraise their awareness on HIVAIDS and STDs and practices, if any, to
prevent HIV/AIDS/STDs.
 Assess the knowledge level of the target groups as well as their human and
legal rights
 Measure the Knowledge and perception of the target group
 Identify their current practices of reproductive health and nutrition
 Determine their health seeking behavior
 Assess their safer sex practicing
 Measure their client negotiation skills
 Assess their constraints regarding their empowerment
 Identified their power structure
1.4 METHODOLOGY
Survey design
The study will follow a cross-sectional design and will be conducted in 13 districts;
such as Tangail, Jamalpur, Jessore, Narayanganj, Narshingdi, Khulna, Jhenidaha,
Kishorogonj, Netrakona Satkhira, Gazipur, Mymensingh, and Bagerhat at different
geographical locations. Both qualitative and quantitative methods (using
pre-structured questionnaire) will be used in gathering data and information.
Sampling design & target population
Considering the wide variations across the project operational areas, it is

worthwhile to design a sampling frame to minimize the sampling error. For
selecting samples, a systematic random sampling procedure will be followed.
A standard statistical formula will be used to determine the representative sample

size based on study population. Thus
n = z2pq / d2
Where,
n = the desired sample size (when population size is ≥ 10,000)
z = the standard normal deviate, usually set at 1.96, which corresponds to the 95
percent confidence level
p = the proportion in the target population estimated to have a particular

characteristics. If there is no reasonable estimate, than use 50 percent i.e.
(.50)
q = 1.0 – p
d = degree of accuracy desired, usually set at .05
Therefore,
n = (1.96)2 (.5) (.5) / (.05)2
= 384
However, the above sample size is not appropriate for our study. Because, our
target population are # 2558 hotel base sex workers, and 742 residence based sex
worker i.e. a total of 3300 sex worker which is provided by RPDO Consortium.
Hence, if the population is < 10,000, the required sample size will be smaller. In
this case, calculate a final sample estimate (nf) by using the following formula:
nf = n / 1 + (n/N)
Where, N is the total population size
Accordingly, the required sample size will be:
nf = 384 / 1 + (384/3300)
= 384 / 1 + .11636363
= 384 / 1.11636363
= 343.973943
= 344 (App.)
1.5 SAMPLING FRAME FOR BASELINE
Primary target group Sample

Sample Size
(SW): No. Size Total
Implementi Districts For
For Hotel Sample/
ng NGO Name Residence
Hotel Res. Total based based HRG
District
HRG
Tangail 235 78 313 24 8 33
RPDO Jamalpur 170 51 221 18 5 23
Jessore 368 56 424 38 6 44
Narayanga 562 120 682
nj 59 13 71
ASARR Narshingdi 97 61 158 10 6 16
Khulna 458 102 560 48 11 58
Jhenidaha 65 24 89 7 3 9
Kishorogon 98 44 142
j 10 5 15
ORA Netrakona 72 26 98 8 3 10
Satkhira 65 41 106 7 4 11
Gazipur 151 52 203 16 5 21
Mymensing 197
CDWF
h 140 57 15 6 21
Bagerhat 77 30 107 8 3 11
Total 13 DiCs 2558 742 3300 267 77 344
To select respondents, individuals who appeared to the interviewer to fit a

particular quota category (e.g., Hotel or residence based sex worker) were
approached, asked if they would participate in a short interview about health and
some personal issues and, if they agreed, than we proceed for the interview.
Target Population**
Category Percent Cumulative Percent
Residence Based 27.1 27.1
Hotel Based 72.9 100.0
Total 100.0
It should be noted that, because of the sampling technique used, the respondents
do not make up a representative sample of the population of Bangladesh or of
their particular quota category. However, the sampling plan ensured that
respondents were selected from most of the Hotels and some specific residence of
the selected towns. Very few individuals approached for an interview refused to
participate, further limiting potential bias.
Thus, though not statistically representative, it is believed that the survey findings
are indicative of the HIV/AIDS knowledge, attitudes and behaviors of those in the
categories of interest and are therefore useful for program guidance.
Design data collection instruments, pre- test and finalization
Based on the objectives of the survey and specific information needs, structured
questionnaire will be developed to interview the sampled individuals. To
fine-tune/finalization of the questionnaire, a dry run of the questionnaire will be
conducted in real field situation.
Field Data Collection Team
A total of 9 (nine) data collectors were assigned to collect the data from
pre-determined-sampled individuals following a data collection schedule which
take about 23 days.
Data entry and processing
In data entry and processing user-friendly database (which will follow standard
skip and range rules) was designed using popular software MS-Access and the
consistency checking, recoding and verifying of data during processing period/time
was done through world famous sophisticated statistical software SPSS.
Develop data analysis plan and analysis
Data in this survey were analyzed to describe/narrate the current situation of the
targeted groups in the specific areas based on the study objectives.
Quantitative data was analyzed using two possible ways-uni-variate and bi-variate
analysis using the software SPSS to generate tables with statistical tests. MS
PowerPoint was used to generate graphical presentations of information.
2. LIMITATIONS OF THE SURVEY

As with any such survey, there are potential limitations that are discussed here to
prevent misinterpretation of the results.
• Bias may have been introduced based on the selection of people to be

interviewed. For example, the selection of commercial sex workers was based on
somewhat subjective criteria.
• It is the perception of the interviewers and supervisors that respondents were

largely forthcoming during the interview, providing open and honest answers to
the questions posed. Nevertheless, as in all surveys, respondents may have
modified their answers according to social norms or to their perceptions of
interviewer expectations.
• Although we believe the survey to be indicative of the knowledge, attitudes and

behaviors of the groups of interest in the selected areas, the results cannot be
applied to the general population.
3. BASELINE SURVEY RESULTS

A. SOCIO-DEMOGRAPHIC PROFILE OF THE RESPONDENTS
Age Distribution1**
About 73% of the Range Number Percentage (%)

respondents were <12 years 0 0
found in the young 12-18 years 62 18
age i.e. 19-30 19-30 years 251 73
years. 18% of the 31-40 years 30 9
sample populations >40 years 0 0
are adolescent. The Total 343 100
mean age found
almost 24 years.
Minimum Age 14 The age of the younger respondent is 14 years

Maximum Age 40 and the eldest 40 years.
Graph: 01 Age Distribution
300
251
250
200
150
100 62
30
50 0 0
0
<12 years 12-18 years 19-30 years 31-40 years >40 years
The graph clearly expresses the scenario of the age distribution. One of the most
highlight area may be the 12 to 18 age group. 62 percent of the respondents are
persisting in this group.
As we have not verified the age through any other sources but only what they’re
saying, there is a possibility to turn this result in a slightly different way.
Marital Status**
1
** indicates the core questions from UNICEF
Category Number Percent The majority of the respondents were

Married 113 32.9 married (32.9%). Next to that, 27.7% were
Unmarried 95 27.7 found unmarried. A significant number of
Widow 23 6.7 respondent are separated, which indicates
Divorced 38 11.1 the vulnerabilities of the target community.
Separated 74 21.6
Total 343 100.0
Dependency Status**
Mean 3.8 Most of the respondents have dependents. The

St. Dev 0.90 dependents are defined in first blood
N 243 connection. An average of 3.18 persons found
dependent on each of the respondents. The
dependency also indicates their vulnerability to lead their life in a decent way.
Most interestingly some of the respondent says that, the parents and in some time
the grand parents are also depend on them, though they have eligible big
brothers.
Choosing Sex profession in age**
Age Number Percentage (%)

<12 years 0 0
12-18 years 127 37
19-30 years 213 62.1
>31 years 3 .9
Total 343 100
Between the age 19-30years, most of them were started working as a sex worker.
Out of 343 respondents, only 3 persons found who have age more than 31 years.
B INCOME & SAVINGS
99% of the respondents say sexual act is the main source of their income. None of
them received any types of financial assistance from their family. The average
daily income found Tk. 166. The minimum daily income found Tk. 50 and
maximum Tk. 600.
Daily Income**
Income in AGE in Years Total

Taka <12 12-18 19-30 31-40 >40
1-100 0 9 69 11 0 89
101-200 0 40 155 14 0 209
201-300 0 12 26 4 0 42
301-400 0 0 0 1 0 1
401-500 0 1 0 0 0 1
>500 0 0 1 0 0 1
Total 0 62 251 30 0 343
Most of the respondents earn Tk. 100 to Tk. 200 per day and more specifically
most of them are 19 to 30 age group. Only one member found who earned more
that Tk. 600 per day. 89 respondent answer that they earn less than or equals to
Tk. 100 per day through sex act.
Savings from the income
Most of the respondents have no savings. It indicates their financial vulnerability

and less interest on future planning.
Savings Status**
Hand Cash Number Percentage (%)

<50 73 21.32
50-100 16 4.5
101-150 1 .3
151-200 0 0
>200 2 .6
No savings 251 72.24
Total 343 98.96
Out of 343, only 19 respondents have savings more that Tk. 50. A majority of 73
respondents says that, they have a minimum amount of savings (less than fifty
taka). As a result, most of them came in to this profession. 275 respondents out of
343 say about their financial crisis and they were derived to this profession to
overcome the situation.
Main cause of choosing this profession
A job may add significantly to family incomes and give women a degree of
independence, but exploitation is widespread and job security non-existent. The
recession and lack of bargaining power of women due to gender inequality, keep
many of them who work in the informal sector trapped in poverty by compelling
them to accept risky and socially neglected profession like Sex Work with low pay
and poor working conditions.
There is a major job gap compared with the available female workforce in
industrial countries. The survey results predict that this job gap will continue to
widen, resulting in a flow into unemployment of increasingly alarming proportions,
particularly for young females and women.
Major causes to choose this profession**
Causes Percentage (%)

Financial need 55
Greed 14.8
Disheartened of Love 6.6
Separated by husband 8.4
Kidnapped 3
By brokers 11.8
Others .4
The survey result also indicates that all of the hotel and residence based high risk
populations are forced to choose this profession, not by their own interest. The
following table indicates that less scope of work (financial crisis) forced the
surveyed population to turn their life in this profession.
Women trafficking is emerge issue now a days. The above scenario also indicates
the vulnerability of not only the respondents but also the local administrations
who are quite fail to control the issue of trafficking. A key alarming information is
that, 11.8 percent said that they were picked-up to this business by the brokers.
As a result of greed, 14.8 percent women came to this business, which indicates
the week controlling systems of our social security.
The following table address the key issues on a more concentrated ways through
separate in different marital category.
Marital status Vs Cause of this profession
Cause of choosing Marital Status

this profession Married Unmarried Widow Divorced Separated
Financial 106 56 19 28 66
By greed 26 27 4 5 12
By end of love 3 30 0 0 0
Separated 0 1 1 15 25
Kidnapped 1 7 0 1 6
Brokers 11 19 9 14 6
Others 2 0 0 0 0
Total 149 140 33 63 115
A total of 149 married women came to this profession and the need of finance is
the key point to turn on this line.
Educational Qualification (General)
Category Number Percentage (%)

Illiterate 57 16.6
1st Class-5th Class 119 34.7
6th Class-8th Class 101 29
9th Class-10th Class 47 13.7
11th Class-12th Class 16 4.7
More than 12th Class 3 .9
Non formal Education 0 0
Total 343 99.6
Though most of the women are picked up from rural areas, they are relatively
having the basic education. 77.8% percent (267 respondents) have formal schooling
of at least class I to X. Only 16.6 % respondents found illiterates. But there is only
a few who have studied more than class 12, and none of the respondent found as a
post-graduate.
The following comparative analysis indicates that, most of the respondents of age
group 19-30 are quite in a literate stage including 2 graduations.
Educational Qualification (Age Frequency wise)
Education Total
9th- 11th- Degree
Age in Illiterat 1st-5th 6th -8th 10th 12th and
years e Class Class Class Class Above
<12 0 0 0 0 0 0 0
12-18 3 14 32 13 0 0 62
19-30 43 94 65 31 16 2 251
31-40 11 11 4 3 0 1 30
>40 0 0 0 0 0 0 0
Total 57 119 101 47 16 3 343
Out of 243, graduation completed by 3 respondents of different specific age group.

The adolescent group of 12 to 18 years found that, out of 62 respondents 59 of
them at least have the basic education.
C SEX WORK AND CONDOM USE
At present, 100 percent use of condom is one of the major ways to prevent the
rate of HIV/AIDS. Uses of condom during sex act, also treated as a part of safer sex
practice. So the proper use of condom among the high risk population is very much
essential to implement such a program.
Knowledge about Condom use
Condom Knowledge Total

Age in Years
Yes No
<12 0 0 0
12-18 59 3 62
19-30 244 7 251
31-40 30 0 30
> 40 0 0 0
Total 333 10 343
As a primary result of survey, 97% of the surveyed person response positively, that
they have at least a primary concept on condom. A few (10 respondents) says that,
they don’t have any knowledge about condom. Most of the respondents of this
leman groups stands on 19-30 ages.
Concept About Female Condom**
Female Condom Total The respondents of this survey

Yes No actually understand only the male
condoms. Only 9 respondents out
94 239 333
of 342 says that, they heard about
3 6 9 the female condom.
97 245 342 In fact female condom is very rare

and also it is not available in the general places. It cost high and most of the
peoples don’t know about the use of this type of condoms.
Proper use of condoms**
Condom use properly Number Percentage (%)

Yes 132 38.4
No 206 60
No respond 5 1.3
Total 343 99.7
But the most interesting findings are that, 206 respondents out of 343, doesn’t
know how to use the condoms.
Though 97% of the respondents knows about the condom and 38.5 % can use the
condom properly, due to ignorance, force of clients and different various region
only 6.7% can use the condom in a regular basis. The following table indicates the
irregularities on condom use.
Condom Use rate (last seven days)**
Condom use Number Percentage (%)

Yes 23 6.6
No 319 93
No respond 1 .3
Total 343 100
High-risk group behaviors regarding condom use are consistent with their low
levels of knowledge and stated lack of concern. Only 18.4% of respondents
reported condom use the last time they had sex, and 76.7% reported having ever
used a condom. Such low levels of condom use among this important group are
alarming.
Condom Use rate (last time)**
Condom use Number Percentage (%)

Yes 63 18.4
No 263 76.7
No respond 17 4.9
Total 343 100
The scenario of last time condom use is much serious. The rate is higher among
the residence based high-risk groups. There is a scope to learn from each other
among the hotel based high-risk groups but the scope is limited between the
residences based.
Condom Use Rate (last time-Population category)

Condom use in the last time of
Target Population intercourse Total
Yes No
1:Residence Based 12 76 88
51 187 238
2:Hotel Based
Total 63 263 326
Most of them know the sources of condom. They treated the pharmacy and the
general/grocery shops as the main source of condom.
Condom Availability**
Condom availability Number Percentage (%)
Family Planning Workers 73 9.6
Health Workers 99 13.1
Pharmacy 325 43.2
General Shop 188 25
NGO 63 8.3
Don’t Know 4 .5
Others 2 .3
Though a huge number of NGOs work on this field only 8.3 percent of the
respondent says that, they collect condoms from the NGO workers. The govt. and
NGO level initiatives can’t play a influential role regarding the condom
availability. Only 31 percent of the respondent goes to this group (FP workers,
Health workers and NGO workers) for collecting condoms.
Client contact**
AGE in Years Total

No of Clients
<12 12-18 19-30 31-40 >40
1 0 5 15 0 0 20
2 0 33 148 16 0 197
3 0 22 54 10 0 86
4 0 2 30 0 0 32
5 0 0 4 3 0 7
6 0 0 0 1 0 1
Total 0 62 251 30 0 343
197 respondent says that, they receive two clients per day in an average. Only one
respondent answer that, she take six clients per day. The age groups of 19-30
contact most of the clients.
Condom promotion/negotiation with the clients is a very critical and sensitive

issue. Most of the people know about the vulnerability of HIV/AIDS and also know
that, safer sex practice with condom is a major way to prevent HIV/AIDS though
most of them are not interested to use condom during any sex act.
The following table indicates the same result during the survey.
Problem to use condom with clients **
Problem of using condom Number Percentage (%)

Yes 273 79.6
No 4 1.2
Sometimes 55 16
No respond 11 3.2
Total 343 100
Out of 343 respondents, 273 of them faced problem with clients regarding using
condoms and 55 of them says that some times they faced problems to use condom
with clients.
Other than that, the clients, whom they enforce to use condom, tortured the high-
risk group in many ways. This type of behaviour of clients indicates the
susceptibility of the high-risk group and violation of the human rights. Most of the
time the law enforcements agencies ignore this type of matter, which encourage
the clients to continue the behaviour in it.
Types of Problems during using condoms**
Types of Problem Percentage (%)

Clients don’t take 24.4
Clients tortured 4.4
Sexual intercourse with pressure 6.8
Don’t take enough time to put condom 1.8
Clients don’t feel interest 21.4
Clients avoid me/give less money 14.4
I perform sexual intercourse without condom .4
I don’t feel interest/satisfaction 3.4
Its take enough time to use condom 1.5
Clients don’t want to use condom 20.2
I don’t want to buy condom .1
I am not dare to say .9
Others 0
Total 99.7
D KNOWLEDGE AND PERCEPTION ON HIV
The respondents were asked about their general perception on HIV/AIDS. Out of
343, about 98.5% (i.e. 338) respondent says that they are heard about the
HIV/AIDS. Most of the respondent in all categories are aware about HIV/AIDS.
Knowledge of HIV **
HIV/AIDS Knowledge Total

Age in Years
Yes No
<12 0 0 0
12-18 61 1 62
19-30 248 3 251
31-40 29 1 30
> 40 0 0 0
Total 338 5 343
The NGOs are playing a leading role in spreading the message (28.2%) to the mass
people. Next to that, friends and TV media played a vital role to disseminate the
message of HIV/AIDS. Significantly only 80 respondents say that they heard the
information on HIV/AIDS from the health workers, which should be the most prior
source of information.
Source of information**
Media Number Percentage (%)
Radio 47 6.5
Newspaper 6 .8
Billboard/Poster 23 3.1
TV 171 23.1
Friends 201 27.2
NGO Workers 208 28.2
Family 1 .1
Health Workers 80 10.8
Clients 1 .1
Others media 1 .1
TRANSMISSION OF HIV/AIDS
The impact of AIDS on women (especially the hotel & residence based high risk
group) is severe, particularly in areas of the world where heterosexual sex is the
dominant mode of HIV transmission. In this sub-continental, women are 30% more
likely to be HIV-positive than men2. The difference in infection levels between
women and men is even more pronounced among young people.
To identify individual concept on HIV/AIDS transmission, a multiple choice

question was introduced. Most of the respondents have a general knowledge on
HIV/AIDS transmission. 62.2% of them say that, sex with AIDS infected persons
without condom is one of the major reasons for HIV/AIDS transmission. Only 16.6 %
of the respondent say that, AIDS can be transmitted through using others used
needle and syringe.
WAY OF HIV/AIDS TRANSMISSION**
Transmission Ways Percentage (%)

Sex with AIDS affected persons without condom 62.2
By using others used needle and syringe 16.6
AIDS affected mothers to child 1.4
Men/Women and Hijra .4
By close relation or taking food or sharing dress or 11
handshaking with affected persons
Byte of mosquito 5.4
Others .2
Don’t know 2.8
A very few respondents addressed that; HIV/AIDS may transmitted through mother
to child. This indicates their low level of perception about this issue. Moreover a
significant number of people were still in dark by thinking that, this may be
transmitted through taking food, sharing dress, handshaking or through mosquito
bites.
“Condom use is a easy way for safer sex practice” this message is known to most
of the participants. Total of 311 respondents responses positively about this issue.
A significant proportion of the respondents bore some misconception on
prevention.
2
2004 Report on Global AIDS Epidemic-UNAIDS
Respondents’ knowledge on prevention of HIV/AIDS**
Protection from AIDS Number Percentage (%)

Using condom at sex 311 73.2
Don’t use others used needle and syringe 29 6.9
Using tested blood 9 2.2
Using jelly or lubricant at sex organ in the sexual 2 .5
intercourse
Avoiding dirty/unclean customers 10 2.4
Using Savlon after sexual intercourse 15 3.5
Don’t sex more than one clients 8 1.9
By taking physicians suggestion 13 3
Testing clients STD 0 0
Others 12 2.9
Don’t know 15 3.5
Poor knowledge levels are reflected in the lack of concern the sex workers feel
about becoming infected themselves by the HIV/AIDS. Only 16.2% of sex workers
that they worried “a lot” about getting AIDS, and almost ¾th of the respondents
(234 persons) reported not being worried at all.
Possibility of AIDS Transmission
250 234
200
150
100
53
30 19
50 3
0
Very low Moderately low Low High Very high
The above graph shows that, most of the respondents feel that, HIV in a very low
risk to transmits them. Only 3 of them identified themselves as a high risk
community. Aware is very much and also immediately required to change the
perception of their existing knowledge.
298 out of 343 respondent says that, there is a high possibility of HIV transmission
if any one doesn’t use the condom properly during intercourse. But this is all they
know. Still some of them don’t know about the transmission through sharing
needles and syringes.
HIV TRANSMISSION POSSIBILITY**
Possibility Number Percentage (%)

Don’t use condom in all times at the intercourse 298 61.4
I don’t know about the use of others used 9 1.8
needle and syringe
I perform sexual intercourse more than one 26 5.4
persons
I don’t use jelly or lubricant at the sexual 2 .4
intercourse
I don’t avoid dirty and unclean clients 12 2.5
I don’t use Savlon after sexual intercourse 20 4.2
I perform sexual intercourse more than one 73 15
clients
I always take physicians suggestion 21 4.3
Others 10 2.1
Don’t know 14 2.9
Only 21 respondent says that, they always take physicians suggestions and that’s
4.3 percent of the total respondent.
E STI RELATED ISSUES
Knowledge and health seeking behaviours for STIs was higher than for HIV, but was
still not ideal. 39.9% of SW’s don’t even go to a recognized physician though they
have got the STI symptoms. A huge percentage of them are used to take the local
treatment. And the most shocking information is that, 97.4% of the respondents
have the symptoms of STI. Too much menstruation, pains at abdomen, itching at
urinate and pains during intercourse are the most common symptoms found during
the interviews.
Symptoms of STD**
Symptoms Number
Itching with menstruation fluid 87
To much menstruation fluid 133
String with menstruation fluid 46
Ulceration in the vagina 15
Itching in the vagina 50
Ulceration or itching into vagina 24
Pain during menses 47
Pain at the abdomen 138
Itching at the urinate 147
Pain during intercourse 131
Pimple or ulcer in the anus 0
No symptoms now 21
Others 0
Access to the Services
Most of the respondents say, they are not interested to afford the government
health services. In the last six-month, only 120 of them gone to Sadar health
complex for treatment but only one respondent say that the service provided by
the government are good.
Taking suggestions from different parties**
Indicators Percentage (%)

No suggestion 39.9
Local Treatment 31.8
Homeopathic 13
Govt. Hospital 14.4
Others .9
Total 100
Avail the services for the last 6 months**
Indicators Number Percentage

(%)
Yes 120 35
No 208 60.6
No respond 15 4.4
Total 343 100
Most interestingly, 65.9% of the respondents are not interested to make any
comments about the quality of government services. Only 35 percent of the total
surveyed population avail services from govt. But most of them are not satisfied
with the services provided from govt. level.
F HARASSMENTS/VIOLENCE/ABUSE
HIV-transmission risk increases during violent or forced-sex situations. The

abrasions caused by forced vaginal or anal penetration facilitate entry of the virus
—a fact that is especially true for adolescent girls. Moreover, condoms are rarely
used in such situations.
Harassment in the last 6 months**
Harassment Number Percentage (%)

Yes 274 80
No 69 20
Total 343 100
The following data represent that, 274 of the total respondent are harassed in the
last six-month which is 80 percent of the surveyed population.
Verbally Abused**
Abused Number Percentage (%)
Yes 274 80
No 69 20
Total 343 100
One of the important parts of the questionnaire is the status of violence against
the high-risk population women. All of the surveyed persons says that, they are
harassed at least in a single way (verbal or physical) by the police, rogue, clients
and other influential parties.
Tens of thousands of women and children are trafficked from Bangladesh each
year. One of the poorest countries in the world, poverty provides traffickers with
people who have no alternatives for survival. They trust the offers of work or
marriage abroad, which promise security but instead lead to slavery. The
defenselessness statuses of this trafficked woman make them more insecure to
talk and to deal with the practical life. As a result the hitchhikers take the floors
to dominate them. And thus the scope of harassment is created.
Age in Years Harassed in Last 6 Months Total

Yes No
<12 0 0 0
12-18 46 16 62
19-30 202 49 251
31-40 26 4 30
> 40 0 0 0
Total 274 69 343
Category of individuals**
By whom Percentage (%)

Police 37.8
Local goons 28
Clients 16.7
Broker 14.4
Pimp 2
Sex Workers 1.1
Others 0
Total 100
80% of the respondents say that they faced harassments in the last six-month.
Surprisingly, police is the major actor on this issue. Next to that, local goons and
the clients take the chance to harass the high-risk groups.
Harassment Status (Target Population) **
Harassed
Yes No Total
Target 1:Residence
75 18 93
Population Based
2:Hotel Based 199 51 250
Total 274 69 343
In general, 75 out of 93 residence based high-risk group and 199 out of 250 hotel
based high-risk group says that, the above-mentioned community harasses them.
They also say that, especially policy take the opportunity most of the time and
they compare the police community with the local goons as the local goons and
police have no basic differences in attitudes.
4 Recommendation
- Develop structured mechanisms for the implementation of integration of STI

& HIV services at district and local level in order to minimize the risk of
transmission.
- Ensure accessibility of services for implementing this type of projects
- Increase role of traditional medicine practitioners in client counseling and

referral
- Design strategies to increase partner notification and treatment (and

prevent re-infection), that include interventions combining provider training
and patient education, and that take cognizance of socio-cultural and
gender issues pertinent to communities
- Promote condoms for dual protection against HIV/AIDS & STIs
- Creating a safe place, where condoms can be picked up freely without

stigma.
- Develop mechanism for promotion and distribution of barrier methods to

non-medical sites, and to high transmission areas e.g. commercial sex
workers and clients
- Adopt peer education approach and distribution of IEC materials regarding

HIV/AIDS
- Develop collaboration with NGOs and other stakeholders for provision of

counseling services
Conclusions
The study showed that the high-risk group in the target areas had a very few
knowledge of the existence, spread, diagnosis and even prevention and control of
HIV/AIDS. They, however, needed a vast support in terms of enhancing the process
of transforming this knowledge into practice or behavior and action. The study
showed that HIV/AIDS had devastating effects on individuals, families and
communities. It had led to death, in addition to affecting specific categories of
the population in different ways.
The misconceptions about the causes of HIV/AIDS are dying away, although people
still lack ways of telling for sure who is or is not HIV positive. They are mostly
unaware about the services from different parties including GO and NGOs. There is
need to sensitize this group of community for receiving the services and appeal to
them to make use of these services.
As far as responses to HIV/AIDS were concerned, the target communities have

responded in a number of ways. The most effective responses were identified as;
condom use, faithfulness, and sensitization. There were, however, a number of
gaps identified by the groups in the fight against HIV/AIDS. These gaps call for
more sensitization of the communities
References:
1. 2nd Round Behavioral & Serological Surveillance –2001
2. 3rd Round Behavioral & Serological Surveillance –2002
3. 4rd Round Behavioral & Serological Surveillance –2003
4. 5th Round Behavioral & Serological Surveillance –2004
5. World Bank Report on HIV/AIDS Epidemic- Bangladesh – 2003
6. EI Publication – “Women in the Economy” by Natacha David – 1998
7. 2004 Report on Global AIDS Epidemic-UNAIDS

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Baseline Report of RPDO Consortium 1

Knowledge, Attitudes & Behaviours

And last but not least,

Executive Summary ............................................................ 6

3. Baseline Survey Results.................................................... 13

4. Recommendation ........................................ .......... .......... 31

5. Conclusion ........................................ ........ ........ ........ 32

5. References .................................................. .......... .......... 33

AIDS Acquired Immune Deficiency Syndrome

DFID Department for International Development

EDL Essential Drug List

HIV Human Immunodeficiency Virus

IEC Information, Education and Communication

NGO Non-Government Organization

NASP National AIDS/STD Program

STI Sexually Transmitted Infection

USAID United States Agency for International Development

VCT Voluntary Counseling and Testing

WHO World Health Organization

RPDO Rural Poor Development Organization

AASARR Association for Social Advancement & Rural Rehabilitation

ORA Organization For Rural Advancement

CDWF Community Development Welfare Foundation

UNICEF United Nations Children’s Fund

I am confident that these findings will make a positive contribution to improving

Md. Fazlul Karim Chowdhury

There is a paucity of data available in Bangladesh on the management of sexually

A number of interventions have been identified to strengthen STI/HIV management

1.1 STI AND HIV IN BANGLADESH

1.2 JUSTIFICATION OF THE STUDY:

The significance of comprehensive baseline information of a given community is

Another dimension of baseline information is to serve as a 'benchmark' to project's

Thereupon, a comprehensive baseline record is essential for the project to help

1.3 OBJECTIVE OF THE STUDY

The specific objectives of the study are to:

Sampling design & target population

Considering the wide variations across the project operational areas, it is

A standard statistical formula will be used to determine the representative sample

p = the proportion in the target population estimated to have a particular

n = (1.96)2 (.5) (.5) / (.05)2

1.5 SAMPLING FRAME FOR BASELINE

Primary target group Sample

To select respondents, individuals who appeared to the interviewer to fit a

Design data collection instruments, pre- test and finalization

Field Data Collection Team

Data entry and processing

Develop data analysis plan and analysis

2. LIMITATIONS OF THE SURVEY

• Bias may have been introduced based on the selection of people to be

• It is the perception of the interviewers and supervisors that respondents were

• Although we believe the survey to be indicative of the knowledge, attitudes and

3. BASELINE SURVEY RESULTS

A. SOCIO-DEMOGRAPHIC PROFILE OF THE RESPONDENTS

About 73% of the Range Number Percentage (%)

Minimum Age 14 The age of the younger respondent is 14 years

Graph: 01 Age Distribution

Category Number Percent The majority of the respondents were

Mean 3.8 Most of the respondents have dependents. The

Choosing Sex profession in age**

Age Number Percentage (%)

B INCOME & SAVINGS

Income in AGE in Years Total

Savings from the income