Population Movements and the Threat of HIV/AIDS Virus at the Bangladesh-India Border RSIS Monograph No. 14 Mohammad Jalal Uddin Sikder RSIS MONOGRAPH NO. 14 POPULATION MOVEMENTS AND THE THREAT OF HIV/AIDS VIRUS AT THE BANGLADESH-INDIA BORDER Mohammad Jalal Uddin Sikder NTS-Asia Secretariat S. Rajaratnam School of International Studies i Copyright © 2008 Mohammad Jalal Uddin Sikder Published by S. Rajaratnam School of International Studies Nanyang Technological University South Spine, S4, Level B4, Nanyang Avenue Singapore 639798 Telephone: 6790 6982 Fax: 6793 2991 E-mail: [email protected] Website: www.idss.edu.sg First published in 2008 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the S. Rajaratnam School of International Studies. Body text set in 10/14 point Warnock Pro Produced by BOOKSMITH ([email protected]) ISBN 978-981-08-1289-8 ii The RSIS/IDSS Monograph Series Monograph No. 1 Neither Friend Nor Foe Myanmar’s Relations with Thailand Since 1988 Monograph No. 2 China’s Strategic Engagement with the New ASEAN Monograph No. 3 Beyond Vulnerability? Water in Singapore-Malaysia Relations Monograph No. 4 A New Agenda for the ASEAN Regional Forum Monograph No. 5 The South China Sea Dispute in Philippine Foreign Policy Problems, Challenges and Prospects Monograph No. 6 The OSCE and Co-operative Security in Europe Lessons for Asia Monograph No. 7 Betwixt and Between Southeast Asian Strategic Relations with the U.S. and China Monograph No. 8 Fading Away? The Political Role of the Army in Indonesian Transition to Democracy, 1998–2001 Monograph No. 9 The Post-Tsunami Reconstruction of Aceh and the Implementation of the Peace Agreement Monograph No. 10 Post-Suharto Civil-Military Relations in Indonesia Monograph No. 11 People’s ASEAN and Governments’ ASEAN Monograph No. 12 Forgetting Osama Bin Munqidh, Remembering Osama bin Laden The Crusades in Modern Muslim Memory Monograph No. 13 Do Institutions Matter? Regional Institutions and Regionalism in East Asia iii On 1 January 2007, the S. Rajaratnam School of International Studies (RSIS) was inaugurated at Nanyang Technological University, Singapore. It was originally established as the Institute of Defence and Strategic Studies (IDSS) on 30 July 1996. The IDSS remains as a key component within the RSIS, focusing on security research, while the School takes over its teaching functions. The RSIS will: a. Provide a rigorous professional graduate education with a strong practical emphasis, b. Conduct policy-relevant research in defence, national security, international relations, inter- national political economy, strategic studies and diplomacy, and c. Build a global network of like-minded professional schools. iv Contents Acknowledgements vi List of Tables viii Listy of Annexes, Figures and Photographs x Abbreviations and Acronyms xi __________________________________________________ 1 Introduction 1 2 Theoretical Framework 13 3 Scenario of HIV/AIDS in India and Bangladesh 28 4 The Interviewees 42 5 Nature of Human Movement across the Border 62 6 Social Behaviour of the Respondents 71 7 Sexual Behaviour of the Respondents 79 8 Knowledge of HIV/AIDS at the Border 91 9 Conclusion and Policy Recommendations 106 10 Case Studies 112 __________________________________________________ Annexes 119 References 142 v AcknoWledgements would like to express my profound gratitude to the NTS-Asia, S. Rajaratnam School of International Studies, Nanyang Technological University, Singa- pore for commissioning the research fellowship and making my intellectual Ifervour more effective to bring it into practicality. In preparing this research report, I have received encouragement, cooperation and guidance from a wide range of personalities from different backgrounds and diverse professions. They have helped me in various ways to acquire information at both primary and secondary level and improved my understanding of the basic concepts regard- ing the theme of the research. It is my immense pleasure to have been able to work with Professor Dr. Tasneem Siddiqui and Professor Dr. Chowdhury Rafiqul Abrar of RMMRU. Detailed criticisms and comments from them have enlightened my views and shaped the report. Special thanks to Associate Professor Dr. Delwar Hossain and A. S. M. Ali Ashraf, Lecturer of the Department of International Relations of the University of Dhaka and Nurullah Azad of Media-Mix Ltd., whose opinions have greatly contributed to the conceptual shape of the report. In bringing this report to completion, we acknowledge the contribution of various levels of governmental officials, NGOs and international organisations’ officials and local people encountered during our fieldwork. It would have been impossible to complete the study successfully without their warm reception and collaboration at every stage of the primary data collection. Appreciation is also extended to Mohammad Khairul Alam of Rainbow Nari O Shishu Kallyan Foundation; Mrinalendu Majumder of JJS; Shafiqul Islam of Social Marketing Company; Dr. Aurangazeb of Paribaric Shastha Clinic; Custom Supernatant of Jessore Benapole Custom House; Basir Ahmed, Upazila Nirbahi Officer of Sarsha Upazila of Jessore district; the President and members of Jessore, Dinajpur and Lalmonirhat Press Club; Md. Abdullah of Gharoni; Md. Firoz Rahman of Gha- rani; Basudev Chandra Suladhar of Padakhep Consortium; Zahid Hasan Shuvo of ActionAid Bangladesh; Laily Islam of Symonti Mohila Unnayan Songsta; Dr. Md. Harunor Rashid, General Practitioner; A. B. Safiul Alam Labu of The Daily Prothom Alo; Abu Taher of Upazila Nirbahi Officer of Patgram Upazila of Lal- monirhat district; Hafizur Rahman of Social Marketing Company; Ataur Rahman of Social Marketing Company; Md. Abdur Rahim of Upazila Nirbahi Officer of Hakimpur Upazila of Dinajpur District; Sirajul Islam; Abu Sufian of HASAB; Dr. Tasnim Azim of ICDDRB B; and Dr. Khandaker Ezazul Haque of UNFPA. vi I have also benefited from the very efficient research assistance of Zohra Akhter; Makfie Farah; Kaniz Fatema; and S. M. Al-Amin over a long period. All of them are the active members of Young Researchers’ Forum (YRF), RMMRU and have played an important role in assisting the researchers in every aspect of their work. I also appreciate the contribution of other members of YRF and office staff of RMMRU in particular Darren Middleton, Towheedul Islam, Niloy Ranjan Biswas and Stephen Hiley. My thanks also go out to Kate Conory, Laura Giani and Kirsty Jenatsch, whose remarks have contributed to the report more qualitatively. Finally, I would like to convey my heartiest thanks to each person who has been involved with the study, helping to create a “lighthouse” in an ocean. Mohammad Jalal Uddin Sikder Research assistants Zohra Akhter, Makfie Farah, Kaniz Fatema, S. M. Al-Amin vii List of Tables Table 3.1 Total reported HIV and AIDS cases in Bangladesh Table 3.2 HIV prevalence rates over the rounds Table 4.1 Total number of respondents Table 4.2 Distribution by sex and area Table 4.3 Location of districts of origin of the respondents Table 4.4 The difference in age Table 4.5 Current average age Table 4.6 Average age when interviewees first crossed the border Table 4.7 Total years of involvement in cross-border migration Table 4.8 Number of people involved in cross-border migration by religion Table 4.9 Marital status by sex and country Table 4.10 Educational profiles by sex and country Table 4.11 Current type of household of the interviewees Table 4.12 Total family size of the respondents Table 4.13 Total number of current earning members of family Table 4.14 Total current monthly income of the household Table 4.15 Occupations of the respondent’s family members Table 4.16 Type of occupation of the respondent Table 4.17 Respondents’ ownership of land Table 5.1 Source of job information Table: 5.2 Members of the family involved in cross-border jobs Table 5.3 Source of problems faced during migration Table 5.4 Frequency of cross-border movement per month Table 6.1 Leisure and entertainment of the interviewees in their home country Table 6.2 Entertainment activities of respondents’ friends Table 6.3 Leisure and entertainment of the interviewees when abroad Table 6.4 Measures taken during illness Table 7.1 Type of sex Table 7.2 Distribution of interviewees’ ages when sex was first experienced Table 7.3 Interviewees’ ages when sex was first experienced Table 7.4 Distribution of interviewees’ first sex partner Table 7.5 Distribution of first sex experience Table 7.6 Opportunity for sex abroad Table 7.7 Frequency of sex abroad viii Table 7.8 Reasons for not having sex abroad (multiple) Table 7.9 Sex partners at different stages of migration (multiple) Table 7.10 Respondents’ condom usage Table 7.11 Frequency of condom use Table 8.1 Interviewees’ perception of HIV/AIDS transmission (multiple) Table 8.2 Interviewees’ awareness of HIV prevention Table 8.3 Interviewees’ source of information for HIV Table 8.4 Interviewees’ knowledge of STDs Table 8.5 Interviewees’ description of symptom of STDs/STIs Table 8.6 Symptom experienced by the interviewees Table 8.7 Interviewees’ experiences of STDs Table 8.8 Treatment of STDs/STIs Table 8.9 Interviewees’ reasons for not using condom Table 8.10 Respondent’s knowledge of the use of condoms ix List of AnneXes, Figures and PHotograpHS List of Annexes Annex 1 List of land ports and immigration