Commentary: Human immunodeficiency virus and hepatitis in Bangladesh: widespread or targeted prevention strategies?

Although Bangladesh has a relatively low level of HIV cases there is still a risk for this country to develop a more widespread and sustained epidemic. In the absence of an affordable and effective HIV vaccine prevention campaigns must be designed to achieve maximum impact. In the study conducted by Gibney et al. truck drivers reported high levels of sexual mixing and low levels of protection. To this effect these and other high-risk groups such as sex workers and their clients; seafarers; and injecting drug users have been the targets of primary prevention activities in Bangladesh. It is noted however that exposure and chronic carriage rates are reported to be high due in part as a reflection of the age of prevention programs in the country and of the multiple transmission routes highlighting the possible roles of both sexual activity and non-sterile injection practices among adult populations. In this regard Gibney and his colleagues highlight the importance of therapeutic injections as a prevention strategy among adult population--to reduce both iatrogenic and sexual transmission.