World Drug Report finds drug use stable, access to drug & HIV treatment still low!

The United Nations of Drug Addiction and Crime (UNODC) Chief Calls number of drug-related deaths worldwide unacceptable; Global opium cultivation highest since the late-1930s.

Drug use prevalence continues to be stable around the world, according to the 2015 World Drug Report of the United Nations Office on Drugs and Crime (UNODC). It is estimated that a total of 246 million people - slightly over 5 per cent of those aged 15 to 64 years worldwide - used an illicit drug in 2013. Some 27 million people are problem drug users, almost half of whom are people who inject drugs (PWID). An estimated 1.65 million of people who inject drugs were living with HIV in 2013. Men are three times more likely than women to use cannabis, cocaine and amphetamines, while women are more likely to misuse prescription uploads and tranquillizers.

Speaking on the International Day against Drug Abuse and Illicit Trafficking, UNODC Executive Director Yury Fedotov noted that, although drug use is stable around the world, only one out of six problem drug users has access to treatment. "Women in particular appear to face barriers to treatment - while one out of three drug users globally is a woman, only one out of five drug users in treatment is a woman." Additionally, Mr Fedotov stated that more work needed to be done to promote the importance of understanding and addressing drug dependence as a chronic health condition which, like other chronic conditions such as diabetes or hypertension, require long-term, sustained treatment and care. "There is no quick and simple remedy for drug dependence and we need to invest in long term, medical evidence-based solutions."

Drug use and its impact on health.

A stable yet still unacceptably high number of drug users worldwide continue to lose their lives prematurely, the UNODC Chief said, with an estimated 187,100 drug-related deaths in 2013. The World Drug Report includes data - gathered jointly with UNAIDS, WHO and the World Bank - on HIV prevalence among PWID. In some countries women who inject drugs are more vulnerable to HIV infection than men and the prevalence of HIV can be higher among women who inject drugs than among their male counterparts. The number of new HIV infections among PWID declined by roughly 10 per cent between 2010 and 2013: from an estimated 110,000 to 98,000. However, the World Drug Report also indicates that many risk factors, including the transmission of infectious diseases such as HIV and Hepatitis C and the incidences of drug overdoses, cause the death rate among PWID to be 15 times higher than in the rest of the population.

While data indicate that the use of opiates (heroin and opium) has remained stable at the global level and cocaine use has declined overall, the use of cannabis and the non-medical use of pharmaceutical opioids has continued to rise. Evidence suggests that more drug users are suffering from cannabis use disorders, and that cannabis may be becoming more harmful, as reflected in the high proportion of persons seeking first-time treatment in several regions of the world. Demand for treatment has also increased for amphetamine-type stimulants (ATS) - including methamphetamine and MDMA or 'Ecstasy' - and for new psychoactive substances (NPS), also known as 'legal highs'.

Illegal drug supply and markets Some 32.4 million people - or 0.7 per cent of the world's adult population - are users of pharmaceutical opioids and opiates such as heroin and opium. In 2014, global potential opium production reached 7,554 tons - the second highest level since the 1930s, mainly due to its cultivation increasing significantly in Afghanistan, the main growing country. The global seizures of heroin, meanwhile, increased by eight per cent, while illicit morphine seizures decreased by 26 per cent from 2012 to 2013.

While maritime trafficking is not the most widely used mode of smuggling drugs, law enforcement operations at sea have potentially the greatest impact as the average volumes of seizures is proportionally higher. In the period 2009-2014, for instance, the average for each seizure by sea was 365kg, while by land (road and rail) it was 107kg and by air 10kg. The 2015 World Drug Report also notes a dynamic shift in the routes used for smuggling opiates, with Afghan heroin reaching new markets. Recent seizures suggest that it may have become more common for large shipments of Afghan heroin to be smuggled across the Indian Ocean into East and Southern Africa. West Africa continues to be a trans-shipment area for smuggling cocaine across the Atlantic into Europe, and Eastern Europe is emerging as a transit area and as a destination for this drug.

This year's World Drug Report indicates that coca bush cultivation continued to decline in 2013, reaching the lowest level since 1990. With a global prevalence of 0.4 per cent of the adult population, cocaine use remains high in Western and Central Europe, North America and Oceania (Australia) though recent data shows a declining trend overall. Cannabis use is on the rise and continues to be high in West and Central Africa, Western and Central Europe, Oceania, and North America. Data for 2013 show an increase in the quantities of cannabis herb and cannabis resin seized worldwide, reaching 5,764 and 1,416 tons respectively.

Methamphetamine dominates the global market for synthetic drugs, and is expanding in East and South-East Asia. Crystalline methamphetamine use is increasing in parts of North America and Europe. Seizures of ATS since 2009 - which have almost doubled to reach over 144 tons in 2011 and 2012, and remained at a high level in 2013 - also point to a rapid expansion in the global market. By December 2014, a total of 541 new psychoactive substances which have negative health impact had been reported by 95 countries and territories - a 20 per cent increase compared to the previous year's figure of 450.

Alternative Development as a long-term strategy against illicit crops

The 2015 World Drug Report thematic focus is on Alternative Development, a long-term strategy aimed at developing alternative sources of income for farmers dependent on illicit drug cultivation. This activity is driven by many factors, including marginalization, the lack of security, and the social and political situations of rural communities. Alternative Development aims to reduce these vulnerabilities and ultimately eliminate the cultivation of illicit drugs. More than 40 years of experience have shown that this approach works when there is a long-term vision, adequate funding, and the political support to integrate it into a broader development and governance agenda.

Marketing licit products, land tenure and the sustainable management and use of land are crucial to the long-term success of alternative development interventions. "Unfortunately, this year's World Drug Report also shows that widespread political support for Alternative Development has not been matched by funding," Mr Fedotov added, as he urged for shared responsibility against illicit drugs. Funding allocated by OECD countries to support Alternative Development declined by 71 per cent between 2009 and 2013, amounting to only 0.1 per cent of global development assistance. UNODC's Executive Director noted that in the lead up to next year's UN General Assembly Special Session on the world drug problem, the international community's post-2015 Development Agenda can help to promote Alternative Development efforts, with broader interventions addressing drug supply and demand.

Statement from Mr Yury Fedotov,

Executive Director of UNODC

on International Day against

Drug Abuse and Illicit Trafficking

26 June 2015

Today is an important day for focusing on the threat of the production, trafficking and use of illicit drugs. Robust action is needed to strengthen criminal justice systems, break-up the criminal networks who deal in misery and suffering, and to nurture health and human rights-based responses.

People also endure unbelievable pain due to a lack of controlled medications for medical purposes. Measures must be taken to ensure that people across the globe can access pain relief where necessary. We must also do everything to promote greater understanding of drug use as a social and health condition that calls for, like HIV/AIDS and hepatitis, sustained prevention, treatment and care.

Science and evidence-based practices must prevail in the delivery of prevention and treatment of drug use. These approaches are the foundation for all our efforts. With nearly 200,000 drug-related deaths and with 1.65 million infected with HIV in 2013, access to evidence based prevention and treatment can sometimes be the difference between life and death.

At present, only one in six people who use drugs globally has access to treatment. Women face numerous barriers to treatment-while one in three drug users globally are women, only one in five drug users in treatment are women.

Africa, particularly West and East Africa, also remains vulnerable to the trafficking and the consumption of illicit drugs. These trends are part of organized crime's attack on the security, health and development of an already-fragile region. The nexus of organized crime and terrorism-including the apparent role of drug trafficking-is a serious threat. Opium cultivation in Afghanistan remains a formidable challenge, as is the production of cocaine in Latin America.

UNODC's own work shows that the balanced approach of confronting drug supply and drug demand is fundamental. Alternative development for farmers who cultivate illicit crops also has a major role. Alternative development promotes environmental protection, supports communities affected by other forms of crime, including wildlife and forest crime, and empowers women.

Countries must also work hard to protect the promise of future generations. Young people should be encouraged to undertake new initiatives that can develop aspirations and opportunities, as well as dignity. 

The UN General Assembly Special Session on the world drug problem, to be held in April 2016, can assist in the exchanges of ideas and lessons learned, and will do much to help achieve the goals set out in the Political Declaration and Plan of Action by 2019.

On the International Day against Drug Abuse and Illicit Trafficking, and ahead of the UN Summit on Sustainable Development, it is important to remember that illicit drugs undermine the environment, security and development. Countering their impact using a balanced and human rights based approach is vital to protect and promote the health and welfare of humankind.

Drug addicts spend Tk 70cr everyday in Bangladesh  

Manzurul Alam Mukul: When the `International Day against Drug Abuse and Illicit Trafficking` is being observed in Bangladesh like elsewhere in the world today (Friday) then it is unfortunate that about six million who are drug addicted in Bangladesh spend over Tk 700 million (Tk 70 crore)  every day on illegal narcotics.

Basically, drug abuse or substance abuse refers to the use of certain chemicals for the purpose of creating pleasurable effects on the brain.  

Drug abuse is a major public health problem globally. According to the UN Office on Drugs and Crime (UNODC), between 149 million and 271 million people worldwide use the illicit drugs such as cocaine, cannabis, hallucinogens, opiates and sedative hypnotics. The problem has been increasing at alarming rates in recent days, especially among young adults under the age of 30.

It is a causal factor in more than 200 disease and injury conditions; these majorly include several types of cancer, hemorrhagic stroke and hypertensive heart disease, cardiovascular diseases, liver cirrhosis, neuropsychiatric diseases, etc. According to a report, illegal drug use causes about a quarter of a million deaths per year, and use is highest in developed countries.

The harmful use of drug can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of drug results in a significant health, social and economic burden on society at large.

In recent years, drug addiction has significantly increased in the South Asian countries including Bangladesh. Hundreds of thousands of youths across Bangladesh are taking drugs on a large scale, sending our society on the verge of ruin.  Daily newspapers and televisions are full of reports of drug network having a turnout of 1 crore (tens of millions) of taka. This agent of human devastation has spread its tentacles to every nock and corner.

There are three types of drugs available in Bangladesh. Opium (like, heroin, phensidyl); Cannabis (ganja, chorosh); sleeping pill (tranquilizer, seduxene). The most common drugs used in Bangladesh are stimulants. The teens are ignorant about variation of drugs. Some of them cannot tell the difference between stimulants and marijuana. There are a large number of young using drugs.

DNC intelligence sources say heroin is the deadliest of drugs in Bangladesh. In recent times, Yaba has gained in popularity and has become a `fashionable` drug. Cough syrup Phensidyl has remained the most popular among the masses because of its low price and easy availability.

According to the police and other sources, the number of addicts in Bangladesh is more than six million who spend over Tk 700 million (70 crore) every day on illegal narcotics.

A study conducted by the Journal of Health, Population and Nutrition (JHPN) of the International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB) shows that in the capital Dhaka, 79.4 percent of the users are male and 20.6 percent are female.  The study finds that 64.8 percent drug users in the country are unmarried while 56.1percent either students or unemployed, 95.4% percent users smokers and 85.7 percent get into drugs under the influence of friends; 65.8 percent addicted to various codeine-containing cough syrups.

According sources with different health facilities, nowadays nearly 10 per cent of outpatients in hospitals are cases of drug addiction involving heroin, ganja and phensidyl.

The trend of consuming drugs is higher in youth and teenagers between 15-30 years of age and come from all strata of the society. Students are the most victim of drug abuse that lowers standards of education and attendance at schools and colleges.  There are a number of reasons why a teenager might try drugs. The leading causes include curiosity and excitement through use, despair and frustration for continuous failure in works or economic insolvency,  some are addicts because they try to follow the western culture of drugs and enjoyment of life, poverty, easy access to drugs, surrounding atmosphere, estranged in love and even mental stress due to family problem.

According to police sources, more than 100,000 people are directly involved with illegal drug trade and supplying. Peddlers prefer women and children for carrying and selling drugs because it is easier for them to evade law enforcers, sources said.

Many experts believe that Bangladesh is often used as a transit point for international drug trafficking, making the country vulnerable to drug abuse.  Bangladesh is situated in the central point between golden crescent (Pakistan, India, Afghanistan and Iran) in terms of geographical location.  And it is also surrounded by the major drug producing countries of Asia, many of which are strengthening their narcotics and stepping up enforcement measures.  Traffickers who supply drugs in the markets of Northern America, Africa and Europe are making their shipments through Dhaka, Chittagong, Comilla, Khulna, Jessore and other routes in Bangladesh.

So, in near future, Bangladesh will face a catastrophe if the alarming drug abuse is not effectively checked through extensive motivation and prevention.

About the irrational behavior and drug addiction, many social scientists blame the examples set by their elders. Firstly, parents and elders who drink and smoke are, in effect, telling their children and juniors that it is a socially acceptable behaviour. Consequently they may have a similar view towards illegal drugs, even if their parents and guardians are against their use.

In addition, drug use shown on television, films, magazines and public displays can only attract children, if not confuse them, about the serious health-hazards that are associated with drug abuse.

Roles of the department of narcotics control, police, RAB and BGB are not up to the satisfactory level.

June 26 is the International Day against Drug Abuse and Illicit Trafficking. Established by the United Nations General Assembly in 1987, this day serves as a reminder of the goals agreed to by Member States of creating an international society free of drug abuse.

The theme for this year’s celebration is dubbed ‘Let’s Develop our Lives, our Communities without Drugs’.

So, it is need to execute properly execution of the related law against the spreading of drugs throughout the world including Bangladesh. Side-by-side all conscious people irrespective of classes and professions including parents, teachers, religious and political leaders, players and sports personalities will come ahead to create social awareness and expedite the anti-drug movement to save our future generation from the aggression of the drugs.

risingbd/DHAKA/June 26, 2015

Sex and the single girl, Bangladeshi-style

The result of restricting the acceptability of sex to marriage is not fewer girls having sex at a younger age, it is more girls getting married at a younger age

There are few issues which are so apparently cut and dried as the age of marriage for women.

It seems self-evident that lowering the age from 18 to 16, as the government proposes to do, is a poor idea, and I hope that the government listens to the legions of experts and critics of the proposed legislation, and that good sense prevails.

The argument that the age of marriage is 16 in many other countries such as the UK (with parental consent) is irrelevant to the case at hand.

The UK does not have a problem with early marriage, Bangladesh does. If the marriage age in the UK were raised to 18 it would make very little difference and impact very few lives.

But in Bangladesh, the proposed change in the law would impact millions and have far-reaching consequences, none of them good.

At a very basic level there is a lot of data out there to show that the later a woman gets married, the later she will typically have her first child, and that this is correlated to a raft of desirable social outcomes, both for the woman and the child.

The later women get married and give birth, typically, the higher their educational attainment, better their earning prospects over the course of their life-time, and the more likely they are to be happy and healthy throughout their lives. This much is incontrovertible.

If there is one thing we should be encouraging women to do to benefit both themselves and society as a whole, it would be to marry and have children later.

This would also have a major impact on the country’s population problem. We have done a great job in reducing the average number of children each woman has to just above two, leading to a population growth rate of 1.2% per year. Not bad at all.

The big problem we face, however, continues to be the age at which these births occur. The math is simple. Compare the difference between a country where a woman typically has her first child at age 20 with one where the average age for this is 25.

In this scenario, even if women in both countries bear the same number of children, over a period of 100 years the first country will see five generations and the second only four, leading to massive difference in population growth over the course of the century.

The average age of first child-birth in Bangladesh is around 18. You do the math. The later first child-birth happens, the better for the woman, the child, and the country.

And of course, the earlier women get married, the earlier that they will have their first child.

There are a lot of social pressures for parents to marry their girls off at a young age, but the government should be helping them resist this pressure, not adding to it.

If the government started an awareness campaign and followed up with tough prosecution for offenders, it could send a stern message and really cut down on the incidence of child marriage.

Now it is true that many parents wish to marry their girls off early so as to ward of the threat of harassment, rape, or assault, which become serious and pressing concerns as soon as girls reach puberty, if not before.

But in lowering the marriage age, the government is solving the wrong problem, and it should instead focus its resources on protecting girls from this kind of predatory behavior so that they would not have to seek the perceived shelter of marriage to be free of it.

It is precisely because girls in their early teens are considered marriageable that they become the object of this kind of unwelcome attention, and often the harassment is used as a prelude to demand their hand in marriage, with parents having no other recourse but to accede.

This is the kind of abuse that will only get worse if the government lowers the marriage age and continues to do nothing about policing marriage at an even lower age, instead turning a blind eye.

In addition to keeping the marriage age at 18, the government should be cracking down both on under-age marriage and the kind of predatory criminal behavior that makes parents think it is their only recourse. A little government attention to this matter would go a long way.

Of course the real elephant in the room here is the social stigma which is attached to pre-marital sex and pregnancy. One reason parents are so keen to marry their girls off before the age of 18, and many girls themselves wish to marry before then, is the strict societal taboo against pre-marital sex and the disastrous consequences of unmarried pregnancy.

We need to recognise that girls may well wish to be sexually active in their teenage years and that the best way to address this issue is to educate them to have responsible sex and to ensure that the costs of doing so are not so ruinous.

Many people might be appalled at such a thought, but the result of restricting the acceptability of sex to marriage is not fewer girls having sex at a younger age, it is more girls getting married at a younger age.

But if we are not willing to seriously grapple with and come to terms with the issue of teenage girls having sex and the high costs of pre-marital sex in our society, then the government’s proposal is not as outlandish as it seems.

WHO reports about Africa 2000-2015

This executive summary highlights key facts from the progress report on the Global health sector response to HIV, 2000-2015. Successful HIV responses are not yet universal, but they are common enough to have made a huge impact in the past 15 years.

The number of adults and children newly infected with HIV globally declined by 35% in 2000–2014.

The number of people dying from HIV-related causes declined by 24% in 2000–2014 and by over 40% since 2004, the peak year.

HIV treatment reached almost 16 million people in mid-2015 – more than 11 million of them in the African Region, where only about 11 000 people had been receiving treatment in 2000.

Millennium Development Goal 6, which called for halting and beginning to reverse the spread of HIV by 2015, was achieved, and the HIV response contributed to significantly reducing child mortality (Millennium Development Goal 4) and maternal mortality (Millennium Development Goal 5).

Global Summary of HIV Epidemic in Women and Children, 2014
	Global	South Asia	%
Estimated number of women (15+) living with HIV	17,400,000	800,000	5
Estimated number of pregnant women living with HIV	1,500,000	36,000	2
Estimated number of children (<15) living with HIV	2,600,000	140,000	5
Estimated number of children (<15) newly infected with HIV	220,000	14,000	6
Estimated number of children (<15) dying of AIDS-related causes	150,000	9,000	6
Source: UNAIDS 2014 HIV and AIDS estimates, July 2015

HIV and AIDS estimates (2015) In Bangladesh

HIV/AIDS Situation of Bangladesh

Although Bangladesh continues to be a low prevalence area, it is surrounded by high prevalence countries (High prevalence of HIV/AIDS in neighboring India). We however must not adopt a complacent attitude in respect as our country has all the determinants for an explosive outbreak of HIV/AIDS epidemic. Curses of poverty, illiteracy, ignorance, proximity of Bangladesh to the so-called 'Golden Triangle' & high prevalence of STDs, make our country seriously vulnerable. Drug use increases the HIV risk and can start very early-for example, glue-sniffing by youngsters living or working on the streets. The danger of becoming infected with HIV by sharing injecting equipment is well known, and real. Unemployment, slum housing, family fragility, frequent cross-border movement of people, lack of information, unsafe blood transfusion, physical and sexual abuse-that create a "risk environment" of violence for many young people in the region. In addition increased number of migrant workers, unsafe practice in health service, unsafe sex practice etc. movement of population, less use of condom, polygamy, homosexuality, extra-marital relations, further increases the susceptibility.

In Bangladesh, the intravenous drug users (IDU) are the most potential carriers of HIV/AIDS among the vulnerable groups in the country. The fourth round of national HIV and behavioural surveillance report showed that the HIV infection rate among the injection drug users (IDUs) is now 4 per cent, up from 2.5 per cent previously which is just short of the 5 per cent mark of a concentrated epidemic. About 93.4 per cent IDUs in central Bangladesh admitted that they share same syringe while taking drugs. Even they use the same syringe several times for taking drug.

UNCDP estimates that between 500,000 and 1,00,000 people in Bangladesh are addicted to drugs. Although HIV rates are comparatively lower (one per cent) among the sex workers but Sexually Transmitted Infection (STI) rates are still quite high (20 per cent) among this group.

 On the other hand, brothel-based female sex workers in Bangladesh report the highest turnover of clients than anywhere in Asia. After several investigate on sex industries have identified more then 1,00,000 various category commercial and non-commercial sex workers in Bangladesh who are most of them illiterate. Some female brothel sex workers have an average of 20-25 clients per week, Female hotel sex worker meet an average of 44 clients in a week, the highest number of clients in commercial sex than any other counties in South-East Asian region. Moreover the residence sex workers and floating sex workers are present in large number though the precise distribution and prevalence is still unknown. By a study ‘Rainbow Nari O Shishu Kallyan Foundation’ also found that a substantial proportion of some young and single textile, garment workers, tea garden female workers, house key-per supplement their low wages by occasional prostitution. Consensual sex or non-commercial sex exists in rural societies, particularly when husbands are absent for a long time.

Meanwhile, most of the people of country are unaware about the deadly disease. The 1999-2000 Bangladesh Demographic and Health Survey found that only 31 per cent of married women and 50 per cent of newly married men had heard of AIDS. Over 90 per cent of rickshaw pullers could not identify a single method of HIV prevention.

Certainly, adolescent girls’ prostitution is booming in Bangladesh. Adolescent girls engage or are forced into prostitution for trafficking or socio-economic reasons. But in addition to sexual exploitation, they face all sorts of violence. Rainbow Nari O Shishu Kallyan Foundation carried out a recent field investigation, the research confirmed that adolescents girls’ prostitution is widespread in Bangladesh, although hidden at first sight from foreigners, especially in Dhaka city. Adolescent girls involved in prostitution are to be found in residence homes converted into brothels or in hotels. The majority are aged 15-18.

According to the National AIDS Committee and surveillance team members and experts, the rate is quite alarming as it remains one per cent less than the highest five per cent HIV epidemic index. The rate of HIV/AIDS remains less than one per cent among the other vulnerable groups -- truckers, migrant workers, gay, hijras (hermaphrodites), professional blood donors, heroin smokers and, hotel, brothel and street based commercial sex workers.

A recent survey in Bangladeshi track drivers by Rainbow Nari O Shishu Kallyan Foundation, found that 80% track driver in Bangladesh have no clear concept of HIV or AIDS. But 90% respond it is a deadly disease. Bangladesh is a country rounded off three sides by HIV/AIDS bloom neighboring country India and the existence of the Bay of Bengal on the other side. Every day a number large of people cross border movement take place both officially and also illegally. Due to reason of that great chance to spread out HIV/AIDS in Bangladesh.

Overview of the sex industry

Commercial sex work is a growth industry. According to an analysis of data from the National Survey of Sexual Attitudes and Lifestyles by Ward et al. [1], the proportion of men who reported paying women for sex more than doubled from 2.0 to 4.2% between 1990 and 2000. There has also been a diversification of sexual services, into areas beyond the traditional exchange of sex for money. Erotic dancing which entails less direct sexual contact between worker and client and other private sex work advertised on the Internet have become increasingly prevalent [2,3].

The sex industry is diverse in the ethnic origins of sex workers, many of whom are economic migrants and include women trafficked and coerced into sex work by organized crime networks [4]. There has been a demographic shift in the origin of commercial sex workers (CSW) working in west London between 1985 and 2002, with a reduction in the proportion with British nationality from 75 to 37%, and a corresponding increase seen in workers from the transitional economies of Eastern Europe and Russia (1–20%) and developing countries, particularly Asia (5–27%) [5]. The Poppy Project, in a survey of female sex workers across London, identified 93 different ethnic groups among women working in off-street premises, of whom only 19% were British [6]. This influx of individuals from many countries inevitably generates language and cultural barriers in access to health and other services.

The pathways that lead people into commercial sex work are also varied. At one end of the spectrum are those who work autonomously, undertake sex work by choice and are well organized with respect to their sexual health and accessing services [7,8]. These workers may have entered sex work for a specific reason (e.g. to fund higher education costs, pay debts or to cover family expenses), may be intermittent or opportunistic in their involvement in sex work [9] and succeed in exiting the industry at a time of their choice [10]. Others make a career decision to work in the sex industry and may enjoy a high level of job satisfaction and independence [11]. In contrast, are those who are driven into commercial sex work through drug addiction or coercion, and have little autonomy. These workers, including women sold for the purposes of trafficking, are highly vulnerable and have little prospect of leaving the industry unassisted [4,12]. Between these extremes lie the majority, who work in the industry due to varying degrees of economic necessity and choice [8].

There are significant differences between indoor work and street work, in terms of harm and risk to health. Street sex work is more likely to be linked with drugs [13,14] and many in the UK have entered the industry primarily out of the need to maintain expensive drug addictions to heroine and crack cocaine. In this setting, sex may either be exchanged directly for drugs, or drugs may be supplied by the pimp in exchange for earnings [15]. As a result, they are likely to be exposed to much higher levels of violence and abuse from clients and pimps than those who work indoors [16]. Pressure from clients for unprotected sex combined with drug dependency and competition among workers for clients lead street workers to offer, or be persuaded to accept unprotected vaginal or anal sex for more money [3,8,17]. Furthermore, street workers are often homeless, living in squats or drug dens, which may in turn have an adverse impact on health through the acquisition of tuberculosis and other respiratory diseases [4,13].

In contrast, workers who are based in off-street premises, whether in flats, saunas or massage parlours, are less exposed to the risk of violence and will generally work with a maid or a manager who can vet clients, look after money and provide security [18]. Indoor workers are more likely to have autonomy in working hours and the disposal of their income, and are less likely to be supporting an addictive drug habit or to be under the control of pimps [19]. As a result, these workers are not compelled to agree to unsafe sexual practices for higher earnings, and use condoms with all clients [20]. Trafficked women and children who have been groomed and coerced into sex work are important exceptions to the paradigm that indoor sex work offers greater protection [4]. Here the individuals concerned are hidden from view to avoid detection by police and social services, and may frequently be moved between locations or across international borders.

Finally, sex work is not gender specific. The existence of a market for male sex workers who offer services to male or (less commonly) female clients is well recognized [21,22]. Transexual and transgendered individuals also participate in the sex industry, and have their own particular needs [8,23].

Research into commercial sex work is hampered by several methodological challenges. First, the study populations are usually small and unrepresentative due to problems gaining access to sex workers and establishing trust. As a result, researchers are reliant on individuals who attend sexual health clinics voluntarily, who may be poorly representative of the local CSW population, particularly the more vulnerable groups. Second, there is likely to be reporting bias in response to questionnaires or structured interviews on topics such as condom use and drug habits [24,25]. Third, the heterogeneity of CSW with respect to adherence to safer sex, drug misuse and local factors such as pimping and policing means that generalizability of results may be limited. Finally, CSW represent an unstable population both temporally and geographically, which means prospective studies are difficult to conduct without the loss of significant numbers of subjects, which itself may bias results.

Risks to health

There are four main categories of health risks faced by workers in the commercial sex industry. These relate to the acquisition of sexually transmitted infections (STI), harm through violence from clients or pimps, factors associated with the use of drugs and mental health.

Acquisition of STI

Bacterial (syphilis, chlamydia, gonorrhoea and Mycoplasma genitalium) and viral STI [human immunodeficiency virus (HIV), hepatitis A, B and C, herpes simplex virus (HSV) and human papilloma virus] are acquired mainly through unprotected vaginal, anal or oral intercourse. Some STI, such as chlamydia and gonorrhoea, cause mucosal inflammation, while others, including primary syphilis and HSV, produce ulceration. HIV, hepatitis B and C and syphilis are also transmitted through injecting drug use. Individuals who are both CSW and intravenous drug users have a dual risk of acquiring these infections.

There are numerous long-term sequelae of STI. Chronic infection with gonorrhoea and chlamydia causes pelvic inflammatory disease leading to higher rates of ectopic pregnancy and infertility. Tertiary syphilis causes neurological and cardiovascular complications. Chronic infection with hepatitis B or C can give rise to liver cirrhosis and hepatocellular carcinoma, while cervical and other anogenital neoplasia are associated with certain subtypes of the human papilloma virus. HIV infection causes progressive immunodeficiency which in turn leads to life-threatening opportunistic infections and cancers. Co-infection with HIV and hepatitis B or C is associated with a worse prognosis than with either alone. The majority of STI can be acquired congenitally and produce high levels of morbidity in neonates and infants.

It has generally been assumed that commercial sex work facilitates the spread of STI in a population [26], but research suggests that this may only apply in certain settings such as the developing world and street sex work, where condom use may not be widely practised [27,28]. The overall prevalence of HIV among UK CSW ranges between 0 and 3.5% [29] while a study from 11 European centres found an HIV prevalence of 1.5% among non-injecting CSW but 31.8% among injecting drug users [30]. A relatively low level of STI in female CSW attending a clinic in west London was also reported [31,32], and attributed to a high level of condom use. Infection rates were still above those for the general population, but this was largely explained by indirect factors such as injecting drug use and having unprotected sex with non-commercial partners who may themselves be injecting drug users [20]. This suggests that even in the context of drugs and street work, it is possible for workers to negotiate barrier protection with clients given the necessary skills.

Harm through violence

Physical violence is perhaps the greatest single threat to the health and well being of CSW. According to Kinnell [33], 87 CSW have been murdered in Britain since 1990. A questionnaire survey of 115 street or outdoor and 125 indoor CSW working in Glasgow, Edinburgh and Leeds conducted by Church et al. [16] found that outdoor workers were twice as likely to report violence such as beatings, stabbing, rape and robbery, than indoor workers. Outdoor workers in Glasgow had a six times greater risk of violence than indoor CSW in Edinburgh. Only one-third of assaults were reported to the police. Among street-based CSW, economic pressures, use of heroine or crack cocaine while working, not being able to control the location for sex and having sex in the client's car were all strong predictors of violence. Norton-Hawk [17] also found that being under the control of a pimp increased the likelihood of violence, partly because of the pressure to earn extra money. These women were more likely to be single, to have come from dysfunctional families and never to have held a legal job. In general, licensed brothel workers felt more secure than in the street setting owing to the closer proximity of fellow workers, the provision of security systems and the right to legal protection [13,34].

Factors associated with use of drugs

Intravenous drug use is associated with multiple medical complications, including cellulitis and abscesses at injecting sites, deep vein thrombosis, pulmonary embolism, bacterial endocarditis, septic embolization, rehab domyolysis and death through overdose or contamination with toxins. Sharing needles and syringes contributes to the risk for acquiring HIV, hepatitis B and C and syphilis, and this accounts for the majority of infections among CSW who are supporting opiate addictions [35]. Other drugs such as cocaine, crack cocaine and crystal methamphetamine can lead to cardiovascular and neurological disease and immunosuppressant.

In general, CSW who inject drugs exhibit higher levels of risk-taking behaviour compared with non-CSW, including higher injection frequency, use of crack cocaine, higher rates of sharing injecting equipment and use of shooting galleries [14,36,37]. HIV prevalence was 32% among CSW and 21% in the non-CSW group (14). Non-injecting drug use, particularly smoking crack cocaine, has been implicated as an indirect risk factor for STI transmission through impairment of judgement, leading sex workers to engage in higher risk behaviours than non-crack users [15,23,38].

Mental health

There is a strong relationship between mental ill-health and risk-taking behaviours (drug use or sexual practices) among CSW [39]. Several studies have reported higher levels of psychological distress levels in CSW, than a non-CSW control group, even after adjusting for confounding factors such as age, previous rape and crack cocaine use [37,40,41].

What remains unclear is the relative contribution to the distress of working as a sex worker versus pre-existing psychological trauma as a result of drug use, previous childhood abuse, domestic violence or imprisonment. Van wizen beck [42] partly addressed this issue in an assessment of ‘burnout’ among 96 CSW in Holland, using measures of emotional exhaustion, depersonalization and personal competence in comparison with a group of female nurses. Increases in the first two were attributed to factors such as coercion, violence, negative social reactions, lack of control with clients and inadequate support from managers. Personal competence was positively associated with having a professional attitude towards sex work and with support from colleagues and managers. It was concluded that the conditions under which sex work are conducted have a greater influence on the worker's psychological well being than the nature of the work itself.

Male and transgender sex workers

The term ‘transgender’ refers both to transsexuals, who display many of the physical attributes of the opposite sex while retaining their natural genitalia, and individuals who have undergone gender reassignment surgery. In terms of commercial sex work, both groups are usually male-to-female transgenders. Transvestites, men who dress as women but do not undergo hormonal or surgical modification, are not considered here in the context of sex work.

Male CSW

Male CSW may be homosexual, bisexual or heterosexual in orientation, and although typically viewed as servicing male clients, a significant proportion also engage in sex work with female clients [21,22].

In a study of 94 male CSW attending sexual health clinics in Sydney, 6.5% of the male CSW were HIV positive, compared with 0.4% of the female CSW and 24% of non-CSW homosexual men, but 21, 5 and 12%, respectively, had anogenital warts [21]. Injecting drug use was twice as common among male CSW than in the other two groups and was significantly higher among workers who reported female non-paying clients than among those whose non-commercial partners were male. Overall, male CSW had significantly more non-paying partners than female CSW. Eighty-six per cent of male CSW reported 100% condom use with clients in the past 3 months compared with 88% of female CSW. In contrast, only half reported consistent condom use with non-paying partners.

Male-to-female transgender CSW

Transgenders form a special group of sex workers in terms of their risks and needs. Discrimination in conventional job markets leads a high proportion to engage in commercial sex work [43]. Incentives to earn money are perhaps also higher in this group compared to other groups of sex workers due to the costs of gender reassignment surgery and hormones used to enhance feminine physical attributes.

Misuse of other drugs is high among transgenders, and reported rates of HIV, hepatitis and syphilis are correspondingly increased [44]. Transgenders also report high rates of needle sharing, both for illicit drugs and for hormones. Post-operative transgenders may engage in both vaginal and anal intercourse, and it has been suggested that surgically constructed vaginas are more susceptible to transmission of HIV and other STI [45]. Transgenders are heavily stigmatized in society, even by other sex workers, and are at high risk both of violence from clients and of being coerced into providing unsafe sexual services for more money [46,47].

The Home Office published a document in 2004 entitled ‘Paying the Price’ [48] which proposed policies for tackling the commercial sex industry. Emphasis was placed on disrupting sex markets to achieve an overall reduction in street work, taking measures to protect communities from the associated ‘nuisance’ and reducing all forms of exploitation in the industry. Following a period of public consultation, the government document ‘A Co-ordinated Prostitution Strategy’ [49] was published in January 2006.

Responses to both documents have been generally unfavourable. Boynton and Cusick [50] point out that the government's failure to address health and human rights for sex workers will undermine efforts to reduce exploitation and minimize harm. For example, it remains illegal for more than one individual to sell sex from indoor premises at one time. As maids are to be classified as ‘controlling prostitution’, sex workers will be compelled to operate alone despite the increased vulnerability that this entails [8]. The government's refusal to license indoor workplaces also acts as a barrier to ensuring that such premises conform with employment and health and safety legislation, and do not harbour children or trafficked women.

The UK Network of Sex Work Projects pointed to the negative effects of anti-kerb-crawling legislation and the use of Anti-Social Behaviour Orders against street workers in pushing the industry further underground. Criminalization affects access to services and the job market while also hampering the efforts of outreach workers in delivering services to those who are most vulnerable. Furthermore, disrupting demand increases competition between workers and encourages more risky behaviour. The UK Network of Sex Work Projects (UKNSWP) also criticized the government for ignoring the benefits that would result from regulating off-street premises and improving conditions for the many who work in the industry out of choice.

The UKNSWP calls for managed zones for street sex work, pointing to the success of projects in Holland and Cologne. By relocating street work to non-residential areas, managed zones improve safety for workers, build good relations with the police, allow regular access to services and reduce the interdependence between street work and drugs. Such proposals were well received in consultations with street workers throughout the UK [8].

Assessment of needs

Service provision to this highly heterogeneous population needs to be tailored to the local needs expressed by sex workers themselves, which are shaped by the individual's own professional, behavioural and social context. For example, street workers may perceive drug dependency or the associated violence from dealers and pimps as their principal problem, while for others, the main requirement may be for suitable housing or childcare. Several surveys of female CSW in London have found that demand was greatest for housing, followed by sexual health and substance misuse services. In contrast, among those wishing to exit the industry, provision of safe house and hostel accommodation, counselling services and peer support groups were highlighted. Other gaps in service provision included dedicated exiting programmes, outreach services, treatment for depression, support following sexual assault, education programmes and community safety strategies [19,24,51].

It is important to recognize that many sex workers are reluctant to seek help through mainstream services such as genitourinary medicine (GUM) clinics and general practitioners for fear of stigma and disapproval [19,23,51]. Service providers must therefore be prepared to overcome these barriers and seek to establish trust by providing surroundings in which confidentiality, non-judgemental attitudes and sympathetic listening predominate [7]. De-stigmatized delivery of service is more likely to be encountered in settings dedicated to sex workers, rather than through piecemeal access to mainstream services for sexual health, drug rehabilitation or housing.

Harm reduction

Services aimed at harm reduction need to address the four main areas of risk discussed, namely, sexual health, physical violence, drug use and mental health.

Sexual health services should include screening for, and treatment of STI, provision of condoms, and education to reduce disease transmission. Mallory and Gabrielson [3] reported that ∼8- to 12-h training is required to impart lasting safer sex behaviours. Effective measures include practice with condom application, and the development of assertiveness and negotiating skills with clients through role play [52]. Sexual health services should also offer reproductive health care, including cervical screening, family planning, management of gynaecological problems and referral for more specialist services such as colposcopy, termination of pregnancy and psychosexual counselling [53].

Reducing the risk of violence towards sex workers depends on a range of strategies that includes safety advice, awareness of potentially dangerous clients, training in assertiveness and negotiating skills and distribution of ‘dodgy punter’ registers based on physical descriptions provided by CSW [7,8,48,54].

Harm reduction in relation to drug use is critically important as a means to protect the individual from the risks of both infection and violence. Needle and syringe exchanges reduce the need to share equipment and visit shooting galleries, and can provide the opportunity for education in safer injecting practices [14,37]. Drug rehabilitation and methadone programmes, as well as those which treat addiction to crack cocaine, are therefore an essential means by which the individual can withdraw from the drug culture [23].

Sex workers who have experienced violence or abuse in early life, or who continue to be exposed either through their work or in their non-commercial partnerships, are likely to suffer in varying degrees from conditions such as depression and post-traumatic stress disorder. These problems require careful evaluation and counselling [3,55] backed up by practical measures such as the provision of emergency housing.

Peer support is recognized as an important means by which important information about safer sex and the reduction of risk from violent clients can be passed between workers [23,56,57]. CSW who act as peer educators are likely to be more successful than health care workers in promoting condom use with both commercial and non-paying partners [24].

Drop-in clinics and outreach

Most dedicated services for CSW concentrate on sexual health, either in the form of clinics or through outreach providers visiting both indoor premises and street locations [24]. The principal role of outreach is to distribute condoms, provide clean needles and syringes, offer information and advice on safer sex and sexual health and refer sex workers to clinic-based services for STI screening and other health needs [7]. Advice may also be offered on safety, access to drug programmes, housing services or legal assistance. One successful pilot scheme in Liverpool involved engaging a wide range of CSW including male workers. A nurse practitioner established links with escort agencies, indoor premises, street workers and a number of outreach projects in order to build trust and provide fast-track clinic appointments for both workers and their partners [51].

Drop-in services for CSW are typically based either in general GUM clinics or in outreach settings, such as general practitioner (GP) surgeries in areas where the sex industry is concentrated. Donegan et al. [58] found specific services offered by 25 GUM departments in the UK providing various combinations of outreach workers, drop-in clinics and outreach clinics. Cooper et al. [59] identified 81 dedicated services for CSW across the UK in a 1995 survey, and 124 in 1999. Most provided outreach and were geared towards harm reduction.

Another model is the Working Women's Project in Streatham, South London run by Mainliners, and based in a primary health care centre. Staff include a GP and female nurses from the nearby Caldecot Centre for Sexual Health at Kings College Hospital. The project provides a full range of services, including sexual health screening and information, pregnancy testing, referral for abortion and other gynaecological problems, contraceptive advice, information on safer sex and drug use, free condoms, a needle exchange, general medical care, an ‘ugly mugs’ list, emotional support and advice on legal issues. Referral can also be made to other services including counselling, housing and drug programmes.

Exit strategies

Workers who wish to leave the sex industry may face multiple obstacles depending on their level of vulnerability [12]. For example, street-based CSW may need protection from pimps or violent partners through the emergency provision of safe houses or shelters, referral to drug rehabilitation programmes or counselling services to address mental health issues. Low educational level, learning difficulties and a criminal record can also act as barriers to the reintegration of sex workers into the non-sex workforce [7].

Exit programmes therefore need to be holistic and tailored to individual vulnerabilities, which is best achieved through coordinated referral to the relevant agencies and the provision of long-term follow-up [8]. Clark and Squires [7] proposed the establishment of Vulnerable Adult Protection programmes in which the coordinating role would be taken on by a key worker. In such a model, an initial intervention to provide safe house accommodation could be followed by referral to drug rehabilitation or sexual health services, and ultimately lead to training in new skills and assistance with job seeking. The Sex Workers in Sexual Health Project in Coventry reported on 10 CSW who had successfully exited over 2 years [60], but few services exist owing to funding constraints and lack of multi-agency co-operation, with the majority concentrating on harm reduction rather than exiting.

Sex workers in the UK will continue to face multiple hazards for as long as the occupation continues to be seen as a policing problem rather than a welfare issue. Clear distinctions need to be drawn between coerced and non-coerced sex work, and recognition given to the heterogeneity and differing needs of this population in order to be able to target interventions appropriately. Decriminalization would open the way for the licensing of indoor premises and the establishment of managed zones for street sex work, which would in turn provide a stable setting for the effective implementation of strategies for harm reduction and exiting. Until such a time, however, existing services will continue to be fragmented and under-funded to the detriment both of sex workers themselves and the wider community.

Human rights: Bangladesh’s LGBT Community and the UPR 2015

Bangladesh will be subject to Universal Periodic Review (UPR) on April 29. The UPR is a mechanism of the United Nations Human Rights Council (UNHRC) that will examine Bangladesh’s overall human rights performance during the last four and a half years. It will be the second UPR cycle, following the first one in 2009.

The UPR aims at improving the human rights situation on the ground in each of the 193 United Nations (UN) member states. Each UN member state is subjected to this review every four and a half years. The reason UPR is important for Bangladesh, or any state for that matter, is the opportunity for stakeholders to submit their own reports along with the one from the government. The mechanism has hence proved to be very popular and powerful in upholding the human rights of marginalized or disenfranchised groups.

The sexual and gender minority community of Bangladesh has also discovered this new mechanism as a way to raise awareness for the violations of their human rights on an international platform. In 2009, based on reports prepared by local rights groups, Chile and the Czech Republic made three recommendations to the Government of Bangladesh that, if implemented, would improve the legal status of lesbian, gay, bisexual, and transgender (LGBT) persons in Bangladesh.

Two of the recommendations were to decriminalise same-sex relationships by abolishing Section 377 of the Bangladesh Penal Code, which is a remainder of British colonialism. Another recommendation was to educate law enforcers and judicial officers about LGBT issues, and to adopt further measures to ensure the protection of LGBT persons against violence and abuse.

The Government of Bangladesh rejected the first two recommendations, saying that “Bangladesh is a society with strong traditional and cultural values. Same-sex activity is not an acceptable norm to any community in the country. Indeed, sexual orientation is not an issue in Bangladesh. There has been no concern expressed by any quarter in the country on this.” The government, however, accepted the recommendation of training law enforcers to protect sexual and gender minorities.

When Bangladesh comes under review for the second cycle in a few days, more specific recommendations from UN member states are expected to ease the plight of LGBT people. But, given the current political situation of the country, the issue may be dumped way beneath the pile of other issues. That is why it is important that the media, civil society and the community endorse the cause of sexual and gender minorities.

Boys of Bangladesh (BoB), the largest platform of self-identified gay men in Bangladesh, have put forward a number of recommendations from the LGBT community in the stakeholders’ report this year. One of the main recommendations is to conduct a government survey about human rights violations victimizing LGBT persons in the country. Such a survey is necessary to learn more about the discrimination, stigma and violence LGBT persons face in Bangladesh, and to develop strategies to address these human rights violations.

The government already has an extensive HIV/AIDS program under the Ministry of Health, which also includes men who have sex with men (MSM) and Hijras. Hence, the government’s claim that sexual orientation is not an issue in the country is only a way to brush aside the realities, and to avoid acknowledging human rights violations of sexual and gender minorities.

BoB thinks that it is time for the government to acknowledge the existence of this clandestine but significant population, and to take appropriate measures to address the violations of their human rights. After all, sexual and gender minorities are part of every family, every society and are integral development partners of the country.

The writer is a human rights activist and a volunteer at Boys of Bangladesh (BoB), a non-registered, non-funded, informal network of self-identified gay men in Bangladesh.

Shame and Guilt over being Homosexual

Do you experience shame and guilt over being gay or homosexual? It's easy for me to say, 'Stop, there's nothing to be ashamed about!" But it's a lot harder to put into practice. The reason for this is that the seeds for shame and guilt are usually sown over a period of many years, since we were very young. In the United States, shame and guilt over being homosexual have their roots in religious philosophy. Religious prejudices have heavily filtered into our legal system, making gay sex illegal in many states and failing to protect gays in most states.

These societal beliefs and laws influence how we are raised by our parents, what our schools teach us and how other people respond to us. Believe it or not, all cultures do not share a negative view of homosexuals. Latin American countries, the Philippines and Sweden are just a few examples of countries that have tolerant laws and attitudes toward gays and lesbians. In general, societies that believe that homosexuality is a born trait are more accepting than societies that think it is a choice. Of course, we as homosexuals know it is not a choice!

So what are shame and guilt exactly? They are not quite the same. Shame is experienced in reference to how other people perceive your actions; guilt is experienced in reference to how you perceive your actions. Is it possible to experience one without the other? Yes, and it is also possible to experience both at the same time. For instance, if you are a woman, you may feel absolutely no guilt whatsoever when you are intimate with your girlfriend. You are joyful, at peace and fulfilled. However, when it comes time to tell another about the experience, you may have a sense of deep shame. Conversely, you may experience guilt when you are together and shame when you tell someone else.

Try to figure out what your feelings are, when you feel them and what triggers these feelings. Ask yourself some hard questions. Do these feelings arise from learned religious convictions? Did my parents teach me these things? When was the first time you heard anti-gay sentiments and what were your feeling then?

Then do a reality check. If you have been an active homosexual you know the truth of what you do, how you feel about your partner and the relationship that you have. Unfortunately, when you examine reality you will discover that the people that wrote the laws, taught you and influenced your thought have no idea what they are talking about. They developed all those prejudices and perspectives, laws and mores, based on fear, poorly interpreted ideology and ignorant judgment. All of these negative beliefs have been developed without any scientific basis or with respect to modern psychiatric insight and findings.

It takes a long time to overcome feelings of shame and guilt. Talking about it is extremely important and may help you get perspective on the subject. You may consider joining a more accepting church or synagogue if religion is a problem. For instance, Unitarians and Reformed Jews are examples of religion sects that do not discriminate against gays and lesbians. Overcoming shame and guilt will go a long way toward helping you come out successfully, accept yourself for who you are and have a healthy relationship with your partner.

Where does Bangladesh stand on homosexuality issue?

Bangladesh is one of 75 countries that currently have laws criminalising homosexuality. In Bangladesh, the highest punishment for "unnatural intercourses" is life imprisonment, but lesser jail terms of up to 10 years in prison and fines might also be handed out under the existing law. According to the Section 377 of the penal code, voluntary carnal intercourse against “the order of nature with any man, woman or animal” is punishable with imprisonment for life or with imprisonment which may extend to ten years and fines.

This phrase is interpreted to mean all forms of sexual activity other than heterosexual penile-vaginal intercourse. Penetration is sufficient to constitute the carnal intercourse necessary to the offence described, the Section 377 also explains. Talking to the Dhaka Tribune, Supreme Court lawyer Jyotirmoy Barua said being gay or lesbian was punishable under that section in Bangladesh. Even though a small number of gay rights organisations and activists in Bangladesh were raising their voice to establish rights for the LGBT community, none of them has so far engaged in a legal fight to recognise the status of lesbian, gay, bisexual and transgender (LGBT) people in the country, said Jyotirmoy.

Of the 75 countries that criminalise homosexuality, most are located in Asia and Africa, while more than half are commonwealth countries. On the other side of the coin, nineteen countries – most of them located in North America, South America and Western Europe – recognise same-sex marriage and grant most LGBT rights to its citizens. In December 2008, Bangladesh was one of 59 countries that signed a statement opposing LGBT rights at the United Nations General Assembly. However, in January 2014, the Bangladesh government granted hijras, who are neither male nor female, official recognition as a separate gender. The move was made to ensure all hijras get priority for education and other rights. In South Asia, the only case of legal fight challenging the criminalization of homosexuality took place in India.

In 2001, an NGO there fought a legal battle challenging the constitutionality of Section 377 of the India Penal Code, which has similarity with the section 377 of the penal code of Bangladesh, but it was finally turned down by the Indian Supreme Court. According to Amnesty International, human rights abuses based on sexual orientation or gender can include violation of the rights of the child; the infliction of torture and cruel, inhuman and degrading treatment; arbitrary detention on grounds of identity or beliefs; the restriction of freedom of association; and the denial of the basic rights of due process.

Some examples of such abuses include execution by the state; denial of employment, housing or health services; loss of custody of children; denial of asylum; rape and otherwise torture in detention; threats for campaigning for LGBT human rights and regular subjection to verbal abuse, says Amnesty International. Source: Dhaka Tribune