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Marguerite Heyns - Blog Post 2: Compromise and Complexity

Marguerite Heyns - Blog Post 2: Compromise and Complexity

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I’m currently sitting in a café on the bank of the Krabi River attempting to reflect on my experience in Bangladesh over the past five months. It’s hard to pin point exactly how I feel about everything. Since departing the country I’ve had dozens of other travellers ask me how I feel, and what it was like, and I rarely have an accurate response. I suppose that is because I didn’t have just one experience. I can’t tell just one story.

During my internship I learned an incredible amount about compromise and complexity. Every issue and every decision is coloured by independent understandings and diverse consequences. It’s too easy to say that Bangladesh’s biggest issue is poverty, because poverty reaches so far beyond the immediate. It infects every part of the culture and the society. Additionally, poverty, and the conceptualization of it is informed by experience and education and religion and politics. The list goes on. Throwing gender into the mix just further complicates the concept, and all of a sudden no solution seems like viable one. So instead you assess what would benefit the most amount of people, while doing the least amount of harm.

The best example in my work that I can share has to do with HIV in Bangladesh. Currently there is little to no reliable data on the prevalence of HIV/AIDS amongst Bangladeshi people, much less migrant workers. This is of course surprising considering both Bangladesh’s immediate vulnerability to HIV and the sheer volume of HIV data in other emerging countries. Let me backtrack a bit and explain the current situation. Most of the reported prevalence rates have come from government-sponsored studies or very small sample sizes or both. Consequently Bangladesh’s reported prevalence sits somewhere below 0.01%. In fact the apparent amount of people living with HIV is as low as 11,000. To put that in perspective, Canada has about 71,000. Meaning Canada has about 34 times more people living with HIV than Bangladesh. But of course this doesn’t really put anything into perspective, what would be more relevant would be to look at surrounding countries. Nepal, for example has a prevalence of around 1%. Given the amount of cross-border migration and documented sexual exchanges amongst the two populations, the numbers really don’t add up. Most academics suspect that Bangladesh is on the verge of at least a concentrated epidemic. Since HIV takes a decade to manifest into AIDS, and very few people are routinely tested for HIV, there will likely be an eruption of cases any year now. Migrants are a particularly vulnerable population to HIV/AIDS, and although there is some research looking at migrant prevalence, it’s really not enough.

Given all this information, I really wanted to look at HIV/AIDS while I was in Bangladesh. Although when I talked to my coworkers about it they said it wouldn’t be possible. At first I was baffled, I had identified an area that was due for some serious attention. If we could prove that HIV infection was common in returnee migrants then programs and policies could be developed to better protect migrants from infection when they go abroad, right? Unfortunately the situation is much more complex than that. Years ago, RMMRU was given a large grant to do research into this very topic and they turned it down. Everyone is aware of what will be found—disproportionately high prevalence rates amongst returnee migrants—but publishing that would lead to more harm to migrants than good. Borders will be closed; sending countries won’t read past the headline that Bangladeshi migrants have high rates of HIV, and will assume that these migrants are bringing HIV into their country instead of taking it with them when they leave. Compromise. Complexity.

These words, more than any other words, sum up my time in Bangladesh. It is layered and evolving, even while I am away. I had massive triumphs and intense lows. I became frustrated at times, and then a few days later I would be in love with the country again. It doesn’t make sense. I still don’t know how I feel. Right now I think I will keep writing and digesting. I think the key is to tell as many stories as possible and to assess them with utmost personal honesty. Of course all of this is easier said than done. Stay tuned.