Now it is pretty clear that AIDS is more than a mere disease. The Secretary General of the United Nations rightly pointed out this phenomenon in his World AIDS Day message of this year "AIDS is a disease unlike any other. It is a social issue, a human rights issue, an economic issue. It targets young adults just as they should be contributing to economic development, intellectual growth, and bringing up young children. It is taking a disproportionate toll on women. It has made millions of children orphans. It does to society what HIV does to the human body-reduces resilience and weakens capacity, hampers development and threatens stability."

To address this globalized epidemic, the urgency of a unified global response was felt and the World AIDS Day has provided us with a unique opportunity to bring messages of solidarity, compassion, hope and understanding about AIDS throughout the world. Acting as a vehicle of global communication by facilitating exchange of experience and information, this very special day put up a universal feeling of "we are in the same boat, brother".

But we have to keep in mind that AIDS is not just a cause for concern of only one day in each year; rather there should be year-round activities for HIV and AIDS to make the effort more meaningful. Recognizing the crying need, UNAIDS launched the first year-long World AIDS Campaign in 1997. For the period from its inception in 1997 until 2004, a particular theme had been chosen usually keeping in mind the priority issues at that point.

But the strategy was changed in 2005. The Global Steering Committee of World AIDS Campaign adopted 'Stop AIDS. Keep the Promise.' as the focus, a tagline for the year 2005 and the coming years-at least until the end of 2010-because of the Declaration of Commitment targets as well as the Universal Access commitments for 2010. World AIDS Day each year will have different variations of the theme whilst keeping the tagline 'Stop AIDS. Keep the Promise' in place. The overall purpose of the World AIDS Campaign from 2005 to 2010 is to ensure that leaders and decision makers deliver on their promises on AIDS, including the provision of Universal Access to Treatment, Care, Support and Prevention services by 2010. Within that five-year mission, annual campaigning themes are selected which are timely, relevant and adaptable to a number of different regions and issues.

In 2005 the theme of World AIDS Day was 'Make the Promise' and last year it was 'Accountability'. The Global Steering Committee of the World AIDS Campaign selected the theme "Leadership" for the 2007 and 2008 World AIDS Day. Promoted with the slogan "Stop AIDS. Keep the Promise", which is the World AIDS Campaign emphasis from 2005-2010, "leadership" will build on the 2006 World AIDS Day focus on "Accountability". The strap line used to express the agenda of leadership is "Take the lead".

Now let us see why the theme of leadership has been chosen. Since the beginning of the epidemic, experience has clearly demonstrated that significant advances in the response to HIV have been achieved when there is strong and committed leadership. We have seen that leaders like Nelson Mandela have made a real difference in the fight against HIV/AIDS. Leadership plays a crucial role in Uganda, Thailand, and Cambodia to generate positive response against HIV. Leaders are distinguished by their action, innovation and vision; their personal example and engagement of others; and their perseverance in the face of obstacles and challenges. Though top level leadership is critical, it is not mandatory that only leaders in the highest offices are only responsible; rather leadership must be demonstrated at every level to get ahead of the disease-in families, in communities, in countries and internationally. Much of the best leadership on AIDS has been demonstrated within civil society organizations challenging the status quo. Making leadership the theme of the next two World AIDS Days will help encourage leadership on AIDS within all levels and sectors of society.

Leadership as a theme follows and builds on the 2006 theme of accountability. In 2006 a number of milestones were reached where accountability was particularly crucial. It was the year of the United Nations High Level Meeting on AIDS, which reviewed the progress on the 2001 Declaration of Commitment on HIV/AIDS-an important blueprint for reaching the Millennium Development Goals on AIDS. 2006 was also the year in which national targets were set, or should have been set, by governments for achieving Universal Access to Treatment, Prevention, Support and Care by 2010. In addition, at 2006's International AIDS Conference, "accountability" was the buzzword throughout the global forum, reflecting the conference's theme, "Time to Deliver".

If we look at Bangladesh scenario we will find that though at present Bangladesh is categorized as a low HIV prevalence country, yet from an epidemiological point of view the HIV epidemic in Bangladesh is evolving rapidly. Bangladesh has a relatively low prevalence of less than 1 percent among vulnerable groups except in IDUs where HIV positivity rapidly increased from 1.7 percent in 2000/2001 to 4 percent in 2002 in Central Bangladesh. Of major concern is-during 6th round of surveillance in 2004/2005-injecting drug users (IDU) had the highest rate of HIV infection with 4.9% prevalence in central Bangladesh and in one pocket of central Bangladesh HIV infection rate among IDUs has reached concentrated epidemic level of 8.9 percent.

According to the National AIDS/STD Programme (NASP) the estimated number of People Living with HIV (PLHIV) was around 7500 as of end of 2006. As of December 2007, a total cumulative number of 1007 cases of HIV/AIDS have been confirmed and reported by the Ministry of Health and Family Welfare (MOHFW), with 365 of these having developed AIDS, and 123 already died. From Dec 2006-Nov 2007, 333 new cases of HIV have been reported along with development of AIDS in additional 161 persons. Fourteen people died with AIDS in the said period. These numbers may be the tip of the iceberg as significant underreporting of cases occurs because of the country's limited voluntary counseling and testing capacity and inadequate reporting system. The social stigma attached to the disease is a further impediment.

Despite being categorized as a low prevalent country, Bangladesh has taken commendable steps to respond to the epidemic. Top-level commitment helped to create an enabling environment to take necessary measures controlling the spread of the disease. Here follow some of the measures taken by Bangladesh:

• A high level National AIDS Committee (NAC) AND Technical committee created in 1985.

•GOB started AIDS Prevention activities in 1987

• In 1989, a 3-year Medium Term Plan was formulated

l1994-1996: UNDP supported the HIV/AIDS intervention

•1997: The National Policy on HIV/AIDS and STD Related Issues was approved.

•1998 -2005: Six Behavioral and Serological Surveillance (BSS) on HIV and Syphilis was completed

•The management struc-ture of NASP has been outlined

•Multi-sectoral Invol-vement: Effective interaction with different ministries to support the NASP has been initiated. Focal Points at 16 ministries have been identified.

•2000: Legislation on blood safety approved

• 2000: The 1st Behavioral communication strategy developed

•2004: 2nd five-year National Strategy (2004-2010) developed and approved by MOHFW

•2005: HIV/AIDS prevention activities were included in the ToR of "District Health Service Development Committee" which is headed by respective ministers in charge of districts

Here, we do dot have any space of complacency as there are still lots of areas to address if we want to respond to the epidemic properly. Programs should focus on harm reduction activities through behavior change communications, aggressive promotion of safe sex and condom use as well as providing necessary clinical care and support to people living with HIV along with provision of Anti-retroviral Drugs. At the same time efforts need to be taken to switch from risky behaviors towards non-risky ones. Large- scale multi-sectoral approach with strong GO-NGO collaboration should be designed with the aim to sustain the programs long term over.

The role of leadership is crucial for this critical journey. There are several initiatives continuing in Bangladesh to involve and encourage political, religious, civil society, media, women, youth, community and professional group leaders to keep HIV/AIDS at the top of their agenda. Bangladesh is fortunate enough as it has still time to avert a potential HIV epidemic, if action could be taken at this very moment with a strong leadership in place. It should be 'NOW'; any delay would be fatal.

(Source: UNAIDS and World AIDS Campaign website and NASP)