Bangladeshi society is influenced by cultural inhibitions towards open discussion about sexual matters. Yet the incidence of STDs is quite high among students, truckers and people in the business community. Except for a few STD clinics that provide clinical services without counselling, young people have no easy access to information about reproductive health-related problems. Devoid of information or knowledge, teenagers remain ignorant of the disease and its consequences.

When people are diagnosed with HIV, they have no place to seek help or are afraid to get help and so they go into hiding. Often they are taunted by their neighbours and sometimes even by the police. In this environment it is difficult for them to seek help and to counsel them. An example: one 18-year-old HIV positive woman was locked up in a hospital room without attention or care. Even the doctors were reluctant to attend her or touch her. Her family refused to take her home because their neighbours threatened to burn their house if the girl lived with them. This was in 1996. Three years have passed and attitudes towards people with HIV/AIDS have not changed.

To combat this problem of fear, lack of information and stigmatization, the Confidential Approach to AIDS Prevention (CAAP) Hotline was established in 1996. CAAP is an education centre providing information and counselling on HIV/AIDS to all and to PHAs and their families. It offers information and training on care and self-care skills through telephone, mailbox and mobile units.

CAAP has an open-door policy of providing anonymous care and counselling PHAs. It also offers free HIV-testing. A team of trained counsellors, university graduates with a Master's degree in Psychology and with two to three years' experience working in health-related fields, counsel clients at the CAAP centre. After recruitment, the counsellors undergo an additional three weeks of training, two weeks in the centre and one week in a neighbouring country with a similar programme. CAAP also arranges refresher training once a year.

Counselling individuals in the CAAP centre is easier and more comfortable for the clients and counsellors and it ensures confidentiality. Counsellors discuss the disease, its progression, the minor problems that may develop and what to do about them, good hygiene, when to report for medical help and how to avoid spreading the disease. Nutrition and selection of food items are also discussed.

Counsellors regularly check the clients' weight and personal well being. Clients are given a small kit containing a pack of Band-Aid, antiseptic lotion, a sample condom for men, and a key ring with the centre's telephone number. In one-hour sessions, counsellors use slides and flash cards with stories of HIV-positive people in other countries to help PHAs build self-help skills.

PHAs are also counselled in hospital. In shelter homes, where PHAs share a residence with non-infected people, the staff is often afraid to care for them. In these cases, CAAP gives the care-providers a one-week training course covering all aspect of HIV/AIDS, with special emphasis on transmission of the disease, risk factors, psychological support and responsibilities of caregivers.

Reaching the families of PHAs is difficult. Either the family denies the presence of a family member with a seropositive status or the PHA concerned refuses to disclose his/her status to family members. Neighbours also often create trouble for the family. Instead of going to the family first, CAAP goes to their neighbourhood, organizes an advocacy programme on HIV/AIDS and distributes leaflets and posters to sensitize the community. Afterwards, CAAP approaches the individual families and PHAs to train them in care and self-care demonstrating a flexible and situation-specific approach.