For 15 years, Maya* lived in the brothel with a fear she might be living with HIV and not know about it. Sold into sex work by her husband at 25, she entered a world controlled by mashis (brothel managers). Because of different client demands, Maya could not request protection, rules were strict and health care was off limits unless the mashi agreed.
“My biggest fear was that if I was HIV positive, my life would collapse,” said Maya. “I thought I would be abandoned, thrown out of the brothel and lose my income.”
Like many brothel-based sex workers in Bangladesh, Maya had little power to insist on condom use and was judged harshly for her work. She knew about HIV but stayed away from testing.
“I didn’t want to know about my HIV status,” she recalls. “I worried that if anyone found out, I would lose everything.”
In brothels, rumours travel fast, and women who are believed to be “sick” risk losing both income and shelter.
Before UNFPA’s Sukh Pakhi (“Happy Bird”) project started, Maya had never met a health worker who treated her without judgement. She was not allowed to visit government or private clinics on her own.
Sukh Pakhi, supported by UNFPA and implemented by Partners in Health and Development (PHD), changes this by bringing free and confidential sexual and reproductive health and HIV prevention and screening services into brothels instead of waiting for women to come to clinics.
Peer educators in the brothel community are trained to share accurate information on HIV, sexually transmitted infections, contraception and gender-based violence. A medical assistant and counsellor team provide voluntary HIV screening, pre and post-test counselling, and referrals for confirmatory testing and treatment. All services are offered in a way that respects the realities of brothel life.
“At first, I only listened from a distance,” Maya says. “As the health workers visited us again and treated us kindly, I slowly gained the courage to talk to them and think about testing.”
In 2024 alone, the programme reached 3,141 brothel-based sex workers with sexual and reproductive health and HIV services. A total of 2,359 women were screened for HIV and 622 were referred for further care at government or NGO facilities. One woman who tested positive was successfully linked to antiretroviral therapy and remains in treatment.
By mid 2025, a further 2,115 women had been reached, with another woman enrolled on antiretroviral therapy and 296 new referrals made for specialised care. To sustain this work, fifteen peer educators were trained in 2024 and seven more were added in 2025, deepening a network of trusted messengers inside the brothels.
However, these gains are under pressure. At the beginning of 2025, three Sukh Pakhi centres closed due to funding constraints. As a result, the number of targeted beneficiaries dropped from 3,141 to 2,115, leaving many women without regular access to safe, trusted services.
In October 2025, after many conversations, Maya agreed to join an HIV screening round. The medical assistant, who also serves as a counsellor, came to her room with a peer educator. They explained about the test, assured her it was confidential and reminded her she would not be left alone.
When the rapid test came back reactive, confirming that Maya was living with HIV, her worst fear surfaced. “I thought, now it is finished,’” she remembers.
Instead, she was met with calm and care. The medical assistant explained what the result meant, how HIV can be treated and how antiretroviral therapy helps people live a long life. She answered Maya’s questions and reassured her that her status would remain confidential.
“The way she spoke to me helped me move from panic to understanding,” Maya says. “I learned that I did not have to die from this. I could take medicine.”
With Maya’s consent, the Sukh Pakhi team activated a referral pathway, accompanying her for confirmatory testing and enrolment on antiretroviral therapy. The project has maintained a 100 per cent success rate in linking all reactive cases to the therapy in 2024 and 2025.
Maya takes her therapy every day and attends follow-up appointments. She understands that staying on treatment and keeping her viral load undetectable protects her health and those around her.
“HIV did not mean the end,” she says. “It meant taking medicine and staying connected.”
The project is also influencing the wider HIV response in Bangladesh. UNFPA is supporting the National AIDS/STD Programme (NASP) to develop a peer referral pathway for sex workers, based on the Sukh Pakhi model, so that seamless care like Maya’s can become standard practice nationwide.
On World AIDS Day, Maya has a simple message for other women who are still living in fear of the unknown.
“No fear,” she states. “Treatment is available.”
Yet her safety net is fragile. Dramatic cuts in international aid are already forcing HIV prevention and treatment services to shrink, as seen in the closure of three Sukh Pakhi centres. Without urgent new and sustained funding from development partners and domestic budgets, more women will be left without the care they need and the progress made so far will be at risk.
As Maya’s journey shows, when judgement is replaced with care and women’s rights are put first, we do more than stop a virus. We protect survival, strengthen dignity and keep the promise to leave no one behind.
*Name changed for safety and privacy.
