A slight increase in the prevalence of HIV/AIDS in Sri Lanka in recent years, has prompted the Health Ministry to call for more awareness raising among the public besides increasing more services for testing and counselling, targeting high risk groups. Currently, Sri Lanka has a low prevalence rate of HIV/AIDS, of less than 0.01% for many years, which is considered as a very low rate compared to other countries in the world. This low figure is due to various factors such as, our culture, religion, family bonds, high level of education, health services, etc. According to Family Planning sources the number of cases reported increased with increasing awareness, improved services and facilities such as, more HIV/ AIDS clinics for counselling, testing and treatment all over the country. Recently, the FPASL installed a condom vending machine in response to what they felt was an urgent unmet need among young, sexually active persons.
The Sunday Observer spoke to Director Family Planning Association of Sri Lanka ( FPASL), Dr Harischandra Yakandawala for his views on the subject. We also asked him why abortion figures were soaring in Sri Lanka to unacceptable levels and the negative impact on the health of the mother due to unsafe abortions as well as exposure to various sexually transmitted diseases among high risk young people.
Excerpts …
Q. The government wants to make this an HIV/AIDS free nation. So even though our HIV/AIDS prevalence rate is low compared to other countries, it could be the tip of the iceberg . What caused this increase?
A. It can be due to several reasons such as, real increase in, good reporting and the increased number of risk groups visiting govt. clinics for testing. There are also many programs currently operating in Sri Lanka to educate and promote for testing and treatment risk groups to STI HIV clinics. The Global Fund (GFATM) project is the main such program against HIV.
Q. The Family Planning Association of Sri Lanka recently installed a condom vending machine outside its premises at Bullers Lane. When installing it, you were reported to have said, it was because those engaged in active sex were reluctant to go to pharmacies where they had a wider choice of options for safe sex . Your comments?
A. Yes, we have observed there is a reasonable percentage of population in the community having risky sexual activities without any protection, who are at higher risk of getting sexually transmitted infections, including HIV, and also unwanted pregnancies. Those people are reluctant to go to the pharmacy to buy condoms. Condom vending machines are used worldwide to reach such people and make condoms accessible for everybody. This specific machine provides an opportunity for the people to buy different varieties of condoms and pay through the mobile phone without it appearing in the detail bill.
Q. You also mentioned that due to not using condoms, around 1,700-1,800 abortions occurred daily from unsafe sex. Why are so many women choosing abortion as the first choice?
A. Because, the foetus is unwanted. A sexually active couple without a proper family planning method should expect a pregnancy at any time. Most women who undergo abortions have not used a proper family planning method. This can be due to ignorance, not having proper awareness, non-availability of condoms or the partner not agreeing to use a condom. We do not have proper information about abortions happening in Sri Lanka, but mostly it is due to non use of proper family planning methods. While we don’t exactly know how many abortions occur every day in our country, my guess would be between 750 – 1,000.
Q. What are the health impacts of abortion on a mother?
A. There are different methods to do an abortion. Many women go to unqualified abortionists to get this done because it is illegal and some methods are very dangerous. It can cause severe infection or severe bleeding. Uncontrolled bleeding can cause death and severe infection also can lead to complications and death. It can also lead to Anemia due to severe bleeding and other complications. Infections can cause damage to Fallopian Tubes which can lead to a blockage. This is a common cause for Ectopic Pregnancy or Sub fertility.
Q. Any health impacts on the child?
A. There is no impact on the child because it is already aborted.
Q. What kind of STDs are commonly associated with the transmission of HIV?
A. Any Sexually Transmitted Infection can be associated with the transmission of HIV because unprotected sexual intercourse is the main mode of transmission for both.
Q. Are these infections caused by bacteria or viruses or both? If so what diseases fall into the category of virus transmitted diseases, and which are bacteria transmitted STDs?
A. There are many infectious agents that can cause STIs. They are Bacteria, Virus, Fungi ,Protozoa , and in between like Chlamydia.
The common STIs such as Syphilis and Gonorrhoea are caused by Bacteria, Herpes, Genital Warts, HIV are caused by Viruses and Candida
by a Fungus , and Trichomonaisis by a protozoa.
Q. I understand there are several ways of transmitting HIV virus . Tell us what they are in detail.
A. The main mode of transmission of HIV is unprotected sexual intercourse – (without using a condom); vaginal , anal or oral, of which oral sex has a low chance.
When a person has more than one partner the chances are high. Men and women having sex with commercial sex workers or with their partners have the highest risk. Men and women engaged in commercial sex trade or prostitution can be the agents of the infection. The highest number of HIV positives reported to government clinics during the last couple of years were of men having sex with men.
It is important to know the sexual behaviour of the people in the community to prevent the spread of the disease.The second mode of transmission is transfusion of infected blood or transplanting infected body parts, because in an infected person the highest concentration of virus is found in the blood and body fluids.
The government of Sri Lanka has a very strong policy for blood and all the collected blood are tested for HIV before transfusion. There are many other strategies to prevent collection of blood from any infected person. The third mode of transmission is from HIV infected mother to the child during pregnancy, during childbirth or through breast milk. Around 25% to 40% of HIV positive mothers transmit the virus to their children.
Q. Of these transmission modes, what are the commonest methods that spread the disease in Sri Lanka?
A. Nearly 98% of HIV infections occur through unprotected sexual intercourse.
Q. The disease is also not transmitted in certain instances. Tell us how it is NOT transmitted.
A. HIV will not transmit through any casual day to day activities such as, being with an HIV positive person, eating , playing , studying , working together or living in the same house or room, sharing clothes, utensils etc.
Q. Once you contract an STD for how long will it remain dormant without symptoms?
A. It depends, such as, Gonorrhea 5-7 days , Syphilis 10 – 90 days and Herpes 7-10 days HIV 5- 15 years.
Q. You also have infants and children under five, infected with HIV. How many children living with HIV/AIDs do you have at present?
Are they treated in special wards or at home? How many wards do you have for such children?
A. Most of the infected children diagnosed with HIV have died because a majority were diagnosed in the latter stage of the disease. Any patient with HIV are treated in the normal ward and universal precautions are followed to prevent the infection in health care facilities because there are many patients unaware of their HIV status.
Q. What is their survival rate?
A. Very low
Q. Is there a relationship between Hepatitis and HIV?
A. Hepatitis B and C also can transmit through sexual intercourse and blood transfusion.
Q. Is it more dangerous and can it impact on more parts of the body than other infectious diseases?
A. No, Hepatitis mainly infects the liver and it can lead to cancer of the liver in the long run.
Q. In your efforts to minimize HIV risk, you come across many problems. Myths for instance, prejudice, stigma. Explain more fully what they are .
A. Yes, HIV is the most stigmatized infection in the world because of the nature of the transmission and there was no cure. In the beginning we had different types of issues in relation to HIV in terms of employing such persons or even dismissing them from their workplace if identified as having HIV/AIDS.
Even children going to school suffered and were forced to leave their respective schools if they or a close family relative had the disease. Often the whole village would gang up against such families, burning their houses , and even killing patients or forcing them to commit suicide. All this is mostly due to myths related to the spread of the infection. But now the situation has improved due to awareness raising on the part of the Health Ministry and various private organizations, and there is more understanding and tolerance among the general population . But, there are still some exceptions as recent reports have revealed.
Q. Is the media also to blame for misreporting or sensationalizing reports of persons inflicted by HIV/AIDS?
A. Definitely, the media can work both ways, either educate them or cause them panic. A responsible media should take the lead in making the population aware of the facts and give them scientific information. Any case history should be taken as a lesson and educate people how to face such situations.
Q. What are the most recent advances in detection, treatment and preventing of HIV/AIDS globally and in Sri Lanka? Are these new advanced treatments available in Sri Lanka? Where?
A. All the tests, and treatment for STIs and HIV is available in Sri Lanka and are free of charge in the government sector .The private sector also provides such facilities, for a fee. However, coming to the clinic, they will be counselled, tested and treated while maintaining confidentiality. STI HIV clinics are available in all the large hospitals in the country numbering about 26.
Q. What are the gaps in treating patients with HIV /AIDs in our state hospitals and private hospitals?
A. HIV is diagnosed with 2 tests, ELISA is to screen and Western Blot is to confirm. Govt clinics provide both, but private sector provide only the screening test. Whoever gets the ELISA for HIV 1 and II positive should go for the Western Blot test for confirmation.
Q. What are the plans of the FPASL for the future? Do you plan to set up condom vending machines islandwide? What will the cost be? Has the health budget provided adequate finds for this?
A. The condom vending machine is not a new thing in Sri Lnaka. The first machine was installed about 20 years ago but it was not accepted by the community. Most of them were broken by some people. Now the situation has changed as most of the people are aware about the disease and on prevention. The new condom machine installed by the FPA is working through the mobile phone just like Ezy Cash system and the transaction will not appear in the bill.
However, the FPA and the NSACP are watching the reactions of the general population to expedite the process and instal more machines.
Q. Guidelines to the media in relation to reporting on HIV/AIDS?
A. Be responsible in your reporting and do good.
Q. Your advice to the public, patients and physicians on dealing with HIV /AIDs infected persons.
A. HIV is mainly transmitted through unprotected sexual intercourse and it should be decided by you only. Any sexual action you are engaged in, always be responsible, be faithful, stick to one partner or use a condom every time you have sex. The general population, stop stigmatizing people who are living with HIV. There may be many in society who do not know about their HIV status and we cannot find them by looking at them.
If you are having any problem about yourself go to the nearest STI HIV clinic for counselling and testing. If you have been found positive, the world is not going to be the end. You can still live your lifespan with quality living and treatment.
Treat HIV positive people just like any other person because they are also human beings and they too have the right to live in this world.