World HIV/ AIDS Day was observed yesterday. As efforts to contain the disease has shown positive results in some countries, it continues to remain a public health challenge with 39.9 million living with HIV and 500,000 newly infected globally. The hardest hit countries are the poorest, with little resource to battle the other infections.
Acting Director, National STD/AIDS Control Program ( NCACP) Dr LILANI RAJAPAKSA, discusses the current status of the disease in Sri Lanka while debunking myths surrounding it. She talks of the latest advances and interventions in place to prevent and treat the vulnerable community, in this interview with the Sunday Observer.
Excerpts …
Q. Efforts to halt the spread of HIV/AIDS have succeeded to some extent. Yet HIV/AIDS continues to remain as a public health problem in many countries. What is the position in Sri Lanka?
A. The first Sri Lankan with HIV infection was diagnosed in 1987. By end September 2018 the cumulative number diagnosed with HIV infection has increased to 3,117. Sri Lanka remains a country with low prevalence of infection with a percentage, 0.02 in the general population. Although among most at risk, such as female sex workers and men who have sex with men, HIV prevalence is higher, as compared to other countries in the region, in Sri Lanka it is still low in these groups.
Q. How was this remarkable achievement made possible?
A. National STD AIDS Control Program under the Ministry of Health took leadership in the prevention and control of HIV in the country and initiated many activities in the early days of the epidemic. Country wide awareness programs provided improved knowledge on HIV, and mass media was used to reach the public.
Youth and other vulnerable populations were targeted through schools and higher education institutes. Prevention was the key word with emphasis on safer sex and condom promotion. Many important stakeholders such as, NGOs, community organizations and support groups of people living with HIV, worked closely with the national STD AIDS Control Program.
Q. Data collected in the integrated biological and Behavioral Surveillance Survey (BSS) of 2017 through 2018 among female sex workers (FSW) and men having sex with men (MSM) populations indicated the presence of risky behaviour. It has been said, in low prevalence settings, the focus of HIV prevention programs should be the most at risk persons (MARP) to prevent an increase in HIV infections. Do you agree?
A. There are four groups identified as MARPs for HIV infection in the country. This includes female sex workers, men having sex with men, ‘beach boys’ and drug users. They are at risk as they have unprotected sex with many partners. They have a risk of getting infected and are capable of infecting others. According to the recently conducted survey among these groups more than 80% of sex workers and men having sex with men have used condoms during the last sex act. However, the number who always, used condoms was less.
Q. What is the ratio of HIV in men and women in Sri Lanka?
A. According to the numbers reported in 2018 up to end September 275 new cases have been reported of which 223 are males and 52 are females, with a ratio of 4:1. While female numbers have remained static during the last five years, infections among males are increasing. Of them close to 50% admit unprotected sex with men. This is a concern and action has been taken to reach MSM through peers to promote responsible behaviour.
Q. Is it possible for an HIV infected pregnant mother to have an uninfected baby?
A. HIV infected women can infect their children during pregnancy but the risk is higher close to delivery. Prevention of mother to child transmission of HIV program was started in 2002. In 2013 this program was strengthened. From 2013 HIV testing services for pregnant women were scaled up and by 2016 it was made available for all pregnant women in the country. Pregnant women identified as having HIV start antiretroviral treatment in early pregnancy.
If she takes treatment properly her viral level will be low at the time of delivery and the risk of transmission to baby is minimal. However, the baby is also given treatment for 6 weeks to prevent any chance of infection. All HIV infected pregnant women who received these services delivered uninfected babies during the last five years. This proves, the mother to child transmission risk can be eliminated through appropriate services.
Q. How is HIV transmitted?
A. HIV is mainly transmitted through unprotected sexual exposures. In Sri Lanka, almost all adults were infected through unprotected penetrative sex. Unprotected anal sex carries the highest risk of HIV transmission followed by unprotected vaginal sex. The risk of transmission through sharing of needles and syringes is high among injection drug users.
Low injection drug use in Sri Lanka is an important reason for low prevalence of HIV. The risk through blood and other body fluids is minimal. However, current practices of ear or body piercing and tattooing can cause HIV infection or hepatitis B if proper infection control measures are not practised.
Q. How is it NOT transmitted?
A. HIV is not easily transmissible. HIV is transmitted only through close relationships between individuals by vaginal and seminal fluids. There is no possibility of HIV transmission through normal social interactions such as, living with an infected person in the same premises, school or working place.
Q. What are the symptoms of the onset of HIV?
A. HIV infection does not cause significant symptoms to give a clue to the diagnosis. When a person gets infected with HIV the person may remain free of symptoms for the next 10-15 years. Therefore, people should not wait for symptoms to appear. If any one has had unprotected sexual behaviour it is important to get a blood test done. These facilities are available at STD clinics, OPDs in all major hospitals and recognized private laboratories.
Q. What are the significant complications if allowed to progress?
A. HIV affects the immunity of the person’s ability to fight against infections making the infected person prone to other infections. When the immunity is suppressed to a significant level the infected person develops many infections and cancers. This stage is called AIDS. During this stage the person is ill and if not treated properly will die within 2 years.
Q. Most men don’t know the dangers of engaging in sexual relations with same sex partners. What are the significant health impacts of engaging in such relationships?
A. Unprotected anal sex is the highest risk for HIV infection. Oral and anal sex can cause other sexually transmitted infections such as, genital herpes, genital warts, gonorrhoea or syphilis. This risk can be avoided by using condoms
Q. Women having sex with women? What are the health impacts?
A. In close contact involving body fluids there is a risk for sexually transmitted infections.
Q.What is the treatment procedure when a person is diagnosed with HIV?
A. In 2016 a policy decision was taken to start antiretroviral treatment to all persons diagnosed with HIV. If taken properly the treatment is highly effective and viral levels reduce markedly a few months after starting the treatment.
If the viral level is low the infected person’s immunity is high. A person who is taking treatment satisfactorily will not develop AIDS.
The quality and quantity of life will improve with treatment, giving an opportunity to lead a normal life. However, the treatment can only control viral multiplication. It cannot cure the infection. Therefore, the person has to take lifetime treatment. Further, treatment has side effects. The answer is not treatment but prevention.
Q. Myths surrounding the disease – what are the most common in Sri Lanka?
A. The main myth is the feeling that HIV is not a problem in Sri Lanka. When we say HIV prevalence is low in the country people get a false sense of security. They feel they are not at risk and their partners are free of infection. Due to this low perception of risk people do not use condoms and get infected with HIV.
Q. Stigma against infected people?
A. Stigma from the society affects social relationships. People living with HIV live in fear despite regular counselling and support services from STD clinics. Society should understand that HIV is just another infection.
Q. Latest interventions of the Health Ministry in preventing the transmission of HIV?
A. The main theme of this year’s World AIDS Day is, know your status. HIV testing should be promoted to identify people infected with HIV, and start them on treatment. HIV testing has been made available at all STD clinics, OPDs of major hospitals, and rapid testing facilities are offered through outreach programs. A mobile testing centre will be started on World AIDS Day 2018.
This mobile unit will cover Colombo and Gampaha districts on a daily basis. By starting antiretrovitral treatment for all infected people, transmission of infections can be reduced.
Reaching those at risk and vulnerable populations with correct messages, to encourage responsible behaviour, safe sex, condom use, through peer outreach programs is important. Implementation of the National HIV Communication Strategy is also important at this juncture.
Q. Since more young people are now at risk of contracting STDs leading to HIV, is there a special message that you have for them on World AIDS Day?
A. Youth need to be aware of the risks of unprotected risky sexual contacts. Living with HIV is not easy. Prevention is the answer. Delaying sex till marriage, being faithful to a stable partner and consistent condom use are the important messages for the youth.