With HIV/AIDS prevalence rates currently 0.01% Sri Lanka is listed among the countries having one of the lowest prevalence rates in the region. Despite this health officials are concerned that many young adults continue to expose themselves to the risk of this dreaded disease due largely to unprotected penetrative sex with an infected partner which is the main method of transmitting the disease. They have urged that priority be given to giving these at risk persons correct information that shatter myths about HIV and information on the many safe sex options provided to them at no cost island wide by the National STD/AIDS Control Program of the Ministry of Health.
Today being World HIV/AIDS Prevention Day, the Sunday Observer spoke to Consultant Venereologist and Deputy Director, NSACP Dr. Lilani Rajapaksa to share her expertise on what HIV is to begin with, how it spreads, and how one can protect oneself from it by early screening and treatment.
Excerpts …
Q. Sri Lanka is listed as a low prevalence country for HIV/AIDS. According to data from the National STD/AIDs Control Program (Dec. 2017) Sri Lanka’s HIV/AIDs prevalence was 0.01%. Are the figures the same today?
A. Yes. Sri Lanka remains as a country with low HIV prevalence even after three decades of experience with HIV with detection of the first HIV infected Sri Lankan in 1987. The country could maintain a low prevalence level due to early efforts taken to increase awareness among the public and introduce prevention services to people at risk.
Q. While most people are familiar with the acronym HIV/AIDS, not many still know what they mean. What is HIV?
A. HIV stands for Human Immunodeficiency Virus. This Virus causes AIDS by attacking the immune system of the body. Immune system gets weakened gradually and the infected person becomes prone to infections later. This process takes 10 to 15 years usually. When the person experiences illnesses due to lowered immunity this stage is called Acquired Immune Deficiency Syndrome (AIDS).
Q. How is it caused? ( Elaborate)
A. HIV is mainly transmitted through unprotected sexual exposures. In Sri Lanka almost all adults diagnosed with HIV were infected through unprotected penetrative sex. Unprotected anal sex carries highest risk of HIV transmission.
HIV can be transmitted from mother to child transmission; from an infected woman to her child during pregnancy, delivery or through breast feeding.
Current practices of ear or body piercing, tattooing, can cause HIV infection or hepatitis B if proper infection control measures are not practised. Risk is very high among injection drug users (IDU) through sharing of needles and syringes.
Q. What are the symptoms to look for in a person who is HIV positive?
A. HIV causes immune deficiency. It is a gradual process. 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. When immunity declines the person develops other infections and symptoms are due to these infections.
If anyone has had unprotected sexual behaviour it is important to get a blood test done for HIV without waiting for symptoms.
Q. Are the symptoms visible from the onset? Or do they manifest themselves later ?
A. HIV lowers the immunity of the person. This can take 10 - 15 years. When the immunity is suppressed to a significant level the infected person develops many infections and cancers and this stage is called AIDS.
Q. What are the adverse impacts of HIV on the human body?
A. HIV causes illnesses including infections and cancers which are difficult to manage and lead to death. People do not die due to HIV. They die due to infections and cancers caused by immune deficiency in AIDS stage.
Q. Can these adverse impacts be reversed by early detection?
A. Yes. Early detection is very important. People who are infected are not aware of their infection until they come to the AIDS stage which is too late. It is important for people to assess their risk and come forward for testing. HIV can be identified only by doing the specific HIV blood test.
HIV blood test is available freely at any government STD clinic. There are 33 STD clinics in the country and these are open clinics. You do not need a referral to get services. Any person can visit the STD clinic and request for the test. The advantage of visiting the STD clinic is you can discuss your concerns and fears. Persons at risk are counselled to modify behaviour to remain HIV negative. More information could be obtained through the National AIDS Control website.
In addition, rapid HIV test is available at all major hospitals. HIV testing services can be obtained from the private sector as well.
Early detection of HIV infection leads to early initiation of treatment. By starting antiretroviral treatment early the impact of HIV can be reversed. Antiretroviral treatment helps to reduce viral levels to very low levels within a few months of treatment.
This allows the person to maintain a healthy lifestyle and live longer. By identifying infection early, the person can continue normal life at work, social life, etc. as a productive person for the family, the community and the country.
Q. Can they be reversed by changing one’s lifestyles and habits? Give us some examples.
A. Yes. When a person does the HIV blood test he/she gets to know the status whether HIV negative or positive. Knowledge of one’s HIV status is important to organize the lifestyle.
If you know you are negative you try to maintain the negative status by modifying your behaviour.
If you know you are positive for HIV you can start antiretroviral treatment early and remain healthy by maintaining very low viral levels in the body. As you are aware of infection you can improve your lifestyle to prevent transmission to your loved ones; spouse and children.
Q. Does HIV invariably lead to AIDS?
A. Yes. If untreated, HIV would invariably lead to AIDS.
Q. How far has modern research and drugs been able to delay the advancement of the disease globally?
A. If taken properly the treatment is highly effective and viral levels reduce markedly within a few months of starting treatment. If the viral level is low the infected person’s immunity is high. However, treatment will not destroy the virus completely.
Therefore, the person has to continue treatment to maintain low viral levels. A person who is taking treatment satisfactorily will not develop AIDS. The quality and quantity of life would improve markedly with treatment giving opportunity to lead a normal life.
Q. Are these drugs available in our state hospitals ? Where?
A. Yes. Antiretroviral Treatment (ART)is available free of charge through STD clinics.
Q. What is the selection criteria?
A. In 2016 a policy decision was taken to start antiretroviral treatment to all persons diagnosed with HIV. All persons diagnosed with HIV are started with antiretroviral treatment early as it reduces the effect of the virus on the body.
Q. Myths preventing at risk persons from seeking treatment?
A. The main myth is that HIV is not recognized as a problem in Sri Lanka due to its low prevalence. This gives people 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 practise safe sex or use condoms and get infected with HIV.
Q. Some are worried about doing HIV blood test. Is it due to stigma?
A. Doing an HIV blood test does not carry a stigma. They need to understand it is one of the tests like blood sugar or lipid test which is important for your health. More doctors are offering HIV test in health checks now as they know of its importance. Currently all pregnant women are offered HIV test.
Q. Misconceptions about carriers of the disease- how much of an obstacle is this?
A. There is misconception about unprotected sex. People have to understand that unprotected sex with any male or female other than your wife/husband carries a significant risk for HIV. Having unprotected sex with female sex workers or men having sex with men has a high risk of HIV.
Another myth is that all HIV infected people look ill. The truth is that in many instances HIV infected persons can remain healthy looking for many years after infection.
Q. Alternative treatment options. How effective are they?
A. There is no effective treatment available for HIV in the world other than antiretroviral treatment. Those who don’t take proper treatment and choose other alternative medicine options invariably develop AIDS and die at a young age.
Q. The number of deaths from HIV/AIDs in Sri Lanka is said to be around 400 with those living with AIDS totalling 3,500. How close are we to end AIDS in Sri Lanka by 2025 which I am told is your set goal?
A. National STD AIDS control has several objectives to achieve the final goal of ending AIDS in Sri Lanka by 2025.
By end 2020 it is expected that more than 90% of people with HIV infection in the country are identified. The challenge lies in identifying people living with HIV. If people understand the importance of early detection and seek services early, the country can achieve these goals.
Achieving 90-90-90 goals in 2020 would definitely pave the way to reach the final goal of ending AIDS in 2020.