An AIDS-free future ... a possibility or a dream? In Sri Lanka it seems a possibility; at least when it comes to infants born to HIV positive mothers.
400 per day. 160,000 per year (2016). Those are the global statistics of the children under 14 years, born with or newly infected with HIV/AIDS. Comparatively though numbers may seem low in Sri Lanka “saving even one child’s life is worth the effort,” comment doctors of the National STD/AIDS Control Program (NSACP).
START FREE
A good start without HIV is what they provide for infants. Elimination of mother to child transmission (EMTCT) is their goal. So far, the program had been successful in prevention and elimination; the number of children born free of the virus being larger than the number affected. Their relentless efforts since 2013 had eliminated mother to child transmission of HIV in about 50 children, noted Dr. Lilani Rajapaksa, Consultant Venereologist; and Dr. Jayanthi Elwitigala, Consultant Microbiologist, EMTCT Program NSACP . The accumulated number of children under 15 years diagnosed HIV positive during the period is 22.
“Elimination of new HIV infections among children starts with preventing new HIV infections among women,” notes the UNAIDS report for 2017. “It also requires a special focus on initiating pregnant women living with HIV on lifelong antiretroviral therapy (ART) and ensuring that breastfeeding mothers are retained in care during the breastfeeding period.”
In a bid to minimize the number of children born with HIV, EMTCT an integrated program of the NSACP along with eradication of congenital syphilis had begun in 2013. Under this project, all pregnant mothers visiting antenatal clinics are screened for prevalence of HIV and syphilis and treated accordingly eliminating mother to child transmission. The project phase 1 had been implemented in the districts of Colombo, Gampaha and Kandy and in the Southern Province, identified as high prevalence areas from 2013 to 2014. Northern, North Western, North Central, Uva & Sabaragamuwa Provinces and Kalutra District had been covered in 2015 under the second phase. In 2016, the whole country was covered under the phase 3, according to Rajapaksa.
As the mode of transmission of HIV is from blood and related body fluids, mother to child transmission happens through the placenta, during the delivery and breast feeding. The amount of viral load in a mother’s blood is the main reason for transmission of HIV from a positive mother to a foetus. Therefore, the goal of management is to minimize the viral load to ‘undetectable levels’. “If the viral load levels of a mother’s blood is minimized by the time of delivery, then the risk of transmission is very low,” explains, Elvitigala.
 Princy Mangalika |
According to Rajapaksa, early detection and treatment is vital in providing a ‘free start’ to an infant. She encourages pregnant women to go through STD/AIDS screening tests during early pregnancy. “Early identification helps elimination. The treatment should ideally start before the 12th week of the period of gestation. Services are available in all the antenatal care clinics around the country.”
Screening facilities for HIV and syphilis - two diseases with lifelong negative impacts on affected children, could be obtained from any antenatal clinic in Sri Lanka, explains Rajapaksa. When a pregnant woman undergoes this test, the result is kept totally confidential. Pregnant women found to be positive for HIV or syphilis are referred to the area STD clinic for baseline investigation and treatment by specially trained staff who care for them with confidentiality and respect; without any discrimination. Further, they are provided the usual care for all pregnant mothers by the field medical staff such as, midwives and nursing sisters.
At the area STD clinic, pregnant women are served together by the consultant venereologist, obstetrician and the paediatrician of the main hospital of the area. They are initiated on antiretroviral therapy (ART) provided free of charge by the government. ART helps suppress the virus in the blood of the pregnant women. “Pregnant mothers are provided with appropriate obstetric care to further minimise risk of transmission during delivery. Further, the paediatrician would care for the newborn,” Rajapaksa points out.
 Dr. Sisira Liyanage |
She is of the opinion that ‘no child should be born with HIV’. “Though we had a pilot program of screening pregnant mothers at selected hospitals since 2002, till 2012 we could only cater to about 5.6 percent of the pregnant mothers,” points out Rajapaksa. However, since 2013, the progam has provided screening services to over “350,000 pregnant mothers.” The numbers identified through screening though minimal, have all agreed to undergo ART and therefore, “managed to deliver healthy, HIV free babies,” she explains.
According to UNAIDS, “Early infant diagnosis is essential to identify the HIV status of infants and to improve prevention and treatment interventions, as peak mortality occurs between six weeks to four months of age for children who have acquired HIV infection. Without treatment, children born with HIV are particularly vulnerable; 50% of them will die before their 2nd birthday, and 80% will die before age 5. The EMTCT Program, combats this by early identification and treatment. While mothers are provided care, the newborns are tested for HIV prevalence and treated with ART for six weeks.
STAY FREE
To guarantee an HIV negative future nation, it is important to ensure adolescents, youth and adults, both, women of childbearing age and their partners stay free of HIV, opines Dr. Sisira Liyanage, Director NSCAP. Irrespective of ethnicity, unsafe sex among youth is controlled by Sri Lankan culture. However, the drawback is the lack of accurate information on sexual and reproductive health. Parents need to gain awareness and knowledge about the changing social norms and prepare children to face these challenges in the proper manner. Age appropriate sex education by parents from an early age would not only assist children to flee paedophiles but also to lead a life free of HIV. Furthermore, access to sexual and reproductive health services; public awareness of the disease and non-discriminatory treatment by health staff and the society in general, would be other aspects that would help people stay free and remain HIV negative, according to Liyanage.
Princy Mangalika, Director, Positive Women, a community organization providing supportive care to people living with HIV (PLHIV), agrees with Liyanage. “AIDS is a totally preventable disease. More so, because it could be prevented and also managed through behavioural changes – just like any other chronic disease such as, diabetes. Many youth are affected with HIV due to ignorance of the disease. It is necessary for children to gain an awareness about HIV/AIDS from a young age. However, accurate scientific facts need to be provided. They get information about sexual and reproductive health from their friends and social media which hardly provides the correct information,” says Mangalika. In addition, access to counselling play a major role in prevention and care, she points out. Access to pre-marital and marital counselling in the community to support couples and counselling for PLHIV to help make right decisions are important, she states.
AIDS FREE
According to UNAIDS, for an AIDS free future, “the global community must super-fast-track its efforts in order to change the trajectory of the epidemic once and for all.” They point out that the window of opportunity to reach children, adolescents and young women is narrower than of adults, as they are more likely to die of AIDS-related causes without immediate access to HIV treatment and prevention services. To achieve this purpose in Sri Lanka, to enable people stay HIV negative and AIDS free, screening and treatment is made available free of charge throughout the country. The NSACP had established “31 permanent clinics throughout the country in Base Hospitals, and conducts mobile clinics in other District Hospitals from time to time,” says Liyanage. The NSACP plans to equip all main hospitals in the districts with permanent clinics within the next 5 years.
It is the “lack of awareness that brings in AIDS,” comments Mangalika. “HIV and AIDS are two different stages. Being HIV positive does not make you a subhuman. However, positive people have to understand that they have responsibilities towards the society as well ” she opines. A regular ART regimen under the supervision of doctors represses the HIV. Adopting appropriate lifestyle changes together with treatment helps anyone to lead a normal life just like anyone else in the society, she says. Having been diagnosed as HIV positive in 2000, leading an active life helping hundreds of other men and women needing emotional, social, economic support, Mangalika is proof of a future which is AIDS free.
