Persons living with HIV/AIDs can lead normal lives with early diagnosis and medication | Sunday Observer
Former Deputy Director National STD AIDS Control Programme

Persons living with HIV/AIDs can lead normal lives with early diagnosis and medication

4 December, 2022
Doctors fighting to reduce the relentless soaring of HIV/AIDs cases worldwide amidst an ongoing Covid-19 pandemic and other infectious diseases, believe that equal access to quality health care and early testing and treatment - to all persons living with HIV or AIDS holds the key to any successful future HIV/AIDS control programme anywhere in the world. According to reports by UNAIDS and UNICEF, an estimated 38 million persons are currently living with HIV or AIDS. However, the expansion of antiretroviral treatment in many countries has shown encouraging results with less people dying from HIV related causes.

A disturbing discovery from recent studies however has shown that adolescents and young people are now increasingly forming a large share of those living with HIV worldwide with mostly drug users using intravenous injectables, sharing needles and tattooing and piercing their ears being most vulnerable to the disease. So concerned were global health authorities that in 2015 UNICEF and UNAIDS in partnership with other international agencies launched a campaign to End Adolescent AIDs worldwide .

The key to its success they reiterated lay in an attitudinal change among the public as a whole in the way they look at persons living with HIV and related diseases. With empathy and understanding. And without prejudice in all areas including labour, education, access to health , testing facilities, and freely moving in society without being treated as outcasts. Three days ago these very issues were brought to the table by Venereologists across the world when we observed another World HIV/AIDS Prevention Day under the theme ‘ Putting Ourselves to the Test: Achieving Equity to End HIV’.

The Sunday Observer asked Consultant Venereologist Independent Expert on STI, HIV care services and EMTCT of HIV and syphilis programme and Former Deputy Director National STD AIDS Control Programme, Dr. Leelani Rajapaksa to share her expertise on challenges that still confront health officials in Sri Lanka which while having the lowest prevalence rate of HIV /AIDS in the region , still needs to improve provision of quality care for HIV patients across the country, remove obstacles like Stigmas and minimise risks of more new cases emerging in the future


Q. December 1 was World HIV/AIDS Day. While most of us have at least a limited knowledge of this particular health issue given the many awareness raising programs carried out by health officials, many are still ignorant about the exact nature of the disease or even what HIV/AIDS stands for. Could you enlighten our readers on this ?

A. HIV (Human Immunodeficiency virus) is the virus which causes AIDS. Unlike other viruses which show affinity to one organ of the body, HIV affects the immune system of the body. It lowers the immunity of the infected person gradually. This can take many years up to 10 years. A person infected with HIV does not experience any significant clinical problem during this period. However, when the immunity is very low the person starts experiencing illnesses due to infections and cancers. When the person is seriously ill the patient is identified as having AIDS. When a person reaches the AIDS stage, if the patient is not managed appropriately he/she could die in 2 years time. HIV patients infected till they develop AIDS are usually identified as Persons Living with HIV.

Q. So how many people are now living with HIV in Sri Lanka?

A. The first Sri Lankan patient with HIV infection was diagnosed in 1987.By end June 2022, the total number of diagnosed persons living with HIV in Sri Lanka is 4686. Number estimated to be living with HIV is 3600.

Q. Has there been an increase since then? Or are the figures the same? According to venereologists , although the prevalence rate of HIV in Sri Lanka is one of the lowest in the region, there has been an increase in the number of newly detected cases in the recent past. True or false?

A. Yes. That is true. There was a significant increase of reported newly diagnosed cases in the first six months of the year 2022.

Q. Who are those most at risk of getting HIV/AIDs infections in Sri Lanka?

A. Majority were among young males with a male to female ratio of 7:1. Most of these infections can be identified as new infections and this indicates the existence of risk behaviour in the community.

Q. Any specific groups that are most at risk due to the nature of their work or their lifestyles?

A. There are a few groups identified as most at risk of HIV infection in the country. This includes female sex workers, men having sex with men, injection drug users and ‘beach boys’. 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, use of condoms as a safe sex practice among these groups has to be improved.

Q. How is HIV transmitted in general?

A. HIV is mainly transmitted through unprotected sexual exposures. Infected women can infect her baby during pregnancy, at the time of delivery or through breast milk. In some Asian countries most HIV infections occur among injection drug users due to use of unsterilised needles and syringes.

Q. What are the most common route/s of HIV transmission in Sri Lanka?

A. In Sri Lanka, almost all adults diagnosed with HIV 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. Though injection drug use is reported as low in the country, a study among injection drug users in Colombo and suburbs reveal high risk of HIV transmission through sharing of needles and syringes.

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 transmitted only through close relationships with infected individuals by vaginal and seminal fluids or blood and other body 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 is the role of condoms in prevention transmission of HIV?

A. People should always practise safer sex to prevent getting HIV or STI. The best way to avoid this risk is by delaying sex till marriage and being faithful to your spouse after marriage. A person is at risk of HIV by having unprotected penetrative sexual exposure with a partner who is not his or her spouse. Consistent and correct use of condoms reduces the risk of HIV.

Q. Many men who engage in same sex do not know how dangerous it is since it leads to a host of other diseases as well. What are the significant health impacts of engaging in such relationships?.

A. Young men are not aware of the risk of HIV. Liberal attitudes towards sex leads men to seek sexual pleasure through different means. Lack of information on HIV and services expose them further to the risk. This is a concern and action need to be taken to reach young men to promote safe sex practices.

Unprotected anal sex carries 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. What are the symptoms of early 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 the symptoms to appear. Anyone who had a history of unprotected risky sexual behaviour need to get a blood test for HIV. HIV testing facilities are available at STD clinics, OPDs in all major hospitals and in the private hospitals and laboratories.

Q. If diagnosed early and treated in time can HIV be cured?

A. HIV infection can be well controlled by early diagnosis. 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.

All newly diagnosed cases are started on antiretroviral treatment. If taken properly, the treatment is highly effective and viral levels reduce markedly within six months after starting the treatment.

If the viral level is low, the infected person’s immunity is high and the person will not develop opportunistic infections and cancers.

Q. What is the procedure followed when a person comes to your clinic asking to be screened for HIV?

A. STD clinics are open clinics and anyone can access the clinic during the working time from 8.00 to 4.00 pm. Some clinics have evening or Sunday clinics to increase accessibility to services.

A person can come to the clinic and request an HIV test. You may not be having any clinical symptoms, but if you had unprotected risky sexual exposures you can request services at the STD clinic. After taking the history the doctor will decide the investigations to identify HIV and other STI. You will be counselled and given information before the HIV test. If rapid test facilities are used, results can be obtained within a few minutes.

Q. How is he diagnosed ? What are the tests used?

A. HIV screening test is used as the initial test. If it becomes positive further testing is done using confirmatory tests. When the confirmatory test is positive the patient is informed of the HIV positive status through positive test counselling.

Q. If tested positive what is the treatment procedure?

A. If the HIV test is positive you will be counselled regarding the services available and the support provided for people living with HIV. Doctors and other staff at the STD clinics are aware of the psychological impact of the diagnosis and try their best to support you during this period. Antiretroviral treatment is started as soon as possible when the patient is ready.

Q.Is there a global target for ending HIV?

A. UNAIDS has identified the global target for ending AIDS in 2030.

Q. How does the Ministry of Health plan to achieve this target? Outline some of the latest interventions to this effect.

A. During the Covid-19 pandemic most of the routine activities were affected due to frequent lock-downs and curfews. To overcome these obstacles new strategies have been introduced in the recent past. Social media was used to take prevention messages to people. Testing services were also promoted through this. Self test kits have been introduced which allows testing in privacy. These services have been made accessible online. In addition., Pre exposure prophylaxis, a new concept has been introduced to men having sex with men to reduce risk of transmission. By identifying HIV infected people in the community and starting them on ART early, will reduce the community viral load and reduce the risk of transmission.

Q. Myths about HIV you wish to debunk?

A. The main myth is the denial, 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 take precautions and get infected with HIV.

Q. More young people are now leading risky lives following the a lifting of the months long curfews exposing themselves to the risk of HIV and other sexually transmitted diseases. Do you have a message for them ?

A. When you get HIV it cannot be reversed. But you can do a lot to prevent getting HIV. Be aware of the risk of HIV. Be aware that HIV is still there. If you get it you have to live with it for a lifetime. Yes, the virus can be controlled with available treatment. But living with HIV is not easy at all. We meet youth infected with HIV and what they are going through is unimaginable. Some of them manage on their own as they are reluctant to disclose even to close family members. It is too much for young people as well as their families.

Youth is there for you to enjoy life. Enjoy your life with correct understanding and knowledge. You have only your family when you are in trouble.

Q. The new thinking now with regard to AIDs patients, is that the public in general should have an attitudinal change when dealing with peopl with HIV and know how to empathise with them rather than sympathise. Your comments?

A. Empathy is the correct word. People living with HIV can live a normal life if they take treatment regularly. They can continue their employment, can look after their families and get engaged in social activities. There is no reason to treat them differently. HIV is not transmitted through droplets during sneezing or cough like in Covid-19.

By being in the same workplace, same school or sharing accommodation facilities will not transmit HIV. People living with HIV need others support to live a normal life without stigma and discrimination.