The estimated total number of infections remains static over the years

The Human T - Lymphotropic Virus is very rare in Sri Lanka and it can lead to neurological disorders 

The world is heading towards eliminating AIDS, and Sri Lanka has also fast tracked its response to this 

The Human Immunodeficiency Virus (HIV) and the Acquired Immunodeficiency Syndrome commonly known as AIDS are two conditions that people fear. From having no cure in the past, both HIV and AIDs could be controlled today, thanks to extensive research done on both conditions.

Contracted mainly as a result of unprotected sex, HIV/AIDS could also be contracted from unscreened blood transfusions and using used needles for drug intake or even when getting a tattoo.  In view of World AIDS Day which falls tomorrow (December 1) the Health Capsule spoke to Dr. Iresh Jayaweera, from the World AIDS Day organising team of the National STD/AIDS Control Programme (NSCAP) who shed light on the importance of testing oneself for HIV, treatments and prevalence in Sri Lanka. 

The crucial test 
‘Know your status’ – the World AIDS Day theme for 2018 calls upon everybody to test themselves for HIV/AIDS. “Many of those diagnosed with HIV have gotten it from their marital partner,” Dr. Jayaweera said in his opening remarks. “Anyone having unprotected sex can be at risk of getting HIV. But the risk is zero if it is a mutually monogamous relationship in which both partners are free of HIV. In Sri Lanka it is estimated that around 3500-4200 people are infected with HIV. But only 2/3rds of them know that they have HIV. Others are in the community. If they don’t test and find out, it will lead to the AIDS stage which has a high mortality. It is important to find out one’s HIV status by testing, since people with early HIV infections  are asymptomatic and only a blood test can detect HIV.” According to him, if all the people with HIV in Sri Lanka are diagnosed for treatment their Viral Load in blood will be undetectable after about 6/52 of treatment. “In other words if there is an undetectable viral load, the risk of infecting someone is almost zero. This will help to prevent and control new infections. The world is heading towards eliminating AIDS, and Sri Lanka has also fast tracked its response to this. It is only possible if you diagnose 90% of people living with HIV (PLHIV).”

Antiretroviral therapy (ART) 
As per the guidelines laid by the World Health Organisation (WHO) Sri Lanka, treatment is recommended for all adults and adolescents with HIV immediately, regardless of their CD4+ cell count. Antiretrovirals (ARVs) are a group of drugs that inhibit different steps in the HIV replication process and the cornerstone of HIV/AIDS management. ARVs have been consistently proven to reduce death due to HIV/AIDS and to reduce the development of AIDS-defining conditions.  It should be noted that treatment is lifelong. 

Treatment literacy 
The Health Capsule learned that most people who seek treatment for HIV come from Western Province. “Unlike other conditions getting diagnosed with HIV involves a heavy dose of counseling and education to the patients,” he further said. “It is continued throughout the care spectrum. So PLHIV are well aware about the treatments available and their treatment regimens, their effectiveness and how to adhere to the treatment plan. We also inform the public that effective treatment is available free of charge.”

Other types of STDs and symptoms 
“Herpes simplex Virus, Hepatitis B, Hepatitis C, Human Papilloma Virus and Human T-Lymphotropic Virus are several other sexually transmitted diseases,” Dr. Jayaweera added. “Hepatitis B and C virus infect the liver and they can lead to Jaundice when severe. These conditions can also lead to cirrhosis and hepatocellular carcinoma of the liver. Various treatment options are available. Hepatitis B can be easily prevented by vaccination.” According to him, the human papilloma virus cause genital warts and cervical and penile cancers in addition to other complications and once infected it is difficult to eliminate from the body. On the other hand, the Human T-Lymphotropic Virus is very rare in Sri Lanka and they can lead to neuorological disorders. Out of these conditions it is possible to cure Hepatitis B and C with continuous treatments.”

Prevalence of HIV/AIDS in Sri Lanka 
From the graphs given (Annual Report 2017), it is quite evident that the cumulative number of PLHIV by province of residence in the Western province is higher when compared to other provinces.  Out of that 670 people are receiving ART in Colombo alone.

Awareness on safe sex methods 
“We are proud to say that spreading awareness on safe sex  methods has been a success,” he further said. “We have been doing it with the Family Planning Association which is our main stakeholder and its success is evident with Sri Lanka still being a low prevalence country for HIV, in which less than 2 out of 10,000 people have HIV.  The estimated total number of infections remains static over the years. A recent bio-behavioral survey done by the Ministry of Health showed high levels of condom use even among high risk populations such as commercial sex workers and men who have sex with men.  About 10% of newly diagnosed HIV patients belonged to youth age group who are school leavers. It is difficult to introduce education about barrier methods to youth due to various societal factors.”

Confidentiality of patients 
It is a known fact that contracting HIV is associated with much stigma. This stigma keeps many of those with HIV away from seeking treatment. Stigma and discrimination prevails due to lack of knowledge among people.  Therefore it is important to support PLHIV so that they could lead a normal life. Another one of their concerns include confidentiality. “The National STD/AIDS Control Programme (NSCAP) had been providing care for sexually transmitted diseases since 1950’s and there is a well-established system to ensure the confidentiality of our patients,” Dr. Jayaweera continued. “Even for the healthcare workers the information will be available on a need-to-know basis for the further care of patients.  The staff enrolled is trained at the enrollment as well as refresher training programmes to tackle confidentiality issues, stigma and discrimination. Patient identification is not mandatory to seek treatment. In addition to that, there is a number system instead of using their names. Only the caring physician and his or her team have access to information.”

About NSCAP

The National STD/AIDS Control Programme (NSACP) of the Ministry of Health, Sri Lanka is the focal point for the prevention and control of sexually transmitted infections (STI) including HIV. It is a specialized public health programme under the Deputy Director General (Public Health services) of the Ministry of Health. Under the NSACP there are 33 full time STD clinics and 23 branch STD clinics around the country. Of these STD clinics, 21 have the capacity to provide treatments for HIV free-of-charge for people living with HIV.  Other than the curative care provided by the clinics, following activities are carried out;

• Prevention of transmission of HIV among high risk population including commercial sex workers, men having sex with men, beach boys and drug users .
• Scaling up of HIV testing services among general population.
• Prevention of mother to child transmission (PMTCT) of Syphilis and HIV. 
• Information, Education and Communication on HIV and sexually transmitting diseases.

“It is important to address the stigma and discrimination related to HIV/STIs which will promote people reaching HIV/STI services and testing including those harder to reach,” Dr. Jayaweera said in his concluding remarks. “Our main goal of ‘Ending AIDS by 2025’ may not be accomplished if the general population is not sensitised on the HIV/STI epidemic in Sri Lanka. Therefore media support with current updates on the available services and care provided by NSACP has become timely and imperative for preventing this epidemic from progression in Sri Lanka.” For more information visit www.aidscontrol.gov.lk