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De-stigmatising HIV On World AIDS Day

Featured image courtesy UNAIDS – Sri Lanka

Today (December 1) is World AIDS Day. According to reports, approximately 4 people are diagnosed with HIV every week in Sri Lanka, with an estimated 5 more going undetected.

The National STD/AIDS Control Programme (NSACP) in Sri Lanka has reported 2,241 cases of HIV as of September 2015 – with the number of positives doubling over the past 6 years. At the same time, there have been 587 reported cases of AIDS, with 21 deaths this year alone.

Figures courtesy the National STD/AIDS Control Programme for 2015

These statistics place Sri Lanka as a country with low prevalence – yet the fear of stigmatisation often prevents people from coming forward for testing.

“These days, society is more decent towards those diagnosed with HIV. I remember just a couple of years ago, people were chased out of their houses when it was found that they were diagnosed with HIV. In one case people even set fire to a house where a mother was living with her two daughters,” recalled UNAIDS Country Manager Kariyaperru Ranatunga.

Prejudice against those diagnosed with HIV still exists, he added. This situation is further exacerbated as those who receive the news that they are HIV positive often go into depression and blame themselves, which can have a negative impact, Ranatunga said.

courtesy National STD/AIDS Control Programme

A recent Integrated Biological and Behavioural Surveillance (IBBS) Survey compiled jointly by Global Fund to Fight AIDS, TB and Malaria (GFATM), Management Frontiers (MF) and the Royal Tropical Institute (KIT), under supervision from the National STD/AIDS Control Programme (NSACP) found that among female sex workers in Colombo, Galle and Kandy, just 35% had been tested for HIV in the last year and received their results. The figures were even lower for men who have sex with men (MSM) in Colombo, Galle and Anuradapura – just 15.4% of those surveyed had been tested in the past year and only 19.3% had been reached by prevention programmes and knew where to go to get tested. “Reasons for not getting HIV tests include not knowing where to go, too busy, and low risk perception,” the survey noted.

And the stigma against those with an HIV positive diagnosis is high – the report notes that while most respondents interviewed said they would care for a family member if they were diagnosed, many also said that an HIV positive student should not be allowed to go to school. Some even said they would not purchase food from a vendor who was HIV positive. Some of the female sex workers, particularly the older ones, mentioned that they are afraid to visit STI clinics for fear of being mocked by staff, or worse, being recognized.

A number of misconceptions continue to exist around HIV – mainly the perception that it is primarily contracted by same sex partners. Yet this is simply not true, even in Sri Lanka –

Figure courtesy National STD/AIDS Control Programme

The highest mode of transmission is male to female – at 55%.

The stigma, coupled with lack of knowledge, can often prevent people from going to get tested, which is a shame as the NSACP found that 75% of people living with HIV who regularly took Antiretroviral Therapy (ART) remained on the first line regimen 10 years later while a further 5% were on second-line drugs.

Figure courtesy National STD/AIDS Control Programme

In fact, those who detect their status early and follow ART regularly can go on to lead full, productive lives, Ranatunga said.

Sri Lanka hasn’t been idle in the search for a cure either – recently, Sri Lankan student Rakitha Dilshan Malewana was invited by the British Prime Minister to attend the Conference of the World Association of Young Scientists’ (WAYS) after he won a gold medal at an international Science Olympiad with a drug which could be used to cure the first phase of HIV/AIDS.

Despite this encouraging progress, ‘no one wants to talk about sex and sexuality, even in Colombo,” Ranatunga said. It was for this reason that UNAIDS partnered with the National STD/AIDS Control Programme and the Beetle Car Owners Club on November 28, hosting a rally ending up at Galle Face, where free HIV testing booths conducted by the NSACP saw over 150 people get tested – the rapid testing method was used, which takes just 15 minutes.

Photo of rapid testing booth courtesy National STD/AIDS Control Programme’s Facebook page

While the programme was targeted with the youth in mind (while most of those diagnosed with HIV fall within the 25 to 49-year age bracket) the theme was “Test Today” to encourage people to get themselves tested for HIV. This is in keeping with the Global 90:90:90 2030 targets, which aims to see 90% of people tested, 90% of those with positive diagnoses receiving treatment, and 90% living with an undetectable viral load (i.e. with the chance of transmitting HIV being nearly at zero). In order to meet this, 73% of people testing HIV positive should be receiving treatment by 2020 – currently, Sri Lanka’s rate is just 50%.

While the number of cases reported in the North and East is much lower than in Colombo, Gampaha and Kandy, a lack of access to HIV and AIDS Control programmes coupled with a conservative culture compared to the South means that they too are at risk. This is why this year’s NSACP programme for World AIDS Day is taking place in Batticaloa, while the previous year’s programme was in Kilinochchi. This year’s programme will consist of an awareness raising walk, with free testing available for those who need it.

Where can you go to get tested?

The figure shows all the island-wide clinics where it’s possible to get tested.

There are 30 full-time STD clinics and 22 branch STD clinics in Sri Lanka. Of these STD clinics, 12 have the capacity to provide antiretroviral treatment (ART) services.

Despite these resources, many people are hesitant to visit the clinics. The IBBS Survey found that some of the female sex workers, for instance, mentioned that they were afraid to visit STD clinics for fear of being mocked by staff, or worse, being recognized. This cultural taboo is having very real consequences – and it is this that programmes like NSACP and UNAIDS are currently combating. There have been some moderate successes – mother to child transmissions have been virtually eliminated, as has transmission via blood transfusions. Yet it’s clear Sri Lanka has a long way to go before achieving the 90:90:90 targets.