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Today is World AIDS Day

World AIDS Day is an annual event commemorated worldwide since 1988 on December 1. It is an opportunity to refocus and reinforce the global efforts to prevent new HIV infections, increase HIV awareness and knowledge and support those living with HIV.

This year, the theme of World AIDS Day is the urgent need to end the inequalities that drive AIDS and other pandemics around the world. “Without bold action against inequalities, the world risks missing the targets to end AIDS by 2030, as well as a prolonged COVID-19 pandemic and a spiralling social and economic crisis,” UNAIDS said in a press release.

“Forty years since the first AIDS cases were reported, HIV still threatens the world. Today, the world is off track from delivering on the shared commitment to end AIDS by 2030 not because of a lack of knowledge or tools to beat AIDS, but because of structural inequalities that obstruct proven solutions to HIV prevention and treatment. Economic, social, cultural and legal inequalities must be ended as a matter of urgency if we are to end AIDS by 2030,” UNAIDS pointed out.

UNAIDS issued a stark warning that if leaders fail to tackle inequalities the world could face 7.7 million AIDS-related deaths over the next 10 years. UNAIDS further warned that if the transformative measures needed to end AIDS are not taken, the world will also stay trapped in the COVID-19 crisis and remain dangerously unprepared for the pandemics to come.

COVID-19 pandemic has significantly impacted persons with Human Immunodeficiency Virus (HIV), interfering with critical health services for HIV prevention, treatment and care. While there are multiple profiles of persons living with HIV and the impact of COVID-19 may differ for each, the severity of COVID-19 in persons with HIV is related strongly to the presence of comorbidities that increase the risk of severe disease in COVID-19 patients in the absence of HIV. An effective response to the juxtaposition of the HIV and COVID-19 pandemics requires a novel coordinated and collaborative global effort of scientists, industry and community partners to accelerate basic and clinical research, as well as implementation science to operationalize evidence-based interventions expeditiously in real-world settings. Accelerated development and clinical evaluation of prevention and treatment counter measures are urgently needed to mitigate the juxtaposition of the HIV and COVID-19 pandemics.

Widespread vaccination is a critical tool to help stop the pandemic. Everyone who is eligible, regardless of HIV status, should get vaccinated. Those with advanced HIV disease and/or not on medications should get an additional dose of the vaccine.

Acquired Immune Deficiency Syndrome (AIDS), officially recognized in 1981 in the US, has become a global epidemic sparing no country from its devastating path. In Sri Lanka the National STD/AIDS Control Programme of the Ministry of Health spearheads the activities that drive forward the national response together with many stakeholders. The national response to prevention and control of HIV was initiated at the beginning of the HIV epidemic even before the first case was detected in the country. As a result Sri Lanka has remained a country with a low HIV prevalence.

Sri Lanka’s first AIDS patient was diagnosed in 1986. The estimated number of people living with HIV in 2019 was 3,600. Of these, 1,845 (51%) were taking antiretroviral treatment (ART). HIV infections are on the increase, according to the 2019 Annual Report of the National STD/AIDS Control Programme. UNAIDS figures showed that some 5,400 people have died of AIDS since 2008, averaging 500 each year until 2018 when the figure dropped to 200 because of the increased use of ART. Sri Lanka has adopted the Sustainable Development Goal target of ending AIDS by 2030 and has accepted the challenge of achieving the target in 2025, five years before the rest of the world. This means reducing 90% of new HIV infections compared to 2010 new infectionsand reducing 90% of AIDS related deaths compared to 2010 AIDS-related deaths.

Political leadership given by successive governments, engaging several stakeholders added value to strategic planning and implementing evidence based interventions. The multi-pronged efforts consisted of a comprehensive HIV/AIDS prevention program with targeted intervention towards populations at most risk to HIV infection and the general population including women and youth and provision of treatment, care and support for those infected with HIV. Blood safety policy introduced in 1988, provision of free of charge anti-retroviral therapy from 2004 from STD clinics to people living with HIV and scaling up prevention of mother to child transmission program, which was introduced in 2002 towards universal screening of pregnant mothers, were strategic directions that have kept the HIV prevalence at a low level.

Prevention still remains the key strategy targeting the most at risk populations such as sex workers, men who have sex with men and people who inject drugs. The main mode of transmission of HIV is through unsafe sexual contact with a HIV infected person who is very often asymptomatic or does not show any sign or symptom of HIV or even does not know that he/she is infected with the virus. The majority of people infected with HIV do not know they are living with the virus but are able to spread the infection. That is why it is necessary to know the HIV status. The best way to diagnose HIV is to get a HIV blood test done following risky sexual exposure or if a person is injecting drugs and share needles and syringes that are unsterilized.

Although much headway has been made, every effort should be made to sustain the preventive efforts and to remove the stigma attached to the disease to create an enabling environment for people to come forward and get the HIV test free of charge from government STD/HIV clinics or from the private sector hospitals or from the family doctor. The test is offered after pre-test counselling and the results are given with post-test counselling. Confidentiality is maintained throughout the process.

The author is a member of the AIDS Foundation Lanka, a non-profit organization that was formed to meet the challenges in prevention and control of HIV and support people living with HIV and their families.