De-stigmatising HIV On World AIDS

Day

Featured image courtesy UNAIDS Sri Lanka

by Raisa Wickrematunge

- on 12/01/2015

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)
Surveycompiled 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 hasnt 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

Programmes 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 Lankas 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 years NSACP
programme for World AIDS Day is taking place in Batticaloa, while the
previous years programme was in Kilinochchi. This years 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 its 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 its clear Sri Lanka has a long way to go before
achieving the 90:90:90 targets.
Posted by Thavam