Today is World Aids Day. While Venereologists come together to share their knowledge to end this disease, HIV/AIDS continues to remain a major challenge due to its unique and profound impact on public health, human rights and societal well being. The Sunday Observer sought the help of Consultant Venereolost Nationol STD/AIDS program Sri Lanka, Dr. Nimali Jayasuriya for more insights into the disease where a proper cure still remains elusive.
Excerpts.
Q: December 1 is World Aids Day. Why is a special day set aside for this health issue amidst so many equally pressing health issues?
A: This day is dedicated to highlight the global fight against HIV/AIDS due to its unique and profound impact on public health, human rights, and societal well-being. Despite significant progress, HIV/AIDS continues to pose a major challenge, affecting millions worldwide, particularly among marginalised and vulnerable communities. World AIDS Day focuses on raising awareness, promoting unity, mobilising action, addressing global inequalities, and commemorating the historical significance of HIV/AIDS, which remains one of the most devastating pandemics in modern history.
Q: What is this year’s theme and why was it chosen?
A: The theme for World AIDS Day 2024 is Take the Rights Path. It was chosen to highlight the importance of protecting human rights in the global fight against HIV/AIDS. The theme underscores the need to address inequalities, eliminate stigma and discrimination, and ensure equitable access to healthcare, particularly for marginalised and vulnerable populations disproportionately impacted by HIV. Furthermore, this year’s theme aims to ensure that everyone has access to the care, support, and dignity they deserve in the fight against HIV.
Q: How does it help the HIV /AIDS community in Sri Lanka?
A: It supports the HIV/AIDS community in Sri Lanka by raising awareness, reducing stigma, and mobilising resources for prevention, care, and treatment. To commemorate this day, public awareness campaigns are conducted to educate people about HIV prevention, testing, and treatment, encouraging more people to access these services.
Numerous outreach activities and free testing initiatives organised on this day encourage people to get tested, enabling early diagnosis and timely treatment, which greatly improve health outcomes.
Q: How many patients are there in Sri Lanka at present who are living with HIV/AIDS?
A: The cumulative total number of people diagnosed with HIV from 1987 to the end of 2023 is 5,705. Of these, the total number of adjusted deaths among all HIV cases up to 2023 is 1,553. Consequently, the total number of people diagnosed with HIV and alive at the end of 2023 is 4,151.
Q: Do you see an increase in the number in recent years?
A: Yes, there has been an observable increase in the number of detected HIV cases in Sri Lanka in recent years. There was a 14 percent rise in newly detected cases compared to 2022, with a male-to-female ratio of 7:1.4 Number of annually reported HIV cases 1991-2023.
Q: How do these figures compare with global figures in the South Asian region?
A: Sri Lanka’s HIV prevalence remains low (around 0.03 percent in the general population) relative to other South Asian countries, such as India and Nepal, where prevalence rates are higher.
Q: Gender-wise and age-wise who are those most at risk of getting HIV? Why?
A: In Sri Lanka, the groups most at risk of acquiring HIV are largely determined by social and behavioural factors. Women, especially sex workers and those engaged in high-risk behaviours, young people, Men having sex with men, people who inject drugs, and transgender individuals are particularly vulnerable.
Young people, particularly those between the ages of 15 and 24, are highly vulnerable to HIV due to a combination of biological factors and lack of access to comprehensive sexual education. They are more likely to engage in risky sexual behaviours and face barriers to accessing HIV testing and prevention services.
Q: Occupation-wise, who are those most at risk in Sri Lanka?
A: In Sri Lanka, the risk of acquiring HIV is not significantly influenced by occupation alone but rather by high-risk behaviours associated with certain groups. For instance, the HIV prevalence among men who have sex with men (MSM) was 2.4 percent in 2023, while among female sex workers (FSW), it was only 0.02 percent.
This highlights that although the prevalence among FSWs is relatively low, they remain vulnerable due to several risk factors including:
* Unprotected Sexual Encounters: Despite the availability of condom distribution programs, not all clients consent to using protection, increasing the risk of HIV transmission.
* High Partner Turnover: Frequent engagement with multiple sexual partners elevates exposure risk.
* Social Stigma: The stigma surrounding sex work often prevents FSWs from accessing healthcare services and HIV prevention programs.
* Limited Access to Regular Testing: Many sex workers lack consistent access to testing and treatment services, leaving infections undiagnosed and untreated.
On the other hand, MSM, including bisexual men, face the highest risk of HIV transmission in Sri Lanka due to:
* Stigmatisation and Legal Barriers: Same-sex practices are heavily stigmatised, and legal restrictions discourage MSM from openly seeking healthcare services.
* Hidden Networks: MSM often engage in secretive behaviours, which make it challenging to reach them through public health interventions.
* Unprotected Anal Sex: This practice carries a significantly higher risk of HIV transmission compared to vaginal sex.
Q: What are the symptoms to look out for early onset of the disease?
A: In the early stages of HIV infection, some people may experience acute retroviral syndrome (ARS), also known as primary HIV infection or acute HIV. These symptoms typically appear 2 to 4 weeks after exposure to the virus and may resemble flu-like symptoms. Not everyone experiences ARS, but those who do might notice fever, fatigue, sore throat, swollen lymph nodes, skin rash, muscle and joint pain.
Q: If detected can HIV be reversed?
A: No, HIV cannot be reversed as there is currently no cure for the virus. However, with early diagnosis and appropriate treatment, its progression can be significantly slowed down, allowing people to live long and healthy lives.
Q: How is it diagnosed? What are the tests used?
A: HIV is diagnosed through blood or saliva tests that detect the presence of HIV antibodies, antigens, or the virus itself. Initially, a screening test is used for diagnosis of HIV. Currently, the most recommended tests for the diagnosis of HIV in Sri Lanka are the HIV antigen/antibody rapid test and HIV (Ag/Ab) ELISA. However, there are several other tests available for screening, such as the dual HIV/Syphilis test and HIV self-tests.
Q: Are they freely available in any state facility with diagnostic labs?
A: Free HIV testing is available at all government-specialised STD (Sexually Transmitted Infections? / Sexual Health clinics. The central clinic is at De Saram Place, Colombo, and there are 41 district STD clinics providing this service island-wide. Various outreach clinics and mobile testing units in Sri Lanka, especially in high-risk areas, provide free HIV tests as part of the government’s initiative. NGO workers who collaborate with government services also provide free HIV testing services.
Q: Are there different stages of disease?
A: The WHO clinical staging system classifies HIV progression into four stages, based on clinical signs, symptoms, and the CD4 count:
Stage 1: Acute HIV infection or asymptomatic HIV.
Stage 2: Mild symptoms, such as unexplained weight loss, minor infections, or diarrhea.
Stage 3: Severe symptoms, including more serious opportunistic infections, prolonged diarrhea, and significant weight loss.
Stage 4: AIDS with life-threatening opportunistic infections and cancer.
The symptoms associated with AIDS (Stage 4) include severe weight loss (wasting syndrome), chronic diarrhea, severe fatigue and weakness, severe lung infections (difficulty breathing, cough, and fever), prolonged fever and night sweats, loss of appetite, swollen lymph nodes, neurological symptoms such as headache, altered level of consciousness, imbalance, and memory loss, as well as cancers associated with AIDS.
Q: Is there a global target for ending HIV? How close is Sri Lanka to achieving it?
A. Yes, there is a global target for ending HIV, known as the UNAIDS 95-95-95 targets. These targets aim to achieve the following by 2030:
* 95 percent of people living with HIV (PLHIV) will know their HIV status.
* 95 percent of people diagnosed with HIV will be on sustained antiretroviral therapy (ART).
* 95 percent of people on ART will have viral suppression (an undetectable viral load).
Sri Lanka is making good progress towards meeting the global targets for ending HIV, but continued efforts are necessary to ensure universal access to testing, treatment, and care. By 2023, 88 percent of people living with HIV in Sri Lanka knew their status, 71 percent had received ART, and 61 percent were virally suppressed.
Q: Gaps you see in the present system are the optimal delivery of care for all patients living with HIV/AIDS? How would you like to fill them?
A: To optimise HIV care and address the existing gaps, Sri Lanka should focus on expanding access to HIV testing and treatment services, reducing stigma, ensuring continuity of care, and creating a supportive environment, especially for female sex workers, men who have sex with men, people who inject drugs, transgender women, and people living with HIV. Involving the community, strengthening healthcare infrastructure, and improving data management will also be key in filling these gaps. With these strategies, Sri Lanka can move closer to providing optimal care for all people living with HIV/AIDS and ultimately achieve the global targets for ending the HIV epidemic.
