A spike in HIV infected cases in the country

Out of 3,600 people living with HIV here at home at present, the majority is men having sex with men (MSM)

By Randima Attygalle

Out of 3,600 people living with HIV here at home at present, the majority is men having sex with men (MSM) and a considerable rise in the infected cases is evident in the last quarter of this year, with about five infected cases being reported daily. These figures were presented by Dr. K.A.M. Ariyaratne, Consultant Venereologist of the National STD/AIDS Control Programme (NSACP) at the symposium held at the Sri Lanka Medical Association (SLMA) under the banner: ‘Ending AIDS by 2030’ last Friday.

The event was jointly organised by the Expert Committee on Communicable Diseases of the SLMA and the College of Sexual Health and HIV Medicine to mark World AIDS Day on 1 December. This year’s theme was ‘Equalise’ implying the need for everyone to unite to fight the inequalities that stop people from getting the life-saving healthcare and support they need.

HIV or Human Immunodeficiency Virus, attacks the body’s immune system and weakens it. When a person is infected with HIV, the virus gradually attacks the immune system and damages the cells. If it is not treated, the immune system functions fail, and it leads to AIDS stage (acquired immunodeficiency syndrome). It takes about 8-10 years to progress from HIV infection to the AIDS stage.

A global public health issue

HIV continues to be a major global public health issue, having claimed 40.1 million lives so far. In 2021, according to UNAIDS, 1.5 million people have acquired HIV. By end of 2021, an estimated 38.4 million people were living with HIV and two thirds of them are in the African region. Second highest number is found in Asia-Pacific region followed by Latin and North America.

The global HIV epidemic is largely driven by MSM, commercial sex workers and injecting drugs users – the latter now constituting almost one-fifth of the new cases, pointed out Dr. Ariyaratne. “Although we still don’t have a large injected drug-user community with HIV, if it penetrates this community, HIV cases can increase dramatically here,” observed the consultant. Of the 3,600 people living with the infection as at end of 2021 here at home, 70% of estimated people are now within the care of NSACP and around 30% still remain outside care either due to non-presentation or not remaining within the treatment process, Dr. Ariyaratne explained.

HIV or Human Immunodeficiency Virus, attacks the body’s immune system and weakens it. When a person is infected with HIV, the virus gradually attacks the immune system and damages the cells. If it is not treated, the immune system functions fail, and it leads to AIDS stage (acquired immunodeficiency syndrome). It takes about 8–10 years to progress from HIV infection to the AIDS stage

Ending AIDS by 2030

Among the Sustainability Development Goals, is the ending of AIDS by 2030. This would call for ‘90% of reduction of new infections compared to 2010’ (the year 2010 used as the baseline) and ‘90% of reduction in AIDS-deaths compared to 2010’. Aligned with this target, Sri Lanka has reduced new infection by 60% by 2021 compared to 2010 and 70% of AIDS-deaths. The elimination of mother to child transmission (MTCT) of HIV and syphilis by Sri Lanka is another milestone by our health system. “However, we need to maintain WHO criteria to sustain our status. This year we didn’t get sufficient kits for testing of MTCT because of the supply shortage and we need to assure that we sustain our monitoring mechanism as treatment is undoubtedly going to be a burden to an already constrained health budget,” Dr. Ariyaratne added.  UNAIDS released a new set of ambitious targets calling for 95% of all people living with HIV to know their HIV status, 95% of all people diagnosed with HIV infection to receive treatment and 95% of all people receiving treatment to have viral suppression by 2025. In 2021 Sri Lanka achieved 82-82-85 status respectively for the three targets.

Of the 3600 people living with the infection as at end of 2021 here at home, 70% of estimated people are now within the care of NSACP and around 30% still remain outside care either due to non-presentation or not remaining within the treatment process

Treatment for a quality life

From 411 HIV positive cases which were detected last year locally, the number had increased to 429 in the third quarter of this year and the male to female ratio has increased to 1:7 (7 males to 1 female) from last year’s 1:5 (5 males to 1 female) reflecting a spike in HIV cases in the country as Consultant Community Physician of NSACP, Dr. Janaka Weragoda illustrated at the special press briefing held to mark World AIDS Day last week. A notable rise of infected cases is also diagnosed among young people between 15 and 24, said Dr. Weragoda further. The male and female ratio among this age group has also increased to 1:10 (10 males to 1 female). More than 90% of the people got infected due to unsafe sex and largely MSM, he said. “The biggest challenge we have in retaining people in treatment is stigma and fear of disclosing their sexual orientation. The special clinics of NSACP established island-wide ensure confidentiality of every person and provide all treatment free of charge, hence there should be no hesitation of reaching out to us.” The treatments available for HIV can control the viral replication and they will help people with HIV lead a near normal life. The available treatment cannot cure HIV, but it can control the virus. “If a person with HIV stays in a proper treatment regime, he/she can life and lead a quality, normal life,” Dr. Weragoda reiterated.

From 411 HIV positive cases which were detected last year locally, the number had increased to 429 in the third quarter of this year and the male to female ratio has increased to 1:7 (7 males to 1 female) from last year’s 1: 5 (5 males to 1 female)

Modes of transmission

HIV can be transmitted to another person in three ways: having unprotected sex with an HIV-infected person, from an infected mother to her baby during pregnancy, at the time of delivery or through breast milk, by injection or transfusion of contaminated blood or blood products, donations of semen (artificial insemination), skin grafts or organ transplants taken from someone who is infected. Sharing unsterilised injection equipment that has previously been used by someone who is infected is also a very efficient mode of HIV transmission. HIV is not transmitted by sharing meals, sharing clothes, holding hands, lip kissing or using the same toilet. MSM, sex workers, IV drug user and prison inmates are among the key populations to drive the HIV epidemic.

Open dialogue

Acknowledging multiple partners who have rallied around the health sector to fight HIV, including community health groups, youth groups, NGOs, media and the tourism sector, Consultant Venereologist of NSACP and President of Sri Lanka College of Sexual Health and HIV Medicine, Dr. Geethani Samaraweera at the press briefing, called for a more open dialogue about safe sex as a prevention mode of HIV. “Anyone from any social or professional background can be HIV-infected through risky sexual behaviour. Hence, what is crucial is to educate people about safe sex.” She also elaborated on the need for a more holistic approach to sexual and reproductive health extending to school, university, vocational and workplace setting.