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SLMA NEWS + Magazine DECEMBER 2020
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The following article is reproduced from the SLMA NEWS + Magazine DECEMBER 2020 with kind permission from the Editorial Board of the Sri Lanka Medical Association.
Combating HIV/AIDS in the New Normal
Global HIV statistics[1]
- 38.0 million [31.6–44.5 million] people globally were living with HIV in 2019.
- 1.7 million [1.2–2.2 million] people became newly infected with HIV in 2019.
- 690 000 [500 000–970 000] people died from AIDS-related illnesses in 2019.
“Covid – 19 is showing once again how health is interlined with other critical issues, such as reducing inequality, human rights, gender equality, social protection and economic growth”
The Sri Lankan Context
Sri Lanka is a country with a low HIV prevalence (community prevalence 0.02%). Even though the estimated number of people living with HIV is around 3600, there has been a gradual increase in the number of newly reported HIVinfectedpersonsin Sri Lanka mainly due to increased uptake of testing(2). NSACP is working tirelessly with its stakeholders towards prevention and early diagnosis and treatement. In 2019 alone, 439 new HIV infections were reported, of which 359 were males.Unprotected homosexual activities accounted for the majority of HIV transmissions in 2019.
“even though the estimated number of people living with HIV is around 3600, there has been a gradual increase in the number of newly reported HIV infected persons in Sri Lanka (2)”
The graph below shows the trends of reported HIV infections in Sri Lanka by age and sex, 2011-2019.
Graph 1 – the trends of reported HIV infections by age and sex, 2011-2019. (Source – Annual Report 2019, National STD/ AIDS Control Programme)
“Three is a gradual increase in the number of infected people in the 15 – 24 age group”
According to the chart below, youth are at risk of HIV-and there is a gradual increase in the number of infected people in the 15-24 age group. Graph 2 shows the number of young people (15-24 y) newly diagnosed with HIV from 2014-2019.
Graph 2 – The number of young people (15-24 y) newly diagnosed with HIV from 2014-2019. (Source – Annual Report 2019, National STD/ AIDS Control Programme)
According to this, there is a significant rise in the reported HIV infections among the youth. Considering this important epidemic pattern, Sri Lanka adopted the theme “Youth responsibility to stop HIV”, as the AIDS Day theme for the year 2020.
The majority of the infected youth are males who are school dropouts. It is alarming to see that there is a significant proportion of people with higher education among those infected.
Adolescents and Sex in Sri Lanka
Ending AIDS and Way forward
In order to end AIDS the following 90-90-90 targets to be achieved by 2022.
- 90% of all People Living with HIV(PLHIV) know their status.
- 90% of all PLHIV diagnosed receive Anti Retroviral Therapy(ART).
- 90% of all people on ART have viral suppression.
“Also about 1/3 of newly reported HIV infected patients are in advanced AIDS stage and indicating that there had been missed opportunities with past health care encounters”
The current status of 90-90-90 targets in Sri Lanka is shown in figure 1.
Figure 1 – Current status of 90-90-90 targets in Sri Lanka against the target by 2022 target (Source- Annual report 2019, NSACP.)
It is of paramount importance to increase testing and reduce stigma and discrimination. Also about 1/3 of newly reported HIV infected patients are in advanced/AIDS stage and indicating that there had been missed opportunities with past health care encounters. Therefore, it is imperative to test and diagnose those suspect of HIV infection early. The annexed chart in page …. shows clinical indications for HIV testing.
Blood tests to detect HIV are being performed free of charge while maintaining confidentiality at STI clinics and main hospitals throughout the country. Rapid HIV anitigen and antibody combo tests which gives a good result within 20 minutes also available. Young people are also provided with risk reduction counselling and behavioral change counselling to maintain their positive behaviors when they come for testing services
Services available at National STD/AIDS Control Programme (NSACP)for PLHIV
- Providing counselling, testing, treatment, care & support including anti-retroviral therapy (ART) and management of opprtunisticInfections
- Currently, there is no cure but the virus can be controlled effectively.Early initiation of drug therapy (ART) will make the virus undetectable in the blood. With good adherence to ART, PLHIV can live a near-normal life.
- When the viral load is undetectable with treatment, the risk of transmission with unprotected sex is zero
- Provision ART for Occupational Post Exposure Prophylaxis (PEP) and Pre Exposure Prophylaxis(PrEP).
- Prevention of mother to child transmission of HIV.
- Public health campaign for high risk and vulnerable populations to address thepreventive strategies like primary prevention and promotion of safer sex practices.
How to refer and contact NSACP
References
- https://www.unaids.org/en/World_AIDS_Day
- National STD/ AIDS Control Programme, Annual Report 2019, 2020 Available from: https://aidscontrol.gov.lk/images/pdfs/publications/NSACP_Annual-Report_2019.pdf
- Family Health Bureau. National Youth Health Survey 2012/2013, Sri Lanka. 2015.
- Thalagala N, Rajapakse L. National Survey on emerging issues among adolescents in Sri Lanka. Colombo, UNICEF [Internet]. 2004; Available from: http://www.unicef.org/srilanka/Full_Report.pdf
- Kanda, Koji & Obayashi, Yoshihide & Jayasinghe, Ananda & Silva, Tudor & Lee, Romeo & TAMASHIRO, Hiko. (2010). Current HIV/AIDS Knowledge, Perceptions and Practices among the General Population in Kandy, Sri Lanka: Program Implications. Kokusai Hoken Iryo (Journal of International Health). 11-19. 10.11197/jaih.25.11.
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