How Effective Is The HIV/Aids Programme In Sri Lanka?

by Camelia Nathaniel

Although the Sri Lankan government claims to have spent around Rs 500 million a year on HIV/AIDS awareness campaigns, one wonders if this money has been spent in vain, considering the level of ignorance among the people of Sri Lanka on HIV.

Speaking to The Sunday Leader regarding the awareness campaign carried out by the National STD and AIDS control programme its Director Dr. Sisira Liyanage said that however there clearly is a need for education on HIV for the general public, but this has to be done through the media. “But the problem is the funding for such a campaign. The government has spent around 300 million from the government and World Bank assistance and totally through the global fund too we have spent around Rs. 500 million for conducting of awareness programs on HIV and STD per year nationally. However in addition the private sector too conducts these awareness programmes. For these awareness campaigns we get our funds primarily from the government and some from the UN organisations.”

However the question that needs to be asked is how effective the awareness programmes have been considering the level of ignorance not just among the ordinary people of this country, but even the Minister of Education.

With the recent incident in Kuliyapitiya where a little boy was refused admission to school, simply because the mother was suspected of being HIV positive, has raised concern in Sri Lanka about the effectiveness of the awareness programmes being carried out. In fact even the comments of the Minister of Education Akila Viraj Kariyawasam, clearly indicated that even those at government level know little about HIV. In such a situation, it is not surprising that the ordinary villagers of Kuliyapitiya created such uproar, about the admission of this child.

Awareness raising programmes by government and NGOs exist at various levels, but the impact is limited, indicating that a change in strategy is required. Healthcare professionals agree that gaps in services and policies for HIV affected children exist mainly in the areas of psychological support and education. Specific policies must be put in place in schools to protect the rights of children affected by HIV/AIDS and for dealing with stigma and discrimination.

Studies conducted have clearly shown that stigma and discrimination against HIV affected children is higher in the education sector than in the healthcare sector. The incident at Kuliyapitiya was a clear indicator of the lack of concern and awareness to this pandemic. Stigma and discrimination around HIV/AIDS needs to be addressed from the micro to the macro level as it infiltrates all aspects of society including social castes, socioeconomic status, religion and gender.

Furthermore although the above programmes claim to protect the rights of these patients who come forth voluntarily for treatment, the education minister himself had breached ‘patient confidentiality’ when he publicly announced that the mother of the 6 year old child from Kuliyapitiya was HIV+. The minister publicly told media “the Zonal education officer told me that the father of this child had died of HIV and that they had confirmed that the mother of this child too was HIV positive. However he informed me that the child had not been detected with the virus and we are trying to take a decision to separate the child from the mother. However the mother insists on wanting to be with the child and the child sleeps with the mother. Even though the child will not get infected by sleeping with the mother, if there is some wound there is a risk that the child could get infected. As ours is a warm country, the chances of bleeding from a wound is higher. Therefore we need to act with responsibility in this instance. Our intention was to remove the child from the mother and place him in the custody of child services, to let all this hype die down and then we could have quietly resolved matters,” adding however that the media  blew this whole episode out of proportion and created this huge issue.

In 2014, 64% of countries reporting to UNAIDS had some form of legislation in place to protect people living with HIV from discrimination.

However, criminalisation of key affected populations remains widespread with 60% of countries reporting laws, regulations or policies that present obstacles to providing effective HIV prevention, treatment, care and support. In 2015, 75 countries worldwide listed homosexuality as a crime

The epidemic of fear, stigmatisation and discrimination has undermined the ability of individuals, families and societies to protect themselves and provide support and reassurance to those affected. This hinders, in no small way, efforts at stemming the epidemic. It complicates decisions about testing, disclosure of status, and ability to negotiate prevention behaviours, including use of family planning services.

As of September 2015, 35 countries have laws that restrict the entry, stay and residence of people living with HIV.

HIV/AIDS-related stigma is a complex concept that refers to prejudice, discounting, discrediting and discrimination directed at persons perceived to have AIDS or HIV, as well as their partners, friends, families and communities.

HIV/AIDS stigma often reinforces existing social inequalities based on gender, race, ethnicity, class, sexuality and culture. In Sri Lanka even sex workers are looked down upon and even treated in a degrading manner and HIV has compounded the stigma of homosexuality, drug use, poverty, sex work and racial minority status.HIV/AIDS stigma is a problem not only in Sri Lanka, but throughout the world. Stigma has been expressed in a variety of ways, such as ostracism, rejection and avoidance of people living with AIDS; but over the recent past, the level of discrimination reached an unacceptable level when an entire community deprived a child his education simple because his parents were infected with the virus.

According to Dr. Liyanage, during the past few years they had concentrated on key affected people, such as those who can transmit HIV and the highly vulnerable groups. “Around 95% of the HIV infections in Sri Lanka are transmitted through unprotected sex, perhaps through female sex workers, male sex workers or homosexuals and intravenous drug addicts. We mainly target them because they pose the highest threat of spreading the virus. This campaign is done with the help of the NGO’s and the global fund and we conduct education programmes and in some instances we even provide condoms to promote safe sex. Getting them to the clinics and having them undergo examinations and providing them treatment if found to be positive is the primary goal,” he said adding that thereafter they do follow up programmes where the infected persons are asked to come in for examination every six months.

In addition the National STD and AIDS control program also targets the vulnerable groups such as youth, beach boys and prisoners and others traveling overseas etc who are likely to have unprotected sex. According to Dr. Liyanage, they are also targeting schools and the education sector and the secretary of education has given the programme permission to conduct school awareness programmes with the consultation of the school principles. “Some school principles have already conducted awareness programmes especially for students above grade 10. We are also covering all the vocational training schools as well. For the youth we have joined hands with the youth corps and conducting a three day programme for youth.

Even the security forces are targeted and we have commenced awareness campaigns to educate them on safe sex and educate them on HIV and sexually transmitted diseases,” he said.

Meanwhile the education minister had stated that there was an intention of removing the little boy from the care of his mother as there was a danger to the child of getting the virus through even a wound. However according to Dr. Liyanage, when a person receives treatment for HIV it reduces the viral load and minimises the chances of infecting others. He said that there was no danger to the child being with the mother unless the child comes in contact with the infected person’s blood through an open wound or skin lesion.

According to Dr. Liyanage, there are around 3600 persons living with HIV in Sri Lanka but only around 1900 of them have come for treatment. “That is why we are doing these programmes for the risk persons in order to get them to come forward and get tested and treated. There is no risk to anyone who associates these persons by sharing meals or the same bed. These patients should not be isolated and can live normal lives in society”

If the mother is HIV positive, in Sri Lanka studies have shown that there is a 40% chance that the new born baby too could contract the virus. Around 1% of the infections are also transmitted through the use of intravenous drug abuse, but the majority of the infections reported in the country are through unsafe sex. However he said that there is no danger in associating persons with HIV and added that those with the virus have rights and they cannot be discriminated and shunned due to their condition. Liyanage also added that without the consent of the infected person no one has the right to divulge their information or their condition. “Even as the director of this programme, I too am not given the information regarding the private details of the patients who come for treatment. It is only the doctor who treats the patient who knows the details of the patient, and he is bound to protect the confidentiality of the patient,” he added.