Sri Lanka is a country of low prevalence in terms HIV/AIDS. Sri Lanka has achieved this status basically due to the strategic planning and highly productive investments by the Ministry of Health and its dedicated agency National STD/AIDS Control Programme. Although Sri Lanka’s prevalence rate of HIV/AIDS is less than 0.01%, there are factors which may trigger a concentrated epidemic in the country. For example, the rate of HIV among the youth population between 15-24 years old shows a steady upward trend in the past ten years.
According to the National STI/AIDS Control Programme, the main mode of transmission is unprotected sex between men and women which stands at 82.8% whereas men who have sex with men is 12.3% and mother to child transmission is 4.4%. Although there is no HIV epidemic in the country, following socioeconomic and behavioral factors have been identified in Sri Lanka as causes which can ignite an epidemic in future;
• Presence of large youth population
• Internal and external migration
• Clandestine but flourishing sex industry
• Low level of condom use
Another complicated public health issue is drug users and particularly injecting drug users who are a hidden and marginalized population, scattered in every corner of every country. Evidently, the may not have proper and easy access to most of the reproductive health services. It is way beyond passing clean syringes and they need strong psycho-social support.
Tourism sector casual workers who are generally called Beach Boys have been identified as a major vulnerable group whereas Sri Lanka has heavily invested in future prospects in hospitality industry. On November 27th, at the first ever Asian Hotel and Tourism Investment Conference, President Maithripala Sirisena officially declared 2017, 18 and 19 as three investment promotion years of the tourism sector. Prisoners, teenage mothers, transgender persons and the partners of high-risk groups are also among highly vulnerable communities.
Since 1987, the year the first HIV infected person was reported in Sri Lanka, over 2500 cases have been reported so far causing at least 402 AIDS related deaths. But we must remind that the Ministry of Health has estimated 4100 HIV positive people live in Sri Lanka. A large number of HIV positive persons go untested.
National STI/AIDS Control Programme revealed last week that 20 blood samples of the donors were identified as HIV positive in 2015 and discarded from transfusion.
Focusing to safety precautions and developing parallel systems to monitor the situation and to act effectively are crucial in this context.
One of the key strategies to achieve the aim of achieving triple zeros in terms of HIV/AIDS, Zero New HIV Infections, Zero Discrimination, and Zero AIDS-Related Deaths by 2030 is condom programming.
In Sri Lanka, the percentage use of condoms by sex workers at last sexual act with a client was 93%, while the percentage of condom use at last anal sexual encounter with a male partner, among men who have sex with men and drug users was 58% and 25%, respectively.
Contraceptive prevalence among currently married women in the age group of 15-49 in Sri Lanka was 68% in 2006/2007, and prevalence of modern methods of contraceptives was 52.5%. Condom use among currently married women in the age group of 15-49 as a contraceptive method has increased from 1.9 to 6 percent during the 20-year period since 1987 in Sri Lanka. While the prevalence of modern methods of contraceptives among eligible couples was 55.4%, condom usage was 7.7% in 2013 although condoms are widely available in the country and are distributed via retail outlets, STD clinics, family planning clinics and Public Health Midwives.
Male and female condoms, when used correctly and consistently, provide dual protection against both unintended pregnancy and sexually transmitted infections (STIs), including HIV.
“The right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice” is a basic human right that was recongnized at the 1994 International Conference on Population and Development (ICPD) to which Sri Lanka is a signatory.