A silent killer lurks amongst us

But once this silent spectre hits you, reality dawns. The terrible and shattering reality that it is a matter of life and death and in most cases it is death.

"I had read about it, but didn't realise the gravity. I couldn't believe that I had got the disease, when I was tested positive three years ago in the Middle East. My life changed forever. I thought I would come back to Sri Lanka and grapple with this problem. I did a job for a while, but when my employer heard about it, I was asked to take long leave, get myself cured and come back. They paid me for six months, but how can I get 'cleared' of this disease. Now I am unemployed. What can I do?" asks Kapila (name changed to protect identity).

Kapila is one of 8,500 adults and children estimated to be HIV Positive, which he dubs the "rahas rogaya" (secret disease) in Sri Lanka. The problems these victims face are many for HIV/AIDS is still incurable and the cost of the medicines which have to be imported is high. There is also society's scorn, the stigma and the recurrent regret that they should have been more careful.

"If I were given the chance to live my life over again, I would be more careful of my sexual behaviour. I would take precautions and also be very careful about the partners I moved with," says Kapila stressing anonymity to keep his relatives from getting to know about his situation.

Although the overall HIV prevalence is low, Sri Lanka too has awakened to the magnitude of this silent killer, looking at the AIDS (Acquired Immuno Deficiency Syndrome) bomb already ticking relentlessly in Africa and Asia. Sri Lanka is vulnerable due to the many risk factors and behaviour patterns, which could lead to a rapid spread of the disease. 

These risk factors include low condom use, commercial sex, sexually transmitted diseases, high mobility of people including migration and injected drug use. 

The government's aim is to keep the number of HIV Positive cases below 1% (100,000) among adults and 5% in the high-risk groups. And towards this effort, the World Bank will lend a helping hand by providing US$ 10 million over a period of five years.

The plans are in the pipeline and should be finalised in about nine months, Salim Habayeb of the World Bank told The Sunday Times. The funds would be for a HIV/AIDS and TB preventive programme as there is a close connection between HIV infection and tuberculosis. 

The programme would focus on advocacy to strengthen commitment among officials and other bodies, awareness creation among the public and bringing about behavioural changes and empowerment of vulnerable groups. 

These groups include migratory labour, such as those working on ships, ME job-seekers and others; commercial sex workers; fishermen; FTZ workers; the military; dislocated people etc. 

Mr. Habayeb, the World Bank's Lead Public Health Specialist for the South Asia region stressed that Sri Lanka has a low prevalence of HIV but very high risk. "Numbers are low. This is why action must be taken decisively and comprehensively now. 

There are many high-risk categories. There is also a mass of HIV next door in India. The problem could be serious."

The pattern in South Asia with regard to the spread of HIV indicates a doubling of numbers every year. "However, the outlook for Sri Lanka is positive, because there are other factors, like a high literacy rate, which could be used to curb and also prevent the infection," he said.

A casual look at the statistics worldwide gives urgency to the action Sri Lanka needs to take. Worldwide the figure stands at 36 million, while Sub-Saharan Africa has an infection rate of 30%; South Africa 15% and India 1%. In terms of numbers, just across the tiny Palk Straits from us there is a mass of four million HIV infected people in India. 

However, the picture is not all that bleak, for countries such as Thailand have made a concerted effort to either curb or prevent the infection. The Thai government has been able to keep the disease at a plateau of 2%.

"In Sri Lanka there is no disease burden yet, but the HIV issue has to be taken under the broader public health sector. The Sexually Transmitted Diseases (STD) Programme is well-managed here but needs to be expanded to public health. A low disease burden should not make Sri Lanka complacent, because the situation could be scary, real. Action now would help make it extremely cost effective," says Mr. Habayeb.

The World Bank will support the development of a surveillance system, with voluntary counselling/testing sites being developed. "There is a surveillance system already, but that is a baby that has to grow, so that effectiveness at community level could be evaluated," he explained.

Presently, in Sri Lanka there are only three HIV testing sites - Karapitiya, Katugastota and Colombo. 

World Bank's Health Specialist Dr. Daya Samarasinghe adds a word of caution that if AIDS spreads it would affect the productive age-group of 15 to 49, and with Sri Lanka having a largely aging population, it would have a disastrous impact on the economy, in addition to the issue of orphans which comes in its wake.

The government is acting now, but the role of the community is also important. The public have to be responsible themselves. Men should make the difference, say in an issue like condom use, he explains.

Yes, the men do have a say, according to several commercial sex workers whom we spoke to last week.

Sumana (name changed to protect identity) engages in the oldest profession around the Fort Railway Station. "I am from a very respectable family. But my husband was a drunkard and I was thrown out of my home with my daughter. There was no option. 

"I worked for a cleaning service, but people laughed at me. Then I started working on the streets. I am old now and go with men only during the day. I earn only about Rs. 200 a day. I have heard of AIDS and insist that the men should use a condom. But some refuse and go to other girls," she says ruefully.

Some in this vulnerable group have heard of AIDS and the need for protection, others haven't. A colleague of hers had contracted the disease and jumped out of a small hotel window in Pettah a few years ago and killed herself because she couldn't cope with it.

That is why Sri Lanka needs to act now, strengthening its public with more knowledge to keep this spectre at bay.

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