|
|
|
  |
| Sunday, 28 November 2004 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
December 1 is World AIDS Day : Women, girls, HIV and AIDS
Dr. Shantha Hettiarachchi of the National STD/AIDS control program in this interview with CAROL ALOYSIUS discusses the current trends of sexually transmitted infections including HIV/AIDs and explains how women and young girls are more vulnerable to these diseases. Q: What are sexually transmitted diseases? A: Sexually Transmitted Infections (STIs) fall into three categories. (1) those that cannot be cured, (2) those that cannot be cured completely and (3) those that can be cured but cause complications. Q: What kind of diseases fall into each of these categories? A: HIV/AIDS falls into the first category since there is no cure for this disease which has killed millions. Genital herpes and genital warts fall into the second category. Syphilis and Gonorrhoea fall into the third category. Q: What cause these infections? A: Genital herpes and genital warts are caused by a virus while syphilis and gonorrhoea are caused by bacteria. Q: What is commonest way in which they can be transmitted from person to person? A: By sexual contact. An infected man can pass the infection to his partner with whom he has sexual relations and vice versa, if he/she has unprotected sex. Q: Is there any other methods of transmitting these diseases? A: Yes. A mother can pass on the infection to her child if she is infected with HIV, syphilis or gonorrhoea. You can also get syphilis and Hepatitis B from infected blood e.g. infected needles and blood transfusions. Q: What are the common types of STIs you find in Sri Lanka? A: Genital herpes, genital warts, syphilis, gonorrhoea, as well as non Gonococcal Urethritis or Cervicitis. The latter (Cervicitis) affects women, while the former (urethritis) affects men. Q: How do these diseases lead to HIV/AIDS? A: STI facilitates HIV transmission. Both the patient and others with whom the patient has intimate sexual relationships are vulnerable to infection, if for example there is an inflammation due to the STI the infection can get passed easily to the partner. We also have an increasing number of asymptomatic patients who show no signs of having the diseases but are carriers and can infect others. Q: How? A: A new bride for example can be infected with HIV from an infected husband. A large number of local transmissions occur where infected men (and women) return from abroad and infect their partners when they have sexual relations with them. Q: What age group is at highest risk of getting STIs, especially HIV? A: Globally over a 100 million STI's, exclusively HIV, occurs among young people below 25 years of age. Q: What percentage of women and girls make up this large group? A: Women and girls make up nearly half of the people living with HIV worldwide. Even in Sri Lanka, when initially the number of women infected with HIV was much less in ratio to the number of infected males, the numbers are now almost even. Out of the total number of HIV cases upto September 2004 in Sri Lanka, 346 are males and 245 are females. Q: What makes women so vulnerable to this disease? A: They are vulnerable because of the risky behaviour of others (their husbands and partners). If men were to practice more responsible sex, there would be less infected women. Q: Who would you describe as 'High risk' groups in becoming infected with HIV? A: Vulnerable groups would include; migrant workers; youth' internally displaced persons. The forces especially the military, and of course commercial sex workers. The latter is our biggest problem as their numbers are rapidly increasing with very young girls being lured into the sex trade and running the risk of getting HIV. To give you an example, the new infections from January to September this year shows that the numbers have doubled since the beginning of the year, from 16 in the first three months of the year, to 39 by September. This is very tragic since some of these patients are parents of young children who are unaware their parents have not long to live. We have come across instances where the mother and father are both infected, so that there is a likelihood that their children will end up as orphans while still young. Q: Talking of children, HIV has claimed the lives of both adults and children. How many children have been infected by the disease according to recent statistics? A: Worldwide out of 3 million deaths an year, some 500,000 are below the age of 15 years. Q: How many children have died as a result of AIDS in Sri Lanka? A: Out of 174 AIDS cases we have seen so far, 129 have died, of which 12 are young children. Q: What have we got to do to stop the spread of the disease? A: By raising awareness and educating the public of the dangers of unprotected sex. You can't stop commercial sex by passing laws, but you can with education and awareness raising. Men and women must be encouraged to stick to one partner; to use condoms if they engage in sex with other partners, and to keep in mind that safe sex can save their lives and those of their loved ones. Q: Do you think this will work in Sri Lanka? A: Why not? We still have several plus points in our favour. The prevalence of HIV is low compared to other countries in the region ; we have a high literacy rate; a well-established health infrastructure with clinics to treat patients with STIs scattered all over the Island. We have a strong political commitment from the government and media support. Besides our cultural values are still strong enough to prevent a permissive society as in the West. **** Fact file New Infections * 5 million a year (4.2m adults and 700,000 children) * More than 95 per cent are in developing countries. * 50 per cent of newly infected adults in 2003 were women * 50 per cent of newly infected were in 15-24 year age group. The local scene 1986 - 1st HIV case reported 1987 - 1st Sri Lankan HIV case reported 1989 - 1st indigenously transmitted case. Reported numbers upto end of September 2004. 591 - Total HIV cases (male 346, female 245) 174 Total AIDS cases 129 AIDS deaths 12 Paediatric cases The modes of transmission of HIV 84% Heterosexual 12% Bi/Homosexual 3% Pre natal 1% Blood Estimated No. of people living with HIV in Sri Lanka upto September 2004 is 3500-7000. Reported number of people are 591. 82 per cent of the known HIV cases were in the age group of 15 to 49 years. Western Province has the largest number of HIV patients - 63 per cent. Since 1981 when the first AIDS case was detected - - 65 million people have been infected. - 25 million have died worldwide. Deaths from AIDS * AIDS has contributed to the highest number of deaths by any single infectious agent. * 1 death from AIDS occurs every 10 seconds. * more than 8000 deaths a day * 3 million deaths a year. ***** New guidelines to prevent mother child transmission The World Health Organisation has published new guidelines underlining the effectiveness of antiretroviral drugs to prevent the transmission of HIV from seropositive mothers to their children. These guidelines take into account the most recent information on the safety and effectiveness of different drug regimens, as well as concerns over resistance to some of the drugs used, including nevirapine. These are the key recommendations contained in the guidelines: Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants. Women who need antiretroviral treatment for their own health should receive it in accordance with the WHO guidelines on antiretroviral treatment. The use of antiretroviral treatment, when indicated, during pregnancy substantially benefits the health of the woman and decreases the risk of HIV transmission to the infant. HIV-infected pregnant women who do not have indications for antiretroviral treatment, or do not have access to treatment should be offered antiretroviral prophylaxis to prevent mother to child transmission of HIV using one of several antiretroviral regimens known to be safe and effective. Zidovudine from 28 weeks of pregnancy plus single-dose nevirapline during labour and single-dose nevirapine and one-week zidovudine for the infant. This regimen is highly efficacious, as is initiating zidovudine later in pregnancy. Alternative regimens based on zidovudine alone, short-course zidovudine + lamivudine or single-dose nevirapine alone are also recommended. ****** The Lankan scenario An extract from a speech delivered by Nimal Siripala de Silva the Minister of Health Care, Nutrition and Uva Wellassa Development at the World Health Assembly in Geneva. In the back drop of a global epidemic, Sri Lanka is classified as a country with a low prevalence of HIV infection which is estimated to be 0.06 per cent. Starting from the first case of HIV/AIDS in 1987, the number of cases have increased gradually. A cumulative total of 591 HIV positive cases have been detected so far. 174 of them have developed HIV and 129 of them have died. Heterosexual transmission accounts for 90 per cent of the reported cases in Sri Lanka. Transmission via injecting drug use has yet to be reported. It is estimated that only one per cent of the 40,000 heroin users in Sri Lanka are injecting users. Sri Lanka was one of the first South Asian countries to ensure blood safety. Screening of donor blood for HIV antibodies was started in 1987 and today it is mandatory to do so. Up to now only one HIV case has been reported following blood transfusion. Routine antenatal screening for syphilis has been in existence since 1952, and the Government now intends to introduce HIV screening in view of the decision to provide free anti-retroviral therapy to prevent mother-to-child transmission. Male to female infection ratio was 4:1 at the beginning and it is now 1.4 to 1 increasing the potential chance of mother to child transmission. A National AIDS Committee steering the National Programme has developed a National Policy. STD/HIV services are delivered through a network of peripheral clinics. The central complex in Colombo houses the National Reference Laboratory for STD/HIV/AIDS. Heterosexual transmission being the predominant mode of transmission, condoms are currently provided free of charge through all STD clinics. A social marketing program for condom use for disease prevention is to be implemented this year. In keeping with government policy, all HIV infected patients requiring institutional care are admitted to normal hospital wards. Domiciliary care, however, is encouraged. National guidelines on clinical management of HIV/AIDS have been developed. Counselling services to patients and their families and facilities for HIV testing are provided. The Government has recognised the need to provide anti-retroviral-therapy (ART) to HIV infected persons. The issue is the costs involved. However, anti-retroviral drugs are provided for the prevention of mother-to-child transmission and for post-exposure prophylaxis following accidental exposure in health care settings. Recognising Sri Lanka's commitment to HIV/AIDS prevention, the World Bank, for the first time in its history, has awarded a grant of US$12.6m to fund a National HIV/AIDS Prevention Project - a comprehensive multi-sectoral programme implemented from 2003 to 2008. It is designed to strengthen the preventive programmes for highly vulnerable populations through the participation of both government and non-governmental organisations (NGOs). It also plans to uplift the commitment of political leaders and reduce stigma and discrimination associated with HIV/AIDS. Though the prevalence is low, Sri Lanka has all the ingredients to precipitate an epidemic. These risk factors include - an expanding population in the productive age group with high rates of unemployment; postponement of marriage by young people; a 23 year old conflict which has given rise to the presence of about 150,000 armed services personnel; the employment of over one million migrant workers, mainly youth in Industrial Promotion Zones away form their homes; the annual emigration of some 200,000 persons seeking foreign employment in the Middle East, Far East and in the European countries; closer proximity to India where the HIV Prevalence is very high. Sri Lanka still has the potential to prevent a generalised epidemic. With its deep historical commitment to human development, highly literate population, and a well developed health infrastructure, the country is in a strong position to control and contain the spread of HIV. The Government of Sri Lanka has repeatedly declared at its highest level its commitment to draw on these strengths to address the issues related to the prevention and control of HIV/AIDS. Though financial constraints are our challenge to sustain our control efforts UN agencies like the World Bank and the WHO have come to our rescue. WHO identifies priority list of medicines The World Health Organisation has released a groundbreaking report which recommends ways in which pharmaceutical research and innovation can best address health needs and emerging threats in the world. Priority Medicines for Europe and the World, commissioned by the Dutch Government as current president of the European Union (EU), identifies a priority list of medicines for Europe and the rest of the world. The report looks at the gaps in research and innovation for these medicines and provides specific policy recommendations on creating incentives and closing those gaps. At present, pharmaceutical research and development are based on a market-driven incentive system relying primarily on patents and protected pricing as a prime financing mechanism. As a result, a number of health needs are left unaddressed. The report identifies gaps for diseases for which treatments do not exist, are inadequate or are not reaching patients. Threats to public health such as antibacterial resistance or pandemic influenza, for which present treatments or preventive measures are unlikely to be effective in the future, also require immediate action. The 17 priority conditions identified by the report are: Future public health threats: infections due to antibacterial resistance; pandemic influenza; Diseases for which better formulations required are: cardiovascular disease (secondary prevention); diabetes; postpartum haemorrhage, paediatric HIV/AIDS, depression in the elderly and adolescents; Diseases for which biomarkers are absent include Alzheimer disease and osteoarthritis. Diseases for which basic and applied research is required are cancer and acute stroke. Neglected diseases or areas include tuberculosis; malaria and other tropical infectious diseases such as trypanosomiasis, leishmaniasis and Buruli ulcer and HIV vaccine. Diseases for which prevention is particularly effective are chronic obstructive pulmonary disease including smoking cessation; alcohol use disorders: alcoholic liver diseases and alcohol dependency. The report suggests that Europe can and should play a global leadership role in public health. In many developing countries, the poor are increasingly affected by the chronic diseases that are widespread in Europe, including cardiovascular disease, diabetes, tobacco-related diseases and mental illnesses such as depression. For a number of diseases that affect people in all members of the EU, no effective and safe medicinal treatment is yet available (e.g. Alzheimer disease and several cancers). For some diseases, potentially large markets exist for medicines (e.g. breast cancer) and associated pharmaceutical research is likely to be intensive for certain therapeutic classes. For other categories of medicines, the number of patients is low (e.g. cystic fibrosis) or the market-driven pharmaceutical industry has failed to pursue research and development (e.g., new medicines for tuberculosis). Innovative solutions The report suggests that efforts to shorten the medicine development process without compromising patient safety would greatly assist in promoting pharmaceutical innovation. The report points out that major pharmaceutical gaps have been closed in the past. For example, until 1975 the main treatment for severe peptic ulcer - a common ailment - was surgery. Following a long period of focused research in biological mechanisms underlying ulcer disease, effective medical treatments were discovered. These breakthrough discoveries, combined with the discovery that most ulceration was caused by a bacteria treatable with antibiotics, made surgery unnecessary. |
|
| News | Business | Features
| Editorial | Security
| Produced by Lake House |
Sexually Transmitted Diseases (STDs) can lead to HIV/AIDS. Yet, in
spite of an intensive awareness raising campaign by the Health Education
Bureau and National STD/AIDS Control Program, the number of STDs is on the
rise, with an increasing number of young patients compared to the past.
