Are we really protected from the killer disease?

AIDS/HIV and sex education in Sri Lanka

by Indeewara Thilakarathne

Though Sri Lanka may not be on the danger map of the countries designated for high prevalence of AIDS/HIV, it is certainly not a reason to be complacent that we are quite protected from this silent killer.

Given the number of commercial sex workers both male and female in the country and the large number of youth (aged 15-25) who are sexually active, it is pertinent to ponder on whether Sri Lanka has reached the expected level of raising public awareness on the spread, containment and prevention of HIV/AIDS, especially among the adolescents.

Although the general perception of HIV/AIDS and other communicable diseases have largely been changed, it is still doubtful whether the social stigma attached to the sexually transmitting diseases in general and HIV/AIDS in particular has undergone a radical change especially in rural Sri Lanka. This pervasive attitude is born out of misinformation, misconception and the myths associated with the disease.

In Sri Lankan family, sex and allied subjects still remain a taboo. This has effectively left the youth with no alternative but to rely upon peer groups and secondary sources of information on sex, such as cheap trash, phonographic literature, and blue films in VCD and DVD forms which in reality spread abnormal sexual behaviours and are of no educational value.

This intransigent attitude coupled with social stigma has prevented the introduction of sex education into the school curricula in an effective way. Family pride and social stigma and the simple refusal to accept HIV/AIDS as a disease by the community and society, has prevented those patients living with HIV /AIDS from leading a decent social life in gross violation of their human rights.

This has and still been a major stumbling block in preventing effective control, and the spread of the disease. It is estimated that 90 per cent of HIV infections occur in Sri Lanka through unprotected heterosexual contacts.

Though the use of condoms as a contraception method is stressed in most of the HIV/AIDS awareness programmes, the youth and adolescents are reluctant to use condoms.

The first case of HIV infection in Sri Lanka was reported in 1986. The total number of AIDS patients reported at the end of 2004 was 614. Of these 363 were male and 251 were female. The reported number of deaths due to AIDS was 131 as of end 2004. The estimated HIV prevalence between 15-49 year olds in 2003 was less than 0.1%.

However, it is estimated that 3,500 persons are living with HIV in Sri Lanka as at the end of 2003. The current ratio of HIV-positive men to women in Sri Lanka is reportedly 1.4 to 1, although in reality, there may be far more men with HIV infection than women as in most early phase HIV epidemics.

The major mode of transmission of the disease is through heterosexual contact which accounted for 86% HIV cases and other modes of transmission include homosexual/bisexual contact and through infected blood and blood products and transmission from an infected mother to child.

Eleven per cent of the reported HIV infections were due to homosexual/bisexual transmission. Since homosexual behaviour is illegal in Sri Lanka it prevents effective intervention in this group.

Although the male to female ratio of HIV infection is 1.4:1, the female infection of HIV has been increasing over the years due to delayed marriageable age among the women and the resultant increase in sexual behaviours.

The percentage of injected drug users in Sri Lanka is estimated to be less than 1% of all drug users. The only case of HIV transmission attributed to injecting drugs was reported in 2004.

Sri Lanka commenced screening blood for HIV in 1987. This has prevented many potential transmissions through blood transfusion. So far only three cases of infection caused by blood transfusion were reported in Sri Lanka.

Major factors in Sri Lanka

The major contributory factors to the spread of HIV/AIDS that have been identified in Sri Lanka are the low use of condoms, commercial sex, Sexually Transmitted Diseases (STDs) and demographic migration patterns (migration of population from rural areas to metropolitans in search of employment) and the low level of awareness among the poor segments on the disease.

Use of condoms

Although the corpus of research on the spread and infection of HIV has been limited in scope, the few studies conducted in the urban areas indicated low use of condoms among men.

For instance, in 1997, only 4.7% of men between the ages of 15 and 49 in Matale and 9.6% of men in Colombo reported ever using condoms though they have heard about them. The study further indicated that men who had had sex with casual partners, only 26.3% in Matale and 44.4% in Colombo used condoms. Generally, the use of condoms has not been an accepted method of contraception.

Commercial Sex

So far it is estimated that about 30,000 women and girls and 15,000 boys work in the commercial sex industry in Sri Lanka. The risk of HIV/AIDS spreading among sex workers is further raised by the low use of condoms and the high prevalence of Sexually Transmitted Diseases (STDs). Considerable sex workers are practising their profession in transit towns such as Anuradhapura in addition to beach boys and women in the sex trade with tourists.

Sexually Transmitted Diseases (STDs)

According to a 1991 estimate, 200,000 cases of STDs occur annually. By 2003, a total of 14,389 persons were newly registered with Government STD clinics. Of them, 49% were diagnosed as having one or more STDs.

Migration

Migration within and emigration to the Middle East and neighbouring countries also contributed to the increase of STDs in Sri Lanka. Women constitute 80% of the workforce in both migrant workers and those who are employed in Free Trade Zone. They are highly vulnerable to STDs and this fact is indicated by the high rate of unwanted pregnancies and the high prevalence of STDs.

Low levels of awareness among poor people

The level of awareness and knowledge of HIV/AIDS in the underprivileged and impoverished communities remain low. For instance, only 40 per cent of women workers in Tea Estates have ever heard of HIV/AIDS compared to 90 per cent of women in other rural and urban areas.

However, the picture is not that gloomy as now HIV can be contained and suppressed, and patients could lead longer lives.

Therefore, it is the responsibility of the community and the society at large to develop a favourable attitude towards men and women living with HIV and to make a conducive environment for them to lead decent lives enjoying the liberties available to citizens.

This in turn, would greatly help to contain and prevent the spread of the killer disease in Sri Lanka.

(Facts courtesy: www.youandaids.org)

[email protected]