Is there a way out?

AIDS and its Socio-economic implications:

by Indeewara Thilakarathne and Ranga Chandrarathne

As the killer disease spreads stealthily into the very heart of the work force, the persons in 15-35 age group, another hitherto unseen aspect came to light with the speculation that the available statistics shields the real figure of HIV infected or positive children in Sri Lanka.

Although the health institutions and children's homes refused to divulge the details of their inmates living with HIV, unofficial figure is much higher than expected by most of the observers given the changing demographic pattern shifting towards an increasing ageing population.

Low level of public awareness on AIDS in general and gross ignorance on prevention methods such as use of condoms coupled with the absence of scientific sex education in particular, have substantially contributed to the steady spread of AIDS. The situation is worse in rural Sri Lanka where, according to a study by UN, that only 40 % of women workers in rural tea estates have ever heard of HIV/AIDS.

By 2005, Sri Lanka had an estimated 5000 persons contracted with AIDS and 1000 died due to AIDS. According to the UNAIDS report 2006, 500 children were orphaned by the killer disease.

Although the main method of transmission remains to be through sex, the other methods such as transmission through blood transfusion, homo-sex and lesbian, drug injection, can not be ruled out.

Social stigma

Social stigma has been a major stumbling block in preventing spread of the disease as patients and HIV positives are reluctant to come out, thus preventing effective treatment and spread of AIDS.

Unless and until Sri Lankans are prepared to change their archetype beliefs and looking down on persons suffering from Sexually Transmitted Diseases (STD), it would not be an easy task to contain the spread of the disease which has a window period as long as ten years, posing a high risk of transmission during that period.

Public education programme on HIV/AIDS should be vigorously launched in order to stamp out social stigma attached with the disease. It is pathetic that the attitude towards the disease on the part of so-called professionals, specially, those who are in the Health sector, is almost similar to that of the illiterate man on the street.

Given the famous case of a HIV infected academic who taught thousands of medical students was castigated and inhumanly harassed by fellow professionals, the change of attitude should first come from medical professionals.

Such a process of education should cover the areas of diagnosing, containing and social integration of persons living with HIV and AIDS patients. It should also be preceded by a comprehensive sex education which should be incorporated into syllabi of schools as well as other higher education institutes such as Universities and various further education institutes.

In addition, HIV/AIDS awareness programmes should be conducted in all public and private sector business establishments, offices and commercial establishments not only to educate the labour force on HIV/AIDS but also to introduce preventive methods such as use of condoms and to stamp out social stigma associated with AIDS.

Although the idea of universal sex education may not be palatable to cultural puritans who live in a make-believe world, time is ripe to change their obsolete views on family, marriage and sex as life-styles have undergone a dramatic change.

Pre-marital sex and practices such as living together are increasingly being practiced by young couples often without a scientific sex education. As the fast moving life-style occupies the place held by traditional close-knit family, age of marriage has been extended either to facilitate further education, achieve career goals or due to inability to set up and run a family on account of a fixed income.

It is naive to speculate that sexual activities of the young couples are halted till they tie up the nuptial knot. If these young couple would further rely on cheap trash and "blue films" in order to acquire knowledge of sex, it would have serious implications on the family, making them vulnerable to Sexually Transmitted Diseases including AIDS.

Demographic change

Therefore, it is imperative that sex education should immediately be commenced with a broader view to address the socio-economic issues arising from the spread of AIDS and the immense strain that it would put on the economy in terms of increasing expenses on health care and medication of HIV/AIDS patients.

One of the important aspects that the policy-makers, decision makers conveniently ignored is the population factor. As each and every programme, be it development or AIDS prevention, is aimed at and catered for a population, the major changes in the sphere of population at a given time and speculation on changes should be taken into consideration if the maximum benefits of that programme is to be reaped.

Currently Sri Lanka's population pyramid is undergoing a dramatic shift towards ageing population with increasing dependency rate.

If the prime of the workforce is at risk of contracting HIV/AIDS due to hard-hearted policies and cultural concerns, AIDS has not only the potential of slowing down the economic growth but also it can cripple the entire economy.

AIDS prevention should be on top of the national priority list as it has widespread implication on economy and society at large.

National Response

The Government initiative of prevention of AIDS was launched in as far back as 1992 with the National STD and AIDS Control Programme (NSACP). The programme was implemented through provincial directors of health services, STD clinics and the National Blood Transfusion Service. The coordination arm of AIDS prevention programme is the National AIDS Committee (NAC).

In addition, two research centres specializing in HIV law and ethics for South East Asia; CEPRA (Centre for Policy Research and Analysis) and Human Rights Centre are based at Colombo University.

As signatory to UN's Millennium Development Goals, Sri Lanka is committed to halt and reverse the spread of HIV/AIDS by 2015 and the Government has under its 2005 MDG programmes identified expanding prevention programmes for highly vulnerable groups, strengthening hospital facilities for AIDS patients and adapting a multi-sectoral approach in prevention with participation of ministries and civil society organisations. One of the programmes prioritised by the Government was a programme for prevention of mother-to-child transmission of HIV.

As the figure of children with HIV/AIDS increases rapidly, focus should be on mother-to-child transmission of HIV and providing health care facilities for children living with HIV.

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