World AIDS Day on December 1:

Telling teenagers the truth

By Nilma DOLE

Nowadays teenagers and adolescents are constantly exposed to media, television, internet and blaring billboards which go to great extents of displaying images of a sexual nature. Be it a poster at a cinema hall, an advertisement on television or some pop-up on an internet website, today’s adolescents are exposed much more compared to the times of their parents.

While such activities were done in secrecy, today’s Sri Lankan society is bolder than before. This is as a result of developing rapidly and being constantly bombarded with Western ideals. As hard as you try to prevent your children from getting exposed to that position, it’s not easy to close their eyes to the evils of the world which is now becoming more tolerated and steadily accepted.

No matter what you do, you cannot stop those prostitutes bargaining their price behind a bus stand when your child stands in front of it, you can’t stop your child from being exposed to the literature passed secretly in schools and you can’t stop lovers from congregating under parasols at Galle Face green.

Even though girls know about their reproductive system for menstruation, they don’t really get the right information about sex education as their parents might just shun away the topic aside, embarrased to talk about it.

Dr. Ayesha Lokubalasooriya, Consultant Community Physician at the School and Adolescent Health Unit of the Family Health Bureau said that it is important to educate children since prevention is better than cure. By educating your children, it doesn’t mean you’re promoting promiscuity but you are preventing serious consequences taking place.

Even though Sri Lanka has a systematic policy framework for teaching sex within schools, sex is still taboo and not fully understood due to lack of awareness.”Adolescents are prone to high-risk behaviour because they want to experiment. Learning about life skills and education on it is important if you want your child to make adult decisions about their sexuality,” said the doctor.

Anyone in the age group of 10 to 19 years are classified as adolescent and the world population of adolescents is 1.2 billion (19 percent of the total population). In Sri Lanka, 19.7 percent of the total population belongs to this age group which is a considerable proportion.

“In Sri Lanka, there are 9,662 schools, of out of the 3.9 million students, about 60 percent are adolescents,” she said.

In 2004, UNICEF (United Nations International Children’s Education Fund) did a survey on school-going children and emerging issues on adolescents. A total of 3,392 students were interviewed and assessed as to what they knew about adolescent issues. Only 18 percent of schoolboys and 6 percent of girls knew about addictive substances but the number increased with age. About 32 percent in the 17 to 19 age group category knew about addictions and how bad it is while 42 percent of those who finished school knew about such issues.

Research

“In 2004, UNICEF conducted a research and discovered that 10 percent of early school-going adolescents and 14 percent of students in the mid and late school-going age were sexually abused at some point in their lives,” said the doctor. She said that family members and relatives were responsible for sexual abuse in early adolescents and 38 percent of family members and 35 percent of outsiders were responsible for sexually abusing those in the mid to late school-going age. “The main health problems faced by adolescents are sexual and reproductive health problems, nutritional problems (girls wanting to lose weight), substance abuse, injuries and accidents and clustering of problems is also common,” said Dr. Lokubalasooriya.

She said that the brain of adolescents is still developing and they are in a very vulnerable stage of their lives. “Adolescence is a period of profound brain maturity and development of the brain is only complete only by the age of 25 years,” said the doctor. This means that adolescents won’t necessarily make the right decisions and will act impulsively. So it’s important to recognise that they need guidance and a friend to talk you especially when they have their personal struggles. Often pre-marital sex especially in adolescence gives rise to conflict between contemporary social values.

Adolescence

Adolescence is a period of emotional and social changes for a teenager who think they know everything but still have an identity crisis.

“They are preoccupied with body image, often daydream, have attitude problems, have mood shifts, display attention-seeking behaviour, want to establish an identity, are curious and begin to masturbate and have sexual attractions,” said the doctor.

The worry in Sri Lanka is that sexual experimentation will lead to an AIDS epidemic if the correct information isn’t passed to society. Sri Lanka’s education system has now developed to accommodate the right kinds of AIDS and HIV information which has seen adolescents not only understanding more about their bodies but have made them be mindful of values and ethics. “They will also start relationships which might even turn sexual and sometimes boys are coerced and bullied to bow down to peer pressure. This might lead them to experiment with substances and have sex with prostitutes,” said the doctor.

Self exploration and evaluation, conflict with family control, peer group defines behavioural code and the formation of new relationships will also assess the adolescents standing. “As parents, we need to be aware of our needs and problems of our adolescents.

It is up to us to use our best judgement to determine what’s wrong and how we can help them,” said the doctor.

Life skills

The best way to deal with this issue is to improve the life skills of adolescents and be careful and sensitive when giving sexual education. “We shouldn’t be embarrassed to talk about decisions that an adolescent makes after finding out they have an affair with someone but it’s best to ensure that they know the right information and clear doubts,” said the doctor. The gap between parents and children should be lessened and we need to improve close relationships between parents and teachers. “It is also upto the adults to set a good example to the children because if the parents behave improperly, then children will see it as the right thing,” said Dr.Lokubalasooriya. She said that parents need to assist their children with challenges that require planning, help them when they seek advice and educate them about drugs, alcohol and other problems.

HIV/AIDS

There have been 1,400 cases reported of HIV contraction this year with at least one case reported a week. In Sri Lanka, there are about 10,000 prostitutes with two to three new cases of HIV/AIDS are discovered per week, for a total of 1,388 cases in the second half of 2011; about 250 people have died from the disease since 1986, the year of the first episode of infection; at least 40,000 sex workers, of which more than 8,000 are women.

AIDS has become a dangerous issue according to the AIDS Foundation of Lanka (AFL), which has launched awareness programs and the setting up of the National Task Force against AIDS. Sri Lanka has a growing incidence of the disease which remains largely unreported and unchecked due to stigma and discrimination.

With cultural norms opposing extramarital sexual behaviour these implications may affect societal values and give way to more dangerous aspects. The Global Summary of the AIDS Epidemic shows that approximately 1.8 million people worldwide had lost their lives to this illness by the end of 2009.

The theme for World AIDS Day this year is ‘Getting to Zero’ as it will be 30 years of the global fight against HIV/AIDS. This time around, there will be a commitment to focus on a zero-tolerance on the AIDS epidemic which inculcates the statement of “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths”. Last year, there were 2.7 million new HIV infections and 1.8 million people died from AIDS.

Moreover, in 2011 people living with HIV were still subject to restrictions and the global HIV epidemic has become more diverse, with both similarities and differences between regions, countries, provinces and communities. After all, isn’t it better to prevent your child from contracting HIV or your daughter getting pregnant by educating them instead of waiting for something negative from happening?

(References courtesy Sri Lanka Family Health Bureau and www.avert.org)

Demand for funds to banish AIDS for ever

A historic opportunity to eradicate the disease is in danger of being squandered, say experts

by Jeremy Laurance

A historic opportunity to eradicate AIDS is in danger of being squandered if the world does not come up with the necessary funds to finish the job, experts warned last week.

Latest figures show that almost 50 per cent of people with the disease now have access to antiretroviral drugs. The number of HIV-infected individuals in treatment rose to 6.6 million last year but is still a long way short of the 14.2 million who need it.

The increase has contributed to a 21 per cent fall in new infections since 1997 and a 21 per cent fall in deaths. Deaths now stand at 1.8 million, their lowest level since peaking in 2005 .

UNAIDS, which released the figures in its annual World AIDS Day report, How to Get to Zero, said new infections had fallen by more than two thirds in Botswana since the late Nineties, where treatment with antiretrovirals covers 80 per cent of the population – the most extensive of any country in Africa. “The end may be in sight if countries invest smartly,” the report said.

Scientists showed last year that treatment reduces the risk of an infected person transmitting the virus to their partner by 96 per cent, suggesting that AIDS could be defeated. In June, the UN Secretary-General, Ban Ki-Moon, called for a global commitment to eliminate AIDS by 2020 by rolling out drugs to all who needed them – “Zero new infections, zero stigma and zero AIDS-related deaths,” he said.

Earlier this month, the US Secretary of State, Hillary Clinton, held out the prospect of an “AIDS-free generation” with three measures: preventing babies from being infected at birth, voluntary male circumcision (which provides 60 per cent protection to men) and universal drug treatment. She announced an extra $60m for Pepfar, the President’s Emergency Plan for AIDS Relief, to fund pilot studies and called on other donors to join the effort.

Barack Obama is expected to make a further announcement on December 1, World AIDS Day.

Despite such pledges, the economic woes of Western donor nations meant that their contributions to the global effort on Aids prevention and treatment fell 10 per cent in 2010.

Although the UN High Level summit on Aids last June agreed to raise the total available to between $22 and $24bn in order to double the number on treatment and end mother-to-child transmission by 2015, there is doubt about whether countries signing up to the declaration will keep their promises.

Adrian Lovett, the Europe Director of ONE, the global advocacy organisation, said: “Maintaining the status quo is not enough. We are only halfway there in the fight against AIDS.

This year, for the first time, evidence shows us that it is possible to change the trajectory of the epidemic. The success stories of countries such as Botswana show just what is possible.

The Independent

Biomedical aspects of healthcare

by Dr Nihal S. de Silva and Dr Tipu Sultan

Environmental Health Signals and Epigenetic Medicine (Epigenome) may top all other forms of Preventive Care: Early Detection Of Epigenetic Changes In Preventive Medicine Require the Deciphering of ‘Evidence-based’ Biomarkers Using the Rapid Diagnostic Techniques of Raman Spectroscopy.

We are in the threshold of a revolution in preventive scientific biomedicine in the 21st century.

The goals of such a true revolution in thinking is to stop an illness before it starts or to discover and treat a disease before it spreads and become serious. The fundamental understanding of health and disease runs much deeper and is dependent not so much on genetic factors but on epigenetic changes that are reversible, and play a unique role in the pathways to prevent disease. This new discovery emphasises the fact that prevention of disease is more important than what the genes tell us.

Thus epigenetics is the study of the effect of the environment on our genes. We can do only so much with our endowed genes but we can have a great influence on our environmental factors under which we live.

Thus the importance of epigenetic factors like modifying the environment to eliminate food allergies, toxins,etc can reverse the disease process, or even modify the environmental factors to prevent disease from happening in the first place! Thus the ability to diagnose the early onset of disease, rapidly and non-invasively is the challenge of the future, but timely due to the recognition that epigenetic changes may be at the root cause of such diseases as cancer, cardiovascular diseases, diabetes, asthma, and other chronic diseases.

Thus Epigenetics is rapidly emerging as one of the most exciting scientific fields in preventive medicine.

As we completed the sequencing the human genome, scientists worldwide are beginning to realize that only knowing the genetic information is not sufficient to understand the entire manifestations in health and disease.

The way the DNA code is translated into function depends not only on its sequence but also on the interactions with environmental signals from outside. So here is where the exciting science of epigenetics comes into play in understanding health and disease. Epigenetics intergrates the different chemical languages that the genome and the environmental signals use to communicate with each other.

Thus epigenetics is the study of heritable changes that affect gene expression without altering the DNA sequence. However, in terms of preventive care, epigenetic events can also be defined as ‘the structural adaptation of chromosomal regions so as to register, signal , or perpetuate altered activity states’.

The known epigenetic modifications include DNA methylation (addition of methyl groups), and other changes of which DNA methylation being the most studied among them.

The importance of epigenetics is indicated by the keyrole played by DNA methylation patterns during embryonic development and the establishment of tissue identities within an organism. However, the epigenetic signature of different tissues is not well defined. Thus the Human Epigenome Project (HEP) has been launched by NIH (US) recently to identify all of the chemical changes and relationships among chromatin constituents (DNA,RNA protein,etc), in an effort to further understand normal development.

This augurs well for a true science-based system to understand health and disease at the molecular level.

At the same time HEP represents an enormous challenge because epigenomic changes not only show intra-and inter-personal variations, but are subject to modifications throughout the life of a human being. Thus the value of the ‘personalised medicine’ concept that no two individuals are the same although we share the genomes to the accuracy of 99.9 %! The complexity of the epigenome poses both biological and technical challenges of a diagnostic nature. For e.g. the development of techniques allowing accurate quantification of chemical levels across genome is a pre-requisite for the success of characterization of the epigenome.

We have embarked on a radically different and novel technique of the true identification of ‘Scientific Biomarkers’ (epigenome markers) for the diagnosis and prevention of disease. The importance of ‘evidence-based’ scientific method becomes apparent to any rational human being!Hence we have developed a novel method of characterisation of any disease by the ‘fingerprint vibrational pattern’ of the non-invasive technique of Raman Spectroscopy.

This non-invasive photonic (light-based) technique provides rapid in vivo biochemical information of cells, tissues, organs and bodily fluids. In this study, the method involved shining a beam of laser light of a particular wavelength (e.g. 532/735/1065 nm) on the human skin and then observing the production of a Raman spectral pattern. This spectral pattern will be unique to a cell/organ or fluid and reveals the chemical composition of the biomolecules of the cells, thus allowing the scientists to identify the biochemical changes that precede the disease process.

Therefore it is preclinical and is of enormous importance for preventive care and treatment of disease. This is of special significance to a fast developing country as Sri Lanka where a good population of people still suffer from non-communicable diseases such as parasitic infections, diabetes, cancer, heart disease, lung infections, autism, and other degenerative diseases (inflammatory) can now be subjected to this type of analysis.

In a recent study we have been able to decipher the spectral changes of the skin of autistic children compared to normal (control) children by this very exciting technique. We hope to continue this study further and also to apply this technique to other epigenome based diseases as described before.

Rapid non-invasive photonic (light-based) diagnostic biomedicine is the wave of the future for Sri Lanka and other developing countries in order to lower the healthcare costs, and also focus on a long-term plan for programs in Preventive Molecuar Medicine in health and disease.

The forthcoming Global Science Conference (Dec.13-15) will augur well for instituting such a program(s) with the scientists (including engineers, medical personnel, etc), the Government and the private sector joining hands for scientific and economic development of Sri Lanka!.

Dr. Tipu Sultan, MD. is a Diplomate of the American Board of Pediatrics & of the American Board of Environmental Medicine.

Dr. Nihal de Silva, PhD, is a biochemist with many years of teaching and research expertise in Lipid Biochemistry, Immunology and Microbiology, Nutrition, Molecular Biology and Molecular Spectroscopy (Raman, IR, NMR, etc).