Risky behaviour:

Nine-fold increase in STDs among female sex workers:

by Carol Aloysius

‘The Integrated Biological Behavioural Survey,’ a new study carried out by the National STD & AIDS Control Programme (NSACP) Sri Lanka, has revealed that risky behaviour on the part of female sex workers was nine times higher than that of the normal population, putting them at much greater risk of contracting sexually transmitted infections (STIs) than the rest of the Lankan population.

- AFP Photo

“Although the prevalence of HIV among them is low (9%) compared to other countries in the region, it is still quite high when compared to the current prevalence rate of .1% for the general population,” Director NSACP, Dr Sisira Liyanage told the Sunday Observer, adding that the highest number of sex workers were found in the Colombo District. “ Of the new patients registered at our thirty STD clinics island-wide last year, the maximum numbers were registered at the Central Clinic in Colombo, followed by Kalubowila, Kurunegala and Ragama. The majority of these clinics had over 151 new patients registered in 2014, which is much lower than our original estimate,” he said.

Of the new diagnosed clinic attendees, it was also found that half of the attendees had at least one STD at the time of their visit. NSACP sources said that while the clinics also screened persons other than STI patients, such as people who come for pre-employment screening and ante natal screening, sixty percent of the attendees at the leading clinics at Kalubowila, Colombo, Ragama and Chilaw were STI patients.

Condom use

The current transmission of HIV/AIDs is indigenous, with no recent ‘imported’ cases. However, according to the new study, over 40 percent of positive cases (largely males) had been employed abroad and returned to the country carrying the infection in their bodies, with or without their knowledge.

“These persons are a risk to the entire society, especially to their wives and partners with whom they have sex. If they don’t use a condom, they can infect their sex partner”, Dr Liyanage warned.

On the plus side, the study also found that most (ninety percent ) Lankan males who engage in sex with commercial sex workers frequently, now use condoms, to protect themselves. “In fact the demand is so great that what we distributed is not enough,” he said, adding, “It is the ten percent we are worried about.” He warned if this segment doesn’t use a condom they could infect everyone they have sex with and “there could be an epidemic of AIDS on our hands.”

He said they distribute around two million condoms every year to STI clinics island-wide, but that due to the surge in demand, many people also opt to buy it at a nominal price from drug stores and other outlets before engaging in sex. The average age of those who buy condoms range from 15 to 50 years. Asked about female condoms, he said the number available in the country was very low due to their high costs. “Besides, our women still have to get used to the idea of wearing a condom although it is a common practice abroad”.

Attributing the wide use of condoms as a significant factor in the current low prevalence rate of HIV/AIDS in Sri Lanka compared to other countries in the region, he said the NSACP was stepping up its efforts to maintain this low prevalence rate by providing all the clinics now in operation with whatever they required in the way of condoms, educational literature and resource personnel to conduct awareness programs.

“ We have spent over Rs 300 million all our programs of which the government provided 65% of the monies and the balance 40 percent came from the global Fund For AIDS TB & Malaria.”

Treatment

Questioned on drugs and treatment available to patients and the quality of care for patients, he emphatically noted that , “all the drugs and treatment given to people afflicted with HIV/AIDS are on par with international standards and could be favourably compared with any developed country”.

He said patients were given 1st, 2nd and 3rd line treatment according to the severity of their condition, and noted that the NSACP offered a package of wide ranging services in managing STI, which included clinical diagnosis, treatment and screening for STI including HIV, health education, counselling, condom promotion and follow up . “We also work with other NSACP clinics, non government organization, and community organizations to develop comprehensive and coordinated plans to implement our national strategic plan,” he said.

Asked when the next national survey on HIV/AIDS was to be, he said, “Possibly in 2030”.

He said the NSACP distributes over two million condoms per year to all 30 STI clinics free of charge. “If anyone wants to get a condom he/she can just walk to the nearest clinic in their respective district and get one free,” he said. Asked about the quality of the condoms, and if they were liable to tear, he said, “That depends on the wearer. The material used is mostly imported and the product is locally packed. However it is also available in private drug stores in different colours, flavours and sizes”.

Alternative treatment

Responding to questions on alternative or non-traditional treatment, which is still popular among certain sections of Lankan society, especially in rural areas, where many patients opt for herbal and Ayurvedic treatment along with other natural remedies, he said ,“ These are dangerous myths that give false information and mislead patients, so that by the time they come to us many of them are in an advanced state of HIV and already have the full blown disease AIDS. My message to them is: There is no cure for HIV. No drugs or vaccinations have been found to cure it anywhere in the world although there have been some promising studies. But that is in the distant future. Right now the best option is to go for western treatment. Drugs to control the progress of the disease and extend the lives of these persons are only available at our district clinics. Although they are very expensive as they are imported, they are given free to every patient who really requires them”.

Transmission and symptoms

AIDS first emerged as a new disease in Sri Lanka in 1986 when the first case of an AIDs patient ( a foreigner) was reported in a local State hospital. However, today the disease is hundred percent locally transmitted. Modes of local transmission include unprotected sex with an HIV infected person, through HIV infected blood and blood products, by HIV infected organ and tissue transplants and through an HIV infected pregnant woman to her child.

Symptoms include severe weight loss, nocturnal fever, and enlargement of lymph nodes at various sites, skin rash, thick white coating on tongue, severe diarrhoea. Vulnerable groups include commercial sex workers, those engaged in same sex, those with certain Sexually transmitted diseases and those with TB who have lowered immunity.

Plans for the future?

“At present we have only one STI clinic in every district. We want to extend this to all base hospitals so that eventually there will be at least two clinics, which every person requiring their services can go to.

Education is the key, since recent surveys have revealed that a considerable number of young persons still have no basic knowledge about sex. To reach out to this sector, we are conducting awareness programs for youth and the results have been positive. We are also trying to debunk the myths and wrong beliefs about HIV /AIDS, to overcome the prejudice that patients face.

Message to persons at risk?

Touching, shaking hands, kissing DON’T spread HIV. Neither do flies, mosquitoes or using common amenities. Risky behaviour, be it consuming drugs or alcohol or engaging in same sex makes a person vulnerable to HIV/AIDS. Get yourself screened at nearest clinic.

Hotline: 2695183
Central Clinic, at De Saram Place,
Colombo 10.