HIV manageable with effective diagnosis, treatment and care | Sunday Observer
Sri Lanka has an estimated 3,600 persons living with HIV

HIV manageable with effective diagnosis, treatment and care

6 December, 2020

World AIDS Day last week brought together several health experts to discussway s of reducing or ending this disease by 2030.  National STD/AIDs Control Programme (NSACP) Director  Dr Rasanjalee Hettiarachchi   tells the Sunday Observer how it is possible for those living with HIV /AIDs to live better and longer lives with the  new tools now available for diagnosing and treating them early.

Excerpts …

Q. World AIDs Day was observed on December 1. Why is this health issue so important that a special day has been set apart for it?

A. HIV continues to be a major global public health issue with  an estimated 38.0 million people living with HIV as at end 2019 globally.  In Sri Lanka the estimated number living with HIV is 3,600 and of them around 2,000 come for HIV care and treatment.

With increasing access to effective HIV prevention, diagnosis, treatment and care, it is now a manageable chronic health condition, enabling people with HIV to lead long and healthy lives.  However, not everyone is able to access HIV testing, treatment and care.

Q. What is AIDS? What is the difference between HIV and AIDS?

A. Acquired Immuno Deficiency Syndrome. It describes the collection of symptoms and signs associated with a deficient immune system.  HIV stands for Human Immunodeficiency Virus. HIV is a retrovirus that infects cells of the human immune system (mainly CD4-positive T-cells and macrophages—key components of the immune system) and destroys or impairs their function.

Therefore, initially although HIV virus infects a person they may be asymptomatic for some time.

Despite the fact that it often does not cause any symptoms, a person newly infected with HIV is infectious and can transmit the virus to another. At this stage the only way of determining whether HIV infection has occurred is by taking an HIV test.

However, infection with HIV virus results in the progressive depletion of the immune system over several years, 10-15 years, leading to immunodeficiency.

This results in an increased susceptibility of the body to infections and cancers that are used as indicators that HIV infection had progressed into AIDS.

Q. What are the main modes of transmission of HIV in Sri Lanka?

A. There are three main ways to get HIV. Over 95% of HIV transmissions in Sri Lanka happens through unprotected sex. Among these in recent years we have observed an exponential rise in new HIV infections among men who have sex with men (Male Homosexual population). Second way of transmission is through HIV infected blood and blood products.  However, in Sri Lanka these products are evaluated thoroughly and for almost the last three decades there have been no cases of HIV transmission through blood and blood products. 

In people who inject drugs by themselves, there is a high chance of HIV transmission if they share needles. In Sri Lanka although the number of people who inject drugs is small, most of them share needles for injections. Thirdly, through mother to child transmission of HIV in pregnancy, delivery and breastfeeding. Here too Sri Lanka has eliminated mother to child transmission of HIV and syphilis infections since 2019 . If a pregnant woman receives the free antenatal care package provided through the Medical Officer of Health antenatal clinics they will be screened, so that treatment and care is provided if necessary to prevent the baby acquiring HIV infection.

Q. Who are those most at risk of getting HIV /AIDs gender wise?

A. A person’s perception of gender may be different from the sex attributed at birth. In this sense the transgender community, chiefly trans women are at risk. What we have to consider in the Sri Lankan HIV epidemic is chiefly the sexual orientation. Homosexual men are considered as the chief driver of the HIV epidemic in Sri Lanka. We have observed that many new HIV infections among the public are where there is a hidden male homosexual community. This hidden population is unaware and does not attend the free services provided by STD clinics due to socio-cultural and religious constraints.

Q. Occupation –wise? 

A. Persons involved in the sex industry both female and male sex workers and their clients. People who inject drugs and beach boys are included in the key affected population and those involved in the tourism sector and garment factory workers are considered as vulnerable populations.

Q. Age group most vulnerable to HIV/AIDS in Sri Lanka?

A. majority of the newly reported HIV infections in Sri Lanka are diagnosed among the 15-49 age group. However, the 15- 24 age group comprising youth are the most vulnerable to HIV. One in 8 new HIV infections occurs among this age group.

Q. What are the main causes that has made these young people vulnerable to the disease?

A. There are many factors which make the youth vulnerable to HIV, such as, inadequate knowledge on sexually transmitted infections (STIs) including HIV, lack of necessary life skills to avoid risky behaviour to prevent being infected with STIs and HIV. Other important factors are misuse of modern technology, forming instant relationships with unknown partners, childhood sexual abuse and peer pressure.

Q. Do all those who have HIV develop AIDS eventually? If so how long does it take to develop the disease?

A. No. if a person diagnosed with HIV infection receives prompt treatment and continues treatment for life it will not progress into AIDS stage and such person will live a healthy life. There is a very small percentage of people known as elite controllers who, even without treatment will not progress into AIDS stage or will take a very long time to develop to this stage. Usually without treatment an HIV infected person will take 8-10 years depending on his/her immunity to progress into AIDS.

Q. Symptoms -  How can a person know if he or she has HIV?

A. Most people infected with HIV do not know they have become infected. In some people 2-4 weeks after (at the time of seroconversion*) the initial infection, a flu-like illness (with fever, rash, headache, joint pains, and enlarged lymph nodes), can occur which may last several days to weeks which is called Acute HIV infection/HIV seroconversion illness. Seroconversion refers to the development of antibodies to HIV and usually takes place between one and two months after an infection has occurred.

Q. Are there different stages of AIDS, e.g. pre –AIDs clinical stages and the more advanced stages?

A. There are three stages. Acute HIV infection, Chronic HIV infection, Acquired immunodeficiency syndrome.  HIV is not curable at any stage of the disease.

However, there are effective treatments which result in a healthy and long life for someone living with HIV that is similar to that in the absence of infection.

These treatments should be taken continuously for life. Once we start the patient on antiretroviral treatment it stops progression of the disease and reconstitutes the immunity by increasing the CD4- positive cells.

Q. Sri Lanka has been recognised by the WHO as having one of the lowest mother to child transmission of HIV/AIDs in the region. The NSACP also eliminated mother to child transmission of syphilis in 2019. Tell us more about this achievement.

A. Sri Lanka had developed a comprehensive STD care facility since the 1950s, and syphilis screening for antenatal mothers were carried out. With the emergence of HIV infection the STD program was upgraded to National STD/ AIDS control Program. Pregnant women diagnosed with HIV infection were treated with Anti-Retraoviaral Treatment (ART) since 2004. 

The universal, free, opt out screening strategy for syphilis and HIV infections were established island wide for antenatal mothers and infected mothers were identified at early pregnancy. They, their children and their partners were given a comprehensive care package and the newborn screened for HIV infection until the infection was excluded.  

The elimination of mother to child transmission of the syphilis program was carried out hand in hand with the elimination of the HIV program.

Q. Where can those with HIV or suspected symptoms get screened and treated?

A. There are 41 full time STD clinics islandwide with at least one STD clinic per district, with trained staff who assure confidentiality of the patients attending them, perform free services including testing, counselling and treatment for sexually transmitted infections including HIV and sexual health services..

Q. The  NSACP is working towards Ending AIDS by 2025 . What are the obstacles you face now that we are in the midst of a new highly infectious and rapid outbreak of Covid-19 virus? Are HIV patients more vulnerable to this virus? Why?

A. We have adopted many strategies to provide uninterrupted service delivery even during the Covid-19 outbreak.  As in the general population, older people living with HIV or people living with HIV with heart or lung problems may be at a higher risk of becoming infected with the virus and suffering more serious symptoms. However, if the HIV status is controlled and the virus suppressed, and there are no other comorbidities it can be presumed that their vulnerability is similar to the rest of the population. 

Q.  What are the current interventions and role of the NSACP in detecting, identifying, screening, potential HIV patients?

A. Despite the prevailing situation we are carrying out full time STD clinics which provide testing and treatment facilities. The National reference laboratory and the laboratories of STD clinics distributed island wide are carrying out HIV screening testing, confirmatory tests (Western blot) and other relevant investigations such as HIV 1 viral load testing and CD4 counts. All STD clinics provide onsite rapid HIV testing facility to members of key populations, so that they can be enrolled without a delay.

Q.  Do you have any feedback programs for patients who have moved to another district?

A. Yes. The STD clinics work as an interconnected channel and when a patient is diagnosed with HIV the hospital consultant will inform the relevant consultant venereologist in the district.

Q. Your message to our  readers on  Dos and Don’ts to prevent getting HIV/AIDS?

A.  Dos – Maintain ABC:  A – Abstinence till marriage, B – Be faithful to one partner, C – Use condoms correctly for every sexual act Don’ts -  Do not have unprotected sex with unknown or recently connected persons, Do not have sex without condoms, Do not share needles for injecting drugs.