As another World AIDS Day approaches and we mull on the grim outcomes this contagious epidemic has unleashed on humanity in the past, dramatic declines in new cases of HIV/AIDs and deaths in recent years hold out the promise of a better future for victims of the dreaded disease.
How this near impossible achievement was made possible in our own country with its limited resources is a story worth listening to, as Senior Registrar in Community Medicine National STD/AIDS Control Program (NSACP) Dr Nirosha Dissanayake fields some questions for the Sunday Observer.
Excerpts
Q. HIV/AIDS although now a familiar disease to most, is still not well understood due to the myths that surround it. What is HIV? How is it different to AIDS?
A. The word “HIV” stands for Human Immune deficiency Virus and it is the virus that causes the HIV infection. Once a person contracted with HIV infection that person becomes HIV infected. Due to the delay in identification and initiation of treatment, the HIV infection can progress into Acquired Immune Deficiency Syndrome state and that stage is called AIDS. Usually, it takes 8 to 10 years for a person with HIV infection to become an AIDS patient.
Fortunately, at present Anti Retro viral Treatment (ART) is available for HIV infection. ART suppresses the HIV virus in the body and the further growth of the virus. Thus ART stops the progression of HIV infection into the AIDS status.
Q. How is it transmitted?
A. HIV is transmitted through exchanging certain body fluids of a person infected with HIV. These body fluids are blood, semen, pre seminal fluids, rectal fluids, vaginal secretions and breast milk.
The transmission of HIV is possible when these particular body fluids come into contact with a mucous membrane or damaged tissue.
Mucous membranes are found inside the rectum, the vagina, the opening of the penis, and the mouth. The main mode of transmission of HIV is through sex including oral sex, anal sex and vaginal sex. Anal sex carries the highest risk for transmitting HIV.
It is also possible if these body fluids are directly injected into the bloodstream from a needle or syringe. So HIV is transmitted when sharing injection drug equipment, such as needles, with someone who has HIV among the injecting drug users.
In the past, some people were infected with HIV after receiving a blood transfusion from an HIV-infected donor.
The third mode of transmission of HIV is called mother-to-child transmission of HIV. From an HIV-infected mother during pregnancy, during the delivery, and during breastfeeding, HIV is transmitted to her child.
Q. Which sexual act carries the highest risk of transmitting HIV?
A. Men having sex with men are at higher risk of acquiring HIV. Studies have consistently reported that anal intercourse carries the highest risk of transmitting HIV for both receptive and insertive partners.
Q Why?
A. Because rectal mucosa is thinner and more susceptible to abrasions thus, creating an entry point for HIV into the blood stream. The other reason is having multiple sexual partners is more common among this group, and many men sex with men do not use condoms correctly and consistently.
Q. How is HIV NOT transmitted?
A. HIV is not transmitted from casual contacts with a person living with HIV.
For example HIV is not transmitted from a handshake, a hug, or a closed-mouth kiss and from contact with objects such as toilet seats, doorknobs, or dishes used by a person living with HIV. Further, HIV is not transmitted by playing, and studying together or working together with a person living with HIV.
Q. What are the early symptoms to look for? Are they visible from the time of infection? How are they detected?
A. Generally, the appearance of a person infected with HIV is not distinct from a person who is free from the infection. Basically, a person infected with HIV does not show any signs and symptoms until he or she progresses into the AIDS state.
A person who is infected with HIV can only be diagnosed by a blood test.
Therefore, it is important to get a blood test done for HIV if somebody has any doubt. But, even at the early stages of the infection, the infected person can transmit the disease to another person.
Q. How can it be prevented?
A. HIV is a preventable infection. To prevent the transmission of HIV through unprotected sexual relationships, following methods are recommended. Sexual relationships should be delayed until the marriage and in the instances when the marital partner is temporarily separated i.e when the partner is abroad.
Sexual relationships should be limited to one mutually faithful partner.
If you have a sexual relationship with anybody other than the faithful partner, correct and consistent use of condoms should be practised.
Further, getting tested for HIV and being aware of the HIV status and initiation of treatment for HIV as early as possible, are also strategies of prevention of HIV.
Q. Transmission of HIV through blood products? How is this prevented?
A. Transmission of HIV through blood products can be prevented by using sterile and disposable syringes and needles.
Also, needles and syringes should not be shared. In Sri Lanka after the year 2000, not a single person has been reported for transmission of HIV through blood transfusion.
Q. If mother is HIV positive will the child be more at risk of HIV?
A. Yes, the new born can be HIV positive.
The mode of transmission is called mother to child transmission of HIV.
During pregnancy, during labour and during breast feeding, HIV can be transmitted from the HIV infected mother to her child.
Q. What about prevention of transmission from an infected mother to the baby?
A. Transmission of HIV from the infected mother to her baby can be prevented by following the preventive strategies. Any mother with a risky behaviour should be screened for HIV before planning her pregnancy. Pregnant mothers who become positive for HIV should seek medical advice immediately. Following medical advice along with Anti Retro Viral treatment can eliminate the mother to child transmission of HIV and the HIV positive mother can have a baby who is completely free from HIV. We have evidence to prove this in our own local situation.
Q. Examples?
A. In Sri Lanka, all pregnant mothers are being screened for HIV during pregnancy. For the last few years in Sri Lanka, no newborn child was born with HIV to an HIV infected mother. So, we are on our way forward to eliminate mother to child HIV transmission, by 2025.
Q. What advice do you give an HIV positive mother on breast feeding?
A. As breast feeding can transmit HIV from mother to child, breast feeding is discouraged.
Q. Is HIV a treatable disease?
A. Yes, of course. Treatment for HIV is available in the world as well as in Sri Lanka, where it is also free unlike in some countries.
It is provided free of charge from the island wide STD clinics. Any person who wishes to get an HIV test done can walk into one of those clinics to do it free of charge. I must say; privacy and confidentiality of the persons who come for the services are highly maintained.
With the initiation and continuation of the treatment, a person with HIV is able to lead a normal life and able to enjoy his or her normal lifespan. Notably, treatment reduces the HIV viral load in the body, thus, infectivity of that person drastically goes down, almost to zero.
Q. Although Sri Lanka ‘s HIV prevalence rate is the lowest in South Asia, there is now concern that it is on the rise among male to male or bi-sexual relationships . Further, the rate of HIV among the young (15-24 age group) shows a steady upward trend from year 2003. What is the reason for this surge? Could it lead to an epidemic if uncontrolled as some of your officials have said?
A. If steps are not taken to prevent the new HIV infections, it could lead to an epidemic and new HIV infections could go up. However, due to many interventions by the Health Ministry and the increased number of awareness programs carried out by the National STD/AIDS Program, many individuals must have come for the tests, so that more cases must have been detected and these persons are now being treated.
Q. Who are the key populations at risk?
A. Men sex with men, commercial sex workers, injecting drug users, prisoners, beach boys and transgender people have been identified as the key populations in Sri Lanka.
Q. What groups have been most affected age-wise and gender wise?
A. In Sri Lanka, three fourth of the people living with HIV belong to the age group of 25 to 49. But, in the age group of 15 to 24 there is an upward trend in the reported persons with HIV. Among the reported persons with HIV in Sri Lanka, the male to female ratio is 1.8 to 1.
Q. What are the chances of women getting HIV by having unprotected sex with other women?
A. Comparatively, the chances are less than in the case of men sex with men. But still there is a chance and the risk is not worth it.
Q. The condom is now being promoted as the safest and most effective scientifically proved method of preventing HIV. Your comments?
A. The correct and consistent use of condoms can prevent the transmission of HIV. The condom provides the dual protection, as it is used as a contraception device as well as, providing protection for sexually transmitted infections and HIV.
Regular condom use during sex, has been recognized as a successful and efficient HIV prevention strategy worldwide. Condom usage offers a safe, economically cheap and practically effective means of preventing Sexually Transmitted Infections and HIV infection.
Q. In spite of this, there are many who still hesitate to use it. Why?
A. Common myths prevail in society regarding condoms due to the lack of knowledge on condoms. But, it is proven that condom does not carry any side effect, and with increased awareness the usage of condoms has gone up.