By Dushiyanthini Kanagasabapathipillai
Sri Lanka had a population of almost 19.69 million in 2005. Sri Lanka ranks 96th on the United Nations Development Programme (UNDP) Human Development Index scale. There were a total of 743 cases of HIV/AIDS, and 144 deaths reported by 2005, according to statistics from Sexually Transmitted Diseases (STD) clinics. There were 432 males, and 311 females reported in 2005 with HIV/AIDS. 129 new cases were reported, and there 13 deaths due to HIV/AIDS in 2005.
HIV surveillance is conducted annually by the National STD/AIDS Control Programme (NSACP). HIV sentinel serosurveillance started in 1993. There were 26,786 HIV tests carried out during 2005. Male to female ratio of reported cases of HIV infection is 1.4:1. However the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates the actual number of PLWHA (People Living With HIV/AIDS) to be 5,000 (3,000- 8,300), and classifies Sri Lanka as a low-prevalence country with an adult rate of less than 0.1 percent. Despite the current low-prevalence, Sri Lanka is vulnerable to an impending HIV epidemic because of the existence of vulnerable groups like commercial sex workers (CSW’s), low condom use, high rates of Sexually Transmitted Diseases, and the ethnic conflict.
“People Living With HIV/AIDS (PLWHA’s) in Jaffna are unable to undergo the test called “Western Blot”, because there is no qualified doctor to carry out this particular test. A few persons have been tested for “Elisa” at the Jaffna Teaching Hospital. HIV/AIDS status in Jaffna is pathetic, because of the prevailing situation in the peninsula. There is no specialized medical officer in the Jaffna Teaching Hospital to carry out the required test. The Public Health Inspector (PHI) is forced to play the doctor’s role, although he is not qualified. There is no privacy for a person who comes to the STD clinic. The patients are deprived of all facilities namely routine test to know the viral load, medication, care and support. The STD clinic at the Jaffna Teaching Hospital is not fully functional” says Kanthar Visuvalingam Kanthaverl, Director and Founder of Pathway Counselling Centre, and Executive Member of People’s Movement for Patient’s Rights.
[Kanthar Visuvalingam Kanthaverl, Director and Founder of Pathway Counselling Centre, and Executive Member of People’s Movement for Patient’s Rights]
Pathway Counselling Centre was the first counseling centre in Jaffna, which was set up in 1991. It extends its service in sex, sexuality, pre and post test counseling on HIV/AIDS, and create awareness. The counselors strictly maintain the confidentiality of the persons, who go there for counseling. There are three trained counselors for HIV/AIDS.
The following are the excerpts of his interview:
Q:What is your responsibility as a counsellor?
“A:Counselling plays a very important role for the person infected, and his or her family. Counsellors are trained on HIV/AIDS, and maintain confidentiality of the information of the persons. It’s very difficult to build confidentiality with the persons, I counsel. It takes more time. The counselors and persons, who are being counseled need a lot of patience. I give counseling for the persons, who seek support before and after HIV test. I give counseling for Internally Displaced Persons (IDPs),Commercial Sex Workers (CSWs), and students.
Smoking and consuming alcohol are habits. Sex is an urge. People have to go for safer sex. A large number of infected persons are in the age group of 25-35 year old. The people of Jaffna do not talk about sex in public. People are shy to have a frank discussion about sex and sexuality with others. Therefore the information exchanged in the society is comparatively low.
The accumulated number of People Living With HIV/AIDS (PLWHA’s) is 38, while people living with HIV is 16 to date. There are more women than men living with HIV/AIDS. Out of these, two are children. The first case of HIV positive was detected in 1993 in Jaffna.
Q: How do you help the People Living With HIV/AIDS (PLWHA’s)?
A:Most of the individuals have tested for HIV without counseling. Conselling is important before and after a test for HIV, because if the person if found positive he or she will not be in a position to accept the results. He or she will be able to handle it, if he or she has gone through the counseling before going for a HIV test. The family of an infected person should be counseled as well. A lot of families do not respect the rights the People Living With HIV/AIDS. Some families throw the HIV positive persons to the road, once they are found to be positive.
Many more undergo the HIV test somewhere, and not at the Jaffna Teaching Hospital. Because they are afraid of their status of HIV would be made public, and they will have to encounter various difficulties in the society. I personally know of seven persons, who have undergone the test somewhere in order to protect themselves, and avoid discrimination and trauma. Few have gone to India to do the test. People Living With HIV/AIDS (PLWHA’s) are stigmatized. Fear, stigma, denial and discrimination still exist in the society.
And young adults do not have the correct and scientific information about HIV/AIDS. Women know very little about the mode of transmission compared to men in Jaffna. Condom use is reported to be low in Sri Lanka, with a usage of only 3 percent. Condom use in Jaffna is almost nil. It’s sad to note that, the women are powerless to negotiate with men for the condom use.
Q:What measures could be taken in order to prevent more persons getting infected in Jaffna?
A:Jaffna has a very closed society with regard to sex and sexuality. I find it very difficult to talk about these issues frankly. But these issues should be addressed without further delay. Our Jaffna society denies that, we do not have HIV/AIDS in our society. We try to site various reasons such as “We are a very conservative society, our culture does not permit us to misbehave, we do not go for free sex, HIV/AIDS is a western disease- we will not get infected, we are a God fearing society”.
People of Jaffna should be able to accept the fact that, there are HIV positives in the society, and should not discriminate them in any way. The society has been through two decades of war. It’s inevitable to avoid HIV in war torn society. But we should create awareness more frequently among the public, and discuss about it.
The society is becoming more vulnerable with the new displacements in the recent violence in the peninsula. Heath issues are to be taken into consideration, when there is displacement. People have no privacy in the Internally Displaced Camps. Some people live in the Internally Displaced Camps for longer time that they expected.
It is estimated that some 30,000 women and girls, and 15,000 boys work in the sex industry in Sri Lanka. There are a number of sex workers in Jaffna peninsula. They can earn more money than a peanut seller in Jaffna. Therefore many women are entering the trade as a sex worker. Due to the ethnic conflict many women lost the male bread winner of their families. They are forced to take care of the rest of their families immediately. These women either single parent or young girls find it very difficult to manage the families. Since they have to take care of their families, they are compelled to take up any job available immediately. They become sex workers, earn an income to feed the family.
Although it’s hidden in the society, it’s noted that there is a number of men who have sex with men (MSM). The society does not want accept this fact either. This is another vulnerable group.
A better facility should be extended to the Jaffna Teaching Hospital in order to help the people. People should build confidence with the counselors, and continue to get the care and support.