The prevalence of HIV in Sri Lanka has been significant during the past few decades. Although much has been done to eliminate this disease the numbers tend to increase. In a candid interview with the Daily Mirror Dr. Dayanath Ranatunga, Country Manager for UNAIDS Sri Lanka, the Joint United Nations Programme on HIV/AIDS spoke on the latest issues in the legal, and education system, stigmatisation and pressure, and future projects planned by UNAIDS Sri Lanka. Excerpts:
Q There were two incidents where a patient with HIV was found at the Karapitiya Hospital and another where 20 schoolchildren were diagnosed with HIV. Is this a wakeup call?
A: The patient at Karapitiya has declared that he was living with HIV and due to this reason that particular consultant has refused to do his heart surgery.
This is an uncomfortable situation for us as well because as organisations, which are fighting for the basic Human Rights of the people living with HIV, we talk about human dignity and we have made it clear that HIV was no longer a death sentence but it is a chronically manageable disease.
When somebody is being discriminated based on the HIV status it is a pathetic situation. A couple of decades ago HIV was diagnosed on rare occasions. This clearly shows the ignorance of doctors. If people could stick to universal precautions the virus could not be transmitted.
Lack of reproductive health knowledge among teenagers
Comprehensive sexual education is a must to mitigate HIV
SL will be the first country in the Asia-Pacific region to eliminate mother-child transmissions
Legal system is manipulated
Q What about the 20 students?
During the 2014-2015, 51 cases were reported where the youths between ages 15-25 were diagnosed with HIV. Nearly 20 of them were in this category and during our analysis we came to a conclusion that they might have contracted the disease during their school days.
But it is like a double-edged sword. On the one hand we do not want to talk about sex and sexuality including HIV in the school curricula or the formal education system.
However, at the same time students are also trying out risky sexual behaviours. As of today there is a more effective communication system and people also have many more opportunities than what we had those days.
In my opinion I believe that we haven’t given the necessary knowledge to the younger generations. This proves an important point, which is that we need to introduce comprehensive sexual education in the school curricula and this should be followed at a University and a Vocational Training level as well.
There are some informal education methods such as youth councils, which we have to effectively use in order to give the necessary knowledge to the younger generations. We do not have to think much; just consider the number of teenage pregnancies. According to the official data gathered from the Ministry of Health about 5-8% of pregnancies are teenage pregnancies or in other words pregnancies below age 20. But this is only the tip of the iceberg.
Q There have been numerous media and other campaigns in order to spread awareness about HIV/AIDS and bring the numbers down. Have these initiatives made a huge impact?
We had huge media campaigns 10 years before. We have a media forum established by UNAIDS Sri Lanka in order to spread awareness and over the last six months we had many of them.
There have been certain instances which have been reported during the last decade where people faced discriminatory practices as a result of being diagnosed by HIV. These included firing employees from the workplaces, setting fire to houses, chasing them away from houses and many more. But today, these kinds of reactions are not seen by people and it has a positive note. However we have to continue these initiatives in order to keep people informed. The message we need to convey is that HIV is not a deadly disease. With proper treatments people can expand their lifetime; if someone contracted HIV today, he/she can live up to 90.
In addition to that the most advantageous situation in the current context is that with proper treatment infectivity can be reduced to less than 1% and this is what we call treatment as prevention.
Q Are there certain factors such as law, and social customs that are pulling down these efforts to eradicate HIV/AIDS?
Some of the customs that were brought in by the Victorian Law have ruined the traditional open-mindedness. This is why sex and sexuality is not openly discussed. There are certain cultural barriers that are pulling down our efforts. We do have institutions such as the Family Planning Association and other places where we speak about reproductive health but these topics are only discussed in places like these.
Also the education system does not follow an evidence-based concept by which the teachers could teach children about the actual situation prevailing in the country and what practical applications should be done.
Q What about the legal and policy level?
The legal situation in the country is manipulated and some of the laws are out-dated. For example Articles 365 and 365(a) of the Penal Code of Sri Lanka, which speaks about criminalising people who are engaged in sexual acts in public or private places or in same-sex relationships, although they have been amended, are quite out-dated. In Sri Lanka however, sex work in private is not illegal.
If a girl above 16 years of age is abducted to a brothel and it is raided, that girl will end up in jail. This is totally unethical and this is how the communities have linked with the existing legal system.
However, we will be working with the Legal AIDS and the Human Rights Commission in the near future to identify these loopholes in the existing legal system and bring about justice to those who fall victim to these manipulated laws.
Q How about the situation of the people with same-sex relationships?
Out of the 51 reported cases which I mentioned earlier, 10 were females and 41 of them were males where 80% of them had had a history of same-sex relationships. Therefore this shows that certain things still happen. The negative side of law is that those with same-sex relationships are not accepted in this society and as a result they cannot stick to one particular partner because they don’t entertain any legal or social status. Then the risk is that they change their partners and it becomes a habit.
"Some of the customs that were brought in by the Victorian Law has ruined the traditional open-mindedness. This is why sex and sexuality is not openly discussed. There are certain cultural barriers that are pulling down our efforts. We do have institutions such as the Family Planning Association and other places where we speak about reproductive health but these topics are only discussed in places like these."
Q At which level does stigmatisation and pressure stand today?
For heterosexuals there is no problem because people do not question men and women who are married or are having relationships. But the problem arises for those with same-sex relationships. The level of stigmatisation is such that people are sometimes harassed by taking the law as a tool. Therefore those with same-sex relationships will accept the fact that they are going against the law and will hide from society.
As a result people may not want to go to any clinics that have services to identify or treat sexually transmitted diseases (STDs). This will impose a challenge to them because they will not be able to get their HIV tests done. In addition to that there is also a tendency for sex workers to be arrested under the vagrancy ordinance based on the availability of condoms in their wallet.
Q The government decided to make the HIV test mandatory for all university entrants and A/L students. Will this have positive results?
It should not only be for university or A/L students. The youth as a whole should have access to testing, treatment, counselling and other reproductive commodity services. Firstly the people should be made aware of their vulnerability and this should be followed by testing. There is actually a problem when it comes to accessing reproductive commodities. We encourage people to use condoms but it doesn’t happen that way. Research has shown that when people know more about reproductive health they are open to a variety of choices and therefore they won’t do anything risky.
Q What about the legal minimum age at marriage?
The age of consent is 16 but girls can only marry after 18. Therefore a girl can have sex at 16 and what will happen if this child gets pregnant? The sad part is to get an HIV test children up to 16 years of age need to get parental consent, but to have sex there is no such rule or law. The national condom services haven’t reached certain communities in society.
Q Is there a lack in services when it comes to screening of patients with HIV, especially pregnant women?
The government has done a huge part in the screening process. Sri Lanka is going to be the first country in the Asia-Pacific region to have eradicated the mother-child transmission of the HIV virus. This part has been taken care of. But when it comes to testing it should cater to a bigger segment of society than what has been identified.
Q Future projects to be carried out by UNAIDS Sri Lanka.
UNAIDS Sri Lanka is supporting the Ministry of Health to eliminate AIDS by 2030. In countries like Sri Lanka all services are available but the situation faced by sex workers, homosexuals and drug addicts are still the same while all the respectable doctors are watching.
Our job is to bring this gap in mind-sets somewhere closer; for example we are supporting the STD clinics to make their services more client-friendly. In addition to that we are organising community-based programmes to encourage their participation at a decision-making level. Here we are trying to encourage sex-worker groups, homosexuals and drug addicts to link with the National STD control programme.
Also we are going to introduce a HIV saliva test for the first time in Sri Lanka. Awareness programmes will be continued via the media to bring down discriminatory practices that exist in society today.
Pic by Nisal Baduge
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