Nirasha Piyawadani, GPJ Sri Lanka
This boy, who is not being named due to stigma surrounding his situation, was denied entrance to a local school because he was widely believed to be HIV positive. His mother, pictured here and who is also not being named, fought for his admission. Stigma regarding HIV is widespread in Sri Lanka, where many people are too fearful to even get tested for the virus.
MORATUWA, SRI LANKA — When Sarath Peiris found out that he was HIV positive, he says, he was handcuffed and questioned by South Korean government officials.
Peiris, now 47, had gone to South Korea as a migrant worker in 1995, and didn’t know his HIV status until he had minor surgery there seven years later. South Korean officials deported him after his status was confirmed. When he arrived back home in Sri Lanka, he says, his family and neighbors shunned him.
“What I have learned is that lot of people in Sri Lanka and in the world are not aware of HIV,” he says.
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He says his family now accepts him.
In Sri Lanka, experts say lack of awareness has led to widespread misconceptions about the virus and AIDS, the disease it causes.
Despite decades of work by awareness advocates, people in Sri Lanka still think HIV is “spread by the wind and playing together,” says Dr. Dayanath Ranatunga, country manager of UNAIDS.
HIV rates are on the decline globally, but Sri Lanka has seen a year-on-year increase. Experts say that’s perhaps in part due to widespread stigma that inhibits people from getting tested, which initially results in a lower number of documented cases than there might be in reality. As more people are tested, the number of reported cases goes up.
To curb the virus’s spread and battle the stigma that keeps many people from getting tested, Sri Lanka will be the first in Asia, according to UNAIDS, to carry out a pilot program of saliva testing for HIV. The program is expected to begin in late May. Those working to raise awareness and promote testing hope people will assent to the saliva test, even those who up to now prefer to remain unaware of their HIV status rather than face the stigma that could come with a positive result.
For the pilot program, the National STD/AIDS Control Programme and UNAIDS will give 1,000 test kits to three high-risk groups: sex workers, homosexuals and intravenous drug users, says Dr. Sisira Liyanage, director of the National STD/AIDS Control Programme of the Ministry of Health, Nutrition and Indigenous Medicine.
Together with UNAIDS, the program has trained people within these groups, identified as peer educators, who will be the first to take the test into their communities.
Ranatunga says these peer educators will clarify to their friends that HIV cannot be contracted from saliva, and the simple saliva test is only the first stage of testing. The saliva test will indicate if the tester’s body has HIV, and they can then be encouraged to take the HIV blood test.
The aim of this pilot project is to draw out people from the high-risk communities who would not usually take an HIV blood test, he says.
This will be the first time the saliva test is carried out in Asia, Ranatunga says. The high health indicators in Sri Lanka and the widespread availability of blood testing facilities, as well as the interest of the National STD/AIDS Control Programme staff to conduct this test, were factors that led UNAIDS to select Sri Lanka as the first Asian country for the saliva testing.
HIV prevalence is low in Sri Lanka compared with other countries, Liyanage says.
The first HIV-infected Sri Lankan was identified in 1987, and just 2,308 HIV-positive persons were reported up to the end of 2015, according to the Annual Report 2015 of the National STD/AIDS Control Programme.
Since the beginning of the HIV/AIDS epidemic, almost 78 million people worldwide have been infected with the HIV virus, and about 39 million people have died, according to the World Health Organization. As of the end of 2013, an estimated 35 million people around the world were living with HIV.
Only a fraction of HIV cases are reported in Sri Lanka, Liyanage says.
But there are signs that may be changing.
Last year, 235 HIV cases were reported to the national program, the highest number recorded in a year, the annual report states. The number of cases reported annually increased 147 percent in the 10-year period from 2006 to 2015, rising from 96 new infections to 235.
“The main reason for it is the increased surveys and awareness programs at district level and identifying affected people,” Liyanage says. “We surveyed 1 million blood samples in 2015 alone.”
The increased identification has led to proper treatment too, Liyanage says.
“Eighty percent of the diagnosed people have been directed to the clinics,” he says. “That is why more HIV-positive people are recorded.”
But this is still not enough, Liyanage says. Their research has shown that the number of people who do not take the HIV test is high.
Ranatunga says that although the annual increase in the number of new HIV-positive people is not large in Sri Lanka, it still needs to be addressed.
“It is not good news in the context that many countries in the world have been able to reduce the spread of HIV,” he says.
Many Sri Lankans who are vulnerable to HIV are unwilling to be tested, Ranatunga says.
Even people suspected of being HIV positive say they face serious discrimination.
In January, a 6-year-old boy in a village in Sri Lanka’s Kurunegala district was refused admittance to school because school officials suspected that he was HIV-positive.
The child’s father died in September of tuberculosis sepsis, according to the official death certificate. But rumors that he was dying of AIDS, and that the wife and son were also HIV-positive, began a month before that, in August, says the 37-year-old mother.
The identities of the child and his mother are not being revealed to protect them from the additional stigma.
When the mother tried to get her son admitted to the village school, the principal demanded that she provide letters from the Zonal Education Office of the Ministry of Education, in Kuliyapitiya, requesting that the boy be admitted. The mother had come armed with these letters, but the principal demanded new letters, which she obtained. She returned the next day to the school.
From there, the situation continued to escalate until Sri Lanka’s Minister of Education threatened on local media to separate the child from his mother.
Ultimately, the mother took her case to the Supreme Court, which decided in her favor and confirmed that everyone, HIV-positive or not ─ has the right to free public education.
Fears related to HIV are more about the stigma than the disease, Ranatunga says.
“There are beliefs in our society, such as that HIV can only be contracted through sexual intercourse. So people are afraid that if they are tested positive, they will have to face insults,” he says.
A lack of sex education is another part of the problem, Ranatunga says.
“Ordinary people are reluctant to discuss about sexuality in public, under the guise of culture and morality, while the social reality is completely different,” he says.
The result of this ignorance is terrible, he says.
“Because we do not discuss about sexuality, the knowledge on sex among youth is very weak,” Ranatunga says. “Ignorance pushes them to insecurity. Neither the government nor any organization can control a person’s sex drive.”
Sri Lankan society needs to urgently address the need for sex education, he says.
“The viable option to banning sex is teaching about safe sex and the results of unsafe sex to children from a tender age,” he says. “This dialogue must be started at school and should stretch to the university.”
Ranatunga says the goal is to make Sri Lanka free of the AIDS epidemic by 2030.
“It not only generates a healthy community but also saves a lot of money to the government,” he says, pointing out that HIV-related illnesses can burden Sri Lanka’s free health care system Ranatunga says.
Peiris, the man who worked in South Korea, says awareness is key to combating the spread of HIV. He says he finds support from and participates in HIV awareness programs.
The term AIDS was familiar to him before he traveled to South Korea, but he says he didn’t know much about it.
“I had not even heard of HIV before I went abroad,” he says.
Ajith Perakum Jayasinghe translated this article from Sinhala.
