Equalising access to HIV services

Stigma and discrimination tied to the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are not limited to Sri Lankan communities but are instead a global issue that the World Health Organization (WHO) is focusing on this World AIDS Day 2022, which falls today, 1 December.

The theme for 2022 is “Equalize” and the WHO is calling on global leaders and citizens to boldly recognise and address the inequalities holding back progress in ending AIDS, and equalise access to essential HIV services, particularly for children, key populations, and their partners – men who have sex with men, transgender people, people who use drugs, sex workers, and people in prisons.

According to the WHO, 70% of new HIV infections globally are among people who are marginalised and often criminalised. They add that AIDS can only be ended by scaling up HIV services and removing structural barriers, stigma, and discrimination of key populations in every country.

However, the global HIV response is in danger, with progress towards HIV goals stalling and resources shrinking. “Division, disparity, and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis,” the WHO states, emphasising the importance of this year’s theme.

WHO also recommends a renewed focus on populations that have been left behind in the global response to HIV and AIDS, as only 52% of children living with HIV are on life-saving treatment.

What are HIV and AIDS?

Global numbers show that 1.5 million people contracted HIV in 2021, while 650,000 people died from HIV-related causes. At the end of 2021, it was estimated that 38.4 million people were living with HIV, the WHO states.

HIV targets the immune system and weakens the body’s defence against many infections and some types of cancer that people with healthy immune systems can more easily fight off. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. AIDS is the most advanced stage of HIV, which can take many years to develop if not treated, depending on the individual.

AIDS is defined by the development of certain cancers, infections, or other severe long-term clinical manifestations.

The local context

According to the National STD/AIDS Control Programme’s second quarter report 2022, 130 new HIV cases were reported during the quarter, a slight drop compared to the 152 new cases reported the previous quarter. At the beginning of the year, there were a total of 4,404 cases recorded by the National STD/AIDS Control Programme, which grew to 4,686 by the end of the second quarter.

Of these HIV cases, 3,377 are male and 1,309 are female. In addition to this, 14 AIDS deaths were recorded during the first quarter of the year and 11 AIDS deaths were recorded during the second quarter. The report states that the number of cumulative adjusted deaths among all HIV cases up to 2022 is 1,455.

Last year, a total of 1,068,309 HIV tests were carried out in Sri Lanka, and the country’s HIV seropositivity rate for 2021 was 0.04%. The report states that 410 HIV cases were reported in 2021, with the fourth quarter having the highest number of cases (159), as well as the highest number of AIDS deaths (16). A total of 49 AIDS deaths were recorded in 2021.

Testing key populations

According to the National STD/AIDS Control Programme, there are 41 clinics islandwide where an individual can get a free HIV test. They also offer tests at outreach programmes carried out in collaboration with non-governmental organisations (NGO) partners, drop-in centres carried out by NGO staff, and prisons.

In addition to these services, an individual can also get tested at a private laboratory, after a discussion with a doctor or healthcare worker.

According to the programme’s 2021 annual report, key populations of interest in the National Strategic Plan are men who have sex with men (MSM), female sex workers (FSW), transgender persons (TG), people who inject drugs (PWID), beach boys (BB), and people in closed settings (prison inmates).

Their goal with these key populations is to prevent new HIV and sexually transmitted infections (STI), with objectives such as using data to improve the design and implementation of HIV/STI prevention activities, implementing a tailored approach to the delivery of HIV/STI prevention activities for key populations to increase scale and quality, and increasing the uptake and ongoing use of prevention activities among key populations.