COLOMBO, Jun 8 (IPS) - With only 614 confirmed cases of AIDS in a population of 19.5 million people and an HIV prevalence rate below 0.1 percent, Sri Lanka looks almost untouched by the deadly disease --but an epidemic is still possible, warn experts.
"We should not take this lightly -- there is a big risk," Dr Hemantha Wickramathileke, medical director of the National Family Planning Association (NFPA) told IPS.
A recent government report on the Millennium Development Goals (MDGs) identified several groups in the South Asian island nation whose behaviours put them at high risk for the disease and admitted that, as in many developing countries, resources to proactively address the problem are limited.
(The MDGs, agreed by the world's governments in 2000, aim to halve extreme poverty, significantly cut maternal mortality and increase early childhood education, by 2015).
"Behavioural factors that facilitate the spread of infection are prevalent in the country, such as the presence of large numbers of sexually active youth, an increasing number of sex workers and overseas migration. These pose the threat that the disease can become concentrated in highly vulnerable groups and then become generalised if not combated at the early stages," said the report.
Widespread alcoholism, sexual abuse, poor sex education and low condom use have been identified as factors that fuel the spread of the disease, said the Colombo spokesperson for the United Nations Children's Fund (UNICEF), Jeffery Keele. "Sri Lanka does have a low prevalence, but there is the potential for spreading," he affirmed in an interview.
Even the low figure itself could be due to low awareness and poor monitoring, according to HWJ Fernando, a former World Bank health expert now with the child rights group PEACE, which carries out AIDS awareness programmes.
"Most of the people don't come for testing. We believe that the confirmed cases can be as high as 8,500," he told IPS. Of an estimated 200,000 cases of sexually transmitted diseases (STDs) contracted yearly only 15 percent of those affected seek treatment at government medical clinics, making detection even harder, he added.
Wickramathileke is also concerned about the long transmission window associated with HIV, the human immunodeficiency virus. "A carrier can remain without testing positive for sometimes as long as 10 years. During that window, the risk is enormous."
The report also identified high rates of internal migration and emigration of job seekers as areas of concern. Sri Lanka's long running civil conflict has left large parts of the population in the northeast internally displaced and living in transitional camps. Exacerbated poverty levels in the camps have led to high levels of partner exchange, the government document revealed.
Also, more than 100,000 Sri Lankans, the majority of them women, are employed in the Middle East and in India, which, according to health experts increases the risk of infection.
"What we have here is a dysfunctional family system due to a variety of reasons, and that creates an environment for casual sex," Fernando said.
According to a World Bank study, removing people from the traditional social structure increases their tendency to have multiple partners and to engage in casual and commercial sex. In 2001, 48 percent of the HIV cases identified in the country were women who sought employment abroad.
The concentration of large numbers of female workers in free trade zones and of military personnel at transit cities has been identified as another risk area. The NFPA has launched awareness programmes targeting these groups, but Wickramathileke admitted more effort is needed.
Even the military has recognised the need for awareness among soldiers, according to Military Spokesmen Brig Daya Rathnayake. "The Directorate of Medical Services regularly conducts programmes educating soldiers," he said in an interview.
The latest such programme is planned in the north-central city of Anuradhapura, a major transit hub for troops rotating from and to the conflict-ridden north.
NFPA research has found higher rates of STD spread and HIV in Anuradhapura compared to the rest of the country, mainly due to the presence of large numbers of commercial sex workers in the city, according to Wickramathileke.
Another risk area is the estimated 60,000 commercial sex workers in Sri Lanka, who, based on limited research to date, report a very low use of condoms.
In 2001 the government estimated that only 10 percent of sex workers used condoms. However, its recent report said that figure had increased to 50 percent by 2004.
The World Bank study said commercial sex workers lacked the ability to negotiate the use of condoms with clients or to seek treatment for STDs, making detection and prevention challenging. "Women and children in prostitution are considered most vulnerable to HIV infection," it said.
The Bank's research found that among men in the capital Colombo who said they had sex with casual partners, only 44.4 percent used condoms. The figure fell to 26.3 percent in rural Matale.
Though the growing use of condoms has been hailed by many social workers, NFPA's Wickramathileke sees in it a hidden danger. "What that means is a lot of casual sex, especially among the youth."
He is also concerned about risk groups that go undetected. NFPA has identified youth and university students as two such groups. "There is a lot of influence on the youth these days and we have a large youth population that is sexually active at a younger age than before," he said.
Sex education at primary and high school level is still not widespread and cultural taboos prevent educators from reaching the vulnerable groups. NFPA, with the help of the World Bank, has launched an awareness programme in the universities.
The Bank is among the main donors funding AIDS education in the country, including a 12.6-million-dollar grant to finance the National HIV/AIDS Prevention Project. UNICEF too has directed its resources at awareness programmes targeting adolescents.
At least on paper, authorities have admitted the need for action. "The government has recognised that although the total number of people living with HIV and AIDS in Sri Lanka is low, there is no guarantee that this number will remain low tomorrow," it said.
Wickramathileke, however, feels that a fundamental change needs to occur in national thinking if the risk is to be tackled in its infancy. "Sometimes governments try to play low when it comes to figures, but we need to recognise that there is pool of HIV carriers that is very dangerous." (END/2005)