Testing patience

Sri Lankan politicians have a unique gift of ‘foot in the mouth’ disease and the latest example ironically stems from Health Minister Dr. Rajitha Senaratne, who has proposed testing all foreign tourists for HIV/AIDS and malaria at the airport. 

People travel for fun and new experiences but Sri Lanka is unlikely to win hearts by jabbing over 1.5 million arrivals with an injection the moment they kick off their holiday. Global health watchdogs have opined universal testing for HIV/AIDS is unnecessary in Sri Lanka as it has a low prevalence rate and while it is essential to assist vulnerable groups, that can be done more effectively within the country than by monitoring tourists. 

For malaria, testing can be done only if travellers are from regions where malaria is rampant but even here there have been minuscule numbers with only a couple of people seeking political asylum in Sri Lanka being identified as carriers so far in the last couple of years. As for HIV/AIDS, just the massive invasion of privacy is enough to land the proposal in the nearest trash can.

UNAIDS estimated that about 3,000 Sri Lankans were living with HIV as at end of 2009. HIV prevalence is less than 0.1%. As of December 2011, there were 1,463 reported cases of people with HIV in the country, out of which 253 have died. Sixty per cent of reported HIV cases are males, and more than half are from Colombo. Underreporting of cases is mainly due to low knowledge about how HIV is spread and barriers to seeking services due to stigma and discrimination.

Most transmission is sexual, 4-5% is peri-natal transmission, and only <1% is through blood transfusion. Only four cases (<0.5%) of HIV acquisition through injecting drug use have been reported. Men who have sex with men have accounted for 12% of HIV transmission.  The ratio of HIV-positive men to women in Sri Lanka is 1.4 to 1. The proportion of women infected with HIV has been rising, from 21% (1987-1991) to 42% (2011), in part because of increased testing of women over the last few years.

Sri Lanka’s health officials already have a pretty impressive system to encourage condom use among both male and female sex workers and push pregnant women to get tested. In fact over 25,000 people have been reached through targeted interventions that have brought positive results. The success of Sri Lanka’s HIV prevention and control programme has even been commended in the World Health Organisation’s ‘Report on Global Sexually Transmitted Infection (STI) surveillance 2013,’ though ceaseless vigilance and resources are still essential.  

Singling out Sri Lanka and Cuba, the report sketches what achievements are possible, even in settings with limited resources, in the implementation of comprehensive STI control interventions. Countries such as Cuba and Sri Lanka offer a basic set of quality STI services that are widely accessible and include outreach to high-risk settings. Common to these examples are large and sustained STI reductions over time and a strong commitment to prevention and control of HIV, says the report. 

The three critical areas covered, according to the report, are availability and accessibility of basic STI services of good quality to all who need them; urgent steps being taken to reduce high-incidence transmission in sex work and other networks; and reliable incidence and prevalence data from high-risk and general population groups being routinely monitored to guide programme efforts.

STI transmission can be slowed rapidly, bringing multiple benefits in terms of averted complications and fewer HIV infections and Sri Lanka has proved this from the 1970s to the present but politicians still have to be open-minded enough to catch up.