World Bank: Maintaining Low HIV and AIDS Prevalence in Sri Lanka

August 13, 2007 - As host country of the 8th International Congress on AIDS in Asia and the Pacific (ICAAP), Sri Lanka is gearing up to welcome more than 3,500 delegates from over 60 countries.

Speaking ahead of the conference, Dr. Nimal Edirisinghe, Program Director for the World Bank-funded National HIV/AIDS Prevention Program, said this the first time the conference is taking place in a low-prevalence developing country.

“We have the opportunity to show the whole world that our health, education, and cultural systems are very well developed.”

According to UNAIDS figures, Sri Lanka has around 5,000 people living with HIV and AIDS. Yet, since 1986 only 712 cases have been officially reported, with underreporting mainly due to limited availability of counseling and testing, fear associated with seeking services, and stigma and discrimination.

“People are afraid of disclosing they are HIV positive due to the stigma the disease carries,” Dr. Edirisinghe said. “Addressing stigma and discrimination will be vital to maintain the low incidence of new infections”

Early Government Response

The World Bank has supported these efforts since 1998. From 1998 to 2002, the Bank provided about US$1 million of support each year to the HIV/STD program through the Health Services Project. In 2002, the Bank’s International Development Association (IDA) provided a US$12.6 million grant to help finance the National HIV/AIDS Prevention Project.

Mariam Claeson, Program Coordinator for South Asia HIV/AIDS, said Sri Lanka has accomplished a lot in terms of generating awareness in the general population and among youth. Much progress has also been made to keep HIV/AIDS on the national agenda through the advocacy work carried out for political leaders at national, provincial, and pradeshiya sabha levels.

Dr. Edirisinghe said advocacy programs are important to sustain the country’s low-prevalence rate. “We need to start awareness programs in schools. Only then can we reach 95 percent of people in this country, which is our aim.”

Focus on High-Risk Groups

HIV prevalence appears to be low, even in populations such as sex workers, despite their higher vulnerability and exposure to risks. High literacy rates, relatively high status of women, and good access to health care services in Sri Lanka, all act to protect individuals and communities against HIV infection.

While Sri Lanka is a low prevalence country, several conditions increasingly contribute to high vulnerability. Dr. Claeson cites a recent evaluation of the national program that identified conflict, high mobility of the military, internally-displaced persons, and separation of spouses due to overseas employment, as key risk factors. Moreover, new economic developments such as the expansion of internal free trade zones, and broad social changes, including the increasing migration of young adults from rural areas to large urban centers, increase their vulnerability to HIV.

She said Sri Lanka has an opportunity now to prevent the spread of HIV among high-risk groups. “Increasing coverage of high quality interventions for vulnerable groups at high risk, such as sex workers, men-having sex-with men, and injecting drug users are critical to sustain the low prevalence rate.”

ICAAP8 provides an opportunity to learn from successful programs in Asia that have focused on high risk groups and achieved results, such as the Tamil Nadu program across the border. “It is also important to build the capacity of Sri Lanka’s NGOs to deliver best practice interventions."

Source: World Bank