Mediscene

From the city to the village

HIV is no longer an urban disease in Sri Lanka, warns Dr. Shantha Hettiarachchi

By Kumudini Hettiarachchi

She was 55 when she walked into the clinic. For two years she had been suffering from chest infections and renal problems. She had been investigated and treated but there had never been a permanent cure. Suspecting the worst, she had been referred to this clinic.

HIV skin rash

The tests confirmed the doctors' fears. She was HIV Positive. How could she be having this jara lede (disgusting illness) as they called it in her remote village? Her husband had been dead for four years, she had grown up sons and she had not been intimate with anyone else during her long marriage to him and after his death.

Gentle coaxing brought out the unhappy story of her life. Her husband had been an alcoholic and she thought in one of his drunken fits he may have had a casual sexual encounter.

Herpes zoster HIV

"Many people are under the misconception that HIV/AIDS is a problem only in the urban areas. But we see that it has gone to our villages as well," explained Dr. Shantha Hettiarachchi of the National HIV/AIDS Prevention Project.

This woman in her fifties was from a remote village. She was tending her bulath koratuwa and trying to survive after an unhappy life with an alcoholic husband, only to find that she was HIV Positive, he says expressing concern over a recent rise in the number of new cases of HIV/AIDS.

The reasons for the rise in numbers could be sexual contacts being easy and a breakdown in marriages, where even small arguments could lead to one partner leaving the house, thus becoming vulnerable to having casual sex, he says.

"Just once is enough for someone to contract HIV," stresses Dr. Hettiarachchi. "When the Human Immuno-deficiency Virus enters the body of a person he/she will be called an HIV infected person.

HIV is transmitted in three ways:

Through sexual contact - Any sexual contact between an infected person and another be it a heterosexual, homosexual or bisexual relationship could result in the transmission of the disease.
Through blood transfusions of infected blood or blood products or by injecting drugs with contaminated needles.
From mother-to-child in utero, at delivery or through breastfeeding.

In Sri Lanka

1986 -- First HIV case reported
1987 -- First Sri Lankan with HIV reported
1989 -- First indigenously transmitted case

Numbers up to March 2006

Total HIV cases -- 771
Total AIDS cases -- 213
AIDS deaths -- 147
Paediatric cases -- 24

The most common mode of transmission is through sexual contact, stresses Dr. Hettiarachchi, pointing out that 96% of those who have been infected have got it in this way. Mother-to-child transmission is about 3% with blood/blood products and contaminated needles accounting for about 1%.

HIV does not spread through touching, kissing, insect bites, using common items such as toilet seats or eating utensils or by being in swimming pools or rivers. When HIV enters the body, some symptoms such as headaches, fever, a rash, enlargement of lymph nodes, nausea, vomiting and diarrhoea may appear within a few weeks but disappear a few weeks later, he says. "The HIV Positive person will be symptom-free for several years but the viral replication continues. Patients, however, cannot be identified during this period."

Timeline and global statistics

1981 -- Unexpected outbreak in USA of Pneumocystis carinii, pneumonia and Kaposi sarcoma
1981-1983 -- A new disease, AIDS, emerges
1983 -- A virus is isolated
1984 -- The virus is named HIV
1984-1985 -- Diagnostic tests developed to detect HIV
Number of infected since 1981 - 60 million people
Number of deaths - 20 million
Deaths
Highest number of deaths by any single infectious agent
1 death every 10 sec
> 8000 deaths /day
3 million deaths/year out of which 500,000 are < 15 yrs of age
New infections
5 million/year ( 4.2 adults and 7, 00,000 children)
More than 95% are in developing countries
50% of newly infected adults are women
50% of newly infected are in the 15-24 yr age group

Following viral replication, there is a major influence on the white blood cells (immune cells); impaired immunity; bacterial, viral and fungal infections, with full-blown AIDS developing later, he adds.

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