When the polonga bites

Another large category of the fauna of Sri Lanka recorded in the second editions of the Oxford English Dictionary (OED2) and Hobson-Jobson (H-J2) concerns reptiles.


As the govt. seeks new foreign funding to fight AIDS, Kumudini Hettiarachchi looks at the burning issues AIDS patients face

AIDS numbers
There were 415 including eight children, who were recorded as HIV Positive victims, as at March this year. Of those 132 are suffering from AIDS.

Treasured photographs of his only son- all Nimal has to hold. Left: Graphic done by Nimal on AIDS. Pix by M.A. Pushpa Kumara

According to estimates there may be between 6,000 to 8,000 HIV Positive people in the country. Commercial sex workers, migrant workers, soldiers and drug users are considered the high-risk groups. Last year 146 of the 385 AIDS cases in Sri Lanka were women, half of whom had been employed abroad.

According to a UNDP estimate announced some years ago, the number of HIV-infected individuals in Sri Lanka would increase to 80,000 by 2005 while HIV prevalence will increase by 5.4 per 1,000 among those aged 15 to 64.

Every time I see my little boy I feel normal, my body-wracking pain eases just a bit. I live for him. I was given only two years to live, I am here today, four years on. I'm begging, begging not for sympathy but for some work which I can do from home."

This is the heart-rending plea of Nimal*, a whiz with computers whom we are meeting in his home in a suburb of Colombo. His breathing is laboured. Speech stopped by breathless attacks. Severe aches mar his otherwise handsome countenance. His movements are slow and deliberate and his face mirrors mental agony.

A debilitating disease, creeping silently on unsuspecting people and then............a slow and in society's eyes, "shameful" death. But long before that, society, that's you and I, have killed them off mentally. By our high moral stand, our revulsion towards what we think is wrong, stigmatization and ostracism, we have doomed them to a private hell.

Yes, Nimal has AIDS and not only does he see himself as doomed, struggling to survive only for his beloved four-year-old son but also as a pariah cast aside by society.

And most HIV Positive victims feel that the government too which should see to the welfare of all its people, be they victims of cancer, any other terminal disease, or Acquired Immune Deficiency Syndrome is turning a blind eye to the basic medication that they urgently need.

"Why, oh why can't someone give me work to keep me from drowning and pay at least my phone bill," pleads Nimal, repeatedly dubbing the phone line as his "only link" with the outside world. He is a computer specialist, not in one but both fields - hardware and software. The graphics on his screen enough proof of his abilities and creativity.

The tears come and his body is wracked by sobs as he relives his childhood. His mother died when he was very young and his father courageously took on the responsibility of bringing up his son alone. They went in search of greener pastures to an African country and that's where he studied, followed by higher studies in the west.

Then he returns to his temporary home in Africa to work.

Our inevitable question, how, follows. He thinks it was one indiscretion, a night on the town with his African colleagues, peer pressure, a few minutes' fling.

"Or," he speculates, "I have very bad teeth. Could it have been due to the dentistry that I needed?" Oblivious, he returns home, falls in love and marries. Has a son and a good job. Life looks good. He's a heavy smoker and gets a throat infection. Many tests and doctors. Later he meets a specialist who has a long chat with him and suggests the 'Eliza'.

What is that? He's shocked because it is the test to screen for HIV. It's positive and the death sentence begins. "Society looks at us with scorn." He tells his wife and she leaves with the love of his life, his son. "Fortunately," he cries, "they are free of the virus."

His family is wonderful. They feed, clothe and look after his every need.

What keeps him alive? The medicines cost Rs. 4,700 a month. He is lucky, because there is a good Samaritan who is providing them for him. He gets only painkillers from the STD/AIDS clinic - the dreaded Room 33 at the National Hospital in Colombo.

Rose* is not so lucky, because society has written her off as an expendable. Soon after Rose's husband committed suicide in July last year unable to come to grips with the fact that he had AIDS, some residents from her village tried to burn down her house.

"Fortunately, others doused the flames which had engulfed my kitchen. But I don't live there anymore," the 45-year-old mother of two teenage daughters, recalls tearfully.

Since learning in June last year that her husband had AIDS, her life has been one of misery with suicidal thoughts, but also determination to ensure her daughters have a decent life and are gainfully employed. Rose has also been tested positive and is carrying the HIV virus but her daughters are in the clear.

She needs treatment but cannot afford it. "When I go to the government-run Anti-AIDS Clinic they tell me there is no treatment except to eat well and sleep well. They give me some vitamin tablets. How can I eat well when I don't have a proper job and how can I sleep with all these problems?" she asks.

Treatment of HIV/AIDS patients has become a thorny issue in the country with some non-governmental agencies (NGOs) and patients urging the government to include treatment or drugs in a proposed World Bank funding of US$10 million under the National AIDS Prevention Project which is in the pipeline along with a government request for a grant of US$ 17.8 million to the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria (GFFATM)

There are those who argue that the focus should continue to be on prevention and awareness since providing drugs and treatment is an open-ended issue.

The cost of drugs worldwide has fallen considerably since South Africa and Brazil successfully negotiated with drug companies to drop prices. Dr Kamalika Abeyaratne, a retired government paediatrician who is HIV Positive and Chairperson of the AIDS Coalition, says her anti-retroviral (ARV) therapy which cost her Rs. 1.5 million a year in 1996, now costs just over Rs. 4,000 a month or Rs. 48,000 a year.

"The majority of patients can't afford the drugs and they are certain to die if we don't provide them medication," said Dr. Abeyaratne, who with her husband Michael, also a retired paediatrician, is making an effort to provide care and support to HIV/AIDS victims.

Dr. Abeyaratne, who contracted HIV from a contaminated blood transfusion after being involved in a motor accident, says treatment of victims was a fundamental right and should be provided by the government.

The AIDS Coalition, which provides a range of services for those with the disease, in April submitted a memorandum to the government stressing the need for a treatment agenda in the proposed World Bank-financed AIDS prevention project.

The AIDS prevention project, while ambitious, focuses solely on outreach and prevention, noted the memorandum prepared with the help of AIDS Lanka, a California-based group of doctors, lawyers and public health experts working on behalf of HIV positive patients in Sri Lanka. "Unless it is amended to address treatment as well, we believe the prevention project will fall well short of its goal of halting the spread of HIV/AIDS in Sri Lanka," it said.

It noted that there was a growing consensus among scientists, public health professionals, human rights scholars, activists as well as political leaders of the indivisibility of HIV prevention and HIV treatment.

The memorandum cites the success of Brazil as an example of how Sri Lanka could benefit if treatment is listed as a state priority in the battle against HIV/AIDS. It said the 1996 Brazilian policy to provide free access to ARV resulted in improved and longer lives for those living with HIV and a 50 percent reduction in the number of AIDS deaths.

Meanwhile, for Rose, her only desire is to make sure her two daughters aged 18 and 16 live a normal life and get employed. "The Abeyaratnes have promised to provide money for my eldest daughter to acquire a skill but after that she'll need help to stand on her own two feet. I also need money for drugs and that I don't have."

She clearly remembers the day her house was nearly burned down. "It was during my daughter's OL examination. She couldn't study anymore because of that incident and after that we became social outcasts. We were forced to leave the village," Rose said.

Some money to exist is all Rose and Nimal are seeking. For Nimal a little computer work he can do from home, as getting about has become extremely difficult and for Rose some funds to buy the essential medication she needs. Is it too much to ask from a society considered very humane and helpful?
*Names have been changed.

Can we afford it?
The provision of drugs for HIV Positive victims is just not an open and shut case, for a developing country like ours, stresses a senior doctor and health advisor. "The proposal to provide treatment is acceptable but it must be tempered with moderation. It's a reasonable demand but it cannot be taken in isolation like most other issues in a developing country. Even if the government decided to include drugs, can there be sustainability? This needs to be addressed. Both the World Bank and GFFATM funding will take at least a year to come. Till then and once that funding is over, what?" he asks.

On record we have 300-400 people to provide drugs for. Some 8000 people are estimated to be living with HIV. Now if all these people start testing themselves and seek free drugs, we would have a budget problem, he said, adding that the government has to consider all these issues before taking a decision.

Other health officials dismissed the charges that only painkillers were given at the state clinic. "It's a misunderstanding," they said. "When people are tested HIV Positive we begin by counselling them because at that point they do not need any treatment. We monitor them and as the virus affects the immune system and the patients get 'usual' diseases like TB, pneumonia, diarrhoea and skin infections, we treat those at that time."

Under the strategic plan for health, the government policy is to use anti-retroviruses which prevent HIV transmission and spreading only in two instances. To prevent transmission from mother to child and in the case of health care workers who could pass it on to others.

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