Low HIV prevalence but high risk

Living with the HIV virus can be extremely frustrating in Sri Lanka, just ask those infected by it. "You are totally shunned," Princy Mangalika, an HIV-positive Sri Lankan, told IRIN/PlusNews. "You can't attend family functions, work or live in your own village; your children can't even go to school."

Mangalika, executive director of the HIV/AIDS advocacy grassroots group, Lanka Plus, said the stigma stemmed from ignorance. "People don't know about the virus and because of that they are scared, and fear can do so many things."

Officially, 862 citizens were living with HIV by July 2007, but according to UNAIDS the real figure is probably closer to 5,000. Although this represents a prevalence level of less than 0.1 percent, a recent study concluded that Sri Lanka was vulnerable to a much larger HIV/AIDS burden.

The 2007 study by the Centre for Policy Alternatives (CPA), a Sri Lankan non-profit organisation, noted that high numbers of migrant workers, commercial sex workers, military personnel, internally displaced people and drug users, combined with a high incidence of unsafe sexual practices and escalating rates of sexually transmitted diseases (STDs), were a recipe for a potential HIV epidemic.

High levels of stigma and discrimination against people living with HIV were also factors in the spread of the virus, the study said.

A March 2008 report on Sri Lanka's progress in relation to the 2001 Declaration of Commitment on HIV/AIDS (UNGASS) noted that attitudes to those with HIV and AIDS were extremely negative.

"Over half of all respondents would not want to work or live in the same house with someone with HIV, and a third did not think a student with HIV should be allowed to attend school," the report said.

Knowledge about HIV prevention was also quite low. The researchers found that "While most knew that HIV was sexually transmitted, over 50 percent of the respondents incorrectly identified HIV as being transmitted by mosquito bites," and "over a third of respondents did not know that condoms provided protection from HIV."

Low prevalence masks risk

Local activists told IRIN/PlusNews that the ignorance could also partly be due to the very small number of openly HIV-positive people in Sri Lanka.

"The low prevalence rate has created ignorance of HIV in society," said Swarna Kodagoda, executive director of Alliance Lanka. "Ignorance has created fear; but little by little the figures [for HIV infection] are increasing, and if we don't create more awareness we could run into a larger problem."

The UNGASS report confirmed the findings of the CPA study that the low prevalence rate obscured the potential for an epidemic due to a large, emerging population of sexually active young people, increasing commercial sexual activity, internal and external labour migration, and a large contingent of armed forces.

Ignorance has created fear; but little by little the figures [for HIV infection] are increasing, and if we don't create more awareness we could run into a larger problem.

Grassroots initiatives

Acknowledging the problem, and the importance local civic groups can play in creating awareness of the disease, the World Bank awarded grants of US $40,000 each to Alliance Lanka and Lanka Plus for implementing grassroots HIV/AIDS education programmes over a period of 18 months, with the goal of reducing the prevailing stigma against the disease.

"I heard from all the participants [applying for grants] that stigma is a huge constraint to fighting the disease," said Praful Patel, the World Bank Vice-President for South Asia, in a statement announcing the funding. "These innovative, homegrown solutions to fight stigma and discrimination have a huge potential to make a difference in their communities."

Alliance Lanka plans to use its grant to set up 48 mobile information stands, three people-friendly permanent centres for HIV counselling and information, and occupational training for at least 12 HIV-positive people in three selected towns, including the capital, Colombo, where HIV-prevalence rates are highest.

"The information available will not be limited to HIV, but will deal with other diseases and related subjects," Kodagoda said. "We will be talking of HIV in the overall health context, not in isolation; that way we might be able to make people more aware."

Financial training

Lanka Plus will use its grant to provide financial assistance and management support to groups of HIV-positive recipients, rather than individuals, to set up and manage small businesses. "That way, if one member falls sick, the business will not get completely disrupted," said project coordinator Milinda Rajapaksha.

Alliance Lanka agreed with the importance of entrepreneurial assistance to HIV-infected people. Kodagoda told IRIN/PlusNews that his organisation planned to help those who underwent training in an occupation to obtain finance for starting businesses.

"We want to see them standing on their own feet, so people will see they are not a burden," she said. "They will be role models to show others that despite the virus you can lead a normal life."

ap/bj/he