Rising HIV Cases in Sri Lanka : Why ?

By Dr. Priya Sammani

A doctor explaining HIV prevention methods to a group of young adults in a clinic setting.

Recently, a news article caught my eye with a concerning report: HIV cases among men in Sri Lanka are on the rise, particularly in the men-who-have-sex-with-men (MSM) community. As a healthcare professional, this is a call to action for more awareness, understanding, and preventive measures. I hope this article will help shed light on what HIV is, how it differs from AIDS, the transmission, symptoms, prevention, and treatment options. Through this, I aim to educate and empower Sri Lankans to protect themselves and others, fostering a more informed and compassionate community.

What is HIV?

HIV, or Human Immunodeficiency Virus, is a virus that attacks the body’s immune system, specifically targeting and gradually depleting CD4 cells, a type of white blood cell. These cells play a vital role in fighting infections, so as HIV destroys them, the immune system becomes weaker. Over time, the body becomes increasingly vulnerable to infections and cancers. It’s important to note that HIV is not spread through casual contact, air, or water. Instead, HIV requires the transfer of bodily fluids like blood, semen, vaginal fluids, rectal fluids, or breast milk to spread from one person to another.

When HIV enters the body, it integrates into the DNA of the host cells, which makes it a lifelong infection. Currently, there’s no cure for HIV, but advancements in medical treatment allow people to live long, healthy lives while effectively managing the virus.

What is AIDS?

AIDS, or Acquired Immunodeficiency Syndrome, is the advanced stage of HIV infection. It occurs when the immune system becomes so weakened that it can no longer fend off infections or certain cancers. However, it’s crucial to understand that not everyone with HIV will develop AIDS. With consistent treatment, HIV can be managed as a chronic condition, and individuals can live without ever progressing to AIDS. AIDS is generally diagnosed when a person’s CD4 cell count drops below 200 per cubic millimeter, or when they develop certain opportunistic infections that are rare in people with a healthy immune system.

Early Symptoms of HIV

One of the challenging aspects of HIV is that its early symptoms often resemble those of other common illnesses, making it difficult to detect without testing. Within two to four weeks after exposure, some people may experience flu-like symptoms as their body attempts to fight off the virus. These symptoms can include:

  • Fever
  • Chills
  • Headache
  • Fatigue
  • Sore throat
  • Rash

This early phase is known as acute retroviral syndrome, or primary HIV infection, and the symptoms usually disappear within a few weeks. After this stage, HIV enters a clinical latency period, where the virus is still present but reproduces at lower levels. Without testing, people may not realize they are infected, as there may be no noticeable symptoms during this time.

HIV Symptoms in Men and Women

While HIV symptoms do not significantly differ between men and women, some unique factors may affect how each gender experiences the disease. Men may be more likely to notice symptoms related to sexually transmitted infections (STIs), such as genital sores or lesions, which can be co-occurring in cases of HIV. Men with HIV also face the same generalized symptoms, including fever, fatigue, and weight loss, as the virus progresses.

Women with HIV, on the other hand, are at a heightened risk for recurring vaginal infections, pelvic inflammatory disease, and may even experience changes in their menstrual cycles. These gender-specific risks underline the importance of regular check-ups and timely STI testing, especially if there has been potential exposure to HIV.

AIDS Symptoms

When HIV progresses to AIDS, the immune system becomes so compromised that the body is unable to fight off infections. This can result in several symptoms, such as:

  • Persistent fever
  • Severe fatigue
  • Chronic diarrhea
  • Rapid weight loss
  • Recurring infections
  • Neurological symptoms such as memory loss or confusion

At this stage, treatment options exist to manage the symptoms, but AIDS dramatically increases the risk of other infections and certain cancers. Without antiretroviral therapy, life expectancy is greatly reduced. However, with proper treatment, many people living with HIV can avoid progressing to AIDS altogether.

HIV Transmission and Causes

Understanding how HIV is transmitted is key to prevention. The virus is transmitted through direct contact with infected bodily fluids such as:

  • Unprotected vaginal or anal sex (the most common route of transmission)
  • Sharing needles, syringes, or other injecting equipment
  • Contact with infected blood, which is particularly relevant in healthcare settings or in cases of needle-sharing
  • Mother-to-child transmission during pregnancy, childbirth, or breastfeeding

In the MSM community, HIV transmission often occurs through unprotected anal sex, as the delicate rectal tissue allows the virus easier access to the bloodstream. Using condoms, proper lubrication, and engaging in regular testing can significantly reduce this risk.

The Rise of HIV Among Men in Sri Lanka

The recent increase in HIV cases among Sri Lankan men, particularly within the MSM community, highlights a need for open dialogue, accessible testing, and targeted preventive measures. Many men who have sex with men may face cultural and societal pressures, making it challenging to access sexual health services without fear of stigma or discrimination. This not only affects their ability to get tested but also limits their knowledge about prevention and treatment, increasing the risk of transmission.

Diagnosis and the Window Period

Testing for HIV involves various methods, each with a specific window period – the time between HIV exposure and when it becomes detectable. Here’s an overview of the most common testing methods:

  • Antibody/Antigen Tests: These detect both HIV antibodies (proteins the body makes to fight the virus) and antigens (parts of the virus itself). This test usually shows positive results within 18 to 45 days after exposure.
  • Nucleic Acid Test (NAT): This is a direct test for the virus and can detect HIV within 5 to 21 days post-exposure but is typically used for individuals with early symptoms or high-risk exposure due to its high cost.

Knowing one’s HIV status is essential, especially for those at high risk or those who have had a recent exposure. The earlier HIV is detected, the sooner treatment can begin, greatly improving long-term health outcomes and reducing transmission risk.

Treatment for HIV

While there is no cure for HIV, it can be effectively managed with antiretroviral therapy (ART). ART is a combination of medications that stop the virus from reproducing, which helps maintain a healthier immune system. Here’s what you need to know about ART:

  • Medication Types: ART consists of multiple drugs that target the virus in different ways. Combining medications prevents the virus from building resistance.
  • Consistency is Key: ART must be taken as prescribed. Skipping doses can lead to resistance, making the treatment less effective.
  • Undetectable = Untransmittable (U=U): With consistent use, ART can reduce the amount of HIV in the blood (viral load) to undetectable levels, meaning it cannot be transmitted to others.

Living with HIV: Coping Strategies

Living with HIV today is vastly different from decades ago. With access to treatment and support, individuals with HIV can lead long, fulfilling lives. Here are some essential coping strategies for those living with HIV:

  • Emotional Support: HIV can bring about emotional challenges, from anxiety to depression. A support network of family, friends, and support groups can make a significant difference.
  • Maintaining Physical Health: A balanced diet, regular exercise, and adequate sleep are all essential for immune health.
  • Mental Health Support: Seeing a therapist, especially one experienced with HIV, can help individuals navigate the psychological impacts of living with the virus.

Preventing HIV in Sri Lanka

HIV prevention goes beyond education; it requires access to resources and a reduction in stigma. Here are some of the most effective methods for HIV prevention:

  • Safer Sex Practices: Consistent use of condoms during vaginal or anal sex is critical. Knowing how to use condoms correctly and using them every time helps reduce HIV transmission.
  • Regular Testing: Regular HIV and STI testing, for both oneself and partners, is foundational for sexual health and early detection.
  • Pre-exposure Prophylaxis (PrEP): PrEP is a preventive medication for those at high risk, reducing the chance of HIV acquisition by over 90%.
  • Post-exposure Prophylaxis (PEP): PEP is an emergency treatment that reduces HIV infection risk when taken within 72 hours of potential exposure.

Life Expectancy with HIV

HIV is no longer the life-shortening illness it once was. Thanks to advances in ART, those who receive treatment early and maintain it have a life expectancy comparable to those without HIV. Life expectancy depends on factors like early diagnosis, access to healthcare, co-existing health conditions, and lifestyle choices. By starting ART early and following it consistently, individuals can keep HIV manageable, leading long, productive lives.

Why Developing an HIV Vaccine is Challenging

HIV is a uniquely complex virus. Its ability to mutate rapidly has made vaccine development particularly challenging. Despite these difficulties, scientists around the world are working tirelessly on experimental vaccines. In the meantime, other vaccines, such as those for pneumonia, influenza, and hepatitis, are important for those with HIV to reduce additional infection risks.

HIV Statistics: Global and Local Insights

Globally, approximately 38 million people live with HIV, with around 690,000 deaths annually due to AIDS-related illnesses. Countries that have made ART widely accessible have seen reductions in both HIV cases and AIDS-related deaths. However, the story is different in regions where healthcare access remains limited. In Sri Lanka, the recent rise in HIV cases, particularly among men in the MSM community, calls for increased awareness, improved testing, and accessible treatment options.

Moving Forward: Supporting Those Affected and Reducing Stigma

To address the rise in HIV cases in Sri Lanka, we must focus on creating an environment of support and inclusivity. This means reducing stigma, offering more accessible testing and treatment services, and promoting open discussions about HIV and sexual health. Health professionals, community leaders, and families all have a role in supporting this change, ensuring those affected by HIV can live openly and access the care they need.

If you or someone you know may be at risk or has concerns about HIV, reach out to a healthcare provider or a local health clinic. Knowledge is power in the fight against HIV, and together, we can build a safer, healthier Sri Lanka where everyone can thrive.