Sri Lankans are not Immune to HIV/AIDS

Although Sri Lanka may boast a strikingly low HIV/AIDS incidence rate, particularly in comparison to many of its Asian neighbors, these low recorded levels do not indicate immunity from this ravaging disease. As a 3rd year Sri Lankan-American Duke university student training with CMOH for the summer, I have been increasingly startled by the absence of discussion and awareness of this pervasive, global epidemic. Though Sri Lankans appear terrified and disgusted by the illness, only a small proportion adequately understand how it is spread, how it manifests itself, and the consequent need for heightened universal precautionary measures. As noted in a recent Sri Lankan newspaper, our island is a sitting time bomb for an HIV/AIDS epidemic. It is time that we protect ourselves from this imminent threat, and vehemently challenge the notion that hailed Sri Lankan family values, sexual mores, or silence will protect Sri Lanka’s population from the disease forever. Attributing Sri Lanka’s low incidence of reported HIV/AIDS cases to inherent moral good within the island’s population is myopic and will only result in a devastating outcome.
Although Sri Lankan society remains fairly conservative regarding matters of sex, reports indicate that the primary means of HIV/AIDS transmission in Sri Lanka to date has been through sex. As sited by UNAIDS and World Bank reports, a 98% sexual transmission statistic (in HIV cases of known transmission between 87’ and 00’) reveals that traditional propriety and upstanding values/mores regarding sexual practices are a rapidly dissipating veneer on social realities. This is not to deny firm and stringent sexual codes and values, but rather to provide a sobering detail on Sri Lanka’s current situation. Take for example the startlingly low rate of condom use within several urban areas of Sri Lanka. For example, in 97’ only 9.7% of surveyed men in Colombo reported ever using a condom, while only 44.4% stated they had used a condom during casual sex in the previous year. Statistics regarding the commercial sex industry, primarily in the coastal regions, are more disturbing.
One of the greatest tragedies in the story of this severe global dilemma is that though it may wreak havoc on any member of the human race, it often devastates the most marginalized members of society. Poor individuals and the nearly 15,000 males and 30,000 females reported as working in the island’s sex industry suffer the greatest from the island’s 20% poverty rate, and thereby remain “hidden” from mainstream government health education campaigns regarding HIV/AIDS. More devastatingly, it is often these women and children who lack the ability/power to negotiate condom use with clients, thereby resulting in a high prevalence of STIs and risky sexual behavior within the demographic. As STIs multiply, immunity deteriorates significantly, making victims of STIs more susceptible to HIV. High-risk sexual behavior and unprotected sex are realities we must acknowledge and address in Sri Lanka today. We cannot afford to allow the nation to succumb to this ravaging universal threat, and must realize that we could be the next large-scale victims of this disaster. Sri Lankans must learn from our neighbor to the North, which despite tremendous similarity in sexual “mores”, now combats a severe AIDS epidemic affecting nearly 5.2 million Indians.
HIV thrives primarily on nations and peoples suffering the tragedies of war, poverty, gender discrimination, insatiable desperation for a better life, and high mobility resulting from the need for economic survival. Sri Lanka undeniably faces all of these ills. This nation, rich with the tenets of democracy and a belief in the positive livelihood of all its citizens, must take responsibility and action against HIV/AIDS immediately. This is not work that may be conducted by health ministries, physicians, and NGOs alone. Attitude changes and awareness development require the cooperation of several societal facets including businesses, religious leaders, health officials, and the entertainment industry. We must begin implementing informative, fact-based, culture-specific health education campaigns regarding HIV/AIDS so that no Sri Lankan feels unsusceptible. Sri Lanka cannot afford to suffer the damages faced by the U.S.’s 1990’s intervention strategies, which involved health education and behavior campaigns targeting white men who engaged in homosexual activities. In the U.S. today, incidence is no longer concentrated within this group, and rather most rapidly ravages Black women. Additionally, we must aggressively combat HIV/AIDS among high-risk groups, and ensure that prevention campaigns are available to the most underserved members of Sri Lankan society. If we are a society that truly embraces equity, we must accept the challenge of destroying the stigma, discrimination, and silence surrounding this blind threat. In addition to rigorous prevention work, it is our responsibility to create a positive, healthy environment for those living with the illness, so these individuals do not suffer the exacerbating burdens of social stigma and harassment.