AIDS Day falls on December 1
Say ĎNoí to risky
The Human Immuno Deficiency virus is still the
single infectious agent which causes the highest
number of deaths globally. This virus caused about 2
million deaths globally, in 2008, and the numbers
are increasing at a frightening pace due to
thousands of newly infected persons on a daily
The first case of HIV infection in Sri Lanka was
reported in 1986, the victim of which was a
foreigner. In the 24 years that have lapsed since
then, of the 285 infections that have been reported
till the end of June 2010, many of them are from
The cumulative number of infected persons with AIDS
is now 332. Tragically a growing number of children
too are being infected with the deadly disease. Of
the total number of infected persons, 44 children
received the virus from their infected mothers, at
While the total cumulative number of deaths, from
HIV/AIDS now stands at 216, more than 3,000 persons
are estimated to be living with HIV in this country.
If not treated, they can pose a threat to the rest
of society as the disease can spread.
According to health officials, cases of HIV positive
people are being reported in every province in Sri
Lanka, both urban and rural, with a larger
percentage of victims living in the western province
where more people engage in risky lifestyles.
The highest number of victims fall into the age
group 24-49, and are thus in the prime of their
lives, resulting in a serious impact on the nationís
Unlike in some countries, sexual transmission is
still the main mode of transmission, with 94.8% of
the total number of HIV patients being infected in
this manner. In contrast, mother to child
transmission amounts to only 4.5%, transmissions
from HIV infected blood transfusions 0.7%, while a
mere 0.3% represent injecting drug users.
Although compared to other countries, the prevalence
of HIV/AIDS is very low in Sri Lanka, almost all the
risk factors such as a growing youth population,
rising number of commercial sex workers, and
internal and external migration, are present for an
epidemic of HIV/AIDS in the not too distant future.
The only way to prevent this is to raise more
awareness on the dangers of getting infected with
HIV/AIDS among those engaged in sexually risky
behaviour, and to underline the importance of
changing their lifestyles, health officials told The
Nation. They said recent studies have found that the
chief culprits for the spread of this fatal disease
are married men who are leading risky lifestyles Ė
and the majority of victims, their spouses.
Around 50 per cent of infected women in our country
have contracted HIV from their spouses without their
There is thus an urgent need to detect the disease
early and treat it at its initial stage. If not,
those with HIV/AIDS can in turn infect the rest of
society. If it reaches epidemic levels as in many of
our neighbouring countries, including India, it will
be virtually impossible for our small island nation
to turn back the clock and reverse the situation.
World AIDS Day falls on December 1. Since this
yearís theme is on the prevention of HIV and giving
access to all who have the disease to be treated
without discrimination, The Nation spoke to health
officials from the National STD/AIDS Control
Programme for their expertise on detecting signs and
symptoms of HIV/AIDS, and the kind of treatments
available to them free in our government hospitals.
Dr Kulasiri Buddhakorala, Consultant, National STD
What is AIDS?
AIDS is caused by the Human Immune Deficiency
virus ( HIV). This virus is different from other
viruses, because it attacks the immune system which
gives our body the ability to fight infections. HIV
finds and destroys cells (T cells or CD4 cells) of
the white blood corpuscles which destroys the immune
system of the body. Various pathogens can enter the
body and cause diseases due to immune deficiency.
Q: How does one recognise the signs and
symptoms of this disease?
Many people donít have any symptoms when they first
become infected with HIV. Some have a flu-like
illness, called HIV sero-conversion syndrome, a
month or two after exposure to the virus. This
illness may cause a variety of symptoms, including
the following: Diarrhea, enlarged liver or spleen,
fever, enlarged or swollen lymph nodes, headache,
muscle pain, nausea and vomiting, neurological
symptoms, rash on the abdomen, arms and legs and
face, sore throat, thrush, a common fungal infection
of the mouth caused by candida, a yeast-like fungus.
These symptoms usually disappear in a week to a
month and may be mistaken for other viral
infections. During this period, people are very
infectious and HIV is present in large quantities in
An infected person may not experience severe
symptoms for 8 to 10 years or more.
Q: What do you call this period?
It is called the asymptomatic period. It varies in
length for each person. Some people may have
symptoms within a few months and others may be
symptom-free for years.
What about children?
Children born with HIV usually have symptoms within
two years of birth. Children may grow slowly or
become sick frequently.
Q: Tell us how the disease progresses.
When you look at the disease spectrum, you will find
that the disease progresses in three stages:
(1) the early stage
(2) intermediate stage
(3) advanced stage.
In the early stage most people are unaware they have
got the disease due to the lack of symptoms and
signs. As the immune system weakens, other
complications may occur. For many people, the first
signs of infection are large lymph nodes or swollen
glands that may be enlarged for more than three
months. Other symptoms before the onset of AIDS
include: fevers and sweats, herpes infections that
cause severe mouth, genital or anal sores, lack of
energy, pelvic inflammatory disease in women that
does not respond to treatment, persistent skin
rashes or flaky skin, shingles - a painful nerve
disease often accompanied by a rash or blisters,
short-term memory loss and weight loss.
Q: How does a doctor identify them?
It is the responsibility of the doctor, depending on
the symptoms and signs, to take the initiative to
test the patient for HIV and refer him/her to a
clinic to make a correct diagnosis.
Q: What are the symptoms of the next stage?
At this stage they are gradually becoming sick and
need to see a doctor because of certain symptoms
that are manifested.
Q: What kind of symptoms?
AIDS is the final stage of HIV infections. When
someone has one or more of these infections and a
low number of T cells he or she probably has AIDS.
When an HIV infected person becomes an AIDS patient
(Acquired Immuno Deficiency Syndrome), he would show
the following symptoms: recurrent chest infections,
respiratory infections such as bronchitis,
sinusitis, tonsillitis, pharyngitis, middle ear
infections, herpes zoster, oral ulcers. They will
also develop sub-skin conditions like seborrhoeic
dermatitis and fungal nail infections, papular
pluratic eruptions which is a skin allergy with
itching and which afterwards heals with rashes, anal
sores, and a thick coating on the tongue. Nocturnal
fevers and heavy sweating at night are also common.
Chronic diarrhea, frequent fevers lasting for
several weeks without explanation, extreme fatigue
and weakness, a cough that wonít go away and trouble
with memory are other symptoms.
Q: Any other symptoms?
They are likely to also experience moderate
unexplained weight loss below ten percent of the
body weight. Sexually transmitted diseases (STDs)
are also an indicator. Girls may experience severe
vaginal yeast infections which donít respond to
usual treatment, as well as pelvic inflammatory
disease (PID). The chances of getting TB are also
much higher for persons with HIV/AIDS.
Q: Will they get all these symptoms at once or
Some or several. If they have several of these
symptoms they are likely to be worried enough to
visit a doctor.
Q: What should the doctor do at this stage?
He must screen their immunodeficiency and refer them
for further investigations. There have been cases of
misdiagnosis and so medical doctors need a high
degree of clinical suspicion.
When they arrive at the hospital for these
investigations, the patient will be investigated for
symptoms such as
(1) Extra pulmonary TB
(2) Toxoplasmosis of the brain
(3) Progressive multi focal Leuko-encephalopathy.
They may also present many unusual infections.
When patients present themselves with these unusual
infections the doctor must immediately refer them
Q: What is the treatment given to them?
Antiretroviral Therapy. While there is still no cure
for HIV/AIDS, ARV drugs can dramatically reduce
death rates, prolong life span and improve quality
of life, and transform HIV/AIDS from a fatal
condition to a manageable chronic illness. But
patients need to get this treatment at an early
stage. If not, their life span will be shorter and
their quality of life too will be diminished.
Dr Chandrika Jayakody, Senior Registrar, National
STD/AIDS Control Programme
Q: What are the main modes of transmission for
There are only three ways one can get this disease.
They are as follows:
(1) Through unprotected sex with an HIV infected
(2) Through HIV infected blood and blood products.
(3) through an HIV infected pregnant woman to her
Q: Could you elaborate?
Transmission can occur when semen, pre-seminal fluid
and vaginal fluid of an infected person enters the
body of the un-infected person during sexual
HIV infected blood given to a non HIV patient during
a blood transfusion can also transmit the infection.
In the case of mother to child transmission, it can
happen in three ways if the mother is HIV infected;
(1) During pregnancy
(2) At delivery. If it is a normal vaginal delivery
there is a high risk of infection being transmitted
to the baby because of contact between maternal and
foetal blood. Or if thereís a forceps delivery or a
vacuum delivery or any other intervention takes
place, which can increase the risk.
Q: So does that mean that delivery by
ceasarian section would be safer if the mother is
To some extent yes, because most of the time,
the baby will not be exposed to the motherís blood
or vaginal secretions.
Q: What about breast feeding?
Thereís a 5-15 % risk of the motherís milk being
infected and entering the babyís body.
Q: So that means not every new born baby whose
mother is HIV infected will get the disease?
Q: Is it possible to tell right way that a new
born baby is HIV infected?
Most of the time, when babies are born to HIV
infected mothers it is difficult to say whether
he/she has got the infection because they are
Q: If they are severely affected what are
their chances of survival?
Only for a few years. If not their prognosis is
Q: What are the symptoms of HIV in a new born
(1) Low birth weight i.e., less than 2.5 kgs
(2) Failure to thrive
(3) Chronic diarrhoea
(6) Recurrent upper respiratory infections such as
ear infections (otismedi)
(7) Retarded cognitive development
There can also be neurological involvement as well,
such as toxoplamosis but we rarely see this in
Q: When the mother has been tested positive
for HIV/AIDS what steps do you take to safeguard the
Even if the baby is healthy and shows no signs of
the disease, we donít take any chances. We monitor
the child and the mother for life.
Q: Having AIDS is a traumatic experience. What
role does counselling play in therapy and
rehabilitation of patients?
As doctors working with STD patients, we are trained
for this job. We do pre-test counselling when
someone comes to be tested for an STD, and after
that, whether the patientís test is negative or
positive, we counsel him/her.
Because that patient has come to us as he felt he
was at risk of getting the disease. So what we do is
to address the risk factor.
We also pay attention to partner disclosure on the
grounds of confidentiality. We also do Adherence
Counselling before administering Antiretroviral
In addition, we do contraceptive-use counseling, and
whenever there is a need, we encourage them to bring
the family members so that they can be present at
these counselling sessions.
Q: Has counselling helped?
Definitely. Many patients who come to us are
shattered when they discover they have HIV/AIDS and
have suicidal thoughts. After counselling them, many
of them have told us that they have been helped
since this is a personal and very private problem
which they cannot share with others.
Q: Where are most patients treated?
At home or at the IDH. There are no separate wards
for them as the disease cannot be transmitted except
for the three ways I have already mentioned.
Q: If a person wants to get himself tested for
HIV/AIDS where should he go?
We have STI ( Sexually Transmitted Infection)
clinics all over the island at general and base
hospitals. Or else they can come to the Central
Clinic at De Saram Place, Colombo 10.
Q: One final question. Since there are so many
myths about transmission of HIV/AIDS, tell us how
the disease cannot be transmitted.
It cannot be transmitted by:
(2) Shaking hands
(4) Using the same cup, spoon or plate
(5) From flies or mosquitoes.
Q: Do you have a message to convey to our readers on
Since risky life styles and having sexual
relationships with many partners can make you
vulnerable to getting the disease, my advice is:
stick to one partner, refuse to have sexual
relationships when forced to have unprotected sex
and insist on condoms. Remember that HIV/AIDS cannot
be cured, but can be easily prevented.
Finally, donít isolate or discriminate HIV infected
persons in the family, in society or at your
workplace. Any discrimination and stigma can only
aggravate the mental trauma of the person living