-World AIDS Prevention Day
become victims of HIV AIDS
AIDS has killed and still kills millions despite
billions of funds pouring into research to find a
drug capable of curing it and none has been
forthcoming. It has spread across the continents
leaving a trail of human suffering behind widows and
widowers, parents without children, and the most
pitiful of them all, orphans, some scarcely out of
their mothers’ wombs.
Even though HIV/AIDS is the most rapidly growing
global epidemic, its prevalence rate is still low in
the South East Asian region. Nevertheless, since the
population is large in these impoverished or
developing countries, the factors of spreading HIV
such as poverty, gender inequality and social stigma
is extremely high. Therefore, the region including
Sri Lanka is highly vulnerable to the epidemic.
In 2003 HIV had spread to an estimated six million
people in the South East Asia Region (SEAR) - the
second highest in the World after sub Saharan
Africa. India, Thailand, Myanmar and Indonesia
accounted for 99 % of the total burden in the
region. HIV also accounted for the highest number of
deaths by any single infectious agent.
Developing countries urgently need antiretroviral
(ARV) treatment to keep their HIV/AIDS patients
alive. Even though no cure for HIV/AIDS has been
found yet, ARV drugs can dramatically reduce death
rates, prolong life, improve quality of life,
revitalise communities and transform HIV/AIDS from a
fatal condition to a manageable chronic illness.
Nevertheless, there is continuing stigma and
discrimination that reduces access to diagnosis and
treatment of AIDS patients in these countries,
states the WHO.
Children are the worst affected. Three million
people die with AIDS every year. Out of them,
500,000 are under 15 years of age. In Sri Lanka,
even though a few children have been affected so far
by the disease, the number is likely to rise due to
the increasing number of women who are infected with
AIDS by their husbands.
The Nation spoke to the Consultant Paediatrician at
the Lady Ridgeway Hospital Dr. Pujitha
Wickramasinghe on how risks can be minimised and
treatment be made available.
Q. There has been a rise in AIDS victims
especially women in Sri Lanka in recent years. What
happens when an infected woman gets pregnant?
A: She could transmit the infection to the baby.
This could happen at different stages of the
pregnancy. It could happen during pregnancy, during
delivery or when breastfeeding. It may not happen in
each and every pregnancy, as many factors will
influence it, such as stage of infection, severity
of the infection, treatment already given and
preventive measures adopted.
Q. What are the risks of passing the infection
to a baby during pregnancy?
A: The risk of passing the infection to the
baby, during pregnancy, is about 15 to 30% and this
would increase about five to 20% if the mother
decides to breastfeed the baby. This will cause an
overall risk of about 20 to 45%.
Q. Can these risks be minimised? If so how?
A: Yes. The risk can be minimized with certain
measures. Taking necessary medication during
pregnancy and delivery, proper planning of the
delivery, giving medication to the baby soon after
birth and avoiding breastfeeding are these measures.
The relevant information regarding these factors
could be obtained from the relevant doctors or from
the STD/HIV control units of government hospitals.
Q: What are the risks of passing the disease
to a baby at the delivery? Are they greater than
passing it during pregnancy?
A. It is difficult to give an exact figure.
However, there is a high probability of infecting a
baby with contaminated maternal body fluids at the
point of delivery. This would be more or less
similar to the probability of infecting a baby
during pregnancy. Nevertheless, adopting proper
preventive measures helps to reduce infection during
Q. Can breastfeeding infects a baby even
though the baby is not infected during pregnancy and
delivery? What’s the percentage of such a risk?
A: Yes. There is five to 20% probability that a
baby can get infected via breast milk compared to a
non-breast-fed baby born to a HIV positive mother.
Q. What are the precautions an infected
expectant mother can follow to avoid such risks?
A: HIV positive mothers should not breastfeed
their babies. Such mothers have to be counselled and
prepared during their pregnancies for alternative
feeding modes. Initially, it is uninterrupted
formula milk. Depending on their purchasing power,
they can start the child on weaning foods after four
months and reduce formula milk. However, the mother
should be educated about proper sterilising
techniques that should be adopted when using formula
milk to avoid contamination.
Q. If the baby is infected, how long would it
take the symptoms to appear?
A: Symptoms can occur over a variable period
after birth. The average duration is about 15 to 18
months. But about 20 to 30% can have symptoms within
a few months.
Q. What are these symptoms?
A: Initially, the symptoms are mild and
non-specific. Mostly, enlarged glands (lymph nodes)
in the neck, long standing or recurrent diarrhoea,
poor growth and wasting and oral thrush (white
plaques on tongue) are visible.
Q. Once infected, what is the treatment?
A: Anti viral medication and relevant
antibiotics to treat any concomitant infections.
Q. How effective are these medications in
prolonging the survival span?
A: Currently available medication cannot cure
HIV. It can only control the illness, prolong
lifespan and minimise related complications.
Q. What is the survival rate? How long can a
HIV/AIDS infected child live?
A: It depends on many factors. Of the most
severe cases the lifespan could be less than three
years. Nevertheless, less severely affected children
could live better quality lives longer, with better
control and treatment.
Q: Could full blown AIDS be prevented in a
child, if the disease is detected early? If so how?
A: HIV is the infection, and it necessarily does
not mean having the disease - AIDS. Progression of
HIV to AIDS depends on many physical factors and
medication. Early commencement of antiretroviral
therapy could prolong the development of symptoms
and onset of disease.
Q. What are the medications and drugs
recommended for children with AIDS?
A: Anti retroviral medication to control the HIV
infection, and other relevant medication to treat
complications, especially antibiotics to treat
Q: Does Sri Lankans have access to these
A: Yes. Most medications are available. Prices
Q: Do Sri Lankan hospitals have special wards
for HIV/AIDS patients and HIV positive babies?
A: No there are no such institutions or wards.
This leads to discrimination and stigmatisation.
Nevertheless, special care is available at any
national hospital. There is no need of having
special units as this illness is not spread through
air, water or simple body contact other than
injections, sexual contact or through open wounds.
The relevant medical staff makes sure the patient’s
body fluids do not contaminate the staff and other
patients. Many patients who are HIV infected but do
not exhibit any symptoms come into our hospital
wards and the hospital staff always takes
precautions to prevent cross infections. This
applies not only to HIV/AIDS but also many other
Q. What are the follow up programmes you have
for them when they return home?
A: A surveillance system is in operation through
the STD/HIV control programme. They visit clinics
regularly and contact patients if they do not come
to the clinics as recommended.
Q. How often do the mother and child have to
visit the hospital once discharged?
A: It is difficult to specify a period. It all
depends on the severity of the infection, how early
interventions had been started and its response to
therapy. Complications that develop and knowledge
and attitude of the parents are all important
Q. With more children running the risk of
contracting AIDS, how can Sri Lanka prevent the
disease from spreading in the future?
A: By giving young people a comprehensive
education on reproductive health and the dangers of
getting HIV if they lead high risk lives. Campaigns
should be conducted to encourage them to lead
healthier life styles and to offer them suitable
alternatives. Ministry of Education educates
adolescents about HIV/AIDS prevention. So does the
STD/HIV control unit of the Ministry of health.