InterPress News Service (IPS); Sunday, 5 October 1997.
Feizal Samath

Most of the funding for HIV/AIDS related programmes comes from U.N coffers and, according to Sri Lankan government rules, any monies for non-governmental agencies (NGOs) must be disbursed through state agencies.

Disbursements take long to come and in some cases funds go unspent, say U.N officials. Just about 15,000 dollars have been spent from 100,000 dollars given for 1996-97 by the U.N for the government's national programme against AIDS.

"My bet is that almost half the money will be returned unspent," a U.N official said in frustration, adding "in most cases the delay is because the project document goes through many officials for approval and at each desk it takes a couple of weeks to move."

NGO sources say other reasons for government complacency is because officials generally tend to view NGOs with suspicion, and that AIDs prevention is not at the top of the government's working agenda.

Sri Lanka is a low prevalence country as far as the AIDS epidemic is concerned with the number of AIDS cases much fewer than the rest of Asia.

The impact on economic development is minimal and tourist inflows, a key foreign exchange earner and a could-be risk area, are unlikely to contribute significantly to the transmission of the disease among locals, experts say.

"The figures are encouraging but we (Sri Lanka) can't afford to relax," observes Dr Hemamal Jayawardene, country programme officer for UNAIDS, an umbrella of U.N. agencies involved in HIV/AIDS related activity.

He says among the many groups at risk are Sri Lanka's approximately 12,000 commercial sex workers, migrant workers, prisoners and female workers at the country's free trade zones where casual sexual relationships are high.

Government doctors say 60 people out of 75 cases have died so far from AIDS since the first case was reported in 1987. There are 200 more reported cases of persons carrying the HIV virus while estimates on HIV carriers range from 6,000 to 8,000.

"This is the tip of the iceberg," concedes Dr Sujata Samarakoon from the government's Sexually Transmitted Diseases (STD) centre. "This floating population can be dangerous. They are moving around not knowing they carry the disease."

She said that most cases are established only after people come to STD clinics for random checking. "We screen a few people - not many." Government inaction or slowness is also a problem.

Dr Samarakoon said that the government was making a concerted effort towards tackling the problem through a state-run National AIDS Committee that was set up several years back with NGO participation.

The programme focussed on strengthening of laboratory services and blood safety, collection of basic information on populations with high risk behaviour to assess, knowledge, attitude and behavioural practices.

A recent U.N report said that although the number of HIV infections detected was low, risk behaviours are prevalent in the country. "This indicates a potential for rapid spread of HIV infection. For example, every year more than 200,000 individuals are estimated to contract sexually transmitted diseases. However only 10-15 percent are seen in government STD clinics," it said.

The report said that the low prevalence of HIV infection in Sri Lanka provided an opportunity to keep the epidemic under control. However complacency at this stage will undermine national response and pave the way for immense human suffering and adverse socio-economic impact in the future.

According to projections contained in another United Nations Development Programme-commissioned report, Sri Lanka could by the year 2005 have as many as 80,000 cumulative cases of HIV infection with an HIV prevalence rate of 0.54 per cent among the population aged 15 to 64.

This study, by a group of eminent doctors and researchers, titled "Socioeconomic Dimensions of HIV/AIDS in Sri Lanka" examined the economic impact of the disease, its economic roots and policy issues.

It estimated that the personal medical care cost component of the direct costs per AIDs patient ranges from 290 dollars to 1,150 dollars. On the economic impact, the report noted that a cross-country multivariate analysis revealed only a statistically insignificant negative association between the growth of real income per capita and the severity of the AIDS epidemic.

"Although a related analysis revealed a sizeable and significant negative effect of AIDS on the UNDP's Human Development Index, Sri Lanka's AIDS epidemic is still not large enough to depress its human development ranking substantially."

The report however stressed that though there was little evidence that the AIDS epidemic threatened economic growth and human development in Sri Lanka, it may have a serious impact on specific groups of people and on particular segments of the economy. On economic roots, the report said -- contrary to findings by other groups -- that the roughly 75,000 workers in Sri Lanka's free trade zones were not a high risk group.

"There is little evidence of promiscuous sexual behaviour here. These workers also appear to be well informed about different modes of HIV transmission." It said that Sri Lankans who work abroad face a small but nontrivial risk of HIV infection, primarily because they are believed to face sexual exploitation by their employees, while some of them also engage in casual sexual relationships.

This assessment is supported by Dr Samarakoon from the government's STD centre. She said in many cases, the returning workers were unaware of HIV and AIDS. More than 500,000 Sri Lankans, mostly women, work in the Middle East and Gulf countries many as housemaids.

In conclusion, the report said that while the AIDS epidemic has not progressed as far in Sri Lanka as in other countries, "even given the most optimistic scenario, the epidemic will soon impose an appreciable economic burden on the country."

Sri Lankan academics say that one of the biggest problems faced by the NGO community in the campaign against AIDS is society's lack of understanding of the problems.

"The problem is a human problem. There are ethical questions - human rights questions that must be resolved. You can't just lock up an AIDS victim and throw away the key. We have to rehabilitate him or her and make them part of society. They have their rights too," said Rohan Edrisinha, co-director of the Centre for Policy Research and Analysis at the Law Faculty of the University of Colombo.

In general, Sri Lankan society frowns on HIV and AIDS victims and newspapers often report how victims are chased away from their homes by neighbours and even their own families, and live in hiding. Victims face humiliation even at the hands of doctors and nurses who treat them with great reluctance.

Edrisinha said that several years ago, a Sri Lankan parliamentarian presented a private members bill seeking compulsory testing for AIDS for all workers returning from the Middle East. The bill was unanimously passed but private members bills are rarely implemented.

"Little did the MPs realise that they were passing judgement on a matter of human rights," he said. Blood testing in Sri Lanka for AIDS is not compulsory. (End/IPS/fs/an/97)

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