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by Talia Jayasekera

Twenty-five million people, worldwide, have succumbed to HIV AIDS since the disease first surfaced almost 20 years ago. A further 40 million are AIDS sufferers, making this illness the fourth leading cause of death and a matter of global concern.

Sri Lanka is no stranger to this epidemic either. Though numbers are comparatively low to other countries in the South Asian region, AIDS is still very much a dangerous killer to our people. Prostitution, low use of condoms, drug users and migrant workers are slowly but surely bringing the virus to our shores.

Creating an awareness of AIDS on international AIDS day

The World Bank recently granted US $ 10 million in funds to the fight against AIDS transmission and infection. Concerns over whether the funds would be appropriately utilised in the relevant sections led to the visit of renowned American Professor Laurel Fletcher of the International Human Rights Law Clinic in California to Sri Lanka.

"I was invited to Sri Lanka by the Fulbright Commission to give a series of lectures on the human rights dimensions of HIV AIDS and to raise awareness amongst Sri Lankans about the relationship between the respect of human rights and HIV AIDS. I've been involved in a project with Manel Kappagoda, who is an attorney at the East Bay Community Law Centre in Berkeley, and the AIDS Coalition for care, treatment and support in Sri Lanka, working on the access to HIV medications", said Professor Fletcher on her week-long visit to Sri Lanka very recently.

"Together with the AIDS coalition and groups that are based in the United States as well as the Humans Rights clinic at the California University, where I work, we are trying to encourage the Government to start to provide medicines to people with HIV AIDS in Sri Lanka. In particular with World Bank funding for HIV prevention that has not included in any significant way HIV treatment, therefore we have been urging both the World Bank and the Sri Lankan Government to expand this, to do more comprehensive screening, testing, counselling and treatment".

"We are focusing in particular on mother to child transmission. Manel Kappagoda is currently involved in a proposed pilot project at the General Hospital in Kandy that would effectively focus on this type of transmission. Through this pilot project, there is a definite way to demonstrate that treatment is both feasible and practicable. It will also provide hard data to the Government to be able to assess what really would be the actual cost for more comprehensive HIV treatment".

What is the present AIDS situation in Sri Lanka?

"There is no dispute that the actual reported number of cases is quite low in Sri Lanka, however all the risk factors that are present point to the fact that the country is on the verge of a major epidemic. The estimates from the World Bank and the projections from the United Nations Development Project (UNDP) predict that there will be between 80,000 to 120,000 AIDS sufferers by 2005.

With numbers like that not to be starting now to look at the feasibility and practicability of providing HIV treatment is a mistake because the consensus between doctors and activists is that in order for prevention programs to be effective, they have to be combined with treatment. Programs will not be efficacious if treatment is not provided because right now HIV is a fatal disease".

What are the rights of an AIDS sufferer?

"An HIV positive person has human rights as everyone else. I think those rights are most implicated in terms of privacy rights so that the information about their status and health is not shared beyond their immediate healthcare provider. There are anti-discrimination norms within the human rights instruments that Sri Lanka has adopted.

The Government has said it will uphold an individual's human rights and protect them from discrimination on the basis of their HIV status. This requires the Government to have on its books, laws that protect people from discrimination and that requires civil society to implement, vigorously, those protections. This does not only include Judges and the Court system but also lawyers as well.

"There is a high degree stigma attached to the illness. People are not going to come forward and be tested if there's not the possibility of hope, treatment and better living conditions available to them. They are essentially learning that they are living with a death sentence and there's nothing they can do about it.

The fact that they know the information and issues of confidentiality or breaches thereof, could put them at risk of losing their jobs, housing and family support, which are the only things they have to rely on. So if you give people the option of treatment, then they are more likely to come forward and be tested".

"I've heard very disturbing reports of discrimination since I've been here from talking with various groups in the country. The issue of discrimination has come up in several aspects. One has been simply that healthcare workers have disclosed a patient's HIV status to members of the community who have then taken retribution against those individuals by burning their houses. Also I have heard of discrimination within the healthcare system based either on ignorance or fear.

The lack of information where healthcare workers will refuse to provide treatment for people with HIV, those could be lab workers who will refuse to perform lab tests on blood samples and also doctors and nurses who have refused to give care to HIV sufferers. There have been instances where private hospitals, where on learning an individual's HIV status, have refrained from informing the person and thereafter refused care while referring them to a public hospital.

Basically, we are talking about the essence of an oath a doctor undertakes to serve patients that is being absolutely ignored for this vulnerable population which I think is tragic and is a gigantic human rights violation".

What could be done to solve this violation of human rights?

"I think there is a serious lack of awareness amongst certain sectors within the healthcare profession about HIV transmission thus leading to misconceptions about the risk that healthcare workers are at. I think there is also inadequate resources at the hospitals to take the precautions that are necessary to prevent transmission such as gloves and sterilised instruments, so therefore doctors and staff are understandably reluctant without those precautions to provide services".

"There is a lot of stigma surrounding HIV AIDS. It is associated with behaviours that go against social norms such as pre-marital sex, intravenous drug use and prostitution and doctors and medical staff may share those same attitudes with the general population and disapprove of the behaviours that may have taken place. Then again, no one really knows because there haven't been accurate studies about HIV transmission in the country. So I am using stereotypes that apply to people living with HIV".

How could the Sri Lankan people combat this epidemic?

"I think its both simple and incredibly challenging. Obviously the initial step would be education. Accurate information about HIV transmission is one aspect but inner relationship between social status and vulnerable groups has to be addressed. In other words all over the globe, if you look at any country, those people who are most affected by HIV are the most marginalised such as minorities, sex workers, and migrant workers.

So in order to strengthen those communities and to make them less vulnerable to HIV infections requires addressing the same social factors that make them socially marginalised. For example, improving the status of women so that women can negotiate with their sexual partners for safe sex practices.

It requires no less than a change in culture within the medical profession to understand that we are talking about HIV AIDS, we are talking about human rights and entitlements for all those involved, whether its healthcare workers, politicians, social workers, legal professionals, private industries.

Every sector of society is a stakeholder in this issue and they should become active and animated on it within their particular spheres to address anti-bias, stigma while taking adequate and appropriate precautions to reduce the risks of transmission". What are the success rates?

Thailand done exceptionally well in combating this problem. Haiti is the poorest country in Asia but has a robust treatment compared with other underdeveloped countries.

Intervention is not only mandated under International Law, its also feasible, possible and I think, particularly in Sri Lanka, because infact it has a fairly strong healthcare infrastructure that its poised to address this problem. Sri Lanka can be the country that actually beats the odds and gets ahead of this disease unlike countries like India, Cambodia and Nepal.

How can AIDS sufferers in Sri Lanka gain access to AIDS drugs?

I believe the best news in this fight is the fact that its possible, through TRIPs (Trade-Related Aspects of Intellectual Property), for the country to do importation of generics which has till 2005 as a waiver. Drug prices, worldwide, are coming decreasing. Facilitating legal importation of those drugs is highly feasible".

"Drugs are only one element of the cost, there's also training, infrastructure and services, much of which already exists or is being supported by outside funding agencies. The Government is also going to have to make some hard decisions and allocate resources. My point is that by allocating resources to hospitals to take universal precautions will also have tertiary benefits by reducing blood-borne transmission of disease protects people not only from HIV transmission but other blood-borne diseases.

So its sort of a two-for-one. There is money in the international community for HIV prevention and treatment and if Sri Lanka can get that,it can then improve its health systems for everyone, not just AIDS patients.

Where should the World Bank funds be utilised the most?

"The World Bank funds are being allocated in a variety of spectrums for education, prevention, training and infrastructure. I would not argue with any of that but I think what our point is that some of that money should be allocated to treatment, in particular with pilot project. A comprehensive study to actually ascertain HIV prevalence in the country should be carried out immediately because right now we are working with estimates that don't really give us a clear picture. But you don't really have to wait to know because already there have been more than 500 reported cases in the country.

Start with treating those people and right now, understandably, the Government might not want to take on that responsibility. So our perspective is to start with mother to child transmission. Stop HIV from being transmitted to unborn children and build from there. So I think the pilot project at the Kandy General Hospital is very promising because it will point the way towards the future to find out what is feasible and replicated more widely throughout the country.

"What is comforting to know is that there are groups, like the AIDS coalition, in Sri Lanka that are working on providing advocacy and services to HIV positive people. This is a home-grown response and we are coming into provide technical assistance to strengthen the capacity of local groups.

It is a global issue and its a local issue. I think the most creative and effective solutions will be generated by people on the ground doing this hard work.

I am happy to be in Sri Lanka and be talking about introducing a rights framework to understanding HIV AIDS because I think its very important as there is so much stigma.

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