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by Fathima Razik Cader

General William Booth founded the Salvation Army, a Christian charitable organisation, in 1883. However, the charitable work of the Salvation Army is not restricted to helping people of the Christian faith only - it has in fact surpassed all barriers and boundaries to reach out to those in need, irrespective of religion, caste, creed or colour. And this fact is amply portrayed by the work that has been carried out for the past eleven years in giving care and support to HIV/AIDS patients and their families in almost every district in Sri Lanka.

Having identified the need to launch a programme with a view to preventing the spread of HIV/AIDS (both acronyms), the Salvation Army appointed a team comprising a coordinator and staff members to systematically plan and implement awareness campaigns. This was in 1992. In 2001, the HIV/AIDS programme was restructured focusing on providing care and support to patients and their families. However, education and methods of prevention are also effectively imparted to the target audience.

Awareness programmes on the disease have been methodically conducted for communities in Slave Island, Ratnapura, Hikkaduwa and Badulla from the inception of the programme and since then, have been extended to almost all other parts of the country.

The Salvation Army works in close collaboration with the National STD/AIDS Control Programme of the Ministry of Health and the Public Health Department of the Colombo Municipal Council. Readers might perhaps recall that the first AIDS patient was diagnosed as positive in 1987. Since then, *the numbers have arisen to 455 cumulative HIV cases at the end of 2002, and as at end July 2003, the number stands at 493. More males than females are affected with the ratio of reported cases being 1.5:1.

Cumulative AIDS deaths reported from January 01 to July 31, 2003, was 114 as against 109 reported deaths for the year 2002. Cumulative HIV cases (of foreigners) as at end of 2002 were 47. Interestingly, the number of HIV tests carried out during 2002 was 262,870. Apart from this grave situation, what is alarming and is a cause for concern is the number of innocent children who are affected with the virus passed on by the mother.

The World Health Organisation estimates around 8,000-8,500 HIV positive cases, as even today, with so much awareness and education on the disease, there are patients who do not seek medical assistance and treatment. This is in view of the stigma that is attached to the disease and the resultant discrimination they face. Those involved in the humanitarian task of reaching out to people in this situation, find it hard to break through the negative response they receive - for no amount of counselling can change the mind-set of such a person. It is a fact that 80 per cent of those diagnosed as positive have got the disease through sexual transmission. And it is this very fact that prevents many a person from coming out in the open to seek medical treatment.

Once again, what is of paramount importance in this situation is prevention and this is emphasised in all awareness programmes that are conducted. The Salvation Army has a full staff of nine personnel and around 50 volunteers in its HIV/AIDS Department and conducts programmes for the Forces, the community and other institutions. Through these lectures and participatory discussions, potential leaders are identified from the audience. Thereafter, Training the Trainer programmes are held so that those identified as leaders can carry out similar programmes amongst others within their area. For example, the Forces once trained, carry out training programmes within their ranks and this method effectively reaches out to a larger number, progressively. Currently, through the Air Force base in Ekala, around 130 people have been trained.

Salvation Army officers have gone to the most remote villages to address these issues and have found that some people are still ignorant about the disease. Undaunted, they pursue with their mission of educating Sri Lankans and have been rewarded with the improvement in the level of knowledge of the disease. This has also brought about other positive features in that some have changed their lifestyle, some have come for screening and some have invited the officers back to their villages and homes for further discussions.

Like any health issue, HIV/AIDS also has far reaching negative aspects - the affected person is ostracised and the family is discriminated against (especially so in the villages), the person losses his/her job and invariably, even the (religious) faith is lost. It therefore involves attitudinal and behavioural changes - both of which come through positive motivation. In the 2 1/2 year period (since the programme was restructured) hundreds of thousands of people have been reached and when one takes the programme from the inception (i.e. since 1992), the Salvation Army has reached nearly 25% of Sri Lanka's population. To its credit, the Salvation Army has gone about this daunting task sans any fanfare or publicity and it is but right that Sri Lankans are made aware of its achievements to date.

Rambukkana and Maskeliya are being covered in September and Mannar will be covered in October. And through each awareness programme, via the community and the town or village, the message reaches far and wide - schools, hotels, estates, hostels, the Prisons, the Police and the Army and the Air Force. A mobile clinic was conducted in Jaffna in 2002, and around 300 people were screened.

Screening is done at the National STD/AIDS control clinic at the National Hospital of Sri Lanka. Testing is voluntary because no one has the right to force a person to undergo a blood test. However, pre-test counselling is carried out to prepare the person to accept the result if it proves positive and to carry on with the correct life style if proved negative. Post-test counselling is given to positive cases to accept the result and lead a life as normal as possible, thereafter. Such people are constantly monitored and counselled by the Salvation Army in order to give them emotional, physical and spiritual support to live. In addition, material support is also given by way of an outright grant to help them to set up a micro project. For example, a woman may be provided the finances to purchase a sewing machine and other necessities to undertake sewing and thereby generate an income. A man was given the finances to purchase two goats. Since then, he has six goats and generates a regular income by selling the milk.

Many misconceptions are also cleared - some people think they can be affected by the sting of the mosquito or by having shared a cup or a plate. IEC - information, education and communication, have led to even those who are withdrawn at the beginning, to open up and coming to terms with the illness.

HIV/AIDS patients go through a series of emotions. Initially, it is shock because no matter how much a person is prepared, it comes as a shock to know that one has tested positive. In this respect, a trusted person should be around the patient. Denial is another feeling that one experiences - 'Perhaps the Doctor is wrong'; or 'It can't be true. I feel so strong'. It's a subconscious force that temporarily protects the person from the threat posed by the disease. Denial also comes from the fear of being rejected by lovef ones. Genuine concern and advice is needed at this stage. Anger follows because it is natural to feel so - against oneself or the person one thinks was responsible.

Here too, patience and concern expressed by the caregiver helps tremendously in containing this negative emotion. Bargaining is another feature that an infected person presents. For example, the persons 'bargains' with God. 'Please cure me and I will stop having sex'. Or 'I will be good and AIDS will go away'. At this point, the person needs help to accept reality. Fear is yet another (strong) negative emotion - fear of pain, losing a job, others getting to know, rejection, future of the family and death. Talking to someone helps in no small measure and in fact, an affected person can relate to, with love and kindness to another affected person. Loneliness also sets in and it is here that family and friends can play a positive role by fulfilling the need for companionship.

Self-consciousness is another aspect that needs to be dealt with as subconsciously, an affected person thinks that others know and are perhaps looking at or talking about him or her. Participating in social activities will change one's mind-set in this regard and people in turn have to learn to accept those affected as valuable members of society.

They should also be made to understand that preventive measures should be taken in order that they do not spread the infection - especially to their loved ones. Depression is another dangerous negative trait that needs to be stemmed through normal activity. An infected person may feel useless and depression also leads to a person being weak in mind and body. A person should be made to feel that his/her family and friends need him.

Finally, acceptance of the situation sets in and this is the beginning of the positive approach. One's faith takes over and some even make future plans - for self and family. Caregivers also give hope to those infected to live a good life, show that they are loved and accepted and even the hope that modern science will find a cure to eliminate the disease.

What can one do to help a fellow being and by extension, his or her family, in such a situation? Whilst one may not have an answer right away, it might be an idea to extend a helping hand to organisations like the Salvation Army in its committed endeavour to ease the pain and suffering of both the mind and body of a HIV/AIDS positive patient.

(* Source - National STD/AIDS Control Programme)

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