By Dr Ajith Karawita, Consultant Venereologist and the President of Sri Lanka College of Venereologists 2015-2016

1. Sexual Health in the Era of HIV
Dr Ajith Karawita MBBS, PgD Ven, MD
President, Sri Lanka College of Venereologists

2. Overview of the presentation
1. HIV epidemic in Sri Lanka
2. HIV treatment cascade in Sri Lanka
3. Challenges in closing the gaps in the cascade
4. HIV within the broader concept of Sexual health

3. 1. HIV epidemic overview
in Sri Lanka

4. History of HIV in Sri Lanka
1981
1983
HIV virus was
identified
First AIDS case
reported in Sri
Lanka (foreigner)
1986
First Sri
Lankan patient
reported with
HIV
1987
First Locally acquired
HIV infection reported
in Sri Lanka
1989 ART
started
2004
First AIDS
case Reported

5. 3600
644
Sri Lanka Epidemic Overview

7. Number of new cases vs Rate of new cases 2014
7

8. HIV Situation in Sri Lanka
07 HIV new infection per week
04 HIV new cases reported per week
Close the gap
Get yourself tested for HIV
©karawita

9. 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Unknown 26 41 36 38 29 44 44 44 20 20 17 16
Blood 0 0 0 0 0 0 0 0 0 0 0 0
IDU 0 1 0 0 1 0 0 3 1 1 2 1
Perinatal 6 2 8 7 3 3 7 3 3 3 6 0
Homosexual 1 8 6 6 8 3 12 7 16 20 27 28
heterosexual 66 48 50 49 59 50 36 58 60 57 48 55
26
41
36 38
29
44 44
44
20 20 17 16
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percent
Trend of probable mode of transmission 2003-2014

11. HIV positivity rate in different settings-2014
(among non-probability samples)

12. HIV positivity rate in IBBS 2014/15
(Probability samples)
INTEGRATED BIOLOGICAL AND BEHAVIOURAL SURVEILLANCE (IBBS) SURVEY AMONG
KEY POPULATIONS AT HIGHER RISK OF HIV IN SRI LANKA
Female sex workers (All) (N=1261) 0.81 %
Female sex workers (Colombo and Galle) 1.03 % 0.3 – 1.7 (95% CI)
Men who have sex with Men (MSM) (N=1217) 0.88 %
MSM (Colombo and Galle) 1.03 % 0.2 – 1.9
PWID (N=326) 0 %
BB (N=306) 0 %

13. 2. HIV treatment Cascade,
Sri Lanka 2014

14. 3600
48%
1737
23%
825
18%
644
8%
299
100%
52%
1863
77%
2775
82%
2956 92%
3301
PLHIV Estimate Detected Linked to care
or Registereed
in clinics
On treatment Virally
suppressed
HIV treatment cascade; Sri Lanka 2014

15. Condom as Prevention (CasP)
Condom use at last sex in IBBS 2014/15
(Probability samples; RDS)
INTEGRATED BIOLOGICAL AND BEHAVIOURAL SURVEILLANCE
(IBBS) SURVEY AMONG KEY POPULATIONS AT HIGHER RISK OF
HIV IN SRI LANKA
Female sex workers (All) (N=1261) 93% 91.4 – 94.5 (95% CI)
Men who have sex with Men (MSM)
(N=1217)
58% 54.1 – 61.8 (95% CI)
BB (N=306) 68% 61.8 – 73.3 (95% CI)
PWID (N=326) 24% 18.8 – 28.9 (95% CI)

17. 3600
100%
90%
3240
90%
2916 90%
2624
3600
(100%)
1737
(54%)
644
(22%) 299
(11%)
Estimate Detected On treatment Virally suppressed
HIV treatment cascade; Sri Lanka 2014 vs
90-90-90 targets 2020
Target Actual
46%Gap
46%
Gap
78%
Gap
89%

18. United States treatment cascade, from HIV
diagnosis to viral suppression (n=1.1 million PLHIV)
Source: Hall et al. Continuum of HIV care: differences in care and treatment by sex and race/ethnicity in
the United States. 2012 International AIDS Conference

20. 3600 3600
1737
825
644
483
3600
1737
825
644
483
299
0
500
1000
1500
2000
2500
3000
3500
4000
Estimated
PLHIV
Detected Registered in
clinics
On ART Viral load
tested
VL suppressed
<1000
copies/ml
HIV treatment and care detailed cascade
and gap analysis 2014: Sri Lanka
Should do no Did no
Gap 3
22%
Gap 5
38%
Gap 4
25%
Gap 2
53%
Gap 1
52%

21. 3. Challenges in closing the
gaps in HIV treatment cascade

22. CLOSE THE GAP

23. Addressing pre-registration gaps
EstimatesDiagnosisClinic Registratipon
50%

24. 1. More robust data need to be fed for realistic
estimations
2. Widespread testing for case detection is a must
with priority for Key populations coverage
3. Creation of enabling legal and policy
environment
4. Creation of enabling environment at healthcare
system
Addressing pre-registration gaps
EstimatesDiagnosisClinic Registratipon
50%

25. Post registration gaps
Registration to ART to VL testing to VL suppression25%

26. Addressing Post-registration gaps
Registration ART start VL testing VL suppression
1. Creation of enabling legal and policy environment
2. Creation of enabling social environment
3. Creating and enabling family environment for
treatment access
4. Creating an enabling personality
5. Law level of defaulter tracing and contact tracing
25%

27. Addressing Post-registration gaps
Registration ART start VL testing VL suppression
6. Lack of availability of VL testing at an accessible
distance
7. Adherence issues among patients
8. Deviations for CAMs complementary and
alternative medicines
9. Change in guidelines for start of ART
25%

28. HIV in the broader concept of
Sexual health

29. Sexual Health
Sexual Health is not merely the absence of
disease, infirmity or dysfunction. It is the
complete physical, emotional, mental and
social wellbeing in relation to sexuality

30. Diversity of expression of Sexuality
Sexuality includes
o Biological sex (Anatomical sex),
o Gender identities and roles,
o Sexual attractions or sexual orientation,
o Sexual preference, Erotism, Pleasure, Intimacy and
o Reproduction.
These dimensions are very diverse and complex and inter-
relating. Promotion of sexual health is important than ever
to address the gaps in HIV treatment cascade.

31. Acknowledgements for the presentation
1. Dr K A M Ariyaratne, and the staff of the strategic
information management unit of the National
STD/AIDS Control Programme for generating
important information
2. Dr Sisira Liyanage, Director, National STD/AIDS
Control Programme
3. Office bearers and the Council of the college of
Venerologist
4. Dr Sriyakanthi Beneragama for HIV and IBBS data

32. Final Remarks and
Remembrance

33. Thank you…