Sri Lankan health officials have called for a greater focus on youth in the battle against HIV as they become more sexually active and the percentage of young people contracting the virus rises.
“Youth and the risk of infection are two particular areas that we are paying greater attention to now,” Sisira Liyanage, the director of Sri Lanka’s National Sexually Transmitted Disease (STD) and AIDS Control Programme, told IRIN.
According to government figures, there are 1,808 (1,083 male and 725 female) people known to be living with HIV in the island nation, an increase over the 1,669 cases (981 male and 688 female) at the end of 2012. In 2013, 20 percent of the cases were between the ages of 15 and 25.
“That is a very a sharp increase that we have witnessed in that age group,” Liyanage said. In 2009, the same age group accounted for just 5 to 6 percent of all infections.
Sri Lanka has a population of some 21 million, and with an estimated 4,200 people with living with HIV is considered a low HIV prevalence country, according to the National HIV Strategic Plan Sri Lanka 2013-2017, released in February 2013.
However, the national plan notes that there has been a gradual increase in the number of infections, particularly in high-risk groups, including commercial sex workers and their clients, men who have sex with men (MSM), and injecting drug users. The report also identifies youth as an at-risk group.
“The low levels of awareness lead to risky behaviours. It is imperative that even in a low-prevalence setting, the general population is made aware of the risks of HIV transmission. All young people need to be aware of HIV and sexual/ reproductive health issues before they become sexually active,” the report stressed.
Of particular worry was that more and more young people were becoming sexually active without an awareness of safety, Liyanage said, noting a lack of up to date data on this issue.
“There is lot of exposure to unsafe sex at a younger age now,” he said. There was also evidence to suggest that young men were often having their first sexual encounter with older women, and at an earlier age.
Another area of concern cited in the national plan has been transmission from parent to child. In 2011 only five such infections were recorded, but only three percent of pregnant women had been tested for HIV, even though over 95 percent of pregnancies had access to prenatal care.
“The lack of testing, the lack of knowledge on HIV infections, and how to prevent more infections creates a vicious cycle,” Liyanage said.
Milinda Rajapaksha, director of the National Youth Services Council under the Ministry of Youth Affairs, said in addition to young people, marginalized populations like intravenous drug users, the gay community, prisoners and internal migrants were also at high risk. The lack of health and testing facilities, and the low level of awareness were the main drivers of increased risk.
He noted that Sri Lanka’s national health policies had yet to identify young people as a special category and undertake the appropriate interventions. “That creates a big drawback when you deal with youth health issues,” he said.
The new National Youth Policy to be released in February 2014 recommends recognition of this group, and the formation of policy accordingly, Rajapaksha said.
“Another major drawback in dealing with youth at risk is that both drug use and homosexuality are criminal offences, making it extremely difficult to work with such groups openly.”
Liyanage said a new committee under his chairmanship, comprising representation from government agencies in health, education and youth affairs, had been formed in November 2013 to draft policy recommendations to stem the spread of HIV among young people. “One of the main focuses would be to create a peer group among the high-risk categories who can spread awareness,” he said.
Rajapaksha said the authorities should also look at introducing sex education in schools. Students learn about reproductive health, but there is no segment on sexual safety.
“Building awareness is the best way to curb the spread,” Rajapaksha said, “and what better places than in the schools to do this, since we have over 90 percent of our children going to at least primary schools.”