Communities at higher risk of HIV infections should be placed at the centre of the AIDS programme design and implementation in Sri Lanka. This was the central message highlighted through discussions between representatives of civil society and the UNAIDS Deputy Executive Director, Programme, Luiz Loures, during an official visit to the country from 16-18 June.
While in Sri Lanka, Mr Loures visited several community-led programmes and met with representatives of key populations such as men who have sex with men, sex workers and women living with HIV. Through in-depth conversations, he listened to examples of focused programming in the country which have helped facilitate greater access to a number of HIV services for key populations, as well as significant network building.
National HIV prevalence remains relatively low in Sri Lanka, estimated at 0.1%, but the country is one of four in the Asia Pacific region that has shown up to a 25% increase in new HIV infections in the period 2001-2011. Higher levels of HIV are often concentrated around certain geographical sites and within communities at higher risk of HIV infection. According to national studies, in the city of Kandy for example, HIV prevalence among men who have sex with men is estimated to be at 4% - more than 40 times the general population average.
"In Sri Lanka - as more broadly in Asia Pacific and across the globe - we see that where communities are front and centre of the AIDS response, the greatest impact is achieved," said Dr Loures, commending the programmes showcased during his visit. He highlighted how successful programmes have been initiated with key populations in Sri Lanka despite challenging legal and policy environments which criminalize sex work and same sex relations.
Speaking about the urgency needed to further scale such programmes across the country to stem rising HIV infection rates Dr Loures noted that, "Even in countries with low prevalence, we must maintain a sense of urgency to ensure responses and financing are focused to where they are most needed and that they are developed for communities by communities."
Across countries that reported on AIDS progress in 2012, only 19% of HIV prevention spending was estimated to be for key affected populations. Despite that 25% of all new HIV infections in the region are estimated to be occurring among men who have sex with men, only around 1% of investments are directed towards programming among this community.
In Sri Lanka, community representatives are urging for much greater attention and resources to be given to ensure coverage and services are increased for people most in need.
"We have built a very successful network and we know what needs to be done, but we need the commitment and the resources to be able to increase programmes in size and scale so we can really make sure people are not being left behind," said Lalith Dharmawardena, Executive Director of the Heart to Heart Organization, a network visited by Dr Loures set up to promote the sexual health and other human rights of Sri Lankan men who have sex with men.
Punitive legal and policy environments and subsequent high levels of stigma and discrimination towards people living with HIV and key communities were also highlighted as presenting a major barrier to Sri Lanka’s AIDS response. Both sex work and sexual relations between men are prohibited by national laws, codes and/or policies. National surveys suggest that many people at higher risk of infection delay testing for HIV and coming forward for treatment because they are concerned by the implications of their identification and testing HIV-positive, and the confidentiality of their HIV status.
Princey Mangalika, President of the Sri Lankan Positive Women’s Network, underlined how normalization of HIV and key communities can have a positive impact on reducing stigma and discrimination. She also urged government and authority officials present at the community interactions to ensure greater participation of people living with HIV and from key communities in decision-making bodies and the national response. Ms Mangalika also thanked the government and the Global Fund for making antiretroviral treatment freely available to those who need it in Sri Lanka.
"We are seeing some really positive signs in Sri Lanka and we now need permanent spaces for women living with HIV and other communities," said Ms Mangalika, whose efforts - both personal and those of her organization - won a Red Ribbon Award in 2012 for outstanding community based care and support programmes. "We need the authorities to listen more closely to particular community needs - women, men, transgender - and let us help lead. We know how to best reach people," she said.
The visit of the UNAIDS Deputy Executive Director, Programme to Sri Lanka coincides with his attendance at the Twenty-Ninth Board Meeting Board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria which takes place in Colombo on 18-19 June 2013.