OVERVIEW OF HIV/STIs IN SRI LANKA, 2000 - 2009

K. A. M. Ariyaratne, MDConsultant Venereologist

HIV EPIDEMIC IN SRI LANKA

1987 •First Sri Lankan with HIV reported

1989 •First locally acquired HIV infection

Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.

HIV ESTIMATES FOR SRI LANKA AS OF END 2009

Adults (>15 years) living with HIV - 3000

Children (< 15 years ) living with HIV - 35

Adult HIV prevalence (%) < 0.1 % (0.02%)

Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.

HIV ESTIMATES FOR SRI LANKA

2001 2003 2005 2007 20090

1000

2000

3000

4000

5000

6000

4800

3500

5000

4000

3000

Dr K A M Ariyaratne, NSACP, MOH, Sri Lanka

Estim

ated

num

ber

Year of Estimate

HIV ESTIMATIONS DONE IN 2009

2007 2008 2009 20100

500

1000

1500

2000

2500

3000

3500

24712644

28182997

Estim

ated

Adu

lts li

ving

with

HIV

HIGH-RISK POPULATIONS FOR HIV

Sex workers

IV drug usersMSM

VULNERABLE POPULATIONS

Clients of sex workers

Drug users

Prisoners

Migrant workers

Internally displaced persons (IDP)

DRAFT NATIONAL ESTIMATES

FSW – 41,000

(35,000 - 47,000)

MSM – 31,000

(24,000-37,000)

Strategic Information Management UNIT/NSACP/2010

NATIONAL ESTIMATES

Drug users – 45,000

IDU – 900

(2% of Drug users)

Source: National Dangerous Drug Control Board

NATIONAL ESTIMATES

Clients of Sex workers 261,000

3.5% of Adult males(Based on BSS 2007)

Strategic Information Management UNIT/NSACP/2010

TRENDS OF HIV PREVALENCE AND INCIDENCE

EPP (Estimation and Projection Package)

Spectrum models

International and National consultants

Epidemiological assumptions and output

estimates were endorsed by stakeholders

Strategic Information Management UNIT/NSACP/2010

HIV PREVALENCE AMONG HIGH-RISK SUBGROUPS

Source: Report on HIV Estimation and Projections 2009, Sri Lanka

MSM FSW

Clients of FSW

Drug users

Perc

enta

ge

HIV INCIDENCE IN POPULATION SUBGROUPS

Source: Report on HIV Estimation and Projections 2009, Sri Lanka

New

infe

ction

s ( T

hous

ands

)

TRENDS IN ADULT HIV PREVALENCE (15+)

Peak around 2012

Current HIV prevalence

Source: Report on HIV Estimation and Projections 2009, Sri Lanka

Perc

enta

ge

HIV SENTINEL SURVEY

HIV PREVALENCE AMONG FEMALE SEX WORKERS

2000 2001 2002 2003 2004 2005 2006 2007 20090 %

0.14% 0.13%0.07%

0.20%

0 %

0.16%

0% 0%

2 YEAR MOVING AV-ERAGE

HIV

PR

EV

EL

AN

CE

%

SOURCE: NSACP /SENTINEL SUVEILLANCE DATA

HIV PREVALENCE AMONGMSM

2008 2009

0.5%

0.0%HIV

PR

EV

EL

AN

CE

%

SOURCE: NSACP /SENTINEL SUVEILLANCE DATA

HIV PREVALENCE AMONGSTD CLINIC ATTENDEES

2000 2001 2002 2003 2004 2005 2006 2007 2009

0.13 %0.08% 0.09%

0.28%

0.08% 0.04 %

0.36%

0.2% 0.15%

2 YEAR MOVING AV-ERAGE

HIV

PR

EV

EL

AN

CE

%

SOURCE: NSACP /SENTINEL SUVEILLANCE DATA

HIV PREVALENCE AMONGTUBERCULOSIS PATIENTS

2000 2001 2002 2003 2004 2005 2006 2007 20090 %

0.11%0.00%

0.06%0.00%

0.13 % 0.07% 0.08%0%

2 YEAR MOVING AV-ERAGE

HIV

PR

EV

EL

AN

CE

%

SOURCE: NSACP /SENTINEL SUVEILLANCE DATA

20

ANTENATAL HIV TESTINGYear Number

tested Number positive

%

2000 30,906 3 0.01

2001 20,409 0 0

2002 17,601 0 0

2003 20,286 1 0.01

2004 14,529 2 0.01

2005 14,476 0 0

2006 13,225 0 0

2007 8,648 1 0.012008 12,239 3 0.02

2009 11,216 2 0.02

HIV TESTING IN FORMER WAR AFFECTED AREASANC MOTHERS(2009 - 2010 up to June)

District Number of HIV tested

Number positive

Prevalence rate %

Vauniya 840 0 0Mullaitivu 101 0 0Kilinochchi 99 0 0

HIV AND BLOOD TRANSFUSION

HIV screening commenced in 1987

No Blood transfusion related HIV infection reported since year 2000

So far 3 cases of transfusion related HIV infections reported (0.4% of all HIV cases)

PERCENT OF VOLUNTARY VS. REPLACEMENT BLOOD DONATIONS

2002 2003 2004 2005 2006 2007 20080

102030405060708090

100

39 %

88%

61 %

12%

Voluntary Replacement

SOURCE: NATIONAL BLOOD TRANSFUSION SERVICE

HIV PREVALENCE IN DONATED BLOOD

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

0.0005

0.001

0.0015

0.002

0.0025

0.003

0.0035

0.004

0.0045

SOURCE: NATIONAL BLOOD TRANSFUSION SERVICE

% H

IV P

REVA

LEN

CE

2005 2006 2007 2008 20090

0.1

0.2

0.3

0.4

0.5

0.6

% P

reva

lenc

e ra

teHEP B & C IN DONATED BLOOD

SOURCE: NATIONAL BLOOD TRANSFUSION SERVICE

DATA ON HIV CASE REPORTING

CUMULATIVE REPORTED HIV CASES AS OF END 2009

1196 HIV infections (309 in AIDS stage)

202 Deaths

43 Children (Mother to child transmission)

During first 9 months in 2010 – 89 cases

Source :, National STD/AIDS Control Programme, Sri Lanka

REPORTED NUMBER OF HIV CASES20

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

20

40

60

80

100

120

140

160

Total

Male

Female

In 2009137 per year

National STD/AIDS Control Programme, Sri Lanka, 2009

In 2000

54 per year

MALE : FEMALE RATIO

National STD/AIDS Control Programme, Sri Lanka, 2008.

54%

46%

UP TO 2000

54%

46%

2001-2005

MALE FEMALE

61%

39%

2006- 2009

1.6 : 1 1.2 : 1 1.5 : 1

CUMULATIVE HIV CASES BY AGE AND SEX AS OF END 2009 (N=1141)

4 % 0.4 %6 %

80 %

10 %

Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.

(Age group % out of the total cases)

NEW HIV CASES BY AGE AND SEXIN 2009

Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.

7 % 0 %

72 %

5 %15 %

(Age group % out of the total cases)

Cumulative HIV Cases by Mode of Transmission as of end 2009 (N=802, 67%)

Hetero, 83%

Homo/Bi, 11%IDU,

0.4%Blood, 0.6%

Perinatal, 5%

Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.

Hetero65%

Homo/Bi

22%Perinatal

13%

National STD/AIDS Control Programme, Sri Lanka, 2010.

NEW HIV CASES BY MODE OF TRANSMISSION IN 2009 (N=77, 56%)

Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.

Cumulative HIV Cases by Province as of end 2009 (N=1196)

% of New HIV Cases by District in 2009

Sexually Transmitted Infections

TRENDS OF BACTERIAL STIs20

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

1

2

3

4

5

6

7

8

9

10

Rat

e pe

r 100

,000

pop

ulat

ion

Gonorrhea

Infectious syphilis

Non gonococcal Infections

TRENDS OF VIRAL STIs20

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

2

4

6

8

10

12

Rat

e pe

r 100

,000

pop

ulat

ion

Genital Warts

Genital Herpes

G.Herpes28%

NGU/NGC22%

G. Warts15%

B.-Vagi-nosis14%

S4E+S4L10%

GC+PGC4%

Other7%

PERCENTAGES OF REPORTED STI CASES IN 2009

G.Herpes Candidiaisis NGU/NGC G. Warts B.Vaginosis S4E+S4L GC+PGC Other

532

457405

275 263

181

84141

NUMBER OF REPORTED STI CASES IN 2009

2001 2002 2003 2004 2005 2006 2007 2008 20090

10

20

3040

50

6070

80

90

100

Penicillin

Tetracycline

Ciprofloxacin

Perc

enta

ge o

f res

ista

nce

ANTIBIOTIC RESISTANCE PATTERN OF N. gonorrhoeae (N= 220-260)

Cefuroxime Ceftriaxone Spectinomycin

2001 3.4% 0 02002 4.2% 0 02003 0 0 02004 0 0 02005 0 0 02006 0 0 02007 0 0 02008 0 0 02009 1.3% 0 0

ANTIBIOTIC RESISTANCE PATTERN OF N. gonorrhoeae (N= 220-260)

PERCENTAGE OF PREGNANT WOMEN SCREENEDFOR SYPHILIS (2005 - 2009)

Source: Annual report on family health Sri Lanka, 2005, Family Health Bureau

yearPregnant Mothers

Registered

Pregnant Mothers tested for VDRL Percent

2006 385,205 139,991 36%

2007 404,138 295,038 73%

2008 397,527 307,213 77%

2009 381,406 307,482 81%

ANTENATAL VDRL POSITIVITY RATE

2003

2004

2005

2006

2007

2008

2009

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.26

0.29

0.25

0.18

0.02

0.03

PERC

ENTA

GE O

F VD

RL P

OSI

TIVI

TY R

ATE

Source: FHB

SYPHILIS IN FORMER WAR AFFECTED AREASANC MOTHERS (2009 - 2010 up to June)

District VDRL tested

VDRL positive

TPPA Positive Prevalence

Vauniya 6,700 29 1 0.02%

Mullaitivu 175 2 0 0

Kilinochchi 104 1 0 0

COMMUNITY STI PREVALENCE SURVEYSStudy STI Prevalence (CI)

Low socioeconomic community women – Colombo -2007

Chlamydia 0.6% (0.04 - 1.16)

Trichomonasis 0.6% (0.04 - 1.16)

Gonorrhoea 0%

Community survey in Rathnapura - 2008

Chlamydia 2.1 (1.2 - 3.6)

Trichomonasis 1% (0.5 - 2)

Gonorrhoea 0%

Source: 1 Hemachandra N, Rajapaksha L , 2 Herath S, Samarakoon S, Fonseka P, 3 Herath S, , Fernando D, Jayasinghe S.

4 Herath S, Dewanarayana A, Senawirtne P

SUMMARY • Sri Lanka continues to indicate low prevalence

• Sizable vulnerable populations, Migration, Changing socio-economic situation can be Challenging

Low injecting drug use

Low sexual

concurrency

High literacy

rate

Favourable socio-cultural norms