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