overview of hiv/stis in sri lanka, 2000 - 2009 k. a. m. ariyaratne, md consultant venereologist
TRANSCRIPT
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OVERVIEW OF HIV/STIs IN SRI LANKA, 2000 - 2009
K. A. M. Ariyaratne, MDConsultant Venereologist
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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.
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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.
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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
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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
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HIGH-RISK POPULATIONS FOR HIV
Sex workers
IV drug usersMSM
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VULNERABLE POPULATIONS
Clients of sex workers
Drug users
Prisoners
Migrant workers
Internally displaced persons (IDP)
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DRAFT NATIONAL ESTIMATES
FSW – 41,000
(35,000 - 47,000)
MSM – 31,000
(24,000-37,000)
Strategic Information Management UNIT/NSACP/2010
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NATIONAL ESTIMATES
Drug users – 45,000
IDU – 900
(2% of Drug users)
Source: National Dangerous Drug Control Board
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NATIONAL ESTIMATES
Clients of Sex workers 261,000
3.5% of Adult males(Based on BSS 2007)
Strategic Information Management UNIT/NSACP/2010
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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
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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
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HIV INCIDENCE IN POPULATION SUBGROUPS
Source: Report on HIV Estimation and Projections 2009, Sri Lanka
New
infe
ction
s (
Thou
sand
s)
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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
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HIV SENTINEL SURVEY
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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
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HIV PREVALENCE AMONGMSM
2008 2009
0.5%
0.0%HIV
PR
EV
EL
AN
CE
%
SOURCE: NSACP /SENTINEL SUVEILLANCE DATA
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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
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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
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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 0.01
2008 12,239 3 0.02
2009 11,216 2 0.02
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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
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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)
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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
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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
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2005 2006 2007 2008 2009
HEP.B 0.08 0.09 0.1 0.094 0.141
HEP.C 0.34 0.330000000000001
0.27 0.28 0.57
0.05
0.15
0.25
0.35
0.45
0.55
% P
reva
lenc
e ra
teHEP B & C IN DONATED BLOOD
SOURCE: NATIONAL BLOOD TRANSFUSION SERVICE
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DATA ON HIV CASE REPORTING
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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
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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
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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
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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)
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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)
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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.
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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%)
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Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
Cumulative HIV Cases by Province as of end 2009 (N=1196)
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% of New HIV Cases by District in 2009
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Sexually Transmitted Infections
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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 p
er 1
00,0
00 p
op
ula
tio
n
Gonorrhea
Infectious syphilis
Non gonococcal Infections
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TRENDS OF VIRAL STIs20
00
2001
2002
2003
2004
2005
2006
2007
2008
2009
0
2
4
6
8
10
12
Rat
e p
er 1
00,0
00 p
op
ula
tio
n
Genital Warts
Genital Herpes
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G.Herpes28%
NGU/NGC22%
G. Warts15%
B.-Vagi-nosis14%
S4E+S4L10%
GC+PGC4%
Other7%
PERCENTAGES OF REPORTED STI CASES IN 2009
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G.Herpes Candidiaisis NGU/NGC G. Warts B.Vaginosis S4E+S4L GC+PGC Other
532
457405
275 263
181
84
141
NUMBER OF REPORTED STI CASES IN 2009
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2001 2002 2003 2004 2005 2006 2007 2008 20090
10
20
30
40
50
60
70
80
90
100
Penicillin
Tetracycline
Ciprofloxacin
Perc
enta
ge o
f res
ista
nce
ANTIBIOTIC RESISTANCE PATTERN OF N. gonorrhoeae (N= 220-260)
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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)
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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%
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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
OF
VDRL
PO
SITI
VITY
RAT
E
Source: FHB
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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
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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
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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