19TH ANNUAL SCIENTIFIC SESSIONS October 2014 Presidential Address “Moving Towards an Era Free of HIV”
“Moving Towards an Era Free of HIV” Dr Himali Perera, President, Sri Lanka College of Venereologists
Presidential Address , SLCV, 2014
Estimated number of adults children newly infected with HIV 2013
Eastern Europe & Central Asia
110 000
North America and Western and Central Europe
[86 000 – 130 000]
88 000
[44 000 – 160 000] Middle East & North Africa Caribbean
12 000
[9400 – 14 000] Latin America
94 000
[71 000 – 170 000]
25 000
[14 000 – 41 000]
Asia and the Pacific
350 000
Sub-Saharan Africa
[250 000 – 510 000]
1.5 million
[1.3 million – 1.6 million]
Total: 2.1 million [1.9 million – 2.4 million] 3
Situation in South East Asia
Situation in Sri Lanka
Annual HIV Incidence
Annual AIDS Incidence and AIDS Deaths
Perinatal 6%
Not reported 17%
IDU 2%
Hetero 48% Homo/Bi 27%
SIM Unit/National STD/AIDS Control Programme-2014
Female
Sex Workers (FSW) Men who have Sex with Men Drug Users/Intravenous Drug Users Beach Boys
Presidential Address , SLCV, 2014
Female Sex Workers Central 8%
Eastern 5% North Central 11%
North Western 7%
Western 52%
Northern 1%
Southern 6%
Uva 3%
Sabaragamuwa 7%
National est. average - 14,132
(12,329 – 15,935)
WP
NCP
CP
NWP
SAB
7278
1436
1173
1052
976
Female Sex Workers
No. hotspots 3683
Street/public places Home/shanty -
42% 22%
Men who have sex with Men
Other MSM 29%
MSW 35%
Nachchi 36% National est. average – 7551
MSW 2672
(6547- 8554) Nachchis Other MSM 2693
2186
Men who have sex with Men
No. of spots 1438 WP
SP
CP
4925
611
560
Street/Public places -76% ; Home/Shanty 26%
Drug Users & Number of active spots : Drug users, Injecting drug users , and those share needles No. spots 1923
1923 2000 1500 1000 125
500 0
DU
Injecting Dus
74
Share needles
National est. average = 17,459 (15,338- 19,452) Typology Street based Home/shanty based
Average
Range
12,927
11,385 -14,504
3599
3123-4075
Injecting happens 125
Needle sharing happens 74
Beach boys Eastern 26%
Western 27%
North Western 3% Southern 44%
No. of spots 102 SP
EP
WP
NWP
No. BB
677
387
386
36
No. spots
43
18
37
04
Beach boys
National est. averages Average day : 873 (752-993) Peak day : 1314 (1142 -1486) Peak month : 2251
Early Diagnosis Treatment , adherence and retain in the care. Prevention of HIV Transmission
Presidential Address , SLCV, 2014
14%
With emergence of HIV epidemic tuberculosis has become a challenge
19 cases of HIV/TB identified in Sri Lanka up to 2012
Therefore ,TB screening in all HIV patients are mandatory .
When there is a co infection treatment of tuberculosis should be initiated and followed by ART to prevent Immune reconstitution inflammatory syndrome.
Number of PLHIV enrolled in HIV Care in 2012 149 Number of PLHIV On antiTB treatment at the diagnosis of HIV 4 (3%)
Number of PLHIV referred for TB screening 139 (96%)
9 Latent TB
7%
4 Pul TB Smear +
3%
1 Pul TB Smear -
1%
5 Extra Pul TB
4%
TB Neg.
10 on INAH prophylasis therapy in 2012
Source: NSACP/SIM
Migrant
workers Prisoners Police and armed forces Tourist industry workers Road construction workers
Ministry
of Health SLR 85 283,185
53.8%
Donors
46.2% Global fund - SLR UNFPA WHO UNICEF
Total spending NSACP
65,468,530 4, 583,250 1, 572, 978 111,176 Rs 158,359, 761
Thailand USA Brazil
Presidential Address , SLCV, 2014
Goal: Zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination
RECRUIT – TEST – TREAT – RETAIN
Presidential Address , SLCV, 2014
11
Estimated millions of people eligible for ART in LMIC 32 15 23
25
1
2
3
4
5
CD4 ≤ 200
CD4 ≤ 350
CD4 ≤ 350 + TasP
CD4 ≤ 500
All HIV+
Recommended Since 2003
Recommended
since 2010
Incremental approach 2012
2013
ART regardless of CD4 count for: - Serodiscordant couples -Pregnant women -TB - Key populations (SW, IDU, MSM)
“Test and treat”
Major reduction in mortality expected Estimated annual HIV-related deaths
-39%
Source: Special analysis conducted by Futures Institute, 2013
Ending the AIDS epidemic by 2030 Getting to ZERO: NEW HIV INFECTIONS
90%
- 90% reduction in new adult HIV infections, including among key populations
DISCRIMINATION
90%
- 90% reduction in stigma and discrimination faced by people living with HIV and key populations
AIDS-RELATED DEATHS
90%
- 90% reduction in AIDS-related deaths
- Zero new infections among children
Delivering equity: indicators to be disaggregated by: age, gender, key population, and income status to measure progress on leaving no one behind. The baseline year is 2010.
The path towards “Zero deaths� Scale up
Innovate
Testing and ART to all people living with HIV
Drugs
Focus on key populations Linkages and retention Quality And Comprehensive care models
Diagnostics
Service delivery models
Research and develop
Preventive vaccine Cure
Presence
of large youth population Internal and external migration Clandestine but flourishing sex industry Low level of condom use Concurrent sexual relationship among key populations
Presidential Address , SLCV, 2014
Prioritise
the targeted intervention to the key populations Raising the public awareness about HIV Ensure blood safety HIV testing and counselling EMTCT Better medical care and supportive environment Reduce stigma and discrimination Presidential Address , SLCV, 2014
HFC -Kurunegala Pinnwala central college University of Colombo All consultants 窶的ntern and post intern period All consultants postgraduate studies- Dr Iyanthi Abeywicrama,Lilani Rajapaksha , G weerasinghe , KAM Ariyarathne , Dr Mananwatha Dr L Jaya suriya, Dr Jayakuru Dr C.Wickramasuriya & Dr Buddakorala Dr Beng tin Goh
All
council members Other college members STD Clinic Staff Kalutara Dr Lasanthi secretary & Dr Hathurusinghe treasurer for their hard work Family
T