Transcript Overview of STIs and HIV in Sri Lanka

OVERVIEW OF HIV/STIs
IN SRI LANKA, 2000 - 2009
K. A. M. Ariyaratne, MD
Consultant Venereologist
HIV EPIDEMIC IN SRI LANKA
1987
•First Sri Lankan with HIV
reported
•First locally acquired
1989 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
6000
Estimated number
4800
5000
5000
4000
4000
3500
3000
3000
2000
1000
0
2001
2003
2005
Year of Estimate
Dr K A M Ariyaratne, NSACP, MOH, Sri
Lanka
2007
2009
HIV ESTIMATIONS DONE IN 2009
Estimated Adults living with HIV
3500
3000
2500
2471
2644
2818
2997
2000
1500
1000
500
0
2007
2008
2009
2010
HIGH-RISK POPULATIONS FOR HIV
Sex workers
MSM
IV drug
users
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
Percentage
HIV PREVALENCE AMONG HIGH-RISK SUBGROUPS
MSM
FSW
Clients
of FSW
Drug
users
Source: Report on HIV Estimation and Projections 2009, Sri Lanka
New infections ( Thousands)
HIV INCIDENCE IN POPULATION SUBGROUPS
Source: Report on HIV Estimation and Projections 2009, Sri Lanka
TRENDS IN ADULT HIV PREVALENCE (15+)
Percentage
Current HIV
prevalence
Source: Report on HIV Estimation and Projections 2009, Sri Lanka
Peak around
2012
HIV SENTINEL
SURVEY
HIV PREVALENCE AMONG
FEMALE SEX WORKERS
HIV PREVELANCE %
2 YEAR MOVING AVERAGE
0.20%
0.14% 0.13%
0.07%
0%
2000
0.16%
0%
2001
2002
2003
2004
2005
2006
0%
0%
2007
2009
SOURCE: NSACP /SENTINEL SUVEILLANCE DATA
HIV PREVELANCE %
HIV PREVALENCE AMONG
MSM
0.5%
0.0%
2008
2009
SOURCE: NSACP /SENTINEL SUVEILLANCE DATA
HIV PREVELANCE %
HIV PREVALENCE AMONG
STD CLINIC ATTENDEES
2 YEAR MOVING AVERAGE
0.36%
0.28%
0.2% 0.15%
0.13 %
2000
0.08% 0.04 %
0.08% 0.09%
2001
2002
2003
2004
2005
2006
2007
2009
SOURCE: NSACP /SENTINEL SUVEILLANCE DATA
HIV PREVELANCE %
HIV PREVALENCE AMONG
TUBERCULOSIS PATIENTS
2 YEAR MOVING AVERAGE
0.13 %
0.11%
0.00%
0.06%
0.07%
0.00%
0.08%
0%
2000
2001
2002
2003
2004
2005
2006
2007
0%
2009
SOURCE: NSACP /SENTINEL SUVEILLANCE DATA
ANTENATAL HIV TESTING
Year
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
%
20
HIV TESTING IN FORMER WAR AFFECTED AREAS
ANC MOTHERS(2009 - 2010 up to June)
District
Number of Number
HIV tested positive
Vauniya
840
0
Mullaitivu
101
0
Kilinochchi
99
0
Prevalence
rate %
0
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
Voluntary
100
90
80
70
60
50
40
30
20
10
0
Replacement
88%
61 %
39 %
2002
12%
2003
2004
2005
2006
2007
2008
SOURCE: NATIONAL BLOOD TRANSFUSION SERVICE
HIV PREVALENCE IN DONATED BLOOD
% HIV PREVALENCE
0.0045
0.004
0.0035
0.003
0.0025
0.002
0.0015
0.001
0.0005
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
SOURCE: NATIONAL BLOOD TRANSFUSION SERVICE
HEP B & C IN DONATED BLOOD
% Prevalence rate
0.6
0.5
0.4
0.3
0.2
0.1
0
HEP.B
HEP.C
2005
0.08
0.34
2006
0.09
0.33
2007
0.1
0.27
2008
0.094
0.28
2009
0.141
0.57
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 CASES
In
2009
160
137
140
Total
per
year
120
100
80
In
2000
54 per
year
Male
60
Female
40
20
National STD/AIDS Control Programme, Sri Lanka, 2009
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
0
MALE : FEMALE RATIO
UP TO 2000
2001-2005
54%
46%
1.6 : 1
39%
46%
54%
MALE
2006- 2009
61%
FEMALE
1.2 : 1
National STD/AIDS Control Programme, Sri
Lanka, 2008.
1.5 : 1
CUMULATIVE HIV CASES BY AGE AND
SEX AS OF END 2009 (N=1141)
80 %
4%
0.4 %
6%
10 %
(Age group % out of the total cases)
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
NEW HIV CASES BY AGE AND SEX
IN 2009
72 %
15 %
7%
0%
5%
(Age group % out of the total cases)
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
Cumulative HIV Cases by Mode of
Transmission as of end 2009 (N=802, 67%)
Hetero,
83%
Perinatal,
5%
Blood,
0.6%
IDU,
0.4%
Homo/Bi,
11%
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
NEW HIV CASES BY MODE OF TRANSMISSION
IN 2009 (N=77, 56%)
Hetero
65%
Perinatal
13%
National STD/AIDS Control Programme, Sri Lanka, 2010.
Homo/Bi
22%
Cumulative HIV Cases by Province
as of end 2009 (N=1196)
Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
% of New HIV Cases by District
in 2009
Sexually Transmitted
Infections
TRENDS OF BACTERIAL STIs
Non gonococcal Infections
9
8
7
6
5
4
Gonorrhea
3
2
Infectious syphilis
1
2009
2008
2007
2006
2005
2004
2003
2002
2001
0
2000
Rate per 100,000 population
10
2009
2008
8
2007
10
2006
2005
2004
2003
2002
2001
2000
Rate per 100,000 population
TRENDS OF VIRAL STIs
12
Genital Herpes
Genital Warts
6
4
2
0
PERCENTAGES OF REPORTED STI CASES IN 2009
GC+PGC
4%
Other
7%
G.Herpes
28%
S4E+S4L
10%
B.Vaginosis
14%
G. Warts
15%
NGU/NGC
22%
NUMBER OF REPORTED STI CASES IN 2009
532
457
405
275
263
181
141
84
ANTIBIOTIC RESISTANCE PATTERN
OF N. gonorrhoeae (N= 220-260)
Percentage of resistance
100
90
Ciprofloxacin
80
Penicillin
70
60
50
40
30
20
10
Tetracycline
0
2001 2002 2003 2004 2005 2006 2007 2008 2009
ANTIBIOTIC RESISTANCE PATTERN
OF N. gonorrhoeae (N= 220-260)
2001
2002
2003
2004
2005
2006
2007
2008
2009
Cefuroxime
Ceftriaxone
Spectinomycin
3.4%
4.2%
0
0
0
0
0
0
1.3%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PERCENTAGE OF PREGNANT WOMEN SCREENED
FOR SYPHILIS (2005 - 2009)
year
Pregnant
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%
Source: Annual report on family health Sri Lanka, 2005, Family Health Bureau
0.35
0.29
0.3
0.25
0.26
0.25
0.2
0.18
0.15
0.1
0.03
0.05
0.02
2009
2008
2007
2006
2005
2004
0
2003
PERCENTAGE OF VDRL POSITIVITY RATE
ANTENATAL VDRL POSITIVITY RATE
Source: FHB
SYPHILIS IN FORMER WAR AFFECTED AREAS
ANC 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 SURVEYS
Study
Low socioeconomic
community women –
Colombo -2007
Community survey in
Rathnapura - 2008
STI
Prevalence (CI)
Chlamydia
0.6%
(0.04 - 1.16)
Trichomonasis
0.6%
(0.04 - 1.16)
Gonorrhoea
0%
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
Low
injecting
drug use
Low sexual
concurrency
High literacy
rate
Favourable
sociocultural
norms
• Sizable vulnerable populations, Migration,
Changing socio-economic situation can be
Challenging