“Though Sri Lanka is still considered a low prevalence country for HIV/AIDS, most local HIV/AIDS experts agree that interventions must shift from general awareness campaigns to behavior change approaches targeted at vulnerable and at-risk populations. Government bureaucracy, lack of systematic data on risk behaviors, low knowledge levels, infection rates of at-risk groups and limited financial and human resources, however, inhibit this shift. Stigma and related discrimination further complicate interventions towards at-risk groups by making them ‘hidden.'” the US Embassy Colombo informed Washington.

The Colombo Telegraph found the related leaked cable from the WikiLeaks database. The unclassified diplomatic cable dated May 17, 2006, details the HIV/AIDS awareness, prevention, and stigma reduction activities in Sri Lanka.

Under the subheading ” Stigma and discrimination permeate Sri Lankan society” the US Embassy wrote;

Accompanying limited knowledge about HIV/AIDS is widespread stigma and discrimination within the health sector, the workplace, current legislation, and the media.

Health Sector: A recent Center for Policy Alternatives (CPA) report documents high levels of stigmatization within the healthcare sector, but respondents noted a marked improvement at the National STD clinic and at the Infectious Disease Hospital (IDH), the national referral hospital. Caregivers’ lack of experience and a severe lack of resources of dealing with the disease are often blamed for feeding discriminating sentiments.

Workplace: High levels of discrimination in the workplace have resulted in 98% of those infected with HIV losing their jobs, an issue currently being addressed by ILO’s HIV/AIDS in the Workplace Program, which was launched on July 8th, 2005.

Legislation: No laws exist to protect the rights of people living with HIV/AIDS (PLWHAs). Homosexual behavior is illegal in Sri Lanka under Section 365A of the Penal Code. Recent efforts to decriminalize it led to a public backlash and even more stringent anti-homosexual provisions.

Media: The media has been critiqued in the past for “numbers-oriented” reporting, breaches in confidentiality, casting moral judgments on mode of transmission, and sensationalizing AIDS as a “killer disease.” Leno suggested that the media can play an important role as an outlet for PLWHAs to begin speaking out publicly so that the disease becomes “normalized.” Therefore, incorporation of the media into future work would help reduce stigma and discrimination.

Placing a comment the Embassy said; “Considering the limited impact of previous HIV/AIDS awareness, prevention, and stigma reduction activities, it remains to be seen if the recent policy turn of using more targeted behavioral change strategies towards at-risk populations will have a greater effect. The small numbers and areas currently targeted in pilot projects speak to the need for greater financial, human, and technical resources to expand programs to reach the threshold necessary to change attitudes and behaviors. Difficulty in follow-up for at-risk groups due to stigma and discrimination pose greater challenges for impact assessments. Such evaluations are necessary for policymakers to assess the ability of their programs to hinder the spread of HIV through behavior change.”

Read the cable below for further details;

UNCLAS SECTION 01 OF 04 COLOMBO 000803 

SIPDIS 

SIPDIS, SENSITIVE 

STATE FOR OIE DANIEL SINGER AND REBECCA S DALEY 
STATE FOR SA/INS 

E.O. 12958: N/A 
TAGS: TBIO KSTH ECON PREL SOCI WHO EAGR CASC MV
SUBJECT: TRANSITIONS AND CHALLENGES IN HIV/AIDS PREVENTION 
ACTIVITIES IN SRI LANKA 

¶1. (SBU) SUMMARY: Though Sri Lanka is still considered a low 
prevalence country for HIV/AIDS, most local HIV/AIDS experts 
agree that interventions must shift from general awareness 
campaigns to behavior change approaches targeted at 
vulnerable and at-risk populations. Government bureaucracy, 
lack of systematic data on risk behaviors, low knowledge 
levels, infection rates of at-risk groups and limited 
financial and human resources, however, inhibit this shift. 
Stigma and related discrimination further complicate 
interventions towards at-risk groups by making them 
"hidden." End Summary 

CURRENT SITUATION 
----------------- 
¶2. (U) Statistics: According to available statistics from 
the National STD/AIDS Program, the cumulative number of HIV 
cases since 1986 (when the first case was identified) is 
¶743.  Ninety-eight new cases were reported within the first 
nine months of 2005. Estimates of Sri Lanka's infection 
rates range from 0.04% to 0.08% making it a low prevalence 
country. Most HIV/AIDS experts in conservative, primarily 
Buddhist Sri Lanka agree the figures are dramatically 
underrepresented due to social stigma and discrimination 
surrounding getting tested, as well as ignorance of the need 
to be tested if engaged in unprotected sex. 

¶3. (SBU) Janet Leno, UNAIDS country coordinator, believes 
that the government erroneously attributes the low 
prevalence to its general awareness campaigns and mass 
communication. She instead cites Sri Lanka's relative 
isolation (as an island), its comparatively low promiscuity, 
an ancient tradition of non-penetrative sex (much of the 
documentation on HIV/AIDS in Sri Lanka discuss the 
prevalence of Kamasutric practices that would not lead to 
transmission), and low intra-venous drug use as the major 
factors. Nonetheless, high risk factors exist, including a 
significant level of commercial sex work, especially 
surrounding military camps, low condom use, high sexually 
transmitted infection (STI) rates, high number of migrant 
and displaced populations returning from high HIV/AIDS 
prevalence regions, increasing drug use, increasingly 
sexually active youth, low knowledge and awareness of 
HIV/AIDS among vulnerable and underserved populations, and a 
limited surveillance system for monitoring. The few studies 
done by both local and international NGOs suggest a low 
level of knowledge and continued risky behavior. Such 
findings contradict assertions about the effectiveness of 
current HIV/AIDS awareness campaigns. 

STIGMA AND DISCRIMINATION PERMEATE SRI LANKAN SOCIETY 
--------------------------------------------- -------- 
¶4. (SBU) Accompanying limited knowledge about HIV/AIDS is 
widespread stigma and discrimination within the health 
sector, the workplace, current legislation, and the media. 

--Health Sector: A recent Center for Policy Alternatives 
(CPA) report documents high levels of stigmatization within 
the healthcare sector, but respondents noted a marked 
improvement at the National STD clinic and at the Infectious 
Disease Hospital (IDH), the national referral hospital. 
Caregivers' lack of experience and a severe lack of 
resources of dealing with the disease are often blamed for 
feeding discriminating sentiments. 

--Workplace: High levels of discrimination in the workplace 
have resulted in 98% of those infected with HIV losing their 
jobs, an issue currently being addressed by ILO's HIV/AIDS 
in the Workplace Program, which was launched on July 8th, 
¶2005. 

--Legislation: No laws exist to protect the rights of people 
living with HIV/AIDS (PLWHAs). Homosexual behavior is 

COLOMBO 00000803  002 OF 004 

illegal in Sri Lanka under Section 365A of the Penal Code. 
Recent efforts to decriminalize it led to a public backlash 
and even more stringent anti-homosexual provisions. 

--Media: The media has been critiqued in the past for 
"numbers-oriented" reporting, breaches in confidentiality, 
casting moral judgments on mode of transmission, and 
sensationalizing AIDS as a "killer disease." Leno suggested 
that the media can play an important role as an outlet for 
PLWHAs to begin speaking out publicly so that the disease 
becomes "normalized." Therefore, incorporation of the media 
into future work would help reduce stigma and 
discrimination. 

SLOW GSL BUREAUCRACY JUMPSTARTED BY WORLD BANK FUNDS 
--------------------------------------------- ------- 

¶5. (SBU) National STD/AIDS Committee: Despite commendation 
for its early recognition of the HIV/AIDS threat, the GSL 
has made slow progress on its national AIDS policy and its 
strategy plan. (Note: Its National AIDS Committee has not 
met in over six months due to a vacancy in the chair. End 
Note.) In addition, local HIV/AIDS activist Sherman de Rose 
has criticized the committee for prioritizing a clinical 
rather than a community focus and stresses the need to 
diversify committee representation beyond medical doctors to 
include other stakeholders. 

--National AIDS Policy: The Committee still has not released 
a national AIDS policy. Even though the current draft 
reaffirms the GSL's commitment to critical issues such as 
voluntary and confidential testing, condom promotion, and a 
commitment to human rights and non-discrimination policies, 
Leno felt it still needed more operational details, 
particularly surrounding the provision of drugs. 

--National Strategy Plan: The 2002-2006 Strategy Plan 
included a long list of relevant actions, but did not 
indicate priorities or the costs of implementing the various 
actions, which will hopefully be rectified in the upcoming 
plan for 2007-2011. 

¶6. (U) National HIV/AIDS Prevention Project (NHAPP): The WB 
pledged USD 12.6 million over five years to jumpstart 
HIV/AIDS prevention activities through NHAPP. Begun in 2003, 
the first component set up targeted interventions among 
highly vulnerable groups to sensitize those at greatest 
risk. A second round of proposals will give up to 40 grants 
for community-level HIV/AIDS prevention among at-risk 
populations with four larger grants to umbrella 
organizations to take on entire at-risk populations in 
certain locations. Funding will be used for data collection 
and behavioral surveys to devise behavioral change 
interventions and for capacity-building assistance to NGOs. 

A SURVEY OF CURRENT INTERVENTIONS WITH AT-RISK POPULATIONS 
--------------------------------------------- -------------- 
¶7. (SBU) Both UNAIDS and USAID suggest that the most cost- 
effective way to maintain low HIV prevalence is to provide 
prevention through behavior change interventions to large 
proportion of groups with highest risk behaviors. Current 
interventions towards such groups include: 

--Internal Migrant Workers: In 2005, partnering with a local 
NGO, IOM trained peer educators in a two-day workshop. The 
project found that poverty and a lack of awareness made 
women traveling from rural areas particularly vulnerable. 

--IDPs: No official studies on HIV/AIDS and IDPs exist as 
their transitory situation inhibits follow-up.  HIV/AIDS 
education remains minimal, largely restricted to posters in 
camps and a few youth life skills workshops in the East. 

COLOMBO 00000803  003 OF 004 

--Overseas Domestic Workers: The Ministry of Labor Relations 
and Foreign Employment (MOLRFE) currently conducts HIV/AIDS 
awareness programs for women leaving for the Middle East to 
work as domestic housemaids (a major source of remittance 
income in Sri Lanka). Existing data suggests that this group 
is possibly exploited for sex work abroad. 

--Male Migrant Workers: As part of their HIV/AIDS in the 
Workplace Program, ILO plans to train peer educators in 25 
recruiting agencies. Indira Hettariarachchi, the National 
Program Coordinator, acknowledged that behaviora change 
strategies and follow-up monitoring woul be difficult with 
this group because it was a one-time intervention. 

--Drug Users: According to Leno, the driving force behind 
HIV growth in Asia is intravenous drug use. Unofficially, 
intravenous drug use has been reported, and a recent 
assessment found that users engaged in risky behaviors such 
as sex with multiple partners, no condoms, and casual sex. 
Persecution by the police and stigma inhibit interventions 
and HIV testing within this group. 

--Child Sex Workers: Apparently there are no HIV/AIDS 
programs in Sri Lanka targeting child sex workers.  Maureen 
Seneviratne, director of PEACE, an NGO that raises awareness 
of the commercial exploitation of children, estimated that 
at least 5,000 male children work as sex workers in beach 
and mountain resort areas. According to Leno, Sri Lanka's 
National Child Protection Agency (NCPA) has a good system of 
identifying foreign pedophiles but the majority of child 
exploitation is local and often within families. 

FUTURE PROSPECTS 
---------------- 

¶8. (U) USAID Funding: USAID is collecting bids for an 
organization to offer capacity-building to more grassroots 
NGOs and Community Based Organizations to enhance their 
effectiveness in HIV/AIDS prevention activities for at-risk 
groups. 

¶9. (U) UNAIDS Activities: With a focus on risk and 
vulnerability in 2006, UNAIDS activities fall under three 
main categories: prevention, targeting at-risk populations, 
and stigma and discrimination. UNAIDS still needs additional 
funds, however, to expand to new risk groups, increase the 
scale of its current interventions, support its move from 
lecture-style to behavioral change-type interventions, 
integrate its efforts into other health initiatives, involve 
more stakeholders, and build local capacity. 

¶10. (U) International Congress on AIDS in Asia and the 
Pacific (ICAAP): From August 19-23, Sri Lanka will host the 
annual ICAAP meeting, which will bring together politicians, 
government officials, medical experts, academics, people 
living with HIV/AIDS, community workers, and the media, to 
discuss issues facing the epidemic in this region.  AIDS 
activist De Rose stressed the need for ICAAP topics to 
extend beyond discussions of appropriate medical treatment 
to include rights-based approaches, participatory methods, 
and patient care. 

Comment 
------- 

¶11. (SBU) Considering the limited impact of previous 
HIV/AIDS awareness, prevention, and stigma reduction 
activities, it remains to be seen if the recent policy turn 
of using more targeted behavioral change strategies towards 
at-risk populations will have a greater effect. The small 
numbers and areas currently targeted in pilot projects speak 

COLOMBO 00000803  004 OF 004 

to the need for greater financial, human, and technical 
resources to expand programs to reach the threshold 
necessary to change attitudes and behaviors. Difficulty in 
follow-up for at-risk groups due to stigma and 
discrimination pose greater challenges for impact 
assessments. Such evaluations are necessary for policymakers 
to assess the ability of their programs to hinder the spread 
of HIV through behavior change. End Comment 
ENTWISTLE