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<\/a>The\u00a0Colombo Telegraph<\/a><\/span>\u00a0found the related leaked cable from the\u00a0WikiLeaks<\/a><\/span>\u00a0database. The unclassified diplomatic cable dated May 17, 2006, details the\u00a0HIV\/AIDS awareness, prevention, and stigma reduction activities in Sri Lanka.<\/p>\nUnder the subheading ” Stigma and discrimination permeate Sri Lankan society” the US Embassy wrote;<\/p>\n
Accompanying limited knowledge about HIV\/AIDS is widespread stigma and discrimination within the health sector, the workplace, current legislation, and the media.<\/p>\n
Health Sector<\/strong>: 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.<\/p>\n Workplace<\/strong>: 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.<\/p>\n Legislation<\/strong>: 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.<\/p>\n Media<\/strong>: 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.<\/p>\n 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.”<\/p>\n Read the cable below for further details;<\/p>\n […]<\/p>\n","protected":false},"author":22,"featured_media":71047,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[3,1,6969,2375,27],"tags":[],"class_list":["post-118806","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-colombotelegraph","category-news","category-popular-stories","category-stories","category-wikileaks"],"yoast_head":"\nUNCLAS SECTION 01 OF 04 COLOMBO 000803 \r\n\r\nSIPDIS \r\n\r\nSIPDIS, SENSITIVE \r\n\r\nSTATE FOR OIE DANIEL SINGER AND REBECCA S DALEY \r\nSTATE FOR SA\/INS \r\n\r\nE.O. 12958: N\/A \r\nTAGS: TBIO KSTH ECON PREL SOCI WHO EAGR CASC MV\r\nSUBJECT: TRANSITIONS AND CHALLENGES IN HIV\/AIDS PREVENTION \r\nACTIVITIES IN SRI LANKA \r\n\r\n\u00b61. (SBU) SUMMARY: Though Sri Lanka is still considered a low \r\nprevalence country for HIV\/AIDS, most local HIV\/AIDS experts \r\nagree that interventions must shift from general awareness \r\ncampaigns to behavior change approaches targeted at \r\nvulnerable and at-risk populations. Government bureaucracy, \r\nlack of systematic data on risk behaviors, low knowledge \r\nlevels, infection rates of at-risk groups and limited \r\nfinancial and human resources, however, inhibit this shift. \r\nStigma and related discrimination further complicate \r\ninterventions towards at-risk groups by making them \r\n\"hidden.\" End Summary \r\n\r\nCURRENT SITUATION \r\n----------------- \r\n\u00b62. (U) Statistics: According to available statistics from \r\nthe National STD\/AIDS Program, the cumulative number of HIV \r\ncases since 1986 (when the first case was identified) is \r\n\u00b6743. Ninety-eight new cases were reported within the first \r\nnine months of 2005. Estimates of Sri Lanka's infection \r\nrates range from 0.04% to 0.08% making it a low prevalence \r\ncountry. Most HIV\/AIDS experts in conservative, primarily \r\nBuddhist Sri Lanka agree the figures are dramatically \r\nunderrepresented due to social stigma and discrimination \r\nsurrounding getting tested, as well as ignorance of the need \r\nto be tested if engaged in unprotected sex. \r\n\r\n\u00b63. (SBU) Janet Leno, UNAIDS country coordinator, believes \r\nthat the government erroneously attributes the low \r\nprevalence to its general awareness campaigns and mass \r\ncommunication. She instead cites Sri Lanka's relative \r\nisolation (as an island), its comparatively low promiscuity, \r\nan ancient tradition of non-penetrative sex (much of the \r\ndocumentation on HIV\/AIDS in Sri Lanka discuss the \r\nprevalence of Kamasutric practices that would not lead to \r\ntransmission), and low intra-venous drug use as the major \r\nfactors. Nonetheless, high risk factors exist, including a \r\nsignificant level of commercial sex work, especially \r\nsurrounding military camps, low condom use, high sexually \r\ntransmitted infection (STI) rates, high number of migrant \r\nand displaced populations returning from high HIV\/AIDS \r\nprevalence regions, increasing drug use, increasingly \r\nsexually active youth, low knowledge and awareness of \r\nHIV\/AIDS among vulnerable and underserved populations, and a \r\nlimited surveillance system for monitoring. The few studies \r\ndone by both local and international NGOs suggest a low \r\nlevel of knowledge and continued risky behavior. Such \r\nfindings contradict assertions about the effectiveness of \r\ncurrent HIV\/AIDS awareness campaigns. \r\n\r\nSTIGMA AND DISCRIMINATION PERMEATE SRI LANKAN SOCIETY \r\n--------------------------------------------- -------- \r\n\u00b64. (SBU) Accompanying limited knowledge about HIV\/AIDS is \r\nwidespread stigma and discrimination within the health \r\nsector, the workplace, current legislation, and the media. \r\n\r\n--Health Sector: A recent Center for Policy Alternatives \r\n(CPA) report documents high levels of stigmatization within \r\nthe healthcare sector, but respondents noted a marked \r\nimprovement at the National STD clinic and at the Infectious \r\nDisease Hospital (IDH), the national referral hospital. \r\nCaregivers' lack of experience and a severe lack of \r\nresources of dealing with the disease are often blamed for \r\nfeeding discriminating sentiments. \r\n\r\n--Workplace: High levels of discrimination in the workplace \r\nhave resulted in 98% of those infected with HIV losing their \r\njobs, an issue currently being addressed by ILO's HIV\/AIDS \r\nin the Workplace Program, which was launched on July 8th, \r\n\u00b62005. \r\n\r\n--Legislation: No laws exist to protect the rights of people \r\nliving with HIV\/AIDS (PLWHAs). Homosexual behavior is \r\n\r\nCOLOMBO 00000803 002 OF 004 \r\n\r\nillegal in Sri Lanka under Section 365A of the Penal Code. \r\nRecent efforts to decriminalize it led to a public backlash \r\nand even more stringent anti-homosexual provisions. \r\n\r\n--Media: The media has been critiqued in the past for \r\n\"numbers-oriented\" reporting, breaches in confidentiality, \r\ncasting moral judgments on mode of transmission, and \r\nsensationalizing AIDS as a \"killer disease.\" Leno suggested \r\nthat the media can play an important role as an outlet for \r\nPLWHAs to begin speaking out publicly so that the disease \r\nbecomes \"normalized.\" Therefore, incorporation of the media \r\ninto future work would help reduce stigma and \r\ndiscrimination. \r\n\r\nSLOW GSL BUREAUCRACY JUMPSTARTED BY WORLD BANK FUNDS \r\n--------------------------------------------- ------- \r\n\r\n\u00b65. (SBU) National STD\/AIDS Committee: Despite commendation \r\nfor its early recognition of the HIV\/AIDS threat, the GSL \r\nhas made slow progress on its national AIDS policy and its \r\nstrategy plan. (Note: Its National AIDS Committee has not \r\nmet in over six months due to a vacancy in the chair. End \r\nNote.) In addition, local HIV\/AIDS activist Sherman de Rose \r\nhas criticized the committee for prioritizing a clinical \r\nrather than a community focus and stresses the need to \r\ndiversify committee representation beyond medical doctors to \r\ninclude other stakeholders. \r\n\r\n--National AIDS Policy: The Committee still has not released \r\na national AIDS policy. Even though the current draft \r\nreaffirms the GSL's commitment to critical issues such as \r\nvoluntary and confidential testing, condom promotion, and a \r\ncommitment to human rights and non-discrimination policies, \r\nLeno felt it still needed more operational details, \r\nparticularly surrounding the provision of drugs. \r\n\r\n--National Strategy Plan: The 2002-2006 Strategy Plan \r\nincluded a long list of relevant actions, but did not \r\nindicate priorities or the costs of implementing the various \r\nactions, which will hopefully be rectified in the upcoming \r\nplan for 2007-2011. \r\n\r\n\u00b66. (U) National HIV\/AIDS Prevention Project (NHAPP): The WB \r\npledged USD 12.6 million over five years to jumpstart \r\nHIV\/AIDS prevention activities through NHAPP. Begun in 2003, \r\nthe first component set up targeted interventions among \r\nhighly vulnerable groups to sensitize those at greatest \r\nrisk. A second round of proposals will give up to 40 grants \r\nfor community-level HIV\/AIDS prevention among at-risk \r\npopulations with four larger grants to umbrella \r\norganizations to take on entire at-risk populations in \r\ncertain locations. Funding will be used for data collection \r\nand behavioral surveys to devise behavioral change \r\ninterventions and for capacity-building assistance to NGOs. \r\n\r\nA SURVEY OF CURRENT INTERVENTIONS WITH AT-RISK POPULATIONS \r\n--------------------------------------------- -------------- \r\n\u00b67. (SBU) Both UNAIDS and USAID suggest that the most cost- \r\neffective way to maintain low HIV prevalence is to provide \r\nprevention through behavior change interventions to large \r\nproportion of groups with highest risk behaviors. Current \r\ninterventions towards such groups include: \r\n\r\n--Internal Migrant Workers: In 2005, partnering with a local \r\nNGO, IOM trained peer educators in a two-day workshop. The \r\nproject found that poverty and a lack of awareness made \r\nwomen traveling from rural areas particularly vulnerable. \r\n\r\n--IDPs: No official studies on HIV\/AIDS and IDPs exist as \r\ntheir transitory situation inhibits follow-up. HIV\/AIDS \r\neducation remains minimal, largely restricted to posters in \r\ncamps and a few youth life skills workshops in the East. \r\n\r\nCOLOMBO 00000803 003 OF 004 \r\n\r\n--Overseas Domestic Workers: The Ministry of Labor Relations \r\nand Foreign Employment (MOLRFE) currently conducts HIV\/AIDS \r\nawareness programs for women leaving for the Middle East to \r\nwork as domestic housemaids (a major source of remittance \r\nincome in Sri Lanka). Existing data suggests that this group \r\nis possibly exploited for sex work abroad. \r\n\r\n--Male Migrant Workers: As part of their HIV\/AIDS in the \r\nWorkplace Program, ILO plans to train peer educators in 25 \r\nrecruiting agencies. Indira Hettariarachchi, the National \r\nProgram Coordinator, acknowledged that behaviora change \r\nstrategies and follow-up monitoring woul be difficult with \r\nthis group because it was a one-time intervention. \r\n\r\n--Drug Users: According to Leno, the driving force behind \r\nHIV growth in Asia is intravenous drug use. Unofficially, \r\nintravenous drug use has been reported, and a recent \r\nassessment found that users engaged in risky behaviors such \r\nas sex with multiple partners, no condoms, and casual sex. \r\nPersecution by the police and stigma inhibit interventions \r\nand HIV testing within this group. \r\n\r\n--Child Sex Workers: Apparently there are no HIV\/AIDS \r\nprograms in Sri Lanka targeting child sex workers. Maureen \r\nSeneviratne, director of PEACE, an NGO that raises awareness \r\nof the commercial exploitation of children, estimated that \r\nat least 5,000 male children work as sex workers in beach \r\nand mountain resort areas. According to Leno, Sri Lanka's \r\nNational Child Protection Agency (NCPA) has a good system of \r\nidentifying foreign pedophiles but the majority of child \r\nexploitation is local and often within families. \r\n\r\nFUTURE PROSPECTS \r\n---------------- \r\n\r\n\u00b68. (U) USAID Funding: USAID is collecting bids for an \r\norganization to offer capacity-building to more grassroots \r\nNGOs and Community Based Organizations to enhance their \r\neffectiveness in HIV\/AIDS prevention activities for at-risk \r\ngroups. \r\n\r\n\u00b69. (U) UNAIDS Activities: With a focus on risk and \r\nvulnerability in 2006, UNAIDS activities fall under three \r\nmain categories: prevention, targeting at-risk populations, \r\nand stigma and discrimination. UNAIDS still needs additional \r\nfunds, however, to expand to new risk groups, increase the \r\nscale of its current interventions, support its move from \r\nlecture-style to behavioral change-type interventions, \r\nintegrate its efforts into other health initiatives, involve \r\nmore stakeholders, and build local capacity. \r\n\r\n\u00b610. (U) International Congress on AIDS in Asia and the \r\nPacific (ICAAP): From August 19-23, Sri Lanka will host the \r\nannual ICAAP meeting, which will bring together politicians, \r\ngovernment officials, medical experts, academics, people \r\nliving with HIV\/AIDS, community workers, and the media, to \r\ndiscuss issues facing the epidemic in this region. AIDS \r\nactivist De Rose stressed the need for ICAAP topics to \r\nextend beyond discussions of appropriate medical treatment \r\nto include rights-based approaches, participatory methods, \r\nand patient care. \r\n\r\nComment \r\n------- \r\n\r\n\u00b611. (SBU) Considering the limited impact of previous \r\nHIV\/AIDS awareness, prevention, and stigma reduction \r\nactivities, it remains to be seen if the recent policy turn \r\nof using more targeted behavioral change strategies towards \r\nat-risk populations will have a greater effect. The small \r\nnumbers and areas currently targeted in pilot projects speak \r\n\r\nCOLOMBO 00000803 004 OF 004 \r\n\r\nto the need for greater financial, human, and technical \r\nresources to expand programs to reach the threshold \r\nnecessary to change attitudes and behaviors. Difficulty in \r\nfollow-up for at-risk groups due to stigma and \r\ndiscrimination pose greater challenges for impact \r\nassessments. Such evaluations are necessary for policymakers \r\nto assess the ability of their programs to hinder the spread \r\nof HIV through behavior change. End Comment \r\nENTWISTLE<\/pre>\n","protected":false},"excerpt":{"rendered":"