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with men who have multiple partners including paying clients and women. Preliminary findings from the 2006 BSS suggest that STIs and HIV among female sex workers are relatively low, as they see few clients per day and have relatively high condom use. However, while reported symptoms of STIs were low, only about one-third knew women could be asymptomatic, and knowledge about how HIV is transmitted was low. Women and children engaged in sex work are considered most vulnerable to HIV infection because they often lack the ability or power to negotiate condom use with clients or to seek STI treatment. They are often "hidden," making it a challenge for HIV prevention services to reach them. Sexually Transmitted Infections: Every year estimates of detected STI cases in Sri Lanka vary from about 60,000 to 200,000, of which only 10-15 percent are reported by government clinics. STIs facilitate the spread of HIV infection and serve as indicators for low condom use and other high-risk sexual behaviors. High Mobility: Migration within Sri Lanka and emigration to the Middle East and neighboring countries is necessary for the economic survival of many rural and urban households. Thousands of women and men live away from their families as migrants abroad and as workers in Sri Lankan Free Trade Zones. An estimated 1.2 million Sri Lankans work in the Middle East and 79 percent of unskilled migrants are women. Removal from traditional social structures is believed to foster unsafe sexual practices, such as having multiple sexual partners and engaging in casual and commercial sex, as well as to increase vulnerability of women and girls to sexual abuse. Very few, however, have tested positive. Injecting Drug Users (IDUs): Current estimates of opiate users range from 30,000 to 240,000 out of which only 2 percent inject. However, an increase in drug injection could spark an epidemic. The BSS found that both knowledge about HIV transmission and that condom use were low among drug users. In addition, drug users often experience difficulty accessing information and services for both HIV prevention and treatment. Low Levels of Knowledge about how HIV is Transmitted: Knowledge about HIV transmission was low among the populations surveyed in the BSS. This increases the potential for HIV to spread as the groups surveyed are the populations engaging in riskier behavior. High Levels of Stigma associated with PLWA: The survey also indicated high levels of stigma towards PLWA among all groups. Stigma and discrimination discourage PLWA and others who fear they may be infected from seeking health care or from being tested. Moreover, they result in poor quality of care by health care workers.
The program has helped to ensure blood safety by increasing the voluntary blood donation rates, upgrading blood banks, and increasing transfusion screening for HIV. In addition, the NBTS has initiated a Communication Program through mass media to increase voluntary blood donation and raise the level of awareness and knowledge of HIV/AIDS among the general population. In addition to these primary prevention efforts initiated by the NSACP through the National HIV Prevention Project, the NSACP established Care and Treatment resources needed to make antiretroviral therapy (ART) available to the HIV-positive patients who need treatment. As of April 2008, the NSACP Central STD Clinic followed up 423 patients (just over half of those currently infected), of whom 113 receive ART. Nongovernmental Organizations (NGOs): Work of both local and international NGOs in the area of HIV prevention in Sri Lanka has been limited. NGO work remains largely uncoordinated, and its program coverage of high-risk populations is estimated to be less than 10 percent. Efforts are being undertaken to improve NGO collaboration and coordination with the government. Key actions needed are to increase the capacities of NGOs to work with vulnerable groups and of the government to systematically contract and fund NGOs.
Sri Lanka Ms. Chulie De Silva 9411-5561-323 cdesilva@worldbank.org Washington, DC Mr. Erik Nora 1-202-458-4735 enora@worldbank.org
www.worldbank.org/lk www.worldbank.org/saraids