The first case of HIV was detected in 1987. Sri Lanka has a low level HIV epidemic, with an estimated adult HIV prevalence of less than 0.1% in 2009 [1], and an estimated 2,800 people living with HIV, up from 1,300 in 2001 [1]. By end 2010, the reported cumulative number of HIV cases was 1,317 (784 males and 533 females) with a male-to-female ratio of 1:5:1 [2]. Two-thirds (66.4%) of the reported HIV cases in 2010 were among individuals aged between 30 and 49 years. Nearly six of every 10 reported cumulative HIV cases (57.2%) have been concentrated in the Western province, where the national capital district of Colombo (36.2% of overall total) is located [2]. By the end of 2009, the reported numbers of cumulative AIDS cases and AIDS-related deaths were 340 and 221, respectively [2]. In 2009, over 397,374 people were tested for HIV, of which 137 cases were confirmed as HIV positive, with 0.03% sero-positive rate. HIV positive men outnumbered women in all age groups, except for the 15-19 year age group in which the numbers for both were almost equal. HIV infected people were mostly found in the 35-39 year age group, which constituted nearly 20% of all cases [2].

HIV is mainly transmitted through heterosexual mode [2], accounting for 82.5% of total cases; followed by homosexual and bisexual modes (11.3%), peri-natal (5.3%), blood transfusion (0.3%) and use of injecting drugs (0.6%). Six groups have been considered as at risk of HIV infection based on the findings of the first round (2006-20007) Behavioural Surveillance Survey (BSS) - sex workers, drug users, men who have sex with men (MSM), “beach boys”, three-wheel drivers and factory workers in the free trade zone.

The estimated number of female sex workers (FSWs) in Sri Lanka ranged from 35,000 to 47,000 – with an estimated 8,332 in Colombo and 1,138 in Anuradhapura [3]. HIV is low among FSWs with HIV prevalence remaining at 0% as of 2009, although it was detected to be 0.2% during 2003–2004 and reached 0.3% in 2006 in Colombo [4]. Clients of FSWs were estimated at 700,000, which included students, police officers, truck drivers, dockworkers, and sailors [5]. The 2006-2007 BSS found that 70% of male patients at STI clinics had reportedly frequented sex workers [6].  

Current estimates of opiate users range from 30,000 to 240,000 individuals and the majority of heroin users inhale or snort heroin [5]. A 2006-2007 study among 278 drug users in three prisons in Sri Lanka found the prevalence of intravenous drug use to be higher than what was officially reported (15.8% vs. 1%). In addition, there was a high prevalence (53%) of risk-taking sexual behaviour – meaning, lifetime prevalence of sex with an FSW was high (67%) and regular condom use with an FSW was low (14%) [7].

The current size estimate for MSM is 30,554 (including 8,869 in Colombo and 700 in Anuradhapura) [3] and they make up a key vulnerable population in Sri Lanka where 11% of the reported HIV infections are attributable to homosexual transmission.  A survey conducted among male university students highlighted that 50% of their first sexual experience had been with a man [8]. The MSM population was included as a surveillance group beginning in the 2008 HIV Sentinel Sero-Surveillance Survey (HSS) and, up until this point, HIV prevalence among this group was 0% in 2008 and 0.48% in 2009 [4].

The term “beach boys” refers to young men who work near or on the beaches (typically tourist-frequented), and who offer sexual services in exchange for some form of payment.  They also include those working in restaurants, hotels, guest houses and boat-related tourism. The United Nations Development Program (UNDP) estimates that there are 30,000 beach boys in tourist resorts. They are at risk of HIV infection due to low levels of condom use and having unprotected sex with male and female sexual partners including tourists from high HIV prevalence countries [6].

Approximately 111,000 registered three-wheeled taxi drivers operate within Sri Lanka and they make up a vulnerable group for HIV infection given their close association with the commercial sex trade. Three-wheeled taxis are frequently used to transport sex workers and their clients and they are used as a venue for sex.  Furthermore, the drivers function as brokers, employers, and customers of sex workers [6].

Among the risk factors include: an emerging sexually active youth population (17-19% of the total population of 18.3 million in 2010) and low levels of HIV knowledge among them [9]; an open economy leading to large industrial zones with an estimated workforce consisting of young people of over 100,000 [9]; high mobility (both emigration and immigration) [10]; increasing commercial sex and networks between sex workers, MSM and IDUs; low level of condom use in MSM, beach boys, IDUs, and some types of sex workers [6]; high rate of sharing needles and syringes among IDUs [6]; low level  of knowledge about HIV transmission among high-risk groups [6]; and low rate of HIV testing among key affected populations (FSWs 43%, MSM 14% in 2009) [11].

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic, 2010

[2] Sri Lanka, National STD/AIDS Control Programme, 2010

[3] Sri Lanka, National STD/AIDS Control Programme,  Mapping Key Populations for HIV Prevention in Sri Lanka, March 2010

[4] Sri Lanka, UNGASS Country Report, 2010 citing National STD/AIDS Control Programme

[5] The World Bank, HIV/AIDS in Sri Lanka, August 2008

[6] National STD/AIDS Control Programme, Ministry of Healthcare and Nutrition, Sri Lanka Behavioural Surveillance Survey (First Round Survey Results 2006-2007), Sri Lanka, 2007

[7] Dissabandara LO, Dias SR, Dodd PR, Stadlin A. Patterns of substance use in male incarcerated drug users in Sri Lanka. Drug Alcohol Rev. 2009 Nov;28(6):600-7

[8] Silva, K.T., Schensul, S.L., Schensul, J.J., Nastasi, B., Amarasiri de Silva, M.W., Sivayoganathan, C., Ratnayake,P., Wedsinghe, P., Lewis, J., Eisenberg, M., & Aponso, H. (1997). Youth and Sexual Risk in Sri Lanka. Women and AIDS Research Program. Washington DC: International Center for Research on Women 

[9] Sri Lanka Red Cross Society HIV Programme (2008-2010), Sri Lanka, 2008

[10] National STD/AIDS Control Programme, Country Report – Sri Lanka, UNGASS report (January 2006- December 2007), 31 January 2008

[11] Sri Lanka, UNAIDS, UNGASS Country Report, 2010