Presidential Address-24th Annual Scientific Sessions of Sri Lanka College of Sexual Health and HIV medicine- 2019

The theme of 24th annual scientific sessions of Sri Lanka College of Sexual Health and HIV medicine (SLCoSHH) and my presidential speech is “Reaching the Unreached in STI and HIV”. Sky is the limit for this theme but we don’t have all the time in the world to detail each aspect. Therefore, I will mainly focus on understanding some areas to be strengthened and propose solutions to achieve “End AIDS in Sri Lanka by 2025” through “Reaching the Unreached” in STI and HIV. Before I reach the theme, “Reaching the Unreached in STI and HIV”, let me bring up some data on global and local burden of STIs and HIV.


It is undeniably another happiest day in my life.
It is a great pleasure and honour to address you as the president of Sri Lanka College of Sexual Health and HIV medicine this evening.
The theme of 24th annual scientific sessions of Sri Lanka College of Sexual Health and HIV medicine (SLCoSHH) and my presidential speech is "Reaching the Unreached in STI and HIV". Sky is the limit for this theme but we don't have all the time in the world to detail each aspect. Therefore, I will mainly focus on understanding some areas to be strengthened and propose solutions to achieve "End AIDS in Sri Lanka by 2025" through "Reaching the Unreached" in STI and HIV. Before I reach the theme, "Reaching the Unreached in STI and HIV", let me bring up some data on global and local burden of STIs and HIV.

Global data for HIV in 2018
• Estimated 37.9 million people were living with HIV in the world. already experiencing Gonococcal and Mycoplasma resistance to most antibiotics.

Sri Lankan Situation
The estimated number of people living with HIV in Sri Lanka is 3500. The island remains a very low prevalent country for HIV since beginning of its epidemic. Total number of PLHIV diagnosed and alive is 2709. This number was generated by subtracting reported deaths from the total reported HIV cases since 1987, therefore needs an adjustment for unreported deaths! According to this cross sectional HIV cascade, 77% of PLHIV know they are positive but this doesn't represent the "Unreported deaths" since 1987. This has resulted low percentages in next two steps of the cascade; 45% for PLHIV on treatment and 38% for who achieved viral suppression.
There is a total of 1656 PLHIV who know their status and are currently linked with HIV treatment and care services. Out of the total 1656 (47.3%) PLHIV who are currently linked with HIV treatment and care services, 1574 (95%) have been started on antiretrovirals (ART), and 1338 (85%) were having viral suppression.

Longitudinal treatment cascade
This graph is a longitudinal cascade of PLHIV who were diagnosed with HIV in 2017, which shows 97% are enrolled in treatment and 90% retained on ART after 12 months and 75% have achieved viral suppression.
These data shows that we have to "Reach" significant number of " I assume your answer is "No". But, now I believe this should be corrected. Of course, they don't attend our clinic, but they are there.
Are we waiting them to reach us? We do "standard outreach" programmes to vulnerable populations, but the problem is that we have not identified most KPs; in other words, we have not "Reached" them. They are "Hidden" amongst general population. Could they be the missing or undiagnosed portion of PLHIV?
I assume my venereology colleagues from other districts where NGOs/CBOs working with these KPs are not operating will agree with me at least to a certain extent if not fully.
I share this beautiful slide from Kenyan National AIDS and STI Control Programme on their KPs and quote this phrase from it.
"These individuals live amongst us and relate with other people and families in the community!" However, STD clinic experience shows highest case finding efficacy is through testing partner/s of newly diagnosed PLHIV. Therefore, we have to strengthen the system of case finding through partner tracing too.

Disproportionate rise of male positives
This graph shows the Number of reported HIV infections by age and sex during 2011-2018. It is obvious that men aged above 15 years show a steady increase over the years while children and women in a plateau. A steady rise of male to male transmission of HIV over last six years warrants more attention on this group to curb the epidemic.
As I mentioned earlier, there are many other aspects of our theme. We already had a very successful pre-congress session on "Early Integration of Palliative care for PLHIV" in the morning. We will be discussing more in detail at Scientific Sessions tomorrow. We have eminent speakers from Australia, India, UK, USA and our own resource personal from Sri Lanka. They will enlighten us with new knowledge on how to reach unreached goals of STIs, HIV, Sexual Health and Prevention sciences.
Sri Lanka is aiming to achieve UNAIDS 95 95 95 target of ending AIDS by 2025; 5 years ahead of global target. We have to reach the unreached targets in STI and HIV to achieve this goal. I wish that scientific knowledge we gain through this 24 th Annual Scientific Sessions of Sri Lanka College of Sexual Health will lead us to that goal.
Thank you