By IPS Correspondents
COLOMBO, Jun 17 2003 (IPS)

Anil (not his real name) resembles a baby and only his long, matchstick limbs reveal that he is older. Very ill, his underdeveloped body is wracked by bouts of coughing.

The plight of this three-year old boy with HIV has revived a debate in Sri Lanka over what many say is the glaring need for the state’s compulsory treatment of people living with HIV/AIDS – especially now that the prices of the required drugs have fallen.

Anil (not his real name) was abandoned by his mother, who most probably also had HIV/AIDS, outside a state hospital in 2000.

Now at a state home for orphans, he was found to be HIV-positive last month in blood tests he had undergone after repeatedly falling ill. However, like all other HIV/AIDS patients, the state does not provide him life-saving anti-retroviral drugs to keep the virus under control.

”Every child suffering from HIV should be entitled to treatment. It is the right of any child,” argues Prof Harendra de Silva, chairman of the National Child Protection Authority. ”For that matter, all those who seek treatment for HIV must get the medication.”

Dr Kamalika Abeyaratne, a retired paediatrician living with AIDS as a result of a contaminated blood transfusion and now head of Sri Lanka’s AIDS Coalition, says that the majority of patients still cannot afford the drugs – and are certain to die if no medication is provided.

The government’s National STD/AIDS Campaign recommended as far back as December 2001 that anti-retrovirals be provided to people living with HIV.

But there was no provision for such treatment in a World Bank grant of 12.6 million U.S. dollars that was approved in February this year for the National HIV/AIDS Prevention Project.

STD/AIDS campaign director Dr Iyanthi Abeyewickreme said she wanted a treatment input in the project, but bank officials believed that Sri Lanka was a low-prevalence country and that prevention was more important. Still, she said, a study to support the feasibility of providing treatment in the future has been included in the project.

Significantly, last week the World Bank approved 5.5 million dollars for an AIDS control project in Moldova, which includes a treatment component for people living with HIV/AIDS, in particular women, children and teenagers.

Sri Lanka’s casualty and fatality rates are also similar to Moldova. According to the United Nations, there are an estimated 8,000 HIV/AIDS cases in Sri Lanka against 5,500 in Moldova. A little over 100 have died in Sri Lanka up to 2001, compared to 300 in Moldova up to the same year.

President Chandrika Kumaratunga on Friday offered to set up a trust fund to support the treatment of patients with financial assistance from the official President’s Fund, the public and the business community.

Kumaratunga also said she would consider support to a proposal to set up a halfway home for victims, said Sherman de Rose, a spokesman for the AIDS Coalition.

But while all the high-level policy talk continues, three-year old Anil lies on a cot, surrounded by pillows, at the Infectious Diseases Hospital, just outside Colombo.

W M Ratnasiri, Western Province commissioner of probation and child care, notes also that though Sri Lanka has been facing HIV/AIDS since 1987, the issue of probation and child care services in case of the deaths of people from the pandemic has not been thought of.

”We won’t and cannot shirk the responsibility of looking after abandoned children who may have HIV. This little boy’s (Anil’s) situation brings out the fact that we are not equipped to handle such cases,” he said.

”We need to rectify this immediately and have homes which can look after these children and also trained staff,” he added.

He said that at least two to three children are abandoned at hospitals or elsewhere in his region, the Western Province, and that Anil’s case has become a fresh issue to the authorities.

The AIDS Coalition, which provides a range of services for Sri Lankans living with HIV/AIDS, as far back as in April 2002 submitted a memorandum to the government stressing the need for a treatment agenda in the World Bank-financed AIDS prevention project.

Sri Lanka’s AIDS prevention project, while ambitious, focuses solely on outreach and prevention, noted a document prepared with the help of AIDS Lanka, a California-based group of doctors, lawyers and public health experts working on behalf of HIV-positive patients in the country.

”Unless it is amended to address treatment as well, we believe the prevention project will fall well short of its goal of halting the spread of HIV/AIDS in Sri Lanka,” it said.

In Sri Lanka, government HIV/AIDS clinics only provide treatment for opportunistic infections like skin diseases, cough, tuberculosis or pneumonia.

Anti-retroviral drugs are provided to health care workers for a month – in the case of accidental exposure to HIV at work – and to HIV-positive mothers to prevent mother-to-child transmission.

Experts say compulsory treatment may no longer as big a financial undertaking as was earlier thought, now that prices of HIV/AIDS drugs have gone down. The costs of HIV/AIDS-control drugs have fallen to about 4,000 rupees (41 dollars) per month in recent times from 60,000 to 70,000 rupees (1,000 dollars) about eight years ago.

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