High-risk behaviour leaves Maldives at risk of HIV/AIDS “explosion”

A new report has revealed that the health authorities detected 18 HIV positive cases and over 400 cases of Sexually Transmitted Infections (STIs) in last year – a “significant” finding which has highlighted the need for additional research to understand the prevalence of STI’s and HIV in the Maldives.

The report, “Annual Communicable Disease 2011” from the Centre for Community Health and Disease Control (CCHDC), revealed that among the 31,016 people tested under the Voluntary Counseling and Testing (VCT) program last year, a total of 438 cases of STIs were reported, out of which 97 percent affected females.

The report says among the 426 females with STIs, 395 involved vaginal discharge cases and 31 ulcers. Meanwhile, males with STIs were reported significantly low at 12 – eight cases of urethral discharge and four cases of ulcers. The report does not specify the age group, however all participants in the study were volunteers.

CCHCDC director Director Moomina Aboobakuru told local media that the authorities are deeply concerned about the increased detection of STIs such as chlamydia and gonorrhea – both conditions that can cause infertility if left untreated.

As the surveillance is limited to the number of people volunteering to take the tests, and with no nationwide survey, Aboobakuru believes that more people are likely to be living in with STIs “undetected”.

Meanwhile, Dr Ahmed Jamsheed, public health expert and former Director General of the CCHDC, argued that it could not necessarily be deduced from the report that the sexually transmitted diseases are on the rise in the Maldives.

He explained that as this was the first published general finding on STIs in the Maldives, there was no reference to determine whether cases were on the rise nationwide without previous data to compare it with.

“But certainly there is an urgent need for additional research for STI’s , including HIV to understand the prevalence of these diseases in the country,” Dr Jamsheed asserted.

Risk of HIV/AIDS ‘explosion’

Jamsheed and CCHDC officials fear that increasing rates of “high risk behaviour” risk the historically low rate of HIV prevalence in the Maldives, putting selective groups such as drug users, resort workers and people travelling abroad at greater risk.

Meanwhile, a total of 18 HIV positive cases were reported last year alone – including 17 expatriates and one local.

Between 1991 and 2011, 15 HIV cases were reported among Maldivians, compared to 168 among expatriate workers. Of the Maldivian cases 13 were males, and two females, and all patients cited heterosexual transmission as the cause.

Despite the country’s conservative exterior, Dr Jamsheed wrote on his blog in June 2011 that Maldivians have always been sexually very active: “High divorce and re-marriage rate, which increases the number of sexual partners any individual have over the lifetime. It is also a known fact that despite being a Muslim community, a lot of Maldivians have multiple extramarital relationships.”

Human trafficking for purposes including sexual entertainment has put more locals at risk, while in 2010 police arrested an HIV-positive prostitute.

Further risk factors include falling rates of contraceptive use, Dr Jamsheed wrote, particularly among high risk groups.

“The condom prevalence rate in the Maldives is very low and on a negative curve, though this data comes from married couples. Studies also show that condom use by the high-risk groups (commercial sex workers, men having sex with men, clients of sex workers) is also very low. Condom is the most effective preventative tool we have to protect from HIV transmission through sexual intercourse,” Dr Jamsheed wrote.

Furthermore, “However much we deny, there is a significant number of gay men in the Maldives, a lot of who are married and having bisexual relationships. There is also reason to believe that the gay community in the Maldives is increasing and becoming more organized and open about their sexual orientation,” he wrote.

Without any formal sexual education in schools and a general stigma around purchasing condoms, the basic defenses against HIV transmission are low.

“With all these extremely high risk factors, it could be said that we are sitting on a ticking bomb for an explosive HIV epidemic,” Dr Jamsheed warns.

“It’s [only] a matter of time for the virus to be introduced to the high-risk circle, especially the IV drug users. Unless we escalate our preventive efforts and introduce new and more effective measures, the low HIV prevalence in the Maldives might change to a very high prevalence in no time.”