Maldives identifies “first” child HIV infection

Senior health figures have called on the government, NGOs and members of the private sector to help step up attempts to promote AIDS prevention in the country after authorities discovered that a two year-old child had tested HIV positive earlier this year.

While accepting that HIV infection rates remained relatively low in the Maldives, Minister of State for Health Lubna Zahir Hussain said that efforts needed to be increased across all sectors of society to tackle attitudes towards high-risk behaviours that allow the virus to be transmitted.

Lubna heads the National Drug Agency (NDA). Her comments followed the hosting of a special NDA workshop on HIV prevention held on December 1 to commemorate World AIDS Day. The workshop was focused particularly on the HIV infection through drug abuse.

Though statistics indicate HIV infection rates have been limited in the Maldives over the space of the last two decades, health officials in the Maldives have begun to raise concerns about the risk of cases spreading across the country.

In October Minister of Health Dr Ahmed Jamsheed Mohamed claimed it was only through “incredible luck” that HIV had not spread across the Maldives, considering the prolific levels of unprotected sex and intravenous drug use.

Addressing concerns raised by Health Minister Jamsheed about the potential scope for HIV to spread beyond high-risk communities such as drug users, Lubna said greater effort was needed to address attitudes of the general public to the spread of the virus.

“I think what the health minister was saying is that it is not only people living bad lifestyles that are at risk [of HIV infection],” she said, reiterating concerns about the number of young people engaged in intravenous drug use and potentially dangerous sexual practices.

She spoke about a child who was suspected of having been infected from her mother at birth.

“We were first made aware of the case in April 2012 and as far as I know, this is the first case [of a child in the Maldives being born HIV positive],” she said. “However, I think it is important for the public to know the reality of the situation right now, whilst respecting [the child’s] privacy and well being.”

Lubna said she was ultimately encouraged by the work of the country’s health authorities in trying to address the HIV risk from national attitudes towards sex and drug use in the country, yet warned against complacency.

“This doesn’t mean that we continue to work at this pace to try and address attitudes towards AIDS and its spread,” she said.

Lubna called on civil society, the business community and government to speed up efforts to hold awareness and education events about the dangers posed through unprotected sex and intravenous drug use, and to promote preventative measures to reduce the national HIV risk.

Attempts have been made to work with local drug NGOs such as Male’-based Journey on running special outreach programs and blood tests to try and monitor and manage infection rates.

However Lubna said that drug use was not the only area of concern in trying to curb HIV infection.

“Prostitution is another area that needs to be looked into. Awareness work in this area needs to be seen immediately,” she said.

She said greater awareness was needed not just among the general public, but by government authorities and law enforcement agencies.

First Lady’s concerns

During the NDA workshop, First Lady Ilham Hussain stressed that growing numbers of the country’s youth were subjected to dangerous habits that could potentially lead to HIV infection.  She highlighted recreational drug use in particular as the leading cause of the virus spreading nationally.

“Incredible luck”

Speaking earlier this year on the issue of HIV infection rates, Health Minister Jamsheed said that although the Maldives had remained on the HIV less-prevalent category since the first HIV positive case was found in 1991, “all the habits that may lead to the spread of HIV is excessively in practice here,” stating that it was only through “incredible luck” that the disease had not already spread widely throughout the country.

“What has always worried me most is that there is a large drug community, and that the virus might find its way into this group, especially the IV drug users. Once it does, it will spread like wild fire,” he said at the time.

“I don’t think this is too far off now. We have already identified one IV drug user who has been infected with HIV. What’s left is to see how much this has spread,” Jamsheed revealed.

Jamsheed said that he believed there were issues which needed to be opened to a “national debate” in order to move forward and take stronger preventive measures.

“We can simply stay inactive and keep talking for any amount of time by assuming the moral highground,’ Jamsheed said at Sunday’s press conference.

“That is to claim that we are Muslims, and by living in a Muslim state in Muslim ways we are doubtless protected from this disease. But that is never the reality anywhere in the world,” he said.

Jamsheed said it was unrealistic to assume all Muslims to live as “perfect Muslims”, and that even if they were, there was still a chance of infection. He stated that HIV is not transferred through sexual activity or visits to prostitutes alone.

In 2011, a total of 18 HIV positive cases were reported, out of which one was of a local. Between 1991 and 2011, 15 HIV cases were reported among Maldivians, while 168 cases of expatriate workers were also filed. Two out of the 15 cases were female, and all patients cited heterosexual transmission as the cause of infection.


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.”