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Viewing cable 06COLOMBO776, HIV/AIDS IN MALDIVES -- LOW PREVALENCE BUT

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Reference ID Created Released Classification Origin
06COLOMBO776 2006-05-15 03:41 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Colombo
VZCZCXRO4007
RR RUEHBI RUEHCI
DE RUEHLM #0776/01 1350341
ZNR UUUUU ZZH
R 150341Z MAY 06
FM AMEMBASSY COLOMBO
TO RUEHC/SECSTATE WASHDC 3346
INFO RUCPDOC/USDOC WASHDC
RUEHBK/AMEMBASSY BANGKOK 2965
RUEHBJ/AMEMBASSY BEIJING 1200
RUEHKA/AMEMBASSY DHAKA 9174
RUEHHI/AMEMBASSY HANOI 0077
RUEHIL/AMEMBASSY ISLAMABAD 6064
RUEHKT/AMEMBASSY KATHMANDU 4099
RUEHNE/AMEMBASSY NEW DELHI 9611
RUEHKP/AMCONSUL KARACHI 2011
RUEHCI/AMCONSUL CALCUTTA 0168
RUEHCG/AMCONSUL CHENNAI 6616
RUEHBI/AMCONSUL MUMBAI 4516
RUEHGV/USMISSION GENEVA 1176
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUEAUSA/DEPT OF HHS WASHDC
UNCLAS SECTION 01 OF 03 COLOMBO 000776 
 
SIPDIS 
 
SIPDIS, SENSITIVE 
 
STATE FOR OIE DANIEL SINGER AND REBECCA S DALEY 
STATE FOR SA/INS 
 
E.O. 12958: N/A 
TAGS: TBIO KSTH ECON PREL SOCI WHO EAGR CASC MV
SUBJECT: HIV/AIDS IN MALDIVES -- LOW PREVALENCE BUT 
WORRISOME TRENDS 
 
1. (SBU) SUMMARY: Despite a low reported prevalence of 
HIV/AIDS in Maldives, the lack of surveillance among high 
risk populations and risky behavior among Maldivian drug- 
using youth suggest underreporting and the potential for a 
serious, but silent, outbreak. Even though Government of 
Maldives (GORM) and UN officials express interest in 
developing targeted, behavioral change strategies, a lack of 
top-level GORM support, religious and cultural 
sentiments,and few resources limit the number and type of 
interventions possible.  End Summary. 
 
Surveillance: From Mandatory Testing to Informed Consent 
------------------------------------------ 
2. (SBU) According to UNAIDS County Coordinator Jan Leno 
(resident in Sri Lanka), Maldives currently tests every 
pregnant woman, incoming migrant, or local resident 
returning after more than six months abroad. Dr. Sheena 
Moosa, Director of Health Services for the Ministry of 
Health, reported that four atolls have voluntary counseling 
and testing and that the surveillance procedure has now 
moved to informed consent. 
 
Worrisome Social Trends and HIV/AIDS Risk 
------------------------------------------ 
3. (SBU) Both Moosa and Mohamed Ramez, the National HIV/AIDS 
Program Coordinator, perceived Maldives to be at high risk 
for HIV/AIDS, with the former citing recent social 
developments such as the rise of massage parlors (a 
potential source of commercial sex), private prostitution 
rings, and emerging intravenous (IV) drug use as causes for 
concern. 
 
Re-evaluating Strategy: From Sailors to Youth, From 
Awareness to BCC 
------------------------------------------ 
4. (SBU) Shaheem, Ramez, and Dunya Maumoon, Assistant 
Representative for United Nations Population Fund (UNFPA) 
Maldives, acknowledged that the most recent HIV/AIDS cases 
attest that transmission now occurs more internally, between 
husband and wife and tourist and local, whereas before cases 
were confined to travelers and sailors returning from 
abroad. Ramez and Maumoon both championed the concept of 
behavioral change strategies but lack knowledge about 
implementation. (Note: Behavioral Change Communication 
strategies develop tailored health messages that are 
disseminated through a variety of channels, such as peer 
education, mass media, and counseling, in order to elicit 
risk-reduction behavioral change. End Note.) 
 
5. (SBU) Ramez mentioned the need to sensitize high-level 
senior officials to the problem, as they must approve all 
HIV/AIDS activities but appear to believe that traditional 
awareness methods have been sufficient. Subsequent meetings 
with GORM officials at least partially confirmed Ramez's 
observations. Maumoon has suggested that the GORM begin 
marketing condoms but mentioned that several GORM 
departments and religious leaders remain reluctant, 
preferring public campaigns focused on morality and values. 
(Note: The government maintains tight restrictions over the 
media with the three major print media sources owned by 
government ministers or families. End Note.) Maumoon felt 
such attitudes reflect ignorance about the reality of youth 
and their behavior, particularly increased drug use. She 
lamented previous aversion to discussing drug abuse, which 
is now a serious problem. 
 
Disregard for Safety and Stigma within Healthcare System 
------------------------------------------ 
6. (U) A recent healthcare management survey found that 
island clinics lacked good infection control, as workers 
failed to cap and dispose of needles properly or use gloves. 
 
COLOMBO 00000776  002 OF 003 
 
 
Given the low incidence of HIV infection, doctors must be 
sent abroad for exposure to cases. To date, two doctors at 
the national referral hospital have attended training in 
Thailand.  Ramez admitted there is still a stigma attached 
to HIV infection, and medical personnel still fear providing 
service even with precautions.  Such attitudes are difficult 
to eliminate, he complained, given the low prevalence. 
 
Reasons for Low Prevalence: Awareness or Atoll Distance? 
------------------------------------------ 
7. (SBU) According to Shaheem, most Maldivians are aware of 
HIV/AIDS, and previous GORM initiatives have helped stunt 
the spread of the disease. (Note: The 2004 Maldives 
Reproductive Health Survey, in which 97% reported awareness 
of HIV/AIDS, and other informants' observations support this 
conjecture about high levels of awareness, but  reported 
promiscuity among drug users highlights a need for more in- 
depth research to ascertain whether awareness translates 
into behavior modification. Maumoon also reported that a 
UNFPA survey revealed that even though almost all people 
know about transmission precautions, less than half use 
condoms. End Note.) 
 
8. (SBU) Ramez attributed the low prevalence of HIV to the 
geographical distribution of the atolls, as the physical 
separation of island communities slows the spread of 
disease. Mamooya also cited high levels of education and 
extensive testing and monitoring. Nonetheless, she feared 
numbers could be higher due to factors such as young men 
working away from home, high rates of serial monogamy and 
divorce and the drug use problem. In particular, Ramirez 
mentioned that little information existed on the infection 
rates of youth and voiced concern the some exchanged sex for 
drugs. 
 
Drug Use and HIV/AIDS: Alarming Bedfellows 
------------------------------------------ 
 
9. (SBU) The recent 2003 UNDP Rapid Situation Assessment of 
Drug Abuse in Maldives identified several risky behaviors 
that put this sub-population at high-risk for HIV/AIDS. 
Despite a majority of drug users reporting awareness of 
common modes of HIV/AIDS transmissions, 73% did not perceive 
themselves at risk for infection, less than 30% reported 
condom use, and 92% reported a sexual experience in their 
teenage years. In addition, of the drug user respondents 
interviewed (202), 75% reported sexual experiences with 26% 
of them engaging in commercial sex. Even though only 8% 
reported actual injection use, over half reported seeing 
others inject.  Twenty-five percent reported knowing a 
friend or acquaintance with HIV/AIDS, a high number 
considering Maldives only has 11 official cases. Such 
statistics suggest that HIV/AIDS could quickly spread if an 
outbreak occurs in this population. 
 
Limited Funding, Limited Interventions 
--------------------------------------- 
 
10. (SBU) Ramirez reported that finances were tight and that 
Maldives' low prevalence status prevented them from 
accessing several pots of money, such as the Global Fund 
through UNAIDS. The British Council funded a few media spots 
two years ago and UNICEF recently funded a project 
addressing mother-to child transmission. Currently the 
government sponsors one or two workshops for employees of 
resorts and the Department of Public Health has trained 3-4 
people to do activities in the atolls, but they are not 
active since the have no incentive (i.e. salary). 
 
 
11. (U) For youth, a health center in Male distributes 
condoms and offers counseling and access to doctors, but it 
 
COLOMBO 00000776  003 OF 003 
 
 
is only utilized by a small percentage of the population, 
presumably in part due to its reputation as a "condom 
distribution center." UNFPA launched a life skills pilot 
project in five schools for two years, but contraceptive use 
can only be discussed above the age of 16. Strong religious 
and cultural sentiments that the discussion of such issues 
promotes promiscuity still prevail. 
 
12. (SBU) Comment: A conservative, traditional society with 
a government that has a slow approach to change and reform, 
Maldives is at a crossroads in HIV/AIDS awareness and needs 
to find ways to bridge the cultural/religious divide that 
keeps more practical, proven techniques from being employed 
in its efforts to prevent this deadly problem. In 
particular, the absence of infection rate statistics on 
Maldivian drug users, recent reports of their risky sexual 
behavior, rising IV use, a lack of funds and governmental 
and religious aversion to discussing or addressing this 
issue suggest this group is at an increased risk for 
HIV/AIDS.  End Comment. 
ENTWISTLE