Although studies suggest that the HIV infection rate is stabilising, the grim reality for Guyanese is that fight against the epidemic it is yet to stem the prevalence among the working population, which accounts for over eighty percent of the infections.
According to statistics in a Ministry of Health supplement published in the daily newspapers to mark World AIDS Day yesterday, surveillance studies point to a stabilisation of HIV prevalence. But the ministry also reported that from January to the end of September this year there were 563 reported infections, with the active group–between the ages of 20 and 49–accounting for 81% or 457 of all the cases. There were also 20 AIDS cases and 15 AIDS deaths reported for the period. Officially, there are 11,579 persons recorded as living with the virus at the end of September, with an infection rate of 1.55% based on a two-year-old survey.
Minister of Health Dr Leslie Ramsammy was asked whether the statistics meant that the awareness messages are not reaching the working population and whether these would have to change. He said the figures meant that behaviour change has not been adjusted to the message. “That is where we have to do something,” he said, though he was unable to go into details owing to his busy schedule.
Another worrying trend is that the rate of infection is higher in women compared with men, a ratio of 51.1% to 44.9%. While the early epidemic affected more men than women it has now been established that there is “an increasing feminisation of the epidemic and more women are recorded with HIV today than men.”
The release of the figures would be welcomed by the National AIDS Committee (NAC) which in its World AIDS Day message expressed concern about the scarcity of reliable information publicly available on all aspects of the epidemic in Guyana.
But while the ministry feels that its strategic information available demonstrates “that Guyana is making significant strides in controlling the HIV epidemic” it did acknowledge that there are groups of persons at higher risk of HIV which is evident in the prevalence among those groups of people. “The prevalence among commercial sex workers and men who have sex with men remains high,” the ministry said, adding by the end of the year the country will be in a position to report on any changes in prevalence for these groups of persons. The ministry also said it would continue to monitor the 15 to 19 age group as it is anticipated that infections in this age group are likely to be new infections and as such provides guidance on the way forward in programme planning and in particular HIV prevention among young persons. There is an infection rate of 2.13% in this age group.
Meanwhile, the ministry said that in areas of Prevention of Mother to Child Transmission (PMTCT) and blood donation screening, the trends demonstrate that HIV prevalence is on the decline. And in the case of tuberculosis (TB) a stabilisation of around 30% co-infection with TB and HIV is noted.
And since the ministry made Antiretroviral (AVR) treatment available in 2002, it has expanded the service from the treatment only being accessed at the GUM clinic to 16 centres offering treatment and care which also includes CD4 testing. Centres are now located in Regions Two, Three, Four, Six, Seven and Ten, while treatment is also being provided in Regions One, Eight and Nine through visiting specialist teams. And two private hospitals, St Joseph Mercy and Davis Memorial, also offer treatment. The ministry said that the number of persons accessing treatment has accelerated since 2005, which is said to reflect qualitative improvements in the national treatment programme. All the treatment is offered free of charge to patients. By the end of October, 2,422 persons were receiving ARVs.
According to the ministry, the immunological monitoring of persons living with the disease commenced with the introduction of CD4 testing since September 2004 and this has been one of the factors that have led to the increased initiation of persons on ARV treatment. It was stated that the clinical decisions on when to start ARV treatment is now based on a protocol which includes the use of CD4, a far cry from when treatment started in 2002 when the decision to treat was based on a syndromic model without CD4. “Today, all persons tested positive for HIV are offered antiretroviral therapy. Treatment with ARVs has resulted in significant clinical and immunological improvement for PLWHA,” the ministry said.
And the ministry touted the successes of its Human Rights Desk and the Food Bank, both set up under the National AIDS Programme Secretariat (NAPS) in 2007 and 2006 respectively, and gave the case studies in the form of two touching stories to demonstrate how effective these initiatives have been.
The ‘real’ face of HIV
The Human Rights Desk was set up to address reported cases of stigma and discrimination from persons living with and affected by the virus and the cases are investigated at the level of the secretariat. There was a primary school vendor who was constantly discriminated against by the teachers and students of the school. She made a report to the desk. Programme Director of NAPS, Dr Shanti Singh, intervened and the school as sensitised about HIV and AIDS resulting in a change of attitude and making life better for the infected woman. “Please don’t stop what you’re doing so that everyone living with HIV can enjoy living as much as me, free from discrimination,” the woman was quoted as telling the officer who investigated her report.
And while initially only persons in Region Four benefited from the Food Bank the service has now been extended to all ten geographic regions. Another story is told of a US-based woman who was shunned by her relatives and turned to alcohol and drugs eventually living on the streets. She accessed food from the bank and after six months, “there was a complete transformation in this patient. She was very jolly, very enthusiastic and more so with an extremely positive outlook of her life.” Most of the beneficiaries of the food bank are patients on and below the poverty line with 68% of them being unemployed. Single parents account for 41%, with females representing 63% and males 27%.
In his speech to mark the day, Dr Ramsammy noted that other ministries and state institutions are increasingly joining the movement for a comprehensive response to HIV. It is through these partnerships that prisoners are now being screened for HIV and teachers are being prepared to teach critical life skills to the nation’s children.
And while the ministry will continue to do everything to provide the care, treatment and support for persons living with HIV, Ramsammy said it should be recognised that the future of the state of HIV epidemic will be significantly influenced by family and community actions. “This means that every father, mother and child must begin to share the responsibility for learning to manage their own health through the choices they make,” he said. On the community level it means working partnership with the school system and civil society organisations, such as religious organisations, to ensure that all of the country’s children are armed with the critical life-skills they need to be successful individual.
And Dr Singh, in her message, stated that her organisation has ensured that prevention programmes target all groups of the society and importantly those groups that are at a higher risk for HIV and other sexually transmitted infections. “Guyana’s approach of combination prevention is well noted with the variety of innovative programmes in place to deal with this issue,” she said.
