Although the money pumped into battling HIV/AIDS is set to decrease by as much as 55% over the next five years as donor funding dries up, Guyana has embarked on an ambitious five-year strategic plan which is designed to place the country on a “trajectory to eliminate HIV.”
Dubbed HIVision 2020, the plan is set to be implemented from 2013-2020 and its aim is to fully fund the country’s HIV response through country ownership and shared responsibility. Its goal is to reduce the social and economic impact of HIV and AIDS on individuals and communities, and ultimately on the development of the country. It has the overall strategic objectives of reducing the spread of HIV and improving the quality of life of those living with the infection.
For many years Guyana has benefited from a significant amount of donor funding primarily from the World Bank, the President’s Emergency Fund for AIDS Relief (PEPFAR) and the Global Fund for AIDS, Tuberculosis and Malaria (GFATM). According to the strategic plan, which was launched by the National Aids Programme Secretariat (NAPS) last week, at the end of 2012 the country’s HIV budget was estimated at $US29M with PEPFAR providing approximately 65% with $25% coming from the Global Fund.
“It is unclear as to the future projections of the PEPFAR contribution to the HIV budget; however it is anticipated to decrease over the years,” the plan stated.
The Global Fund has granted preliminary approval for years of funding totalling US16.1M in the first phase covering the period of March 2010 to March 2013 and the project has performed well. It has since been invited to submit a continuation application for phase two for a maximum ceiling funding of $US23.9M covering the period of April 2013 to March 2016.
However, based on the information garnered during the HIV and AIDS Programme Sustainability Analysis Tool (HAPSAT) exercise, it is evident that Guyana’s annual HIV budget is projected to decrease over a five year period by as much as 55%, with the transition of services being gradually undertaken by the government. The Guyana government’s contribution is expected to increase by at least 61% from US$2.3M in 2010 to $$US3.7M in 2015.
This new strategic plan succeeds the previous one ‒ 2007-2011 ‒ and addresses the issues and challenges of the epidemic in the country today. The plan states that it is taking into consideration the priorities for national development and specifically for the prevention and control of HIV, the regional priorities as guided by the Caribbean Regional Strategic Framework (CRSF) and the international commitments to the Political Declaration on HIV and AIDS and the Millennium Development Goals (MDGs).
Incidents
Meantime, according to the plan there have been a total of 9,598 cases of HIV and 2,439 cases of AIDS reported to the Ministry of Health for the period 2003-2012. The most recent estimation exercise conducted for 2011 revealed an HIV prevalence rate among adults aged 15-49 as 1.1%. This, the plan said, represented a decrease from 2.4% in 2004 and 1.2% in 2009 while the HIV prevalence among pregnant women was maintained around 1% between 2009 and 2011. Preliminary mortality data for 2010 show the proportion of all deaths attributable to AIDS steadily declining from 9.5% in 2002 to 3.2% in 2010.
Importantly, mother to child transmission of HIV continues to decline with the absolute number of babies being infected reducing each year. In 2011 five babies were born positive and the Mother to Child Transmission (MTCT) rate was 2.5%. HIV prevalence among blood donors has also remained below one per cent in the last five years.
And the male to female ratio for HIV cases has been fluctuating over the past four years. While it appears to have initially been most prevalent among males, data indicate that there are an increasing number of women becoming infected. Further, more than three-quarters of HIV cases are reported in the combined age group of 20-49, which is considered to be the productive workforce. Notable increases were observed among the age groups of 15-19 and 20-24 (in and out of school youths) in 2010 but there was a marked reduction in cases within these cohorts in 2011.
Giving the picture of the incidence rates by region, the plan said that Region 4 continues to account for the largest proportion of notified HIV cases, reaching over 70% by 2011.
There have been fluctuations across other regions over the past six years; however the coastal regions (2, 3, 5, 6) and part of 10) have stood out in terms of the proportion of reported HIV cases which may be attributed mainly to better access to the prevention programme in those regions as compared to the hinterland regions where there are challenges as a consequence of the difficult terrain associated with those locations.
The plan acknowledged that findings from focus group sessions and key informant interviews, suggest that access to HIV prevention, care and treatment services is limited for the indigenous populations and the mobile communities of Regions 1, 7, 8 and 9. The health ministry admits that this situation requires more work in those areas while there is a need to intensify the Health and Family Life Education (HFLE) that is currently ongoing through the Ministry of Education.
It was added that in the area of legislation and policy, the National HIV Policy had been revised and draft HIV legislation crafted that was currently under review. While the coordination of national sectors has been achieved there is a need for regular AIDS-spending assessments to be conducted and for better coordination of donor resources, the plan said.
The attrition of health workers, largely due to migration, both internal and external, continues to affect implementation. According to the plan this issue affects not only the HIV response, but also the wider health sector. In recognition of the problem, the ministry has developed a human resources strategy, and it said strides had been made to increase the number of health care workers. More nurses are also being trained than in previous years, coupled with more doctors under the Cuba-Guyana agreement. Additionally, post graduate and specialty programmes had been developed by Guyana’s tertiary clinical institution, the Georgetown Public Hospital Corporation, in the areas of surgery and emergency medicine, among others, in collaboration with the University of Guyana.
