Government plans to introduce the HIV transmission countermeasure Pre-exposure prophylaxis (PrEP), a move welcomed by rights advocate Joel Simpson, who described it as an important first step and expressed hope that the drug would eventually be available countrywide.
The announcement was made by Minister of Public Health Volda Lawrence at an HIV Clinical Management and Implementation of PrEP through a Public-Private Partnership Workshop on Wednesday. The Department of Public Information (DPI) reported that the ministry is planning to introduce PrEP to combat HIV transmission while another countermeasure will see the government establishing a public-private partnership with doctors within the private sector to whom patients will be referred for treatment.
Exactly how the two measures will be implemented was not made clear by the DPI report.
PrEP is an HIV prevention approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected if they are exposed to the virus. PrEP can stop HIV from taking hold and spreading throughout the body. Research shows that the once-daily pill reduces the risk of getting HIV from sex by more than 90 per cent. Following research on its effectiveness, the World Health Organization (WHO) in 2014 recommended PrEP as an additional HIV prevention choice for groups, such as men who have sex with men and transgender women. This recommendation was extended to all groups in 2015.
According to the DPI report, the goal of the two new countermeasures is to ensure full HIV prevention coverage is attained. “Our goal is to ensure that we reach everyone everywhere. Guyana is a very small and unique country. As a result of that, it has become a stumbling block in terms of people accessing these services,” Lawrence was quoted as saying.
Meanwhile, Simpson, the Managing Director of the Society Against Sexual Orientation Discrimination (SASOD), in an interview with Stabroek News, welcomed the announcement of the impending PrEP rollout and expressed hope that the drug will be accessible to all Guyanese by next year.
Following a survey of key populations last year, SASOD had urged the government to include PrEP as part of its combination prevention approach for adult HIV infections. The principal investigator, Nastassia Rambarran, had stated that once made aware of the option, several participants noted that “anybody who was HIV negative, having sex and willing to take it,” should have access to PrEP.
“PrEP is a necessary part of what is called combination prevention for HIV/AIDS in the 21st century. If you combine PrEP with condoms, it’s a sure way of preventing HIV. This (PrEP) is extremely important ‘cause there are clearly key populations that are at more risk from the disease,” Simpson said in the interview with Stabroek News.
He emphasised that the combination prevention approach, where persons use condoms, lubricants and PrEP to help to prevent HIV, is urgently needed by the country. Considering that Guyana is expecting a tsunami of wealth, the government will soon have no problem with making PrEP available to citizens, he added.
“Having a pill that could provide that shield against HIV along with the prevention commodities is a sure way to go and that’s what the WHO has long recommended. It [the Public-Private partnership] is an important first step,” he said
However, Simpson observed that there are limitations to the public-private partnership. Firstly, he said, most of the doctors involved – whom he indicated were seven in number – if not all, are based in the city and therefore not a lot of persons will be able to access their services. He noted that like Region Four, Region Six has a lot of “active and visible” lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, who, during the survey, expressed interest in having access to PrEP.
The SASOD head said he is hopeful that by 2020, the government will make PrEP available in other parts of the country, rather than only in Region Four. He stressed that this not only benefits the LGBTQ community but the entire country regardless of sexual orientation.
Simpson also highlighted that he understands that even if persons are able to have access to the services of the doctors, the majority of persons who are more vulnerable to HIV will not be able to afford the consultation fees.
“Yes, the government will be paying for the drug, testing and so on but persons will still have to pay a consultation fee,” he said.
He revealed that some of SASOD’s clients are usually skeptical about going to a private hospital when they are referred there so they can get treated faster but with the prevalence of sexual discrimination in the country, which results in some of them being unemployed, they are unable to do so simply because they cannot afford it. He said only a minority of the LGBTQ population will be able pay for the services.
“So poor people are more vulnerable to human rights violations and more vulnerable to HIV infection. The most at risk can’t afford to pay consultation fees and they get their health services in the public system so we quickly need an expansion,” he emphasised.
“We want to see it (PrEP) at public health centres, at private hospitals, private providers across the country and also at the community level. We would like to see organisations like the Guyana Responsible Parenthood Association, which has a fully functional clinic, and other kinds of NGOs (that exist around the country) connect,” Simpson stressed.
He further revealed that SASOD has already begun contacting the doctors who are reportedly involved in the partnership. However, he said, he is yet to clarify whether the public-private partnership is for serodiscordant couples (where one partner is HIV-positive and the other is HIV-negative) only.
“We need to clarify that PrEP is also for persons who are single and not in a serodiscordant relationship and see themselves as being at risk from HIV,” he said.
Due to the lack of knowledge about PrEP in the country, Simpson said, SASOD will be visiting communities countrywide to educate persons about PrEP.
“When we did the assessment, a lot of people weren’t clear on what it is or know about it but once we explained to people what PrEP was, there was a great deal of interest and demand for it so the first step we want to conduct a community education programme about PrEP. We will go out back into those regions where we did those assessment and teach them about the drug,” Simpson disclosed.
In addition, he said, they are in the process of developing a strategy which will advocate for a more diverse model of delivery of PrEP, not just private and public but also involving civil society.
“It’s long overdue, a great start but far too limited,” Simpson concluded.
