AIDS and the Guyana fight

Spotlight on Issues

Stabroek News

November 30, 2000

Tomorrow World AIDS Day is being observed. In recognition of this day and the huge challenges facing Guyana this week's Spotlight focuses on the problems wrought by the disease and the various efforts to battle them.

As many as two-thirds of AIDS cases going unreported

HIV + man recalls the tribulations

Mother-to-child transmission poses a huge challenge

Socio-economic conditions contribute to spread of HIV

The difference between HIV and AIDS

Offering a 'Lifeline' to those in need

Peer helpers address sex, sexuality concerns

Ready Body project urges youths to act responsibly

Negative attitudes to HIV/AIDS disappearing

As many as two-thirds of AIDS cases going unreported

Growing number of women being infected

The first suspected Acquired Immune Deficiency Syndrome (AIDS) case in Guyana surfaced in 1987; a homosexual man who died before laboratory confirmation was possible. According to information provided by the National AIDS Programme Secretariat (NAPS), by the end of 1987 there were ten reported cases, all homosexual men. In 1988, however, there were five females among 34 cases for that year and between 1989 and 1997, the total reported cases was 1,055. The prevalence among the general adult population is estimated at between 3.5% to 5.5%.

The majority of infected people are young, productive adults, within the 19 to 35 years age group, accounting for 75% of the overall total of HIV infections. Transmission is primarily heterosexual, 80%, with 18% of the cases being transmitted homosexually or bisexually, and with only two reported cases being the result of intravenous (IV) transmission.

By 1996, the male/female ratio was 1:0.7. By the end of 1999 the number of accumulated AIDS cases totalled 1,602. From January to June 2000, 141 AIDS cases were detected at the GUM clinic. Of these 32 died - 8 females, 24 males. Of the other 109, 58 were male and 51 female.

It is now estimated that the rate of infection is greater among women than men. For example, in 1989, women accounted for 25% of the reported cases, while this figure for 1995 was 42.2%.

There is a lack of reliable data, as it is believed that there is 60% under-reporting of cases, and it is likely therefore that officially reported cases represent less than one third of the total number of cases in Guyana.

Guyana has been seriously affected by this scourge because while the epidemic in most countries is in the early stage, the incidence of HIV/AIDS is generalised in Guyana, and the prevalence rates among specific groups are the highest of all 21 Caribbean Epidemiological Centre (CAREC) member countries:

* 3.2% among blood donors in 1997;

* 3.7% among pregnant women in 1993, rising to 7.1% in 1995 and dropping to 4.5% in 1997;

* 21% among male STI patients in 1992-1995;

* 25% among commercial sex workers in 1989, rising to 45% in 1997.

The regional distribution of reported cases is skewed, with Region Four (Demerara-Mahaica) accounting for 70% of reported cases, Regions Six (East Berbice-Corentyne) and Ten (Upper Demerara-Upper Berbice) accounting for about 24% of reported cases, and the remaining seven regions accounting for about six percent.

Higher reporting from these regions is believed to be the result of Voluntary Counselling and Testing (VCT) Services which are only available at the Genito-Urinary Medicine (GUM) Clinic in Region Four (Demerara/ Mahaica) and the five VCT sites piloted in Regions Five (Mahaica-Berbice) and Six (East Berbice-Corentyne), where the greater part of the population resides.

The Guyana Human Rights Association (GHRA) says there is general agreement that both qualitative and quantitative data available on HIV/AIDS in Guyana require much improvement. NAPS' 1998 end-of-year report estimated that more than two-thirds of AIDS cases in Guyana go unreported. Furthermore, NAPS in 1998 estimated that fewer than 20% of HIV-infected persons were aware of their serostatus.

Contrary to Guyana, Suriname was able to provide statistics up to last month. That country's National AIDS Programme (NAP) statistics showed that from 1995 up to September 2000, about 1,100 AIDS patients have been registered in Suriname, among whom about 40% were women. According to reports, if figures for previous years and unregistered cases are taken into consideration, this number would be much higher. Furthermore, there is also an increase in the number of infected persons. In 1999, there were 300 new cases. This year already shows 232 new cases. About 800 persons are tested for the deadly virus every year in Suriname. Of this number, 300 are tested HIV-positive and a very worried Chairperson of NAP, Jennifer Simons Geerlings, said, according to a recent edition of the Surinamese newspaper De Ware Tijd "We cannot control this matter. We will certainly have more patients this year. But we can change this. We are in a situation where we have to work very hard."

The Caribbean Region since 1997 was identified by UNAIDS as having the highest incidence of HIV, after Sub-Saharan Africa, because of an accumulated prevalence rate of 172 cases per 100,000 persons. Sexual transmission (75%), mainly among heterosexuals (63%), has been the main mode of spread. But sex tourism, commercial sex among young girls, male macho behaviour and multiple sex partners for both male and female are other factors fuelling the epidemic in the Region. (Back to Top)

Ten years and counting:

HIV+ man recalls the tribulations

"It was hot on the morning that I woke up, but it was strange because I was feeling cold, shivering uncontrollably. I was taken to the [then] Public Hospital Georgetown (PHG) and the doctor was told to run an (Human Immuno-deficiency Virus) HIV test. It came back positive. I refused to believe. I couldn't accept the result, because I felt it could not happen to me."

That was ten years ago. Joe (not his real name), a former member of the joint services, said he had allowed his civilian life to catch up with him.

Joe was never married, and did not like children. He didn't like strings attached, and so didn't want that kind of responsibility, yet he was promiscuous without any safeguards. He said he did not know how he acquired the disease and was not interested in finding out. "It's a case, where I have it and cannot give it back."

Joe regarded his situation at first as a disaster, because the thought running through his mind was that he was going to die. While in the hospital, he fell off the bed a few times and couldn't get up because he couldn't walk. The treatment prescribed should have helped with this, but Joe was not responding to it. The doctors enquired of this strange development, and found his chart reflected that he was not getting the required injection available at the hospital, and on time.

Joe remembered a dream he had of seeing himself dying, something he related to his father, who was visiting from overseas. His father extended his stay to "bury me", but Joe did not die, and his father returned home, where he purchased the much-needed "injections" for Joe who was at then Georgetown Public Hospital.

After spending some months in the hospital, Joe was released only to find that his viral load was increasing quickly, and he needed to go on one of the expensive HIV "cocktail" drugs fast. But these could not be afforded. His only resort was to live from day to day, something he is still doing, since he found out he had the disease ten years ago.

After he tested positive, Joe said, he did not stay put at home, despite the diarrhoea and violently fluctuating body temperatures. He tried earning a living doing security work, among other jobs, but none of these lasted.

Joe now works as a counsellor for persons living with HIV/AIDS. Joe said he "went through hell" with his family. The relative whom he was living with, "did not want to hear anything from me... She was scared."

He has been in situations where he was embarrassed; in mini-buses no one wanted to sit next to him. On another occasion, a nurse, he said, pointed him out "to her friends walking down the street" as having AIDS. He told her off, he said. Living at the relative, Joe said, he had to observe certain dos and don'ts; he had his own separate utensils. He said he keeps the cup today as a reminder of those days. The relative also barred him from revealing his status-no television appearances and no "walking around the place." But Joe does not want anyone to feel sorry for him.

"I might die, and there is so much to be done for persons living with HIV/AIDS. Nobody looking at it can absorb the impact of the inevitable. Many of us do not work for a livable salary. We need attention for how we are perceived by others. [Because of all these deficiencies, including no legislation] you create a new world for yourself."

He recalled having a friend who was thrown out of his home because of his HIV status. He wanted to commit suicide. But for Joe, suicide was a coward's way out, because he had already found out that HIV was something persons could live with, once they operated within certain parameters.

Joe can eat anything. However, he has to stay away from certain types of milk, because these give him diarrhoea. He must never come off high-protein foods and vitamin supplements. He has to have plenty of rest and "stress is the worst thing for us." He would like to see a more patient-friendly atmosphere at the Genito-Urinary Medicine Clinic.

Joe expressed the fear that Guyana could be heading in the direction of some African countries. "This country does not have one million people, and everyday I look at the TV, people are dying at ages you would never imagine. Persons need counselling."

He urged children to talk to their peers, and appealed to persons to use condoms or stick to one partner. "Mankind is weak by nature."

(Back to Top)

Mother-to-child transmission poses a huge challenge

German company to provide key drug for five years

The mother-to-child transmission (MTCT) of HIV is posing a huge challenge to not only health workers but also to governments in finding the resources to deal with the complexity of issues in this area.

The rate of MTCT of HIV-1 ranges from 13% to 48%. In the Caribbean, results of studies conducted on the natural history of MTCT of HIV have shown that the rate of MTCT of HIV is 28%.

There are approximately 20,000 births annually in Guyana-about 18,000 of these in the public sector health institutions. Using the most recent estimates of HIV prevalence among ante-natal women in Guyana, it is likely that there are 1,400 HIV positive women giving birth during the year. If a transmission rate of 28% is used there may be some 400 HIV-infected babies born each year. (This is a rough estimate as the incidence rate has been applied to the whole population and the rate of transmission used has been applied to the Caribbean and not specifically to Guyana.)

It is recommended that mothers-to-be or even those already pregnant do an HIV test to determine whether they or their partners have the virus. Although it is important to determine its presence, counselling is highly recommended because of the physical, social and emotional trauma attendant on its discovery.

Some women may already know they have the virus and are interested in becoming mothers. Again counselling can help, by providing information on what choices they may have, so that they and their partners can plan for themselves and their babies.Back to Top)

Research has shown that pregnancy is not harmful to the woman's health, will not cause an increase in HIV-related infections, and will not cause HIV to progress more quickly. In other words, a pregnant woman with HIV is not any more or less likely than any other HIV positive woman to develop an HIV-related illness. All pregnant women though, have a slightly weakened immune systemwhich returns to normal by about six weeks after the birth.

The possibility of the baby becoming infected with HIV during pregnancy or delivery (vertical or peri-natal transmission) depends on a number of factors:

* the amount of virus in the mother-to-be's blood (viral load);
* the state of her health and immune system;
* the effect of anti-HIV drugs now or later;
* other infections during pregnancy including sexually-transmitted diseases;
* aspects of delivery.

While not every baby born to an HIV positive mother is infected with the virus, a woman can transmit HIV to her baby during delivery or while breastfeeding.

Options for treatment during pregnancy are the prerogative of the mother, and she may talk to her doctor about these. Some HIV-positive women take anti-HIV drugs, while others want to have a drug-free pregnancy. Prevention of HIV mother-to-child-transmission may be achieved with the use of Azidothymidine (AZT) in the last trimester of pregnancy and during the delivery, intravenously, followed by treatment for the baby up to six weeks after birth.

Guyana's Ministry of Health has developed a draft prevention programme aimed at reducing MTCT of HIV by 50% by the end of December 2002.

The proposed MTCT prevention programme would reinforce the importance of education of women and their partners, as well as young persons, as the means of ensuring healthy sexual lifestyles and the primary prevention of MTCT. It would also stress the importance of strengthening reproductive health programmes including family planning. In addition, the programme proposes that all women attending ante-natal clinic will be offered testing for HIV accompanied by adequate pre- and post-test and support counselling.

The programme also anticipates that all HIV-positive pregnant women will be offered antiretroviral treatment free of charge to reduce the risk of transmission. The pregnancy should be considered high-risk and throughout the pregnancy, appropriate health professionals should provide the necessary care, and proper arrangements for delivery should be made.

New Programme Manager at the National AIDS Programme Secretariat (NAPS), Dr Morris Edwards, said a committee has been set up to look comprehensively at the issue of MTCT. The committee comprises representatives of NAPS, the Ministry of Health's Maternal and Child Health Division, Pan American Health Organisation and other health workers. A workshop to work out a programme of HIV reduction was last held on February 15.

"There are lots of issues involved... It is not just about getting drugs, but we have to look at increasing voluntary counselling and testing sites around the country, and pre- and post-test counselling." Dr Edwards, who has just returned from England after completing a Masters of Science in sexually-transmitted diseases and HIV/AIDS at the University College of London, said the committee should complete a pilot survey in a number of areas among pregnant women. Two areas under consideration are Georgetown and Region Six (East-Berbice/Corentyne).

Dr Edwards said with no testing facilities there, a pilot study in Berbice may give a reflection of what is happening in other Regions; Georgetown on the other hand can change the dynamics of the entire situation in the country because it has testing capabilities.

He pointed out that pregnant women are being used to determine the wider national picture. Previous surveys were conducted, according to Dr Edwards, but they were not comprehensive.

The outcome of this study will become available by 2003 and includes the 18 months after which the infant should be tested for HIV. In the meantime, because of limited testing sites (five), government, he said, was considering pooling blood samples for sending to the Caribbean Epidemiology Centre (CAREC) for testing.

The former acting director of the Genito-Urinary Medicine (GUM) Clinic for nine years said the chance of a mother not becoming infected in the rural areas was 50% compared with 33% in the urban areas.

He said the scientific community had come up with a new anti-retroviral treatment called neviropine, which is less complicated to administer and far cheaper than AZT. The dosage of the latest drug is less, according to Dr Edwards, and is give to the mother as a one-off treatment just before the onset of labour, and then to the infant within 72 hours of delivery.

A German drug company, Boehringer Ingelherim is committed to providing the neviropine for five years free of charge to Guyana, Jamaica and Haiti based on the outcome of feasibility studies.

Many other Caribbean countries are in the early to advanced stages of implementation of this programme as the acceptance rate ranges from 65% to 90%. The programme is also being regarded as the most efficient way of preventing HIV transmission to babies.

In addition, Dr Edwards disclosed that another source of feed in Guyana, maybe the ordinary formula, is being considered for the infant because breast milk of the HIV-infected mother is high risk. (Back to Top)

Socio-economic conditions contribute to spread of HIV - Hinds

HIV/AIDS was first perceived to be a health problem rather than a social one. And it was not until the authorities recognised that it was the latter a government initiative was launched.

The potential adverse impact of HIV/AIDS on the entire population prompted the Ministry of Health to create the National AIDS Programme Secretariat (NAPs) in 1989:

-to prevent and control the transmission of STI/HIV infections;
-to reduce the morbidity and mortality due to STI/HIV infections;
-to promote sexual health;
-to reduce the social and economic impact resulting from HIV/AIDS on individuals and communities.

But the role of NAPS became proactive with its secretariat coordinating, monitoring and evaluating the activities for fighting the disease.

NAPS Office Manager Simone Hinds noted that almost all of the reported statistics up to the end of 1999 (1,602) represented those from the public sector who were symptomatic, dying or dead, and because of little or no reporting from the private sector, management of the disease could not be made effective. But she pointed out that this trend was changing and so a holistic analysis-though not picture perfect-should be available next year. Hinds stressed the need for finding creative ways of debating whether the activities of responding to the disease are working because "HIV is hidden" and "it is difficult to see the results."

But she, like others with whom Stabroek News has spoken, remarked about deteriorating social and economic conditions which are "fuelling" the spread of HIV/AIDS, and which contradicts moves for influencing changing sexual relationship patterns. "There are things people are just forced to do because they do not have a choice, and so have to compromise to fulfill certain needs."

She said the responsibility for stopping the epidemic lies totally with the individual and stakeholders can only try their best to influence positive behavioural change.

Government's response to the problem was similar to what countries around the world were trying to do to contain the situation, Hinds stated. Guyana became the first country in the English-speaking Caribbean to put out a policy document on how to deal with the epidemic. In fact, according to Hinds, the Bahamas and the Turks and Caicos, and maybe other countries, are requesting Guyana's help in guiding the formulation of a policy of their own.

She emphasised that the policy document which was approved by the National Assembly was crucial for dealing with the epidemic and described it as a "big representation of national response. From this we can legislate enforceable means that are necessary to deal with the epidemic such as standards for laboratories and the issue of discrimination against HIV-infected persons in the workplace."

Hinds said NAPS was at the point now of pursuing a coordinated approach in targeting all regions in the country through the help of a strategic plan which was just completed. So far only Regions Three (Essequibo Islands-West Demerara), Five (Mahaica-Berbice), Six (East Berbice-Corentyne) and Ten (Upper Demerara-Upper Berbice) have established Regional AIDS Committees (RACs). Hinds said Region Seven (Cuyuni-Mazaruni) was now being targeted. She noted that with the high cost of transportation, logistics-especially with regard to difficult terrain, such as in riverain areas-not all the regions can be given the same attention. "Sometimes the criticisms are unfair... Look at the objectives we have and what we can achieve. It is very costly."

Hinds said that the Strategic Plan, 2000 to 2002, (though one year late because it should have been implemented in 1999), was produced out of the Ocean View National Consultation on the issue. The plan costs $450 million, which would come from government and non-governmental organisations, and should better be able to guide the secretariat on a way forward.

She said NAPS has been spending a significant amount of money on building capacity of NGOs for playing a more effective role.

Citing the importance of having the financial backing and skills for the task, Hinds feels that the role of non-governmental organisations should be incorporated into the national programme. However, NAPS's role of "coordinating, monitoring and evaluating" is being stymied by a "lack of capacity" meaning limited skills especially in the scientific field for gathering data on trends of HIV/AIDS in the country. Her comment was also in response to a recent editorial in the Stabroek News which alluded to the direct interventions by some Caribbean leaders. According to the editorial, "there is a danger that the band will play on here too" if the government does not "move to involve more non-health personnel and entities in the fight."

NAPS is also attempting to work on draft regulations for HIV/AIDS in the workplace, but not without the sanctioning of unions and private sector groups. There are efforts as well to bring all government ministries and departments on board.

But NAPS has suffered budgetary cuts every year. In 1999 NAPS was allocated $80 million; this year its request for $113 million was slashed to $82 million.

As for whether the political will is there, Hinds said more of this was needed. At the September 11-12, 2000 Caribbean Conference on HIV/AIDS in Barbados, a number of leaders did not see it as time wasting to attend the Conference. Grenada's Prime Minister, Dr Keith Mitchell, even sat through working sessions at the meeting.

Hinds said she was invited to stay on for the conference after attending a NAPS Coordinators Workshop in Barbados, and this was how Guyana was represented.

This newspaper spoke with Minister of Health and Labour, Dr Henry Jeffrey, about Guyana's participation at the forum. Dr Jeffrey said an invitation was sent to him requesting that the NAPS representative attend. He said an invitation was also sent to the Office of the President inviting President Bharrat Jagdeo, but because of an apparent mix-up it got lost.

The September conference was sponsored by the Barbadian Government, the CARICOM Secretariat, PAHO/WHO, UNAIDS and the World Bank. Recognising the gravity of the pandemic, participants included governments of the English-, Spanish-, French- and Dutch-speaking countries and territories, representatives of Caribbean regional organisations, UN agencies, multilateral and bilateral agencies, civil society and associations of people living with HIV/AIDS, academic institutions and the media.

The meeting recognised that investing in HIV/AIDS now will significantly reduce future costs. A conservative estimate of the cost of a comprehensive response to the epidemic in the Caribbean would be in the order of US$260 million per year. This is more than a ten-fold increase compared to the level of current national and international spending in the region per annum.

The summary sheet of the meeting said that mobilising the required funding will demand creative solutions and an increased commitment at national levels from governments and the private sector, as well as support by the international community.

The meeting concluded that leadership at the highest political level was essential to the response. Pledges were made by the multilateral and bilateral agencies. The World Bank is considering lending US$85 million to US$100 million to the region to fight HIV/AIDS, pending approval from its board. (Back to Top)

The difference between HIV and AIDS

AIDS is the Acquired Immune Deficiency Syndrome.

Acquired means that AIDS is a disease you get from another person;

Immune means that the body lacks the power to fight off invading germs and infections;

Deficiency means that the body lacks resistance to fight diseases; Syndrome means the person with AIDS suffers from a collection of illnesses, or show signs and symptoms of diseases.

In other words, AIDS is a condition in which the body's immune system-its defence against diseases, is damaged. This damage leaves the body open to attack by virus and bacteria.

AIDS, the disease phase, is caused by a virus called Human Immuno-Deficiency Virus (HIV), the infection phase.

Human means that the virus only lives in humans;

Immuno-deficiency means the body's lack of resistance to fight diseases;

Virus is the organism or germ which causes AIDS.

HIV can be found in blood, semen and vaginal or cervical secretions, which in an infected person can be passed on to other persons in a number of ways:

* through sexual contact, man to woman (heterosexually) or man to man (homosexually);
* from an infected woman to her newborn baby-before, during or shortly after birth, and from breastfeeding;
* by sharing dirty syringes and needles with HIV-infected persons;
* if HIV-infected blood is used in a blood transfusion.
AIDS is not spread by mosquitoes or other insects, sharing utensils-crockery or cutlery, sitting on toilet seats, using a swimming pool, sitting next to infected persons, casual hugging, people coughing or sneezing, working with AIDS-infected persons, caring for them, or donating blood for transfusion.

People living with HIV/AIDS (PLWHIV/AIDS) were infected by persons with the disease. They may live with the virus for as many as eight to ten years before they begin to feel unwell.

For a long time these persons may not know that they are infected with the virus.

They usually look and feel well, and there are no signs and symptoms by which one can tell that they are infected, though they can pass on the virus to others. Only an HIV anti-body test will tell if the person is infected or not.

Common signs and symptoms of the disease are:

* weight loss (more than ten percent of normal body weight);
* persistent or intermittent fever;
* persistent dry cough;
* prolonged tiredness;
* diarrhoea;
* generalised swelling of the
lymph nodes;
* pneumonia;
* respiratory tract infections;
* tuberculosis;
* skin rashes or sores;
* night sweats. (Back to Top)

Offering a 'Lifeline' to those in need

With a mandate to reduce the psycho-social impact of HIV/AIDS of persons who are living with or affected by the disease through counselling and education, Lifeline Counselling Services, a non profit, non governmental organisation was launched in 1996 by former health minister Gail Teixeira.

At that time, counselling was only offered at the Genito-Urinary Medicine (GUM) Clinic. Public Relations Officer of the organisation, Wayne Hunte, said the agency was set up because of a recognised need, as "a perceived stigma is attached to the clinic. People don't want to be seen at the clinic, and so Lifeline became an alternative for people... Behind every statistic is a human face."

Since then the organisation has formed the intention of taking on a proactive instead of a reactive approach to health.

Lifeline counsels individuals before they have an HIV test done (pre-test) and psychologically manages individuals who have had positive post-test results.

Those who test negative are also counselled on need to remain HIV free and the window period. The counselling is also geared at reducing the risk of persons infecting others.

Hunte stated that some persons still do not understand that testing "positive" for the virus means that he or she has HIV or AIDS, and he has had to counsel a number of persons in this regard.

He said there is also a support programme for groups of HIV/AIDS persons to meet at mutually-agreed locations for assistance.

Hunte disclosed that Lifeline, as part of its social responsibility, is currently mobilising resources for orphans who lost their parents to AIDS-related illnesses. At the beginning of this school term, the agency assisted six such families with school clothing. He said most of the children were being placed in the care of grandparents and other relatives or in foster homes.

Lifeline also participates in training persons to counsel, especially youths so that they can talk to their peers. He said this method is very effect as it serves a multiplier effect for inducing positive behaviours. Lifeline's message is abstain, or use a condom during sex.

Hunte expressed concern that small and crowded apartment homes in Guyana pose a risk to children experimenting with sex, "because when they see their parents do it, they also want to do it."

He also spoke of other dimensions to the ill-health of the population stemming from the influence of television on the family, especially children, truancy, illiteracy and crime among others.

Lifeline is in a coalition of a group of similar organisations targeting more youths, particularly those out of school.

Lifeline is driven mainly by volunteers. Apart from grants from the donor community and the National AIDS Secretariat, Lifeline gets its finances from managing projects and fund-raising activities.

To drive home the need for care and support, Hunte recalled Phillip Vanderhyden who died of AIDS in 1998 who wasn't afraid to declare the need to generate funds for care and support for people living with HIV/AIDS, pointing out that they can continue being a part of society and contribute productively.

Lifeline Counselling Services' centre is located at 354 Cummings Street, Cummingsburg and is open from 9:00 am to 5:00 pm, Monday to Friday. (Back to Top)

Peer helpers address sex, sexuality concerns

The Guyana Responsible Parenthood Association (GRPA) has had to shift its focus from generally dealing with sexually-transmitted diseases to making HIV/ AIDS prevention part of its mandate in promoting reproductive health.

It has been involved in training peer educators and counsellors since the 1980s, and recently the title of that category of persons had to be amended to peer helpers.

The peer helpers, who operate in the school system, educate, counsel and help their peers who have concerns about sexuality, sexual and reproductive health, including sexually transmitted infections (STIs) and HIV/AIDS. They function in Regions Three, Four and Five. Recently peer helpers were trained in communities in Port Mourant, Victory Valley, St Cuthbert's Mission and Beterverwagting, as a part of the adolescent sexual and reproductive health project funded by the United Nations Population Fund.

As part of its community outreach, GRPA has facilitators in Regions Three, Four, Five, Six and Ten, who conduct sessions and mobilise communities to take action on sexual concerns. GRPA's staff members also have discussions with community groups, religious groups, schools and sports clubs.

GRPA, along with five other non-governmental organisations (NGOs), is implementing a project targeting youths between the ages of eight and 25 years. This project aims to reduce the incidence of HIV/AIDS/STIs through promotion of safer sex and responsible sexual behaviour.

The project is being implemented in Georgetown, New Amsterdam and Linden.

The GRPA provides counselling through face-to-face interviews and through its Hotline (02-56493). It also distributes condoms to all clients and to health clinics and other NGOs for the wider community.

In her analysis of the response to HIV/AIDS so far, Programme Manager, Gillian Butts-Garnette, said there was need for more people to get involved in the campaign, but at the same time she recognised that this was challenging because of shortage of personnel.

She said the education programmes did not make an impact because they were more "lecture" oriented. She urged an approach of sharing knowledge and experiences which would carry "meaning" to people and could do more to influence positive behaviours.

But she noted that in the final analysis it was the individual who had to internalise habits for change. In addition, she said the media could play a powerful role in transmitting the right messages through creative means to influence positive behaviour. She said the media could also help to reduce cultural influences of other societies which contribute to negative behavioural patterns. She also advocated the need for messages to be sent via music, drama and poetry.

Butts-Garnette observed as well a large link between alcoholism and substance abuse with rising STIs, and noted that bars, as well as hotels and shops, should be targeted in the education campaign.

However, the GRPA's share of funding from the International Planned Parent-hood Federation (IPPF) was being reduced considerably every year as bilateral donors were ending their commitment to the body and finding other areas "of priority" to finance. (Back to Top)

Ready Body project urges youths to act responsibly

When Head of the United States Agency for Inter-national Development (USAID), Dr Carol Becker, a former population and health officer, assumed her tour of duty here two years ago, she was confronted by the need to do something about the steady increase of HIV/AIDS in the population, about five percent of which is already infected.

She contacted the autonomous agency, Family Health International (FHI) and asked for help, and also sought aid from the US. The efforts began when she sent for an anthropologist who worked in Africa and Asia, along with a consultant from Washington to undertake a study on the Guyana situation. She also noted that the situation for response by her agency was made even more urgent because of too little investment here, and there was need for something "catalytic."

The Guyana HIV/AIDS/STI Youth Project is a five-year project funded by USAID and targets young people between the ages of 8 and 25 in Georgetown, New Amsterdam and Linden. The target groups are out-of-school youths, mini-bus drivers and conductors, and organised groups. The focus of the project is to increase awareness to the dangers of sexually transmitted diseases, self-risk assessment and treatment thereof under the theme 'Ready Body! Is It Really Ready?'

USAID feels that this age group needs to exercise responsible behaviour and so needs to be educated early. The project is scheduled to last five years at an approximate cost of $1.2 million approved by the US Congress. It will be split into two phases, the first of which is currently being implemented-key messages on preventing STDs, and preparing a Peer Education Manual. The money is allocated to individual NGOs, which are expected to submit monthly reports on use.

Dr Becker, who is preparing an estimate for next year's spending said the US$1.2 million may be adjusted "as Congress sees the need." Because of the cost of opportunistic diseases from AIDS, Dr Becker said there was going to be a shift in resources from existing pools to fund AIDS.

Project Coordinator, Julia Rehwinkel, says Guyana's funding base was really low because of a lack of worldwide NGOs.

In some countries, she said, governments contracted NGOs to do awareness campaigns. She was "amazed" at the talent of members of NGOs here, noting that they only needed the skills of managing resources.

As for hope of the donor community providing the trial vaccines to the infected population, Dr Becker said this would be too expensive, noting that prevention needed to be stressed because "treatment is far down the road." But then she pointed out that even if the drugs became available, there would be need for specialists to ensure that the treatment was having the desired effect. She said providing specialists was also very costly.

The NGOs involved in the exercise are: Artistes in Direct Support, Comforting Hearts, the Guyana Responsible Parenthood Association, Lifeline Counselling Services, Volunteer Youth Corps and Youth Challenge Guyana. A governmental organisation Regional AIDS Committee of Region Ten is also a partner. (Back to Top)

Negative attitudes to HIV/AIDS disappearing - Springer

Ignorance of HIV/AIDS was at its apex in 1993/94. Doctors and nurses at the Georgetown Public Hospital were simply abandoning patients because they were afraid they would contract the disease, even through their protective gear.

Pan American Health Organisation AIDS Programme Assistant, Dereck Springer, who has been at the heart of working in HIV/AIDS, recalled that when he began counselling at the Genito-Urinary Medicine (GUM) Clinic in the early 1990s, Guyana was not addressing the epidemic as it should have been doing. The first reported case of AIDS in Guyana was in 1987.

"Nobody was responsible in terms of creating a safe environment," said Springer. And because of the ignorance, "persons were left unattended... not being recommended medical care, nurses were reluctant to provide nursing care, families abandoned their sick relations, and patients of both sexes were left in the beds, rotting away. Even persons at home were isolated." Persons with the disease felt that their dignity and self-respect were taken away, said Springer.

At that time, Springer said, people had the perception that the disease only affected homosexuals. This was reinforced by the fact that the persons who were dying or had died at the time were homosexuals.

"I chose to work with them [the patients]," Springer said. He recalled that a young resident of the East Coast Demerara, had been stricken with what the residents there believed to be "AIDS", and needed to be taken to the hospital. No vehicle would take him, and so he was transported on a donkey cart. Even though the GUM Clinic referred him to the then Accident and Emergency Unit for admittance, the doctors there refused to see him or have anything to do with him. His family, at their wits end, decided to abandon him.

He was left outside the hospital compound and because he could not walk, subsequently rolled into the drain. He was there for two days-half covered with leaves, dirt and garbage-before someone brought it to Springer's attention.

Springer said that when he found the young man, his face was sunburned and peeling. Had it rained, he would have drowned. Springer summoned an apprehensive attendant (porter) and got the man out of the drain and into the hospital compound, where he "demanded to see" whoever was in charge at the time to refer the man for admittance and treatment. The young man was admitted to the ward, where he died a short while later.

Because of this and many other similar incidents, Springer was at the centre of endless controversy at the hospital. Hardly a week passed when he wasn't at the Matron's or Administrator's office, lodging a complaint. He was even dubbed "The AIDS Doctor".

In the absence of a policy then, Springer also remembered interceding for a private sector employee who was being discriminated against, and was almost fired.

Springer also attended funerals of patients to lend support to their families and relatives. But his presence lent to those persons being identified as having had HIV and he eventually abandoned this practice. But it was such daily fare that led to Springer and a few other concerned persons forming Lifeline Counselling Services.

He attributed the negative attitude by hospital staff to them not being sensitized about the disease.

Now the UNAIDS Focal Point here, Springer noted that there has been a remarkable turnaround in the way persons with HIV/AIDS are treated. Families are more accepting. Many of them are opting to let their HIV positive family members remain at home and receive outpatient care, rather than have them admitted to hospital. And those who must be hospitalised, are being cared for by medical staff who have been sensitised. Some nurses have even been trained as counsellors and are now volunteering at HIV/AIDS non-governmental organisations.

Springer, the "Lifetime" counsellor too, has many more stories to tell of his experiences being in the vanguard for defending the rights of persons living with HIV/AIDS to have equal access to medical attention, employment. He continues to fight for these and moreover inform on the national policy on HIV/AIDS, which would eventually evolve into legislation. (Back to Top)

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