Making the AIDS policy work

Stabroek News
September 1, 1998

The government's policy documents on the Human Immune-deficiency Virus (HIV) and the disease it causes - Acquired Immune Deficiency Syndrome (AIDS) - raises serious questions which require decision makers to act speedily.

Totally unrelated to the contents of the document is its tabling in Parliament without a date, a time frame for implementation or a broader overview to give its audience a better grasp of its applicability.

Its most recent data refer to 1995. We are in the middle of 1998.

Up to the end of 1995, 796 cases of AIDS were reported. Of this number, 519 were males. There were 10 reported cases in 1987, 62 in 1990, 105 in 1993 and 192 during 1995.

More than three-quarters of these persons were less than 39 years old and 21 were below the age of five (indicative of mother to infant transmission).

More importantly, there has been a sharp reconfiguration of the male to female ratio of those infected. In 1988, it was 5.8:1; 2.8:1 in 1990; 2:1 in 1992 and 1.3:1 up 1995. What about 1998? The shifting ratios are reflective of an increasingly predominant mode of heterosexual transmission of the disease. This will have grave repercussions.

The challenges for those at the helm of the campaign against AIDS are many. The major objectives must be to restrain the spread of this killer disease and to offer a glimmer of hope to those infected with HIV.

Educating the public on the danger of AIDS requires a high profile saturation campaign to tutor all classes of society from the illiterate labourer to the university graduate. This is a challenge that has signally failed to materialise.

Secondly, in respect of HIV positive persons, the ultimate objective would be to apply treatments to knock back the viral loads rather than simply fighting opportunistic infections.

How are these objectives and the host of others in the policy document to be achieved? The simple answer is lots of money and in imaginative sensitisation campaign for the public.

The policy means very little unless the government is willing to commit hundreds of millions of dollars or can attract support from multilateral agencies such as PAHO or the WHO.

And if this is not prioritised, the country is likely to face a much higher infection rate given the more liberal attitudes to sex. Furthermore, it is widely believed that the figures for HIV carriers, AIDS and AIDS related complex sufferers are significantly under reported. Are doctors at private hospitals dutifully reporting on numbers of HIV/AIDS cases? The government needs to do at least three things.

First, it must be more forthcoming with up to date information on this dreaded disease. It must also demystify the figures. How for instance has the country done over th last six years combatting HIV/AIDS? Do the increased cases represent a normative figure for a developing country of this kind? What of the shift in the transmission rate? What sort of threat does this pose and how will it be handled?

Secondly, the government must drastically increase its outlay on the AIDS education programme to drive home the message. This must be innovative and straddle schools, workplaces, churches, the tourism industry, the public and private sectors, unions, the media etc. Such an effort is not in evidence. While money will be a consideration , it should be borne din mind that the cost to the economy - considering that more 75% of the persons infected up to 1995 were in the most productive age category - would eventually be much higher.

Thirdly, novel means must be found to give those suffering from the disease more hope than just hoping to survive the next opportunistic infection. Alliances with some of the major drug testing establishments abroad could give those who volunteer a much better chance on the expensive array of drug cocktails used to fight the disease.

The tabling of the AIDS policy requires the government to come up with strategies to back it and make it workable. What are these?