All HIV/AIDS patients to get anti-retroviral drugs
-Health Minister By Miranda La Rose
Stabroek News
April 29, 2002

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Universal anti-retroviral treatment for HIV/AIDS patients, though extremely costly, will be instituted as it is the only way to reverse the increase in new cases locally, Health Minister Dr Leslie Ramsammy has disclosed.

Earlier this year, the New Guyana Pharmaceutical Corporation began producing anti-retroviral drugs - now widely used for keeping the HIV virus at bay - at a fraction of the commercial price quoted by international drug companies. The government had said then that the issue of universal treatment would have to be addressed.

In a brief interview with Stabroek News at the end of the Caribbean/US Conference on HIV/AIDS in Georgetown last week, Dr Ramsammy said that universal treatment "is going to put huge pressure on us but we have decided to go in that direction. If we don't, it will be prohibitive in any case."

Apart from the pilot project which began recently using anti-retroviral drugs, Ramsammy noted that at present HIV/AIDS patients are treated with everything including antibiotics and anti-fungal drugs except for costly anti-retroviral drugs. The government believe that by using anti-retroviral drugs and reducing the need for people to go to clinics and be hospitalised the cost will eventually be lowered.

In relation to a reversal of new cases, Ramsammy said that when treatment with the anti-retroviral drugs takes effect there will be a slowing down of the number of new AIDS cases because people will not move from being HIV positive to AIDS as quickly. Secondly, he said that there will be fewer new cases but they will not show up for a number of years because those already infected over the last couple of years will then be tested and found to be positive.

Because of this, the number will appear to be increasing though there will actually be no new infections. "In another two or three years", he said "we will see a reversal. What we will begin to see first, however, will be a slowing down, then a reversal."

He expects that by sharpening the treatment "we'll begin to see progress within a short period of time because new AIDS cases will be reduced almost immediately and the new HIV cases will begin to come down as a result."

Preventing mother-to-child transmission of the HIV virus has been a cornerstone of the state's fight against the disease and drugs were specially procured for a pilot programme.

Asked about the state of Guyana's national HIV/AIDS strategy, Ramsammy said it is in a revised form but was still being used as a guide. He explained that a desk review of the strategy was being done and when completed, he expects that it will basically be the same as the last.

Head of the National AIDS Programme Secretariat (NAPS) Dr Morris Edwards said that while there was an increase in the reported number of AIDS cases for Guyana last year compared to the year 2002, it would be difficult to speak about HIV infections because the required surveys, that is, ante natal surveys to give trends of infections have not been done.

In an ante natal survey pregnant women are asked to volunteer to be tested for HIV at designated sites, over a six-week period. The level of antenatal infections will give an indication of what is happening in the general population. After one year Bahamas saw a 50% reduction in new cases through its antenatal programme.

Nevertheless, NAPS plans to start an antenatal survey by next month with funding already obtained through the Caribbean Epidemiological Centre (CAREC).

On the issue of the effectiveness of condom campaigns, Dr Edwards said that there should be no loose statement as to their effectiveness as there has been no survey to evaluate whether people have increased their use of condoms. A USAID-funded project conducted a baseline study on condom use about two years ago, he said, but an evaluation is now needed to find out whether there has been a change in the level of condom use in the target population.

On the issue of anti-retroviral therapy which started at the Georgetown Public Hospital, Dr Edwards said that plans were in place to build the institutional capacity to deliver treatment in other parts of the country as well. Last year a workshop on the clinical management of HIV/AIDS using anti-retroviral drugs for medical practitioners from most of the regions of the country was postponed. This workshop was rescheduled to this month end but was cancelled because the consultant was no longer available. He hopes the workshop could be held next month.

Asked about a designated HIV/AIDS ward in the Georgetown Hospital, Dr Edwards said there was none. He explained that previously persons living with HIV/AIDS were placed at the back of the old medical ward in the southern section of the hospital compound. In the new location, he said that persons living with HIV/AIDS were admitted there like any other patient who has a medical condition.

Commenting on the situation globally and regionally, Assistant Secretary General of the United Nations and Director of UNAIDS, Dr Peter Piot told Stabroek News that the situation in the Caribbean is serious because HIV continues to spread and Guyana and Haiti are the two most affected Caribbean countries. The Caribbean has the highest rate in the Americas and the highest rate outside of Sub-Saharan Africa.

The good news, he said, was that there are a number of countries where there are less new infections than there were five or ten years ago. "This means that the strategies to deal with this epidemic can work if they are applied on a large scale," he said adding that in South America, Brazil has done a good job and has less infections. Thailand and Cambodia in Asia; and Uganda, Kenya and Tanzania, in Africa were other examples.

Piot noted that at present there are about 40 million people living with HIV in the world. The projection is that in 20 years time another 60 million will become infected. Sub-Saharan Africa is by far the most infected region the world. There are countries in which 30% to 40% of the adult population was infected.

Director of CAREC, Dr James Hospedales told Stabroek News that the overall situation in the Caribbean "is gradually getting worse" but "we are beginning to see signs of a turnaround in a few countries, the Bahamas and Bermuda, in the region". These countries have implemented more comprehensive care and treatment programmes with proper resourcing of programmes as mandated by the political leadership. The epidemic, he noted, continues to rise in most of the Eastern Caribbean, Guyana and Trinidad and Tobago.

Asked about transmission of infections by heterosexual, homosexuals and other means, Hospedales said that 20 years ago the epidemic "had more to do with men who had sex with men but today overwhelmingly it is more a heterosexually transmitted epidemic. In Guyana, the Bahamas, Haiti, the ratio of men to women is one to one."

Noting that Guyana has been relying mostly on its national purse to fight the epidemic, Hospedales said that with the level of the problem here there are now several donors who are going to contribute or implement substantial programmes. Among them are the United States through the US Agency for International Development, the Centers for Disease Control and Health Resources and Services Administration of the US Department of Health and Human Services and Canada through the Canadian International Development Agency.

On Guyana's unilateral action to produce anti-retroviral drugs, he said that such action tends to draw attention to the situation. He said that it would be important to have the quality of these drugs assured so that both the local population and the rest of the Caribbean could rest easy on quality and safety issues.

Asked whether developing countries should be part of vaccine trials, the CAREC head said that most of the new infections are in the developing world and therefore the developing world should be part of properly conducted vaccine trials.

He said that at present there is a vaccine from the US being tried in Trinidad, Haiti and Brazil. This trial has already been tested for safety and efficacy in the US. The test now being conducted in the region, he said is called the phase two trial. If it is going to be effective, that trial will then be taken to a bigger population and tested yet again. HIV/AIDS vaccines, he said are still a distant prospect, probably not for another five to seven years.