$3.8B plan approved to fight HIV/AIDS
$3B for patient treatment
By Samantha Alleyne
Stabroek News
November 25, 2002

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The Ministry of Health with the help of other partners has designed a $3.8B National Strategic Plan for HIV/AIDS for the years 2002 to 2006.

Head of the Presidential Secretariat Dr Roger Luncheon said Cabinet approved the plan earlier this month and also called for the inclusion of a hospice for HIV patients.

The plan covers the areas of surveillance, care, treatment and support, risk reduction and management coordination and policy formulation.

It was formulated following a review of the National AIDS Programme Strategic Plan 1990-2001 and after consultations with government ministry officials, NGOs, the National AIDS Programme Secretariat (NAPS), representatives of People Living with HIV/AIDS (PLWHAs) and civil society groups. According to the new plan, while the 1999-2001 strategic plan was comprehensive it suffered from an insufficiency of resources, human, technological and financial, for its successful execution.

The aims and objectives of the new plan are the same namely: to reduce the risk and vulnerability to infection through prevention and control of the transmission of STIs and HIV; the promotion of sexual health; saving/prolonging and improving the quality of life of persons with STIs/HIV/AIDS; and to reduce the social and economic impact on individuals and communities.

The last goal can be achieved by prolonging the productive lives of individuals infected with HIV, thus allowing them to contribute to the well-being of their families and reducing the burden to the welfare system. This can be done by encouraging persons at risk to seek early testing and treatment, make treatment easily available and create a supportive environment that will encourage persons to seek early testing and treatment.

The estimated sum of money to be spent in the area of surveillance is $552M; $3.08B will be spent in the area of care, treatment and support; risk reduction - $145M; and management - $26M.

Surveillance is expected to provide the information on the extent of the epidemic, the population groups most affected and behaviour patterns. Care, treatment and support is expected to contribute to the reduction in the spread of the disease and improve and prolong the useful life of those infected.

Management is proposed as the engine to drive the other three components.

The plan said it must be understood, however, that there is only one plan and it is essential for the components to come together as an integrated whole.

In 2000 the virus accounted for 14,154 years of potential life lost (YPLL), more than that of acute respiratory infection (ARI), ischaemic heart disease (IHD) and cardiovascular disease (CVD) combined.

Unfortunately the true extent of the problem is unknown since AIDS data is incomplete and sero-prevalence data outdated. A serious situation of under reporting exists, estimated at approximately 40%. Additionally the dynamics of transmission have not been fully explored.

According to the plan, information is essential to rational planning and decision-making. Good surveillance is therefore, going to be the cornerstone of the execution and monitoring of the plan. This requires data collection to be active and provide both quantitative and qualitative information.

“Quantitative to define the extent of the problem and the population groups to which qualitative surveillance must be directed, and qualitative to gain a better understanding of what is fuelling the epidemic, to help guide the type of intervention needed and determine what works and what doesn’t and why,” it stated.

Further, the plan states that laboratory capability is essential to good surveillance. There is therefore a need to plan for increasing the capacity and capability of laboratories to handle the volume of work that is expected to be generated with the increased demand for diagnosis and monitoring. This will include equipment, testing supplies and human resources.

It is expected that under this component that all designated sites in the public sector will be reporting on the number of new STIs, TB, HIV and AIDS cases and opportunistic infections (OIs) on a monthly basis by the end of 2002; at least 50% of sentinel surveillance private physicians and laboratories reporting on the number of new STIs, TB, HIV and AIDS cases and OIs on a monthly basis by the end of next year; and at least 80% reporting by the end of 2005.

Other expectations includes, all treatment centres reporting monthly on the percentage of HIV positive clients returning for follow-up care, starting 2003, surveys carried out biennially, starting in 2003, among youths and other specified population groups to provide information on condom use, contact with non-regular sex partner, age at first intercourse, drug use and monogamous relationships and a system to be developed and institutionalized for providing feedback to stakeholders on the status of the epidemic by the end of this year.

Care, Treatment and Support
Currently treatment for STIs and OIs is available in both the public and private sectors. National guidelines for the syndromic management of STIs exist and training of health personnel in the public sector in most of the regions has been carried out using the approach.

Only the Genito-Urinary Medicine (GUM) clinic routinely treats patients with anti-retrovirals (ARVs) and the decision to treat is based on clinical criteria.

It means that persons already have AIDS at the time they start treatment and are starting later than is optimal. The plan said that it is unfortunate that the above situation is all that is possible at this time given that there is no testing currently being offered locally for cluster designation 4 (CD4) count on viral load, two of the parameters used in deciding when to start treatment.

“This situation has to be changed pretty quickly since treating persons when they have already started to show signs of disease, although it may improve the quality of life, will not reduce the number of new cases of AIDS,” it stated.

It is hoped that by implementing the different parts of this component that the survival time between diagnosis of AIDS and death increases to at least 3 years by the end of 2006. Also that prophylaxis and treatment of OIs and other co-infections are available as part of a minimum care package by the end of 2003.

ARV therapy should be provided through the public health services, free of charge to all those who cannot afford it by the end of 2004. Also that the anti-discrimination legislation be in place by mid-2004 and that social support services be available to all PLWHAs and their dependants by the end of 2005.

Risk Reduction
It is expected that at least 60% of persons having sex with a non-regular partner were using a condom by the end of 2002 and that the average age at first consensual sex will increase to at least 16 years by the end of 2006. There is also hope that teenage pregnancies would be reduced to a certain percentage by the end of 2006; and at least 75% of persons reporting sexual risk behaviour have an appropriate perception of their own risk.

There has been a progressive increase in unreported AIDS cases since 1987 with a significant hike between 1997 and 1998 and an even sharper rise between 2000 and 2001. The rate of increase of AIDS cases is faster in females than males, with an accelerated rate beginning in 1993. Females now make up 38% of all AIDS cases but outstrip the men in the 15-24 group.

In general the majority of cases occur among persons 20-49 years of age with the largest number in the 30-34 age group. “Considering that it takes from 7-10 years after infection for AIDS to develop it is clear that persons in their teens and early twenties are at highest risk, especially teenage females,” the plan said.

It was stated that providing information and educating the general public and groups that are particularly vulnerable, and promoting supportive values and attitudes are an integral part of risk reduction. In setting out its policy the ministry, according to the plan, gave recognition to and endorsed the promotion of abstinence, fidelity, marriage and strengthening the positive reinforcement of the family structure and family values as effective lifestyle patterns against the spread of HIV.

Management, Coordination and Policy Formulation
This component will focus on the plan being managed in a well coordinated and transparent manner, with a multi-sector approach.

It was hoped that at least seven regions wouldl have the Regional AIDS Committees (RACs) in place with an action plan within the context of the National Strategic Plan by October 2002; and annual work plans with budgets by August each succeeding year starting 2003. It is also hoped that at least five subject ministries will have provision for HIV/AIDS programme(s) identified in their 2003 budget, and others by 2004 budget. Also that public health laws as they relate to communicable diseases will be reformed and enacted by the end of 2003 and the accompanying regulations in place by June 2004.

Under this component it is assumed that the government will accept the recommendations about the composition of the National AIDS Committee (NAC), RAC and restructuring and repositioning of the NAPS. Further, that PLWAs will be empowered enough to come forward to participate in the programme at all levels and that legislation having been drafted and policies developed will be enacted/ endorsed.

Monitoring and evaluation is an integral part of management, and the role of the secretariat should be to coordinate activities where indicated and to ensure that those agencies charged with the responsibility of implementing each component carry these out.

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