HIV/AIDS challenges
Stabroek News
December 2, 2002

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When one considers the mercilessness with which HIV - the virus that causes the fatal disease AIDS - strikes its victims, it renders completely meaningless the unceasing political confrontations here over issues that cannot be compared to the suffering and the loss of life that is characteristic of this plague.

Georgetown itself is the locus of this deadly epidemic and no effort can be spared or dissipated in battling it. For each man- hour that our politicians and MPs haggle over mere placatory words in a communiqué on fighting crime, there have been multiple new HIV infections, sentencing victims to a life of innumerable traumas and the constant threat of death.

Based on recently released figures, between January and June this year 235 persons contracted the HIV virus and as in many other countries, this figure is believed to be significantly less than the actual figure. The lives of these people and their families have been changed immeasurably and they cut through all classes and strata of society.

As grim as the picture is, there have been positive developments this year in the fight against HIV/AIDS. The government in collaboration with the New Guyana Pharmaceutical Corporation began producing anti-retroviral (ARV) cocktails to combat the disease modelled on existing patented therapies. Considering the economic plight of the country and the high infection rate, it was a decision that was taken in the national interest and must be commended. There is, however, much work still to be done to get on top of this disease.

Treatment, free of cost, has started with 128 patients at the Georgetown Hospital and most of these have shown abatement in symptoms. The major challenge for the Ministry of Health in what is essentially a pilot programme is to ensure that patients are thoroughly schooled on the need for regular treatment in the prescribed way to prevent disastrous relapses. This is treatment for the rest of their lives as there is as yet no cure for the disease and the prospects for a potent vaccine remain distant. The patients must also recognise that they can improve their circumstances through healthy eating and living and the relevant counselling has to be made available on an ongoing basis. The ministry must also ensure that sufficient numbers of staff are trained to handle this programme and that facilities to test viral loads in patients are available. A crucial aspect of the treatment regimen is whether the patient is responding to a particular mix of medications and this can only be answered by determining the viral load. Cooperation with Brazil - now a key producer of ARVs - could be very beneficial in the supply of the testing supplies and the sharing of treatment experience.

More challenging issues will arise once these initial patients respond positively to the medications. There must not be any discrimination in the treatment of those infected and the programme would have to be expanded to all parts of the country either through the public health system or in affiliation with private health care providers. It isn't feasible for patients to travel to Georgetown for treatment. The issue of cost will then arise. Can the state afford the cost of treating all HIV/AIDS patients? Can it afford not to?

The treatment programme is only one aspect of the overall campaign against HIV/AIDS and there are many other challenges. First, there is an absolute need for reliable and up-to-date data. The true profile of the HIV/AIDS scourge has to be known. Has it peaked, is the rate of infection among teens going up, is mother-to-child transmission stable and what is the level of new manifestations? These all need to be known on a progressive basis so that a flexible response can be charted. In the UNAIDS/WHO AIDS epidemic update issued to coincide with World AIDS Day yesterday, it was pointed out that Thailand's AIDS cases in the 1990s were predominantly due to commercial sex. Today, heterosexual relations and risky sexual practices account for the lion's share of new cases. A different response had to be charted.

For this data to emerge more clearly, the stigma of the disease and societal disdain have to be overcome. Infected persons will remain underground infecting others unknowingly and refusing to come forward to be tested and treated. The message that has to be drummed incessantly by the media, the government and NGOs is that HIV/AIDS is like any other affliction and there is little margin for complacency. Those affected have to feel that it is OK to seek help and treatment. For this to happen, all Guyanese have to examine the attitudes, prejudices, myths and stereotypes they harbour about HIV/AIDS. The disease can strike anyone.

Education, education, education is another mantra for all those stakeholders taking on the disease. A 2001-2002 national behavioural survey in India quoted by UNAIDS/WHO has shown that Indians who cannot read are six times less likely to utilise a condom during casual sex than other men who are educated beyond secondary school. There must be a saturation campaign that explains simply and clearly what the disease is, how it can be transmitted and how it is to be treated. This campaign must have as its fulcrum the message of safe and responsible sexual behaviour. Eschewing multiple partners and using condoms to reduce the risk of transmitting the HIV virus must be at the core of this appeal. It must be heard in relevant sections of educational institutions, churches, cinemas, workplaces and in the home. There is room for everyone to be involved.

There is no time to lose. The UNAIDS/WHO December 2002 report points to the gravity of the situation in the Caribbean and Latin America. It was pointed out in the report that Guyana has an estimated HIV prevalence of 1% or more among pregnant women - a dangerous figure which is being tackled through a mother-to-child programme. The Caribbean has one of the highest infection rates after sub-Saharan Africa and the latest figures continue to bear that out and with several startling trends. The Caribbean now has 440,000 persons living with HIV/AIDS and there were 60,000 cases of new infections. The adult prevalence rate - the proportion of adults 15 to 49 living with HIV/AIDS - is 2.4%. This is the second highest figure after sub-Saharan Africa at 8.8%. The percentage of HIV+ adults who are women is 50%. Only sub-Saharan Africa at 58% and North Africa and the Middle East at 55% have higher figures for women. UNAIDS/WHO suggest that this ratio for Africa is linked to economic circumstances which force women into relationships with generally older men who are infected with HIV and with whom it is difficult to demand safe sex or end relationships.

In Latin America and the Caribbean, the UNAIDS/WHO report suggests that men who have sex with men "appear to feature prominently in the increasing feminization of the epidemic; recent research has shown that a large proportion of men who have sex with men also have sex with women". The report noted that sexual identities are more flexible than assumed and that prevention efforts need to be fitted to apparently widespread but hidden bisexual relations. The report also asserted that in countries with HIV/AIDS prevention programmes oriented towards homosexual relationships the quality and effectiveness usually depends on the countries legal outlook on the matter and the extent to which a range of social sectors was involved. Brazil was hailed as an exemplar. Jamaica and Trinidad were singled out for prevention, care and support facilities but it was noted in the report that many such initiatives are hamstrung by discriminatory laws on homosexual relations.

Clearly there are many challenges facing the health ministry and NGOs in shaping a multi-targeted and comprehensive treatment, prevention and education programme. The start in the use of ARVs and the recent approval of an AIDS strategy are two important first steps on a long road.

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