HIV/AIDS to be fought on many fronts - strategic plan Stigma remains key problem
By Samantha Alleyne
December 2, 2002
The war on HIV/AIDS must be fought on all fronts including the continued drive to educate the public, provide testing and counsel and offer treatment for infected persons.
This was the message of the Ministry of Health's $3.8B National Strategic Plan for HIV/AIDs for the years 2002-2006 which was recently approved by Cabinet.
The report noted: "But a truly expanded response requires not only greater involvement of all sectors of the society but a recognition of the inter-relationship between reducing risk, vulnerability and impact and the need to act on all three simultaneously. The most effective responses to the epidemic have integrated education, prevention and care and support strategies," the plan advised.
And while counselling and testing for HIV/AIDS is widely available treatment, care and support remain limited with anti-retroviral (ARV) therapy only available in Georgetown in the public sector since April.
The plan stated that there is still a lot of stigma attached to being HIV positive and this is most likely responsible for the late testing of persons diagnosed with AIDS, the mean age of survival between diagnoses and death being only four and a half months.
The first AIDS case was diagnosed in Guyana in 1987 and according to the plan there has been a progressive increase in reported AIDS cases since that time with significant hikes between 1997 and 1998 and a further sharp rise in 2001 over 2000. The sharp increases, the plan stated, may in part be due to improved surveillance or a reflection of the infections contracted 7-10 years ago, which had not had the benefit of treatment. It said that the epidemic has spread to all sectors of the population and by the end of 2001 some 2,185 cases had been reported.
According to the plan 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 the AIDS cases and outstrip the men in the 15-24 age group. In general the largest number of cases occur among persons 20-49 years of age, peaking in the 30-34 age group. The numbers of HIV positive persons within these age groups are not currently available.
Giving data on HIV prevalence rates, the plan said that 1.0% of infected persons are found among blood donors, (down from 3.2% in 1997), 7.1% among pregnant women in 1995 (up from 3.7% in 1993); 13.2% male (1992) and 6.5% female (1993) among STD clinic patients; and 45% among female commercial sex workers (1997 - up from 25% in 1989).
According to the data from 2000, approximately 80% of HIV/AIDS cases are from Region 4, (at a rate of 144.8 per 10,000, about 6% each from Regions 6 (25.9 per 10,000) and 10 (86.6 per 10,000). Region 3 has a rate of 33.8 per 10,000 while the other regions have rates ranging from 6.2 to 28.6.
From the above data the plan stated that the virus could be seen as a national problem.
"With the opening of Guyana's hinterland for development, the proposed Guyana/Brazil road, and the subsequent increase in the transient population, a further drastic increase in the prevalence of HIV/AIDS is anticipated. Because of the difficulty of access to some of the interior areas, the response so far has been concentrated primarily in Georgetown, with some activity in Regions 6 and 10," the plan stated.
Over the past three years there has been a considerable amount of public and targeted education but the emphasis has been on awareness raising and providing information on the cause, spread and prevention of the disease. Sensitisation of the general public, health care providers, youths and employers/employees, entertainers and female commercial sex workers was also carried out.
The plan stated that there are now several opportunities to reduce the spread of the virus. Firstly, officials know the virus that causes the syndrome and how it is spread, and from collective experience all know that it is technically feasible to reduce the spread and impact of the epidemic. Secondly, there are means of ensuring the safety of the blood supply and of providing a physical barrier to the sexual spread of infection through the use of condoms. Thirdly, there are means of reducing infectivity by lowering viral load through treatment with ARVs.
The first is clearly a service issue, the plan said, however, the second and third have implications for both service delivery and behaviour change on the part of the population.
It was stressed that people need to recognise the value of consistent condom use in situations that put them at risk, and the services have to ensure an adequate supply and non-discriminatory and non-judgmental access to those condoms. Additionally services have to provide universal access to care and a supportive environment that will create early care-seeking behaviour on the part of the population. This requires political and financial commitment.
Based on the allocation for the HIV/AIDS programme in the 2002 budget, which has been substantially increased, it can be assumed that the financial commitment to the programme is there, the report states. "Nevertheless funding is never infinite and realism had to be weighed against idealism and what is feasible in the perpetration of the plan."
According to the plan up until now the main responsibility for responding to the epidemic has been the Ministry of Health, although recognition has been given to the need for involvement of other stakeholders including other government ministries/agencies. It was suggested that one way of showing commitment to the process would be by inclusion of HIV/AIDS related activities in the annual programme and budget of those ministries/agencies.
Partnerships with key social groups, non-governmental organisations (NGOs) and religious organisations, and greater involvement of people living with HIV/AIDS (PLWHAs), have also been shown to contribute tremendously to successful strategies. The plan said while the NGO community and some of the international agencies have played an important part in the response to date, this needs to continue and be strengthened and better coordinated.