HIV/AIDS treatment in the regions Editorial
Stabroek News
October 6, 2003

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Considering that not so long ago the treatment of HIV/AIDS was virtually an underground operation, the country has come a long way in the last two years or so. First the indigenous production of anti-retroviral drugs (ARVs) was started by the New Guyana Pharmaceutical Corporation and then the government launched a Georgetown-based programme for the treatment of HIV-infected persons who had begun showing signs of having AIDS.

A critical new part of this programme is to be rolled out soon. Treatment of HIV/AIDS patients will be regionalised. Previously those who were afflicted had to travel to Georgetown if they wanted to be treated and this was just not feasible. Sometimes their weakened state would not allow it and moreover they needed to be in close proximity to their centres of treatment for this programme to work.

Therefore, the plan to begin ARV treatments at state health facilities at Linden, on the Essequibo Coast, on the West Demerara and at New Amsterdam is an important step forward and the Health Ministry should be commended for it.

There are numerous pitfalls, however, and the ministry would be well advised to ensure that it doesn’t over-extend the facilities and resources at its disposal.

First, given the enormous threat that HIV/AIDS poses to the populace - around 5% of the adult population is believed to be HIV+ - this programme has to produce results and has to be tightly managed. It makes no sense doling out expensive ARVs indiscriminately to patients and hoping that they get better. That probably works for some ailments but not HIV/AIDS.

Patients in this programme have to be educated about their condition and have to understand what their obligations are i.e. that the medication that they are being given has to be taken in the prescribed dosage at the prescribed times. Anything less than that spells disaster. They will suffer relapses and worse could begin cultivating highly resistant strains of the virus which could be spread in the population.

So the success of the programme really depends on enlisting the patient in the battle for his or her own survival.

Then, there have to be regular visits to the clinic to check whether the patient is abiding by the treatment protocols and if these are keeping the virus in check. This requires regular viral load testing which the public health system will have to spend more on, probably in conjunction with the private sector.

Where therapies or regimens have to be altered this has to be done again under the guidance of the physician.

Patients in this programme require intensive and continuous counselling to cope with the trauma of being HIV positive; how to cope with societal pressures, family ostracisation, lifestyle changes and to accept that they have a lifelong illness which, if properly managed, can allow them to lead productive lives.

The ultimate goal is saving the lives of these people and it would be very instructive for the Health Ministry to present a report to the public describing the experience to date with the ARV programme. How many people in total have been treated, how many have dropped out and what efforts were made to get them to rejoin, what has been the mortality rate, what has been the state of health of those who have survived and related issues such as confidentiality, the stigmatisation of these persons and family relations.

Such a report would provide a practical basis for not only assessing how well this programme is working but whether it can be successfully spun-off to other regions.

Given the continuing exodus of teachers and medical professionals there will be legitimate concerns over whether the programme could upkeep a certain standard. The Health Ministry must address this dilemma.

Secondly, the Health Ministry also has to convince international donors like the World Health Organisation, the World Bank and in particular the Bush administration that its treatment programme is working.

There is mighty competition for HIV treatment dollars. Because Guyana and Haiti were the only countries in the Caribbean included in the Bush HIV/AIDS plan, the US administration has been besieged by requests by other Caribbean countries to be included in the plan. So far, these requests have been rebuffed. At a meeting in Trinidad last week, US Caribbean ambassadors said they had no plans to push for changes to include more regional countries in the package but things could change ever so quickly if we fail to properly steer our programme.

The issue of stigmatisation is also one that the government and all Guyanese have to address or else those who need treatment to stay alive will not come forward. There are a number of non-governmental groups which are making an effort such as the Guyana Responsible Parenthood Association which organised a minibus motorcade in the city two Sundays ago to highlight the issue. But more needs to be done and the state should also participate fully in this.

Following a 10-day visit to Africa last month, US Senator Mike DeWine in his report to the US congress highlighted the issue of the HIV/AIDS stigma.

While in South Africa, DeWine - who visited Guyana on a similar HIV/AIDS mission - said that he met a doctor who was running his own treatment programme. The doctor said there was a woman working in his household who suddenly left her job. After seven weeks he drove several hours to her village only to discover that she had died of AIDS. She was working for a doctor treating HIV/AIDS patients but felt too stigmatised to even tell her doctor-employer.