Positives and negatives - Ramsammy says PMTCT a success, continuing discrimination disappointing WORLD AIDS DAY 2006
By Neil Marks
Guyana Chronicle
December 1, 2006

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TODAY, food cooked by people living with HIV/AIDS would be on sale at the World AIDS Day rally in Georgetown.

But how many would feel scared to buy?

If Health Minister, Dr. Leslie Ramsammy, was in the country, he surely would have taken a bite. But he is not so sure how many would follow him.

Ramsammy feels that while his ministry through the National AIDS Programme Secretariat has carried out the most effective mass communication campaign in the Caribbean, adjudged so by the Pan American Health Organisation, even those with all the right answers might feel scared to eat from people living with HIV/AIDS.

Stigma and discrimination, he said, continue to plague the fight against the disease which more than 12,000 Guyanese live with.

It’s the biggest challenge he has to confront today, World AIDS Day 2006, against an otherwise successful programme which sails on massive international funding from the Global Fund, the World Bank and PEPFAR, the U.S. President’s emergency programme for AIDS reduction and prevention, which alone is expected to plug an estimated US$90M at the completion of its five year duration.

Ramsammy is so confident of the success of Guyana’s programme that he refuses to pay attention to statistics that say Guyana has the second highest prevalence rate in the Caribbean behind Haiti, noting that countries such as Trinidad, Belize and the Bahamas, have reported a higher prevalence rate than Guyana.

Owing from government and independently commissioned investigations, he said two per cent of all Guyanese are living with HIV/AIDS. But that figure is high, he said.

While pushing country ranking aside, Ramsammy believes Guyana has too many infections as does much of the Caribbean, all of which fall above a prevalence rate of one per cent.

Guyana’s intensive HIV/AIDS fight began a mere five years ago, and Ramsammy has been at the start of the initiative. Then, when Guyana had no international funding, save for technical assistance, under his stewardship began an intensive resource mobilisation effort at home and internationally.

One the most successful programmes in Guyana is Prevention of Mother to Child Transmission (PMTCT), which provides Anti-Retroviral Drugs (ARV’s) to mothers to reduce the risk of them passing the virus on to the unborn child.

“If there was truly an innocent victim in this disease, it would have to be the child,” Ramsammy said.

Before 2001, there some studies done in Guyana that showed an increasing number of mothers getting infected. The figure was as high as seven per cent of all pregnant women, amounting to just more than 18,000.

Today, the prevalence rate has dropped to 1.6 per cent and according to Ramsammy this figure has been verified by an independent survey conducted this year. “This is one of the indicators that we have come a far way,” he said.

Seventy eight per cent of all women infected with HIV/AIDS now have treatment and care available in all regions of Guyana.

With the world aiming for 80 per cent access by 2010, Guyana is already close to meeting that target, four years earlier, when the world now averages eight per cent.

Guyana has also now moved towards testing babies for the HIV virus as soon as they are born.

In 2001, when a baby was born, it was not possible to determine if the virus was transmitted, since it would take 18 months for the mother’s anti-bodies in the baby to “clear up” before it could be determined if the baby was infected. And since the drugs are too powerful, they could not be given to the baby without knowing its status.

Today, however, through a DNA test, it is possible to test the baby at birth, and if the baby tests positive and requires treatment, liquid formulations of the ARV’s can be administered.

Ramsammy boasts of this too, since many countries are not able to administer the liquid formulations because of the cost factor.

Ramsammy has much to brag about when it comes to his treatment programme, but he said the entire country needs to brag with him, because it was a nationwide effort that has allowed Guyana to be able to provide ARV’s free to all HIV/AIDS patients who need them.

It costs US$300 per person every year. In 2001, very few people were on treatment, and those who were, accessed the drugs from relatives overseas.

“Then, if you didn’t have relatives overseas to send the drugs to you, which then cost US$12,000, it was effectively a death sentence,” Ramsammy said.

Currently more than 1,500 people are being treated with the ARV’s free of cost, and so too with a single pill a day.

Ramsammy said when the world was with abuzz of news recently of the U.S. being able to give its HIV/AIDS patients one pill a day with manufacturers of the different patents coming together, Guyana had already began to do so two years ago. “Many people don’t know this and know of the leadership role we have taken in fighting the disease.”

Guyana began producing generic drugs through India in 2001, but has had to discontinue because the local manufacturer, the New Guyana Pharmaceutical Corporation (New GPC) did now have the U.S. Federal Drug Administration stamp, and thus buying the drugs using donor funding had to be discontinued. Now, Guyana tenders out for drugs being manufactured in India and supplied by the same New GPC.

In addition, Ramsammy said, HIV/AIDS patients who fail to respond to the second line treatment can also be given, free of charge, second line treatment, which though is much more expensive.

Fortunately for Guyana though, not many people living with HIV/AIDS require the second line treatment, which would cost about US$3,000 per person per year.

Ramsammy feels that an additional 1,000 persons who have not come forward might need ARV’s. If all come out they would be treated, he said, adding that there would be no waiting list.

Guyana, he said, can treat all who might need ARV’s.

At the moment, 3,000 persons who have HIV but who do not need ARV’s as yet, are being managed.

Another success of Guyana’s programme that makes Ramsammy heart well up, is that HIV persons no longer need to wait until they get sick to start receiving treatment.

This is now possible with a CD4 count, which is also offered free of charge.

Your T-cell count, also known as a CD4 count, reveals the number of T cells in your body. A T cell is a special kind of white blood cell, and the more you have, the stronger your immune system is.

When you were infected with HIV, the virus entered into some of your T cells. When these HIV-infected T cells make more copies of themselves, they end up making more copies of HIV as well. HIV can also destroy T cells, as well as other surrounding cells.

After living with HIV for a while (if you don't take medications) the number of T cells you have will usually go down. This is a sign that your immune system is being weakened. The lower your T-cell count, the more you risk getting sick. A normal T-cell count for someone without HIV is usually between 500 and 1,600.

Someone begins to get sick when their CD4 count reaches 200. Guyana began offering ARV’s when a person reached 200. Today however, it does not have to get that low.

For the past two years, Guyana has been following developed countries, such as the U.S. and Europe, in administering ARV’s when a person’s CD4 counts reaches 350.

This is much higher than Caribbean countries. Trinidad is the only other country that comes close, offering ARV’s when the CD4 count reaches 250.

“Guyana has the widest range being practiced in the developed world and today we are also able to do a viral load that tests the level of HIV infection. The goal of the treatment programme is to reach the undetectable stage,” Ramsammy said.

This year Guyana was recognised by the Pan American Health Organisation for having the best mass communication programme in health for its HIV/AIDS campaign, but Ramsammy said even with this improved education discrimination continues.

“Someone would tell you that if you sit next to a person who has HIV you would not get the disease. But ask them if they would buy food from that person – their attitude changes,” he noted.

He said that without question, people are learning more, be they school children or cane cutters. In fact, he said the knowledge base of Guyanese is as high as that of Americans, according to a recent study.

However, some myths still persist, such as mosquito spreads HIV/AIDS and Ramsammy said more needs to be done towards this end.

Another challenge he sees is being able to get adequate resources when developed countries continue to scour Guyana and the Caribbean for skilled personnel and lure them away with better paying jobs.

He said too, the supply management chain in Guyana needs to improve, because there are still cases where there is a shortage of testing kits at some institutions at times.

In addition, Ramsammy is disappointed that the law that prevents discrimination has not yet been passed. However, he said, much has been done towards this end. The legislation has been drafted, and “hopefully in 2007 we would be able to say we have the law now.”

Despite these challenges, Ramsammy feels that on this World AIDS Day, Guyana deserves to score high marks, and it is a tribute to all who have thrown their weight behind the fight.

As the fight continues, an estimated three persons will die of HIV/AIDS in Guyana, today.