HIV/AIDS afflicted should be placed on treatment earlier
Kaieteur News
December 20, 2006

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Health Minister Dr Leslie Ramsammy believes the time has come for Persons Living with HIV/AIDS to be placed on treatment earlier.

He also believes that the process for persons to enter the treatment programmes should be made easier.

When Guyana began offering anti- retroviral treatment a few years ago it targeted HIV+ persons who had evidence of opportunistic infections.

The country then moved to identifying also all HIV positive persons with CD4 counts of less than 200.

Today, persons with CD4 counts of below 350 are now placed in the ARV-based treatment programme.

“I still believe that earlier treatment is important and we have moved in the correct direction. But the time is rapidly approaching where treatment on diagnosis might have to be considered. There is an economic factor in the decision-making. Let us not delude ourselves any longer – the scientific basis for restricting treatment at this time is thread-bare. When we place people on ARV-based management is, for me, now a political/economic issue, not a scientific one. We hide behind science and there is an unseen complicity. I put this matter on the table for us to consider once again,” Ramsammy told participants of a recent HIV/AIDS forum held at the Cara Lodge.

The meeting, aimed at gaining consensus on universal access to prevention, treatment, care and support of PLWHA's saw participation from a wide range of stakeholders involved in the process.

The Minister also posited that treatment must be available to all Guyanese living with the disease.

Ramsammy also stressed that in addressing issues affecting children, including those not affected by or infected with HIV, should be made a priority for care.

“We cannot deal with this issue only on the basis of those children who are living with HIV or those children whose parents might be living with HIV or who might have died because of HIV.”

He posits that all children who are within the category of Other Vulnerable Children (OVC), whether their issue is related to HIV or not, must be addressed. To do otherwise, the Minister believes, is to court failure.

“We will fail if an OVC strategy is implemented on the basis of HIV alone. We must look at all children who have become orphaned or who live in vulnerable circumstances. All children who are vulnerable are at risk for HIV, whether their present vulnerability is related to HIV or not. Therefore, we must avoid the temptation of putting together an OVC programme to cater for HIV children. Unless we deal with these children now, we will inherit a group which itself will become a high driving force for the spread of HIV later,” the Minister said.

He pointed out to the participants that human resource challenges must also be recognised.

Noting that in this regard the major challenge is migration, the Minister highlighted the need for innovation and multi-skilled training, stating that the least sensible thing would be to encourage specialisation within the HIV programme.

“The problem with the large number of partnerships is that we have a temptation to have a project-like approach, where persons are trained to work in a specific area,” he told participants.

The minister also pointed out that while the approach of focusing on all Guyanese is commendable, organisations involved in the battle must target vulnerable groups for more rapid and effective outcomes. He specifically mentioned youth, young girls, women, FSW, MSM, miners and prisoners, noting that strategies must be devised and implemented to reach them, while not ignoring any person or group.

The minister said Guyana is presently remedying a situation where there has been a paucity of information.

“As we gather more and more information, it is clear that certain groups are affected disproportionately. The recent survey showing that HIV prevalence in FSW has dropped from 48% in 1997 to 27% in 2006 is encouraging. Yet, at 27%, this is an astounding prevalence rate. Similarly, prevalence rate of 21% among MSM and 3.9% among miners in a country where the overall prevalence rate has now dropped to about 1.5% must be alarming.”

Ramsammy also advocated for a link between nutrition support and comprehensive care and treatment.

He is adamant that resources must be committed towards nutrition as an important intervention in the HIV programme.

He pointed out that PLWHAs, like others who are ill, require special attention to be paid to nutrition. Too many of the programmes, he posited, are lacking of nutritional interventions.

“If we are to provide comprehensive care, then what is the linkage between nutrition and care of PLWHA's?” the minister questioned.