All have to know HIV status for universal access to care -Ramsammy
UNAIDS rep sees need for alignment in fight
Stabroek News
December 18, 2006

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Minister of Health Dr Leslie Ramsammy says that in order for universal access to HIV treatment every Guyanese must know their status and access testing.

He said there must be testing capacity for the effective management of persons living with HIV so as to monitor them. And no mother should have to deliver her baby without knowing her status or be denied access to the treatment that would ensure that her baby does not become infected if she is HIV positive.

"Universal access must not be a long-term goal, it must be now," the minister said. He said that there is too much talk and no reciprocal action and therein lies the problem. It is now time to deliver, he added.

And UNAIDS country representative, Dr Ruben del Prado has said that there needs to be alignment in Guyana's fight against the virus. According to him, the programme seems to be in chaos as various organisations are not working in tandem with each other. He presented a chart of what Guyana's HIV and AIDS programme looks like, illustrating the chaotic state it is in. Dr del Prado stressed the need for regular meetings among key stakeholders who can then inform each other on what each is doing.

"If the work you are doing is not part of the national plan then don't it," Dr del Prado said.

Both Dr Ramsammy and Dr del Prado were speaking at the National Consensus Meeting on Friday geared to set targets towards universal access for HIV prevention, treatment, care and support in Guyana. The meeting which was held at the Cara Lodge was in response to the UNGASS+5 Political Declaration on HIV/AIDS, made last June, where governments committed to set ambitious national targets for 2010 with interim targets for 2008, through an inclusive and transparent process, with full participation from civil society.

Consensus lacking

Ramsammy said that locally there is no consensus on the approach but while the disagreement comes from genuine concerns and anxiety there is need for all to come together and work towards one goal.

He said one of the issues where consensus is lacking is in the area of abstinence and according to him while abstinence is an important part of the overall strategy towards HIV/AIDS, it should not be the only preventative programme as it is not enough. "I hope for one and all we could all stand and say so," the minister declared as he stated that the approach to HIV must be prevention, treatment and care as one or the other would not be enough.

He said there is also need to work with female sex workers (FSW) and men having sex with men (MSM).

At the moment Guyana is introducing anti-retroviral (ARV) treatment when an HIV person's CD4 count reaches 350 and the minister said this needs to be maintained. But the minister said that human resource challenges must be recognised as the country's health sector is losing its skilled workers to migration and the way to go is to have multi-tasking health workers who can help to alleviate the pressure of this loss.

Ramsammy said that the gender equality issue must be addressed in the HIV programme along with violence against women and children and how these issues are dealt with in the judiciary. Also there is need for the Rights of the Child Commission to be established along with the Women and Gender Equality Commission.

"HIV does not give us time, we need to act now," the minister stressed.

Meanwhile, Dr del Prado praised Guyana for its work in the HIV fight for the year 2006 but stated that globally the year has been a very bad one as there has been more new infections than any other year. However, he said on the brighter side prevention has now been placed on the front burner again.

Civil responsibility

He said while Guyana is writing history in its HIV fight the money the programme needs is critical and so the partnership with UNAIDS is extremely important. He pointed out that making the money work goes beyond the donor industry as there must be accountability on the part of civil society as they cannot just be beneficiaries. "The time for lamentation is over; they (persons in civil society) are equally responsible for the failure."

Universal access

He also said that there is need to do less "feel good things" in order to reach universal access. According to him, until the HIV positive people can go on television and talk about their positive status and be allowed to walk down the streets freely it is not universal access.

He gave the example on Friday where some HIV positive persons left the meeting when they realised that the media was covering part of it.

And Ramsammy told Stabroek News that there is more need for budgetary support than project support. He said that government does not control much of the money given to the country for the fight and while they are grateful for the project support there is more need for budgetary support. He said that the donor agencies could hold the government accountable for delivery. He said the European Union is the only agency that provides budgetary support. He added that many times officials from the health ministry are out at meetings with donors instead of being out in the fields doing what needs to be done.

No waiting list

At the moment, according to the minister, the country has a 1.4 prevalence rate which means between 12,000 and 15,000 persons are infected with the virus. He said that approximately 2,000 persons are on ARVs but there is a total of 2,500-3,000 persons who need treatment.

He said that 3,500 persons are being managed by the health system and there is no waiting list for persons who need treatment. Once a person is in need of treatment they can access it as there is no shortage of ARVs. "There may be people who need treatment but who have not been found but no person is placed on any list. . ."

Further, the minister said, while the country has had to discontinue its purchase of ARVs from the New Guyana Pharmaceutical Company (NGPC) here because of the lack of bio-equivalency testing of the drugs, and purchase drugs from a company in India and the US, there is no threat to the country's treatment programme for another five years.

While it costs US$40 per annum for a person on first line treatment when the drug was being purchased locally it is now around US$350 to purchase it from Cipla, the Indian company, and another US$2,000 for persons who are on second line treatment. However, the minister said that not many persons have developed resistance to the first line drug so not many are in need of the second line. Money used to purchase the drug is accessed from the Global Fund, the World Bank and the US President's Emergency Plan for AIDS Relief (PEPFAR).