Practical approach to pre-emptive measures key to PMTCT success
• Health Minister
February 22, 2007
The key to real success in the Prevention of Mother to Child Transmission (PMTCT) Programme is preventing women from becoming infected in the first place. This is a ccording to Health Minister Dr. Leslie Ramsammy.
However, the minister noted that such an accomplishment presents a real challenge. “What can women do to protect themselves? We know what causes the infection (HIV) and how it is transmitted. In terms of sexual transmission, the only 100% foolproof way is abstinence.”
He however noted that a more realistic approach would be the practice of monogamy between non-infected persons. Outside of this, there is also the consistent and correct use of condoms, but he acknowledged that this carries some risk since it requires a high degree of discipline as well as knowledge about proper storage, etc.
The minister said since the male condom is the one most commonly used, this requires agreement from the man, something which is fraught with many problems. He pointed out that the female condom is not readily available in Guyana , but even if available - putting more control in the hands of the female - there is still some negotiation which must take place.
“In other words, unless the woman has the strength to say no, her exposure is still at the mercy of the man,” the Minister said.
Of the 3,900 cases reported at the end of 2003, 1509 or 38.6% were female, compared with only 24% of the cases at the end of 1989. This is a clear indication that the transmission is increasing rapidly among women. Since that time, the percentage of females among those diagnosed annually has fluctuated between 38%-43%. In a survey done in 2000 among commercial sex workers in downtown Georgetown , 46% were found to be HIV positive.
Overall, although there are a larger number of males with the disease, the rate of increase among females is greater, and among the 15-24 age groups, there are more females diagnosed than males. The reason for this is unclear and is an area begging to be researched. It has been well documented that women are more susceptible to contracting HIV than men.
While the reason is unclear some postulate that the composition of the female anatomy is a contributing factor. The vagina allows for the retention of spermatic fluid for extended periods of time; an erosion of the cervix may also be present without being discovered and quite often, sexually transmitted infections (STI's) are asymptomatic in women and go undiagnosed. The latter two are known to be associated with increased risk of transmission.
Sociological factors may also be at play, the minister added. He pointed out that various sexual practices also contribute to the risk of STI's. They increase the chance of exposure to disease-causing organisms and the chance of being infected.
Aspects of high risk include the number of sex partners, the frequency of change of partners and the type of sex acts involved. He noted that behaviour is therefore an important aspect of vulnerability to infection.
He posited that women are particularly more vulnerable in this regard. A woman in a stable relationship - from her point of view - might have a partner who has several other partners at the same or at different times and not practicing safe sex.
In a survey carried out in 2000 by UNFPA among 10 to 24-year-olds in four communities in Guyana , 96% of the females who were sexually active indicated that they had only one partner as compared to 52% males.
He pointed out that a woman who becomes pregnant is at risk of contracting HIV unless she is in a monogamous relationship that is mutual and her partner is HIV negative. He noted that some of the factors during pregnancy, which influence the transmission of HIV are the extent to which the mother's immune system is deficient, and whether there are any communicable diseases or other sexually transmitted diseases present.
Minister Ramsammy posited that the spread of sexually transmitted infections is dependent on the degree and duration of infectiousness, which are themselves dependent on the availability and effectiveness of treatment.
He noted that this is essential not only in prolonging and improving the quality of life but also in reducing the risk of transmission.
He lamented that unfortunately, most people infected with HIV do not know that they are, making prevention of spread and control more difficult.
Providing information and educating the public about risk factors and risky behaviour, defining the vulnerabilities of specific groups and promoting supportive attitudes, are integral to risk reduction. Extensive programmes have been initiated in this regard, according to the Minister.
He however acknowledged that unfortunately, knowledge does not always translate to behaviour change, making the road to breaking the back of the epidemic slow and painful.
He stressed that women can however play a significant part by arming themselves with as much information as they can, taking control of their lives, socialising their children to respect their bodies and by supporting them in making appropriate lifestyle choices.
He added that society also has to acknowledge that in spite of the prevailing situation, men have a responsibility in raising their children, supporting their womenfolk and contributing to the reduction of transmission of HIV.