Guyana needs consensus on approach to HIV/AIDS

Kaieteur News
March 19, 2007

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Local consensus on approaches to the HIV/AIDS fight must first be achieved if universal access for HIV prevention, treatment, care and support is to be attained rapidly.

This is according to Health Minister, Dr Leslie Ramsammy, who noted that while consensus has already been reached on a number of ideas, policy directions and goals, the country is still divided on approaches.

“I wish I can say that we are in agreement on the way forward, that we have consensus on the approaches. But if we are to achieve these goals rapidly, we must strive to achieve consensus on the approaches.

“Disagreements there will be, but there need not be protracted acrimony on how we do things, on how we move forward.”

He identified abstinence advocacy as one area where consensus needs to be achieved, adding that abstinence as a strategy is important.

He stated that the Health Ministry's position is that ‘abstinence only' approaches cannot work.

Government, he said, endorses a comprehensive approach to sexual responsibility that include encouraging young people to delay sexual debut, and encourages those who are sexually involved to develop the habit of using condoms every time.

He said the Health Ministry also promotes fidelity in relationships and discourages multiple-partner relationships.

He, however, acknowledged abstinence as an important strategic measure to reduce transmission of HIV.

“Young people should be encouraged to delay sexual debut. But it is time that we arrive at a consensus – abstinence only programmes do not work.

“Abstinence as a strategic measure has been around before as we tackled other social issues. The centuries have been replete with examples of enforcing abstinence as a policy or as a measure. Whether we deal with young people or others, the world has never succeeded.”

He noted that the Catholic Church, in requiring abstinence among priests, can tell this story.

He posited that a more realistic approach would be to encourage a behaviour adjustment that will allow young people to delay sexual debut for as long as possible.

“But we must not be arrogant that just because we encourage young people to abstain, they will. We must cater also for those who would not be able to adjust behaviour in time.”

Another area where Dr Ramsammy believes that consensus must be gained is in the Menu of Prevention measures, which he says needs to be identified and included in all work programmes.

“The fact is that there are many prevention strategies and a place must be created for the use of all of these. Each strategy will work in a different way, for different groups.

“These must include PMTCT, condom use, delay of sexual debut, addressing the issue of relationships, looking at target groups and behaviour, such as sexual work and MSM.”

In this regard, he stressed that the issues of substance abuse, the homeless and street children must also be addressed. He pointed out that the Menu of Prevention Measures must not only look at behaviour, but should examine the social conditions that drive the epidemic.

Routine testing and counseling, with an opt-out strategy to protect human rights, was also identified by the Minister as an area that requires consensus.

According to him, minimum conditions of testing that embrace the notion that it is being made easier for people to be tested rather than creating barriers needs to be found and defined.

“I am happy that we have defined what are opt-out strategies and the conditions where the opt-out strategy will apply within our PMTCT programme.

“We are not advocating abandonment of the counseling and testing programme presently in place at more than 87 PMTCT sites, but we consider as an opt-out strategy, embracing all the norms of human rights and best practices, to be a prudent approach to make HIV testing possible and overcoming barriers preventing people from being tested.”