Local and international health officials yesterday declared that Guyana created history when it launched its National HIV Principles, Standards and Guidelines – a document which among other things is expected to reduce the duplication of prevention efforts and ensure that the country gets value for money spent in the HIV fight.
The document, said to be the first of its kind in the world, was launched at the Hotel Tower and is expected to be the first step in reorienting stakeholders towards a more defined national approach to HIV prevention, with the objective of reducing, even further, the spread of HIV.
The Ministry of Health is now expected to facilitate a series of hands-on training in the use of the document, as part of its national roll-out and implementation strategy.
Head of the National AIDS Programme Secretariat (NAPS) Dr Shanti Singh said the standards and guidelines document was an indication of the future; not just a document but a tool to assist the practitioners of prevention in producing high quality prevention services.
“Services that are based on evidence and research and culturally relevant to the Guyanese people; services that are geared to all Guyanese and in the long run are sustainable in ensuring universal access to prevention in our country. Services that will yield maximum benefits and in this case prevent new infections,” Dr Singh said.
Minister of Health Dr Leslie Ramsammy said the document is intended to ensure that the country “uniformly delivers prevention interventions… within the public and private sectors and among our NGOs that are of the highest quality and are effective.
“It is intended to strengthen our partnerships and our services that we offer to people,” the minister said of the 34-page booklet.
The minister said through the launching the country is showing that while it is good to learn from others and to follow others “we can and we are ready to lead in the fight against HIV.”
Meanwhile, UNAIDS Country Coordinator Dr Ruben Del Prado is of the view that the document will reverberate far beyond the boundaries of Guyana, and could well be one of the most important ways forward for countries that wish to intensify their HIV prevention activities towards delivering high-quality prevention outcomes.
“All that has been incorporated in these 34 pages is the result of over two years of intensive labour, under the leadership of the Ministry of Health National AIDS Programme Secretariat, on content, form and presentation that has been well thought through by many, nationally, and with expert feedback, internationally,” he said.
He further said that “with the global ‘Prevention Revolution’ announced by UNAIDS, and the entire world now seeking revitalised and endearing guidance on how to move HIV prevention to the next level – Guyana has captured and encapsulated the essence on the way forward in one single, national-level document.”
Reduce duplication
According to Dr Singh the new guidelines will facilitate the reduction in duplication in prevention efforts even as the new tool seeks to ensure that the prevention services provided to all are standardised and would make sure that the standardisation occurs for everyone including persons with behaviours at a higher risk to contract the virus.
“The principles, standards and guidelines will see an increase in Guyana getting value for dollars spent. We will benefit in this regard as we will be require to scale up on the use of more concrete evidence to reduce a disconnect between the science and the intervention and to rely less on the use of anecdotal evidence,” Singh said.
“Importantly, prevention efforts would be guided to ensure that quality is not compromised… In other words irrespective of where you live or who you are, a high quality of prevention service is the minimum,” the NAPS head said.
Further, Singh said, the new tool would allow NAPS to truly coordinate the key elements of the delivery of prevention services that are in tune with the national strategic plan.
Also, institutions and organisations will now have to ensure that their prevention strategies and efforts are aligned to the national strategy.
Singh said the country has made some strides in the HIV fight and she gave some statistics as testimony to this which revealed that mother to child transmission has been reduced from 16% in 2005 to 3.8% in 2008, while the HIV prevalence among the antenatal population has decreased from 3.1% in 2003 to 1.1% at the end of last year. The prevalence among blood donors has declined from 0.9% in 2005 to 0.6% at the end of last year, while there “are encouraging signs” with regard to reducing the prevalence among most at risk groups, particularly among female commercial sex workers with a decline of prevalence rate of 26.6% in 2005 to 16.6% in 2009 and also among men who have sex with men from 21.2% in 2005 to 19.4% in 2009. Some 2,832 persons were actively receiving antiretroviral treatment at the end of last year, which accounts for close to 85% of the persons who are eligible for treatment.
“The represents a more than 100 per cent increase from 2005 when a total of 940 persons were on treatment accounting for a little over 40 per cent who were eligible,” Singh said.
The NAPS head noted the importance of patients continuing to receive high quality uninterrupted antiretroviral therapy earlier rather than later and that the health sector’s diagnostic capability continues to be strengthened to better mange opportunistic infections.
Prevention strategy
Meanwhile, Minister Ramsammy yesterday said while Guyana supports the ABC (Abstinence, Be faithful and Condomise) strategy the country’s prevention strategy goes beyond ABC.
The minister said the country embraces the “ABC to Z strategy” which seeks to promote a wide range of HIV-STI risk avoidance and risk reduction approaches that must include male child circumcision, the use of anti-retroviral (ARV), the prevention of parents to child transmission through viral load reduction and the prevention of alcohol and other substance abuse. It must include a focus on gender disparity; and sexual abuse and violence against girls and women must be confronted forcefully.
“We must address the issue of commercial sex workers; we must address the issue of men who have sex with men. We must stop this holier than thou attitude as if AIDS brought men who have sex with men. They were there in biblical time they are here now. They are part of our universality,” the minister said.
Ramsammy said the time has come for Guyana to pursue “earnestly” a trajectory of elimination of HIV instead of reduction as that’s the only way to guarantee that a child would not be born with the virus.
“Let there be no doubt also that unless we pursue strong effective prevention programmes we will not win the fight against HIV,” the minister said.
“As we launch today the guidelines, policies and standards for HIV prevention programme, we reiterate Guyana’s determination to transform the struggle against HIV from a struggle against crisis, from a struggle for survival to one of elimination of HIV as a public health challenge by 2020,” the minister said.
Zeroing in on another issue, the minister took issue with the way money is being spent worldwide in the fight against HIV and he believes that there are no reciprocal returns on the investment in the fight.
“I believe it is not just mobilising funds, but it is how we use our resources and I believe there is vast room for improving how we use that money. We must use our money more smartly,” the minister said echoing the sentiments of many in recent years as more and more monies are poured into the HIV fight.
“There are too many highly paid consultants running around the world utilising HIV resources when there are children [who have no access to] … paediatric formulation of ARVs; when there are too many places that we cannot test for STIs,” the minister said. He continued that while there is a place for technical support he believes that it is better to allow the money to reach the people where they live and to meet their needs.
“I believe that there needs to be greater accountability. We need to assess the impact of what we do. We need to persuade our people that our programmes do work. We need to present our score sheets to our people; a score sheet of our successes and our failures so together we can improve on what we are doing,” the minister said.
