The National AIDS Commit-tee (NAC) at a recent workshop identified a number of impediments in the effective delivery of HIV care, treatment and support.
The review workshop drew forty participants from nine of the country’s ten administrative regions.
The “Universal Access” Review workshop on February 4 at the Methodist Outreach Centre for Persons Living with HIV and AIDS (PLWHA), identified issues such as mistakes in dispensing ARVs, a shortage of trained doctors and nurses to work along with PLWHA, difficulty in recruiting home-based care providers, and religion in certain instances being a primary driver of stigma, which still exists.
According to an NAC press release, treatment is more accessible in urban than rural areas and limited treatment is available in both first-line and second-line drugs. However, concern was expressed over the treatment schedule in Guyana where a second-line drug (e.g. Truvada or Kaletra) is being used as a first-line drug, particularly since there is no third-line drug available locally.
The workshop found too that most health care professionals do not seem to have enough time to explain side-effects of anti-retrovirals (ARVs), the importance of a balanced diet or the importance of adherence.
The NAC also pointed out that issues are arising in some pharmacies because PLWHA do not feel empowered or confident enough to ask questions in order to learn the correct names for the ARVs and be able to identify them. “Mistakes can easily happen since two ARVs are now being dispensed in the same colour (white tablets) and pharmacists and their assistants make mistakes. This has happened several times at the main dispensing site,” the NAC stated in its release.
Technically ‘care’ refers to quality care provided by a trained person to an infected person mainly at a treatment site and so it is now a norm that persons be trained in this area to be effective, not simply relying on the goodwill of untrained relatives. Such care is also given to persons outside of the treatment site upon request and/or approval by the PLWHA.
However, the NAC noted, some regions have great difficulty recruiting home-based care (HBC) providers. The workshop urged that more needs to be done to have those regions adequately covered with trained personnel to perform the HBC.
According to the release, “Financing to support projects in rural areas is still to filter down, resulting in no care and treatment sites in many communities. Most families do not give the necessary support and care that PLWHA need and family members need to be trained in this regard.”
While there are lots of educational materials, advertisements and television programmes, there is not enough support by family members and despite a slight improvement in some regions, this needs to be accelerated. The release added that the amount of care is inadequate.
Moreover, there is a shortage of trained doctors and nurses to work along with PLWHA and concern was also raised over the lack of an ‘understudy’ doctor to the UN Volunteer doctor (whose contract may soon be completed) who is solely responsible for TC&S in the interior regions when he makes his quarterly visits.
And according to the release, “there is a widely accepted consensus that the Cuban doctors do not know how to deal with HIV patients and do not seem to want to work with them. The same can be said about certain Guyanese nurses who also do not want to work with HIV and AIDS patients.”
However many of the social workers work fairly well with PLWHA but there is a shortage of such personnel in most regions, the release added.
Lab investigations
While there has been a great improvement over the last couple of years both in the number of labs and quality of lab work, this improvement is not uniform because many of them are regularly short of qualified lab technicians and supplies. Results from many samples from the regions sent to the Georgetown central lab continue to suffer from delays, the release said.
On another issue, the NAC drew attention to public assistance being made available through the Ministry of Human Services “but the system doesn’t seem well developed and has hazy criteria and is lacking in uniformity to all regions.”
“Similarly criteria for distribution of hampers are not uniform nor in place in all regions,” the NAC said.
According to the NAC, poverty, expressed as the inability to finance care and support arrangements, is the root cause of many issues referred to in the workshop, and there is no system in place for caregivers who suffer ‘burn-out’.
Interior locations
The workshop also found that education/awareness by peer educators and religious groups is being disseminated more in schools, religious institutions and in the community, but not sufficiently in a number of interior locations where DVDs can be used more effectively. Volunteers are still willing to do community outreach but problems of funding prevent moving from one area to another, the release noted.
At the workshop the need for counseling in the area of partner notification was also highlighted, and a number of instances were reported in which positive partners, usually male, continued to have unprotected sex with non-positive partners.
Stigma &
discrimination
On the issue of stigma and discrimination, it was noted at the workshop that the public assistance voucher some PLWHA receive has an additional stamp to the general one presented at post offices, thereby identifying persons as PLWHA. “PLWHA themselves have drawn this to the attention of the relevant authority but this system remains unchanged to date,” the release stated.
In the meantime, compulsory testing is still required by some private entities despite the fact that the national policy discourages this practice. “A particular banking institution was named as requiring an HIV test to be done for housing loans and mortgages … Some insurance companies also have special provisions for PLWHA and some guard services require HIV testing to secure employment,” the release said.
It also noted that special hospital beds in A&E have been assigned to HIV suspected cases while it was reported also that there have been instances where lab technicians, social workers and nurses would inform relatives of results of tests before the information is given to patients, thereby infringing confidentiality rules. Therefore, the release added, more work needs to be done in this regard in a number of workplaces, including hair dressing salons.
Meanwhile, lack of family support remains widespread across regions, extending to family members remaining at the gate and being unwilling to enter the house. Many PLWHA continue to keep their status to themselves rather than risk divulging and being condemned and blamed.
Instances across regions were reported of health workers’ reluctance to perform tasks in the lab and for PLWHA in-patients who were often isolated. “Breaches of confidentiality and separation from other patients is common practice in some regions among doctors and nurses, and also in Amerindian areas,” the release said further.
The workshop also determined that “religion continues to be a primary driver of stigma, particularly in the Christian and Muslim faiths. Condemnation of infected persons is still rife as some religious leaders ask to see test results and then use the occasion to ‘pray over’ and preach condemnation, quoting religious texts on fornication, and Sodom & Gomorrah.”
Participants agreed on the usefulness of the information-sharing which had taken place and the need for such regular assessments. They also acknowledged their responsibility as change agents and advocates in securing more effective HIV delivery, the release said.
