HIV prevalence rate now estimated at 1.4%

-more persons being kept alive, Ramsammy says

Guyana now has an HIV prevalence rate of about 1.4%, just a little higher than the 1.3% that was estimated two years ago, Minister of Health Dr Leslie Ramsammy has said.

According to Ramsammy, while the country has made strides in the fight against the virus, the figures would not get much lower in years to come as infected persons are being kept alive.

The 1.4% figure is an estimation that may change by the end of this month, when the final figures are given to the Joint United Nations Programme on HIV and AIDS (UNAIDS) to be included in a global report, after consultations with all major stakeholders are completed.

Leslie Ramsammy

On Thursday, the National AIDS Programme Secretariat (NAPS) held one such consultation at the Grand Coastal Inn, where the estimates compiled during a recent workshop in Trinidad were presented.

According to Head of NAPS Dr Shanti Singh, there is confidence that the figure is closer to a true reflection of the situation. She pointed out that two years ago when the estimate was done in Barbados, NAPS only had one monitoring and evaluation (M&E) staffer, but it now has a full complement.

The estimates were shared with local stakeholders in an effort to ensure they are comfortable with the assumption the team came up with. Contributions made by the stakeholders will be taken into consideration and the results would be submitted to the global UNAIDS office by the end of this month.

Dr Singh explained that the results would be released in a global report on December 1, World AIDS Day, but in a combined format so the numbers would represent the Caribbean region; not national numbers. However, she said that by mid-2012 another report would be released that would have Guyana’s national estimate.

‘Third generation strategy’

Meanwhile, speaking at the consultation, Ramsammy revealed that his ministry is in the middle of putting together the country’s “third generation strategy,” with the goal being to end HIV as a major public health scourge. Admitting that the goals being set are “very ambitious,” the minister said it is also hoped that by 2015 the country would meet the zero stage in mother-to-child transmission.

As regards the estimates, the minister pointed out that underestimating the numbers of any disease represents a grave risk and puts the country at great peril; overestimation would also skew the health response and create neglect in certain areas.

According to Ramsammy, not so long ago Guyana was always failing when it came to its commitment to HIV and for tuberculosis and malaria because the estimates were way above what the truth was. He pointed out that based on the estimates, Guyana was expected to have some 5,000 HIV patients on ARVs by the end of 2005 but at that end of that year there were just about 3,000.

He said the early projection of about seven per cent HIV prevalence rate had led to many saying that the country had the highest prevalence rate in the Caribbean, which was not true.

The minister said that for some time “we have been telling people” that the numbers do not reflect that Guyana has the highest prevalence rate in the Caribbean but many chose not to believe.

Ramsammy said his ministry has developed better data collection systems around the country. He added that while there are still weaknesses, the truth is that for some time the data from the programme did not match the data that was coming out of the international agencies.

“These international agencies had developed a mathematical formula and ignored the fact that there were clinics seeing people and accumulating data,” he said.

He acknowledged that while mathematical formulas are very useful mechanisms, care must be taken that they match and link with the data gathering processes that do exist, which cannot be ignored. He said two years ago he had cause to engage the international experts on their use of formula and ignoring the data generated by the health workers and they conceded that they were wrong and they needed to make adjustments. The adjustments led to the present numbers that are being used by the country.

“I say these things not because I think the mathematical formula and international agencies are wrong or wicked but one size don’t fit all is a common cliché… and we need to take into consideration the special circumstances of each country,” he pointed out.

Ramsammy also said the engagements he has had with the agencies have led to better models and formulas have been adjusted to take into consideration large and small countries. “We need to have estimation models in order to test our health information service and in order to test our M&E, they should be talking to each other so that one could serve as a kind of check and balance and a verification process,” he said.

He added that the models for Guyana have been developed with the help of UNAIDS, the Centers for Disease Control and Prevention, Guyana HIV/AIDS Reduction and Prevention Project and the Pan American Health Organisation, which all participated in various aspects of the models. He said too that the results garnered should be respected by all and not disowned by agencies when they are publishing prevalence for the various diseases and health issues. He said there is need for a more principled approach when the agencies are working with the country.

Progress

Ramsammy said that both the mathematical formula and the country’s data collection process have demonstrated unequivocally that Guyana has made progress in the fight against HIV and that the prevalence rate has not only stabillised but the trajectory has begun to reverse in keeping with the Millennium Development Goal (MDG) for the HIV prevalence rate.

Before 2000, the estimates were between 3 and 5 per cent and sometimes studies would show 7 per cent. But at the last estimate two years ago, the estimate was that the prevalence rate had fallen to 1.3%. However, Ramsammy cautioned that there would not be a dramatic reduction of the rate from now on because in addition to the prevention work that is being done, persons are also being treated and being kept alive. He said the prevalence would not drop unless people are dying and therefore disappearing from the pool.

“Since we are keeping them alive, we would go through a period of stabillisation and the struggle is preventing new infections and to prevent people from dying,” he noted, while adding that the struggle would continue.

Ramsammy said it would be a significant new frontier that Guyana has embarked on and as such the interventions must not only be at the level of making the diagnosis, it must also be at the level of the monitoring and evaluation.

Meanwhile, he revealed that moving into the area of looking for and recording resistance to the most potent HIV medication is not limited to the virus but also extended to other sexually transmitted diseases. He also revealed that the latest scientific information has confirmed that a new strain of gonorrhea is becoming a public health challenge in developed countries and “is on its way into developing into a major public health challenge in developing countries.” He said the new strain of gonorrhea is resistant to all of the existing antibiotics.

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