A recent study conducted in four of Guyana’s most populated regions has found that limited mental health support and the lack of tester-counsellors and social workers in Region Six as major gaps in providing HIV services during the COVID-19 pandemic.
The study, which was conducted by the Society Against Sexual Orientation Discrimination (SASOD) with funding from the UK-based Frontline AIDS organisation, was done to assess how key populations (KPs) experienced HIV services in Guyana during the COVID-19 pandemic.
Based on the findings, SASOD is now calling on the government to “urgently prioritise mental health”.
“Given the country’s high suicide rate and taboos around the subject, collaborating with CSOs [civil society organisations] and service delivery centres to ensure all clients know about their access procedures and are reached, will require an increase in the cadre of available social workers and mental health professionals, as well as, accompanying sensitization campaigns,” it said in a release.
However, notwithstanding the gaps the study also found that all the persons living with HIV (PLHIV) who were interviewed were able to access treatment services during the pandemic, while others went for testing and collection of condoms and lubricants mainly through CSOs. No one tried to access pre-exposure prophylaxis (PrEP), and two persons had never heard of the intervention. It was noted that 58% of the study participants identified as PLHIV.
“There were many good other experiences relayed, such as travel allowances being provided for clients in Region Six and the friendliness of health care professionals. Having services still open, being able to uplift medications, social workers consistently following up and sometimes offering assistance unrelated to HIV, and the smooth testing process were also highlighted as good practices. Gratitude was expressed by several persons for the hampers provided by the National AIDS Programme Secretariat (NAPS) and CSOs like SASOD Guyana,” the release said.
The study was conducted by SASOD’s Human Rights Coordinator Kobe Smith, who served as the interviewer on the research team, and presented the methodology, findings and recommendations.
Smith, the release said, related that the qualitative assessment was conducted in regions Three, Four, Five and Six, which is home to more than 75% of the population. The data was collected during November and December, 2020. The collection process utilised convenience and snowball sampling of men who have sex with men (MSM) and transgender women over 18 years of age, residing within any of the four regions of interest and who had accessed HIV services (preventative or for treatment) from March 2020 to the interview date.
It was stated that at least one service provider from each region was also interviewed to triangulate the findings. Inter-views were conducted online or via telephone using a semi-structured interview guide, involved informed consent, and were audiotaped for subsequent transcription.
The participants emphasised that that support for mental health was a big issue not only for themselves but also for others, and as one person made sure to emphasize, for trans sex workers who face many layers of stigmatization with few mental health resources.
It was noted that the Skeldon Public Hospital has no social workers and would refer persons needing assistance to the local CSO, Family Awareness Consciousness Togetherness (FACT). Others said that COVID-19 decreased the mental health support that was available, although the CSOs were trying their best, or that they had access to informal sources of support in the form of a peer counsellor or CSO staff, with United Bricklayers in Region Six being specially mentioned in this regard.
According to Smith’s assessment, the pandemic has placed a strain on both clients and providers. Without directing the national public health measures, two particularly important strategies could help to ameliorate the stress at this level, he said, and these include having a focused, key-population-specific plan, and implementing increased comprehensive mental health access points for both clients and providers.
He recommended that the food hampers that have been delivered so far should be sustained, at least in the short term, and that the provision of transportation reimbursements for clients should be considered.
He also revealed that some clients were unaware that they would be allowed to see a doctor if they had complaints that needed to be addressed urgently and resented not having their vitals taken along with routine consultations. The study proposed telemedicine to overcome these issues, but the lack of regular, quality and widespread internet services required to enable this may not be possible. Expanding clinic hours that cater to clients in treatment and letting them know the criteria with which they would be allowed to consult with a doctor should be considered as an alternative approach, he said.
The release added that SASOD Guyana’s Research Consultant Alessandra Hereman, has revealed that she has developed an advocacy toolkit and will be leading a virtual training programme with 60 key populations across the four study regions to sensitize them to lobby for improved KP-friendly HIV services in order to bring action to the study.
SASOD Guyana’s Managing Director and co-investigator of the study Joel Simpson revealed that the report will then be presented to five key health officials: the Minister of Health, Chief Medical Officer, Director of Disease Control, Programme Manager of the National AIDS Programme Secretariat, and the Director of the National Care and Treatment Centre.
Public health researcher and consultant, Dr Nastassia Rambarran, who served as the principal investigator, designed the study instruments, analysed the data and compiled the study report.
