Guyana’s decision to use ARVs as prevention strategy vindicated – Dr Ramsammy

May 27, 2011 News

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Guyana’s decision, a decade ago, to implement a programme whereby Antiretrovirals (ARVs) were introduced as a prevention strategy rather than just a treatment regimen, has been vindicated.
This assertion was made by Minister of Health, Dr Leslie Ramsammy, on Wednesday, when he addressed the start of a consultation meeting intended to discuss ‘Country Ownership for a Sustainable Human Immunodeficiency Virus (HIV) Response in Guyana’.
The forum which was held at Cara Lodge, Quamina Street, Georgetown, was spearheaded by the collaborative effort of the Ministry of Health and UNAIDS, and saw the attendance of a number of stakeholders involved in the fight against HIV/AIDS.
In addressing the gathering at the start of the meeting, Minister Ramsammy recounted that it was in 2001 when the Health Ministry had articulated about the position of universal access for prevention treatment and care.
He noted that even while there were discussions about every one living with HIV having access to ARV treatment at the time “we were being cajoled into changing that policy aspiration that it must be everyone living with HIV who met a certain criteria.”
And the criteria at that time, the Minister noted, was that infected persons must have had a CD4 (cluster of differentiation 4) count of at least 200 before they could become eligible for treatment. However, Guyana’s position was clear at that time, Minister Ramsammy underscored. He pointed out that it was even then the view of the Ministry of Health to not only treat persons to prevent morbidity and premature mortality, but rather that was merely one of the objectives of Guyana’s universal treatment programme.
A second equally important objective of the Guyana universal access to treatment policy was that treatment was an important prevention strategy.
However this notion was rejected by many, Dr Ramsammy recalled. The rejection was however not forthcoming from international partners, but rather there were local organisations and groups that objected to that, the Minister added.
“I know because I was the one in the chair…I was the one who occupied the lonely seat. But time has absolved us sisters and brothers…I see all the articles coming out of Lancet and other places that says that treatment in fact effectively reduces the transmissibility of HIV.”
“We may not have had the evidence then but we had the good sense as a national programme to know that prevention has to be a combination strategy; that prevention cannot be just walking around and talking and educating people it has to be a diverse set of action that we take.”
Guyana’s national programme, according to Minister Ramsammy, had the right policies in 2001 and those policies have been vindicated today.
It was just last week that global reports surfaced that researchers have unearthed tantalizing data that the antiretroviral drugs doctors currently use to treat HIV infection could also be effective in preventing transmission of the virus.
It was revealed that in a large randomized trial involving more than 1,700 heterosexual couples — in which one person was HIV-positive and the other was not — infected people who took the anti-HIV drugs reduced their risk of transmitting the virus to their partners by 96 percent, compared with those who did not immediately start treatment.
The results were so stark that Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), which sponsored the trial, elected to release them early and stop the global study four years before its scheduled end. All study participants are now being offered antiretroviral therapy.
These results come not long after another large-scale landmark trial that found evidence that using antiretroviral drugs could be an effective prevention measure.
The trial included nearly 2,500 HIV-negative men in six countries, who were at high risk of contracting HIV.
Those who took a combination anti-HIV pill called Truvada (a combination of the drugs tenofovir and emtricitabine) were anywhere from 44 percent to 73 percent less likely to acquire HIV, depending on how faithfully they took their medication, during the study’s three-year follow-up than participants who took a placebo.
The findings add weight to the “treatment as prevention” strategy that some AIDS scientists increasingly believe, if broadly implemented, can help slow the spread of HIV and AIDS.
“As we continue to build our HIV response we must be bold, we must look forward and the programmes must have insight on what will happen in the future and not only developing programmes for today,” Minister Ramsammy urged.
“Everything we do must be for today and tomorrow. If we can ensure that our programmes will be sustained and that these programmes will meet every citizen of our country then we have little to worry about.”
According to the Minister country ownership must give concrete expression to the ‘Three Ones’ principle which is premised on one national programme, one national coordinating agency and one monitoring and evaluation plan.

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