Public health issues remain major HIV challenges – NAC observes

Dec 01, 2015 News

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—as World AIDS Day is commemorated
The public health dimensions of the national HIV/AIDS fight are lacking. This assertion has been made by the National AIDS Committee (NAC) which has awarded poor grades to efforts at combating stigma and discrimination and protection of vulnerable sectors, particularly indigenous people, prisoners and women.
According to NAC, “Unwillingness to address stigma along with other public health facets of HIV such as violence against women, illegality of homosexuality and discrimination against HIV-positive people, has always been the contentious issues of the HIV programme, both in Guyana and the wider English-speaking Caribbean.”
NAC has linked the shortcomings in the local HIV fight to dwindling funds. It went on to point out that the medical response to HIV in Guyana is still adjusting to the substantial reduction in funding available to the State from international sources.
“The impact of shrinking funds has been felt in all areas of prevention and response,” NAC underscored. However, it has admitted that the impact is seemingly uneven over the various programmes.
Moreover, NAC has assigned ‘A’ grades to the area of preventing mother-to-child transmission, ‘B’ grades to aspects of counseling and access to ARV medication (apart from the hinterland), while passing grades have been offered to HIV awareness.
But the existing shortcomings are not limited to funding, as this failure, according to NAC, is influenced by reluctance to discard attitudes – often of a religious nature – incompatible with modern concepts of equality, respect for individuals and compassion.
The limited availability of condoms in the prisons was also alluded to as a situation that has reportedly allowed for a high incidence of HIV among prison inmates.
“This issue, however, is more complicated than handing out condoms. In the first instance, it is believed, but needs to be verified, that a high percentage of homosexual activity in over-crowded prisons is non-consensual.
Verifying non-consent in a prison environment is difficult because victims frequently do not complain for fear of retaliation from perpetrators,” NAC noted. In fact, it has pointed out that an additional consideration is that condoning behaviour in prisons which is illegal outside of prisons would create an anomaly.
However, the most comprehensive guide to the legal, social and prison-based adjustments required prior to condoning homosexual activity in prisons, can be found in the Recommendations for Revision of Legislation Embodying the Guyana National Policy on HIV/AIDS published by NAC in 2006.
These recommendations were adopted following a National Assessment Report and two major national and regional consultations which included public sector organizations, government Ministries, religious and civil organizations, the media, regional and international organizations and HIV-AIDS networks, comprising a total 157 organizations.
Section 20 (iv) of the Assessment recommends establishing the legality of homosexual activity in general by  including ‘sexual orientation’ as a prohibited ground of discrimination in the national Constitution, followed by applicable amendments to the Prevention of Discrimination Act and other relevant public health legislation, thereby rendering legal all consensual private sexual activity among adults.
With respect to the specific conditions which must be in place in prisons Recommendation 22 (i) states: “The Prison Act should be amended to address the transmission of communicable diseases including HIV/AIDS while inmates are in custody.”
Specifically, responsibilities should be imposed to ensure: The provision of HIV-related information and education to both inmates and staff; Measures to prevent non-consensual sexual activity; Access to means of prevention and access to care and treatment; Facilitating voluntary testing and counseling programme; The provision of guidelines regarding confidentiality of medical information; Provision of isolation for inmates with acute infections such as Tuberculosis and the provision of binding regulations setting out procedures which must be followed in cases of isolation due to Tuberculosis infection  or due to an inmate knowingly infecting others with HIV.”
According to Recommendation 22, “such regulations must include the necessary due process protections (for example, notice, rights of review/appeal, fixed rather than indeterminate periods of orders or other rights representation).
Measures to prevent non-consensual sexual activity can include inadequate staffing, proper lighting, effective surveillance, disciplinary sanctions and education, work and leisure programmes.”
NAC therefore noted that it welcomes recent concerns raised by Minister of Public Health, Dr George Norton, over the incidence of HIV among prisoners. The Committee, as a result, is encouraging the Ministry, in conjunction with the Guyana Prison Service and other relevant agencies, to promote the fundamental constitutional reform as a prelude to systematically addressing each of these pre-conditions for legalizing homosexual activity in Guyanese prisons.
NAC’s concerns about the HIV shortcomings come even as World AIDS Day (WAD) is observed today.
The Committee, which is made up of Regional AIDS Committees (RAC), commenced the commemoration of WAD 2015 on Sunday (November 29) and is aiming to bring the curtains down on Sunday (December 6). The commemoration is being done along with HIV groups and community leaders in religious services and will include activities such as pinning the Red Ribbon – from workplaces to transit urban/interior bus-stops and inter-active discussions and quiz competitions.

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