Increased community involvement being sought as…Mission to end AIDS by 2030 intensifies

Dec 01, 2019 News

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By Sharmain Grainger

With more than 80 percent of the 5,000-plus HIV clients accessing antiretroviral therapy being virally suppressed, Guyana is fervently advancing towards the goal of ending AIDS by 2030. Records suggest that there are just over 8,000 persons living with HIV here. However, there is need for more persons to be placed on treatment.
Guyana has joined the call for the UNAIDS 90/90/90 targets with an accelerated implementation plan by 2020. With the targets in place, 90 percent of the estimated HIV population should know their status; of those that know their status, 90 percent should be accessing care and treatment services, and of those on treatment, 90 percent should be virally suppressed.
Guyana’s progress in achieving the UNAIDS targets and the efforts towards the Sustainable Development Goals (SDGs) to end AIDS by 2030 have been quite impressive.
Speaking on this recently was Deputy Programme Manager (ag) of the National AIDS Programme Secretariat (NAPS), Dr. Niccollette Boatswain. She revealed that Guyana has achieved “93 percent for our first target, 75 percent for the second and 81 percent for the third…and these are based on verified data.”
Based on this data, Guyana is the first country within the Caribbean region to have achieved the first 90 of the UNAIDS targets.
The UNAIDS targets, she explained, serve as “sort of a thermometer that can be used to measure where we are in our response.”
CLOSING THE GAP

Considering the gap between the first and second targets, the Deputy NAPS Director [ag] said, “that gap I believe exists because we still need to strengthen our linkage into care and I think an influencing factor is still the misconceptions and issues of stigma and discrimination”.
Added to this, Dr. Boatswain explained that “Sometimes people get tested and we do work with them, we do what is necessary to get persons into care, but sometimes they still have to grapple with the diagnosis, some of them are still in denial and don’t want to accept the diagnosis.”
Although the Ministry has been working with verified data to determine its progress in terms of the UNAIDS targets, Dr. Boatswain speculated that the achievements here could be found to be even greater after efforts are made to further analyse the data. “We believe there may be persons who were diagnosed and have either migrated or have died as a result of issues unrelated to HIV. So there is now a process of cleaning our records, which I believe will also increase our percentage. Once we go through our records and we have a clean list, more than likely we can see that we are doing much better,” said Dr. Boatswain.
The local health sector is working feverishly to swiftly achieve the other UNAIDS targets.
A move in this direction is being ably supported by the hard working staff at NAPS, the National Care and Treatment Centre and all the testing and treatment sites, said Dr. Boatswain.
“We have 50 active testing sites across the country and these include testing sites at Civil Society Organisations [CSOs], and when persons go out to get tested, they also have access to information on HIV and AIDS. Also we try to distribute risk reduction materials and that principally includes things like condoms,” she disclosed.
With the designated responsibility for the country’s response, as it relates to HIV sensitization, testing and treatment, NAPS has being working overtime to accomplish its mandate. This, Dr. Boatswain said, has been evident by the moves to further increase accessibility to testing sites. This is in light of the fact that there still remains a great need for persons who are not aware of their status to ensure that they are tested. This, she said, can be achieved by targeting particular populations so that they understand why they need to know their status.
NATIONAL RESPONSE
Moreover, NAPS is on a mission to continue working to strengthen its engagement with CSOs in its national response.
“When we talk about HIV response, we always have to take into consideration the importance of the grassroots community-based sort of intervention, and that is why I think this year’s World AIDS Day theme is so reflective of what we have always recognized at the national level,” said Dr. Boatswain.
World AIDS Day is observed globally on December 1 each year. This year the observance is embracing the theme: ‘Communities make the difference’.
According to the Deputy Programme Manager [ag], CSOs have been playing an instrumental role in this regard, especially by helping to target the key at-risk populations.
Here in Guyana, Men who have Sex with Men, transgenders, sex workers, miners and loggers comprise the key populations. Youths are also among the key targets.
To reach those within these populations to ensure that they receive the necessary attention as part of the quest to end AIDS, Dr. Boatswain said that “we are piloting a social contract initiative. The Government of Guyana and Global Fund, with some support from USAIDS and PEPFAR, have launched a social contracting initiative and we are asking two CSOs to go out and provide services to these key populations”.
“They will be providing HIV counselling and testing services, distribution of condoms, lubricants, etc…This is important because our key populations have a prevalence of about three times higher than the prevalence in the general population. We must always work with them to ensure that first of all our prevalence doesn’t go up, and then it is reduced, so when we get everyone on board, and it is an inclusive approach, that is when we will get more work done,” she explained.
But even as she emphasized the importance of the community in the fight against HIV, Dr. Boatswain added, “What we look forward to, is to have more engagement on a community basis and that also means our partners in the media and other stakeholders must be involved. We want to strengthen and build in terms of sensitization, education and awareness… we also want to consider a targeted approach for youths. I think that we need to ensure that our sensitization and education is continuous, so even if there are generations of persons who would have benefited from an overload of HIV information, we are now seeing the need for us to reboot that sort of approach.”
“With all hands on deck,” the Deputy NAPS Programme Manager [ag] is optimistic that Guyana will remain well positioned to achieve the long awaited and very ambitious goal of ending the scourge of AIDS.
STIGMA AND DISCRIMINATION
But true success can only be attainable, she added, if efforts are made to rid the society of the stigma and discrimination linked to HIV and AIDS.
The steps to end stigma and discrimination begin with each and every one of us. We all have to choose that path, because even if I decide not to stigmatize and everybody else decides to do it, then what will be the impact? If as a population we understand that we can respond to each other with love and respect, then we can make even more significant strides in terms of reducing stigma and discrimination,” said the senior NAPS official.
In fact, she looks forward to the day when the taboo surrounding this disease is entirely lifted.
“Persons should no longer feel as if they have to hide to get tested or to get treatment. We should never feel as if we have the right to treat someone as a second class citizen because of any health status…we don’t do it when a person is diagnosed with diabetes, we don’t do it when a person is diagnosed with cancer and we shouldn’t do it when someone is diagnosed with HIV,” she passionately insisted, as she turned her attention to the issue of self-stigmatization.
In explaining this concept, she revealed that “sometimes nobody really is discriminating against an infected person but because of their knowledge or perception of what it means to have HIV, a lot of persons think people are looking at them strangely or are treating them differently and they are very self-conscious all the time.”
To combat this, Dr. Boatswain said that patient empowerment is important.
“Patient empowerment to me is very big, and as an extension, community empowerment through education is important…people must have the knowledge and they must know what HIV entails.”
With high quality treatment, nutritional and other support being readily available, Dr. Boatswain said that persons living with HIV are able to be productive members of the society. “HIV is no longer a death sentence and we don’t have the right to stigmatize or discriminate against anyone who is infected, because persons can get infected under a series of circumstances.”
In addition to unprotected sex, HIV can be transmitted through blood and breastmilk.
Without adequate diagnosis, care, treatment and support, this disease can easily progress to AIDS which can weaken an infected person’s immune system due to its susceptibility to opportunistic infections.
THE ULTIMATE GOAL
To ward off the treat of AIDS, a valiant fight continues.
“We can end AIDS. As ambitious as it is, it is something to work towards. We are seeing less and less AIDS-related deaths and a lot of it is because of treatment. If persons know their status early and we get them on treatment early, and get them to viral suppression, this will significantly reduce their ability to transfer the virus,” Dr. Boatswain reiterated.
She added, “when we talk about ending AIDS, we are also talking about significantly reducing new infections, but if we do have infections we have to manage them so that they do not develop to AIDS and it is important to note that HIV care, among the other response from the health sector, is available for all persons, irrespective of gender and nationality.”
The ultimate goal therefore, Dr. Boatswain noted, is to have no new infections. For this reason, she disclosed that immense focus is being directed to prevention.
“When we speak of reducing infection, it is to reduce new infections and to place all known positive cases on treatment especially pregnant women and their partner[s].”
This has translated to sustained efforts being made to sensitize and to provide services to the population to ensure that those who are HIV negative remain that way.
“I think it saves us a lot of resources in terms of time, in terms of human resources, in terms of financial resources, and once we have a healthier country, we will have a more productive country. That is why we work in close proximity to quality treatment, quality support for those who are already infected, to ensure viral suppression to reduce their ability to transmit HIV,” said Dr. Boatswain.
SUSTAINABILITY PLAN
In the face of dwindling international funds to fight HIV/AIDS, Dr. Boatswain said that Guyana is not prepared to lose the gains made. To this end, she said that a sustainability plan has been initiated by the Government of Guyana which highlights the country’s commitments towards the fight against HIV/AIDS. This has been evidenced by the increasing domestic funds for interventions and aspects of the national response.
“This was inevitable as donor funds continue to reduce. Government has been responsible for the purchasing of our medication for a few years now but we still do get inputs and contributions from the Global Fund and other international organisations but there is a solid plan in place,” Dr. Boatswain assured.
Owing to this, she revealed that “a lot of our human resources that were once being sponsored or paid for by external donors have already transitioned into the government system, a lot of our consumable and materials that were once purchased by donor funds are now being purchased by the government of Guyana…government has put measures in place for us to transition,” the senior NAPS official said.
With such measures in place and abounding stakeholders’ support, she is confident that the country will continue to see laudable gains that will position it to bring an end AIDS by the 2030 timeline.

 

 

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