Category Archives: HIV/AIDS

PAHO Representative lauds Guyana’s HIV/AIDS gains

- prepared to support fight against stigma and discrimination

PAHO Resident Rep., Dr. William Adu-Krow

With a one percent Human Immunodeficiency Virus (HIV) prevalence, Guyana has done an admirable job in managing its national HIV/AIDS programme.  This is the assertion of Resident Representative of the Pan American Health Organisation (PAHO), Dr William Adu-Krow.
“I think a lot has been done to bring the prevalence to where it is and therefore it (the programme) has been managed well,” said Dr Adu-Krow during an interview with this publication. And it was because of such an achievement, he noted, that the United States President Emergency Programme for AIDS Relief (PEPFAR) has been winding down.
According to Dr Adu-Krow, who is relatively new to the position of Resident Representative here, Guyana has been able to do a great deal in terms of raising awareness regarding the facts and myths relating to HIV/AIDS.
However, there is yet work to be done, he noted, since there are persons such as Men who have Sex with Men (MSM) and Commercial Sex Workers (CSW) who are still marginalised in the society.
“Once society doesn’t accept them they hide and therefore it is difficult to treat them,” said Dr Adu-Krow, as he alluded to stigma and discrimination as one of the major issues that has long been threatening to hamper the gains made in the HIV/AIDS fight.
Among those mostly discriminated against, he noted, are those who engage in homosexual lifestyles. He disclosed that while there are organisations, some local, that were established specifically to advocate for the rights of such individuals, there are still some who cannot afford to come into the open for fear of discrimination.
“If they can’t come out to the open, they cannot be treated (if they are infected), if they cannot be treated then the viral load (the amount of HIV in the blood) that they have might be so high that they can transmit the virus,” Dr Adu-Krow observed.
He is therefore of the belief that there may be a great deal of persons still living in the shadows because of their sexual orientation and therefore may not be aware of their HIV status.
Moreover, the PAHO Resident Representative has concluded that “we have got a lot more work to do on this issue of stigma and discrimination, especially with the marginalised population.”
Although many are convinced that homosexual tendencies come down to an individual’s personal choice, there are many who are unwilling to openly reveal their status in light of the fact that such lifestyles could be punishable by existing laws, with men who engage in homosexual relations and cross-dressers  being specifically targeted.
But according to Dr Adu-Krow, “if we have incriminating laws whereby if you are a homosexual you can be imprisoned, the people are not going to come out to be tested for you to realise that they are homosexuals who may have HIV too.”
There have been continuous calls for the repeal of the existing legislation, a move the PAHO Representative intends to support.
“The advocacy has started, even before I came, because at the last meeting with Global Fund it was decided we needed to look at those laws and see how best legislation can come and assist us, because the more you incriminate them (homosexuals) the more they go underground and their viral load will increase in their system,” disclosed Dr Adu-Krow.
Global Fund is an international financing organisation that disburses resources globally to prevent and treat HIV/AIDS, tuberculosis and malaria. For a number of years, Guyana has been a beneficiary of the Global Fund disbursements.
According to the PAHO Representative, in light of the fact that stigma and discrimination is a hindrance to progress, efforts must be channelled to ensuring that it is not permitted, as far as possible. He made reference to early fights against tuberculosis and leprosy, both of which were affected by stigma and discrimination, thereby resulting in persons refusing to be tested. “Once you open up to these people they feel free to come and get tested and get medications so that they can prevent themselves and other people from getting the disease. So there is no doubt we still have work to do,” Dr Adu-Krow asserted.
Moreover, he is calling for efforts to be made to reach out to religious bodies to help reduce existing levels of stigma and discrimination. He noted that “normally institutions are the last groups to embrace change; individuals do change, but institutions I think are very dogmatic, so we have got to work through churches and gradually get them on board.”
And although churches may not be willing to accept certain lifestyles, Dr Adu-Krow has warned that efforts must be made to guard against shunning persons.
“From a PAHO/WHO standpoint, we need to work with all individuals without discrimination because we know we all have our own choices to make at the end of the day.”

HIV fight still being hampered by stigma, discrimination – Dr Singh

- As Guyana prepares to submit Progress Report to UNAIDS

Stigma and discrimination continue to be major challenges faced by the Ministry of Health’s National AIDS Programme Secretariat (NAPS) even as a fervent battle to reduce the impact of the HIV/AIDS epidemic continues.

NAPS Programme Director, Dr Shanti Singh

This was amplified yesterday by NAPS Programme Director, Dr Shanti Singh, who insisted that the only way to address the existing challenges is to strengthen education programmes throughout the society, even at the level of the workplace, among key target populations and even among health care workers.
“We have had real cases being reported to us of discrimination in the work place, in the health sector and in a number of other areas. (Stigma and discrimination) have to be tackled from a number of fronts… If you look at the consequences of stigma and discrimination they are many,” asserted the NAPS Programme Manager.
She said that the whole concept of treatment and prevention is one that speaks to having persons who are HIV positive being able to access treatment to lower or suppress their viral-load to a point where HIV becomes almost non-transmissible.
The national fight against the disease is likely to be severely hampered since the continuance of stigma and discrimination is likely to see infected persons being unwilling to access treatment programmes. The extent of the situation is that persons who may suspect they are HIV positive may be unwilling to get tested while those who would have been tested positive would be hesitant to get treatment because of the perceived high level of stigma and discrimination, Dr Singh said.
She said that NAPS is currently looking at a treatment cascade concept that emerged over the past year whereby attention is given to persons knowing their HIV status in the community to the point where they have a suppressed viral-load with a view of reducing transmission.
Dr Singh’s deliberation came ahead of presenting a Draft National AIDS Progress Report before a gathering of stakeholders at the Regency Suites/Hotel.
The stakeholders were expected to give needful input to aid the completion of a final report which must be presented to UNAIDS by this month end.
The meeting yesterday was one in a series of many stakeholder meetings which saw the crafting of “many, many drafts before we got to this first Draft that we are disseminating here today,” said Dr Singh.

Section of the gathering at the stakeholders’ meeting yesterday.

The Report is one that seeks to detail the progress made in the HIV fight over the period 2012 through 2013, even as it examines some of the difficulties and some of the challenges that were faced by NAPS.
It will also give a brief comparison between the 2010 and 2011 reports.
The modelling and estimation of the epidemic for 2012 suggested that there was a 1.2 per cent adult prevalence which, according to Dr Singh, translated to about 7,200 people living with the disease.
“We are currently modelling, so we don’t have an estimate for 2013 as yet but this should be confirmed by March 31,” she assured.
Speaking to the preparation of the Report, Dr Singh said that a meeting of a Monitoring and Reference Group, which is in fact the technical group leading the preparation of this report, was convened.
An initial meeting was held on January 28, last, and, according to Dr Singh, “basically what took place at that meeting was an outline of how we would approach the preparation of this report.
“We had a good overview and understanding of what the process should look like based on the UNAIDS guidance and based on that information and background we started with the preparation of the report.”
As with the preparation of previous reports, support was forthcoming from UNAIDS and the UN system which saw at least two consultants joining the preparation efforts.
One consultant, according to the NAPS Programme Manager, was tasked with scrutinising the overall big report that must be submitted while a second dealt with the National Commitments and Policy Instruments (NCPI).
The main objective of the NCPI survey was therefore intended to evaluate Guyana’s progress in relation to the National Strategic Plan and to garner stakeholders’ feedback on the extent to which progress has been made in achieving national commitments on HIV and AIDS.
This information was acquired by utilising 52 key informants, —25 from Government, 17 from civil society organisations and 10 UN organisations— and bilateral partners.
The informants were drawn from Regions Three, Four, Six and Ten. They were interviewed using questionnaire.
“The NCPI really looked at persons’ perception of the response…in a number of areas for example political commitment and support, policy issues, HIV care and treatment, prevention and a number of other issues,” explained Dr Singh.
She added that the NCPI report is built into the overall progress report of the country which will be submitted Monday to UNAIDS.
The opening of the stakeholders’ forum saw remarks being delivered on the state of the HIV/AIDS fight by Civil Society Representative, Desiree Edghill; UNAIDS Guyana Country Coordinator, Dr Roberto Brant Campos; and Chief Medical Officer, Dr Shamdeo Persaud.
The submission of Guyana’s report will be in keeping with the targets set in the 2011 Political Declaration on HIV/AIDS.
The 2011 Political Declaration on HIV/AIDS committed countries to, by 2015, halve sexual transmission of HIV and transmission among intravenous drug users, eliminate mother-to-child transmission, significantly reduce AIDS-related maternal deaths, halve tuberculosis deaths in people living with HIV, and put 15 million people living with the disease on antiretroviral drug therapy.
In addition, member states committed to accelerate research and development for a safe, affordable, effective, accessible vaccine and for a cure for HIV, as well as to deploy new biomedical interventions-such as microbicides, HIV treatment prophylaxis and early treatment as prevention as soon as they are validated. Moreover, countries are expected to report annually on progress towards those aims.

The Caribbean, answering the global call to end stigma and discrimination

The Caribbean response to HIV has known many successes in recent years. Since 2001 there has been a 54% decline in AIDS-related deaths while new HIV infections have dropped by 49%. Twenty times more people are accessing HIV treatment now than there were ten years ago. And several countries are on track to virtually eliminate new HIV infections among children by 2015.

However, stigma and discrimination are still hampering efforts to reduce new HIV infections, increase the numbers of people accessing antiretroviral treatment and ensure that all people living with HIV can live full and productive lives. Prejudice towards people living with HIV and other key populations such as men who have sex with men, transgender people, sex workers, people who use drugs, homeless people and prisoners, remains a major obstacle throughout the region.

“HIV is a by-product of social inequities,” said Carolyn Gomes, Executive Director of the Caribbean Vulnerable Communities Coalition at the Caribbean Consultation on Justice For All in Kingston, Jamaica. “We need a bottom-up approach. We have to find ways to be heard. We have to apply resources to what we know would bring about transformative change.”

The “Justice For All” initiative is meant to link the voices and actions of members of civil society with governments, faith communities and the private sector. It is an attempt to collectively propel Caribbean countries toward improving citizens’ access to justice and equity. It also aims to build alliances in order to increase awareness and support for human rights.

Coordinated by the Pan-Caribbean Partnership Against HIV and AIDS (PANCAP), the effort is led by the United Nations Secretary General’s Special Envoy on HIV for the Caribbean, Professor Edward Greene, supported by UNAIDS.

“The world now knows what to do to end this epidemic,” UNAIDS Deputy Executive Director, Luiz Loures told participants. “We have the tools but we have entered a phase in which some people are getting left behind. The Caribbean is part of this contradiction. The general epidemic is going down but there are still laws, attitudes and practices that stop us from achieving our goals.” Dr Loures encouraged participants in the consultation to choose concrete targets and milestones to chart their progress towards ending stigma and discrimination.

The Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, Mark Dybul, noted that this regional approach to building a culture of respecting human rights is unique. “The Caribbean can become the leader in ending AIDS,” said Mr Dybul. “We are at an historic moment when we can end AIDS as a public health threat. No other epidemic is pushing us to respond to one another differently and to embrace everyone, every small subset of people, as part of the human family.”

Mr Greene identified key areas of focus including reducing gender inequality, promoting sexual and reproductive health and rights and repealing discriminatory laws that infringe human rights. Sex between men is a criminal offence in 11 nations in the region and several Caribbean countries prohibit aspects of sex work. Some countries also have laws that restrict entry on the basis of sexual orientation, HIV status and disability. The Prime Minister of St. Kitts and Nevis, Denzil Douglas, assured that “Justice For All” will be a focus of discussion for the region’s political leaders.