My COVID-19 vaccination experience and what lies ahead for us

(Georgetown, Guyana via Kaieteur News)  This past week gave me renewed hope of us getting ahead of this pandemic. I never thought I would be getting vaccinated against COVID-19 so early. It’s been less than a year since the World Health Organization declared this pandemic, and we already have access to vaccines against it in Guyana. I am grateful to the authorities, and I am also optimistic for my fellow Guyanese as the government has declared that there should be sufficient vaccines for all Guyanese in 2021. This has obviously provided us with an opportunity to exit the pandemic, and we need to grasp the opportunity to get vaccinated with both hands. Today, I will share my vaccination experience with you and present facts that will hopefully encourage you to get vaccinated as soon as your turn comes.

How I felt after getting vaccinated?

I was given my first dose of the AstraZeneca vaccine late last week, and it was a surreal experience. As a health worker that routinely deals with COVID-19 patients, it felt like I was being given a dose of freedom as I wouldn’t have to put my life in jeopardy every time I have to see a patient. The nurse who administered my vaccine was as nice as they come, and I didn’t feel much when the vaccine was given to me. I then went back to work as per usual and had a productive workday. As it progressed into the evening, my arm got a bit sore, and I had a mild headache. As the night progressed and early the next day, I had some body aches and felt a little fatigued. I am currently firing on all cylinders and I’m feeling much more optimistic than before I was vaccinated.

Is it bad to get symptoms after being vaccinated?

While many see some post-vaccination symptoms and side effects as bad, I was very happy to have the body aches and fatigue. Knowing what I knew, I realised that my symptoms were a sign that my body was mounting an immune response to the vaccine, and therefore, I am developing immunity against COVID-19. If I didn’t get any symptoms after the vaccine, I would have been worried that I may not have mounted an immune response. While most look at the following symptoms as side effects of the vaccine, I look at them as our immune response to the vaccine:  sore arm, headache, chills, tiredness, feeling sick, fever, dizziness, weakness and aching muscles.

Of course, there may be a few persons with allergic reactions to the vaccine, but that is extremely rare. Most of the time, these persons would have had a history of being allergic to other vaccines. Please note that vaccines are different from injections that are given for pain and routine infections. If you were allergic to a pain or antibiotic injection, it doesn’t mean that you are allergic to vaccines. If you never had allergic reactions to vaccines, then it’s likely that you will not be allergic to the COVID-19 vaccine.

What lies ahead for me?

Now that I would have gotten my first dose, I will have to get a follow-up booster shot in three months. This booster shot basically seals the deal and strengthens my immune response even further, so that my body is more prepared to combat COVID-19. Currently, my immune system is developing antibodies against the SarsCov2 virus (Coronavirus) and it will take about a couple of weeks for sufficient antibodies to form. While there should be a decent amount of antibodies in about a month from now, the booster shot in three months will ramp those antibodies level further up so that I have an extremely strong defence system that is prepared and ready to overwhelm the coronavirus if I get in contact with it.

Can I finally move around without masks?

No, I cannot! As you just read, my body will take time to prepare a proper immune response against the Coronavirus. During this time, I can still get infected and be affected by COVID-19. In addition, there is a small percentage of people who the vaccine does not work as well as it does in most others. While I am optimistic that the vaccine is efficacious in me because of my symptoms after being vaccinated, I will not leave anything to chance. Therefore, I will still practise social distancing, wear my mask, and practice proper hygiene until enough of us are vaccinated and we can exit the pandemic.

What lies ahead for Guyana?

I am optimistic for us as a country especially after the government announced that it should have sufficient vaccines for all Guyanese in 2021. We need to vaccinate around 75-80 percent of our population before we can begin to safely move around freely and without masks. If we take too long to do this and the virus continues to spread, then the virus is likely to mutate even more and the current vaccines may become ineffective. We are racing against the virus and these vaccines are the boosters that we have to win this race before the virus mutates too much and we can never catch up with it.

I urge you to get vaccinated as soon as your turn arrives and encourage everyone you know to do the same. We are in this together and can only get out if we all play our part and get vaccinated. If more than 25 percent of us choose not to get vaccinated, then we are stuck in this pandemic and we will all continue to suffer for years to come.

Public Health Champion – Dr Ruth Ramos

Dr Ruth Ramos Gonzalez-Ram is a Cuban born, Guyanese-trained physician who has made significant contributions in HIV medicine, patient care and services provided in Guyana. On the occasion of her retirement, I sat with her to find out a little more about her journey and her experiences over the years.

Dr Ramos graduated from the University of Guyana School of Medicine in 2000 and started to work at Georgetown Public Hospital Corporation (GPHC). In her days at the Internal Medicine department, Dr Ramos recalls that she was always attracted to what was referred to as the “back cubicle”- where all the AIDS patients were placed. At that time, knowledge of HIV and AIDS was minimal, there were no antiretroviral drugs available, and there was little one could do to help these patients.

Fast forward a few years, and in 2002, she was asked to be a substitute doctor at the Genito-Urinary Medicine (GUM) Clinic at a time when they anticipated they were going to be short of staff. She worked at the GUM clinic initially for two months, but her interest was solidified in working with infectious diseases and HIV medicine during this time. Upon her return to GPHC, she requested to be permanently transferred over to the GUM Clinic.

Dr Ramos recalls that there were many challenges in the early days: delayed HIV results, unavailability and limitations with regards to treatment options and lack of knowledge on HIV management. She said there were many times when improvisation was necessary, especially when treating children, but that they always worked to make the most of what they had in every situation to do the best for patients.

Dr Ramos says there have been many improvements and she has been a first-hand witness to these as they have happened over the years. Presently, HIV testing is available across the country, care and treatment have been de-centralized, and people can access both antiretrovirals and treatment for opportunistic infections at many locations. She says human resources have significantly increased. More doctors, counsellors, outreach workers, and nurses have been properly trained and equipped to manage HIV. Literature has become widely available, and the country has developed its guidelines and protocols for HIV management. Dr Ramos is proud to have witnessed this transformative period and to have played a role in making it happen.

When asked to share some of the key things she has learnt over the years, Dr Ramos says that working with HIV patients, at the time when she did, introduced her to a virgin field in medicine in Guyana. She enjoyed growing and learning with the development in the field; discovering new diagnostic methods, new therapies, understanding management of opportunistic infections. However, above all, she says that the most important thing she learnt was to “be less of a doctor and more of a human”. She said some of the most important things she learned were to be a better listener, more patient, less judgmental, more compassionate, and overall, her experiences have made her a better person.

Dr Ramos’s most significant achievement over the years has been having the privilege of motivating and supporting patients in some of the darkest moments of their lives, giving them hope and reassuring them. This has given her great joy, to see many of her patients lead productive lives and have undetectable viral loads. She said, “To see little children, now grown up, having healthy children of their own, that gives me great satisfaction, and I call it success!”.

Dr Ramos hopes that HIV can be integrated into healthcare as just another chronic disease in the future. She hopes that stigma and discrimination will be eliminated from both the medical community and society at large. She hopes that there will be better treatment options developed and that maybe one day, we will even have a vaccine to prevent HIV infection and relegate HIV to the history books.

Dr Ramos says to young doctors thinking about entering the field of HIV medicine, “If you want to be challenged every day, to keep exercising your brain and never be bored, go for it!”. She says that because HIV and infectious diseases are continuously evolving, it is imperative to keep updated.

Dr Ramos stresses the importance of staying humble as no one person will live long enough to understand all the mysteries of the human body and the diseases that can affect us. She says that she has had a most rewarding career and “I could never regret the day I decided to become an HIV physician!”

Caribbean Youth to benefit from UNFPA Sexuality Education Initiative

Youth in the Caribbean will benefit from Comprehensive Sexuality Education (CSE) activities launched by the UNFPA in a virtual webinar in February. CSE programmes enable young people to protect their health, wellbeing and dignity and are a strategic vehicle for promoting gender equality and human rights. The activities will be conducted under the Spotlight Regional Programme for the Caribbean which is part of the wider Spotlight Initiative (SI), a global, multi-year partnership between the European Union and the United Nations to eliminate all forms of violence against women and girls by 2030.

The webinar provided an outline of the CSE activities to be implemented, and participants were allowed to provide inputs in accelerating the planned efforts. The effects of COVID-19 in the education sector that might also put at risk the continuity of the CSE delivery through Health and Family Life Education (HFLE) were also discussed.

Director and Representative for the UNFPA Sub-Regional Office of the Caribbean, Alison Drayton, who welcomed participants to the launch, highlighted that Caribbean youth’s growth and development continued to be undermined by what she called “new manifestations of age-old threats”. She identified several CSE challenges being faced by Caribbean youth. She expressed that vulnerability to all forms of violence, particularly bullying, sexual violence, abuse and exploitation and adolescent pregnancy rates remained very high.

Highlighting the role of the CSE initiatives in addressing these issues, the Director explained that strengthening regional capacities to advocate for and deliver quality CSE for in and out of school youth in the Caribbean was at the heart of the Regional Spotlight Programme. “The Comprehensive Sexuality Education interventions, through the Spotlight Initiative, are informed by robust evidence and aim to contribute to the collaborative efforts in preventing violence against women and girls in the Caribbean,” she said.

The CARICOM Secretariat is one of the organisations that has partnered with the UNFPA on this initiative and is playing a significant role in implementing the Spotlight Regional Programme for the Caribbean.

Helen Royer, Director, Human Development, CARICOM Secretariat, said the implementation of a regional HFLE curriculum, the creation of resources and toolkits, training of teachers to communicate the curriculum, and improved coordination among all the agencies at the regional and national levels are among the outcomes of CARICOM’s efforts at strengthening HFLE. Despite those investments, she was concerned that the key messages of HFLE were still not being converted into measurable behaviour change.

Against that backdrop, Ms Royer said CARICOM welcomed the Spotlight Initiative to enhance regional capacities to advocate and deliver quality Comprehensive Sexual Education.

“The interventions are aligned with the hopes for healthy and contributing Caribbean citizens, as outlined in the CARICOM Human Resource Development 2030 Strategy and are also in support of the recently launched Road map by PAHO for promoting the health and wellbeing of adolescents and youth in the Caribbean which received CARICOM’s support and endorsement,” Ms Royer stated.

UNFPA works with governments, civil society and other partners to implement CSE. UNFA also promotes policies for and investments in comprehensive sexuality education programmes that meet internationally agreed standards. This initiative is financed through funding from the European Union and UN agencies through the Spotlight Initiative.

COIN launches “Caribbean United against Gender-based Violence – GBV”.

The COVID-19 Pandemic has resulted in a surge in cases of violence against girls and women in the Region.  In response,  the Centro de Orientación e Investigación Integral (COIN) with support from the U.S. Department of State’s Bureau of Western Hemisphere Affairs has launched “Caribbean United against Gender-based Violence – GBV”.

The goal of the project is to address the root causes of GBV in the Caribbean and to contribute to the end of violence against women and promote equitable environments.

Santo Rosario, Executive Director, COIN expressed that “One of the biggest problems in the international framework has its roots in the cultural and educational processes of our societies, which place women in a situation of vulnerability compared to men. Gender inequality is a structural problem that requires that all the structures of the state and civil society recognize the implicit bias as well as the explicit discrimination that exists and promote laws and mechanisms that transform the way women are seen and treated. We must do segmented politics, as GBV is reflected in each one of the segments: at work, in politics, and relationships, as women are vulnerable in all these spheres. Policies, mechanisms and sanctions must be developed that accompany a new educational perspective that places women in a position of equality.”

The project will support the creation of an enabling environment through a series of community-level small grants that will include four types of interventions:

  • Change social norms: baseline surveys, training for men and boys that address socio-cultural attitudes that lead to GBV and social-emotional learning programmes.
  • Build institutional capacity and alliances: training with civil society organizations as well as with government entities, the establishment of multi-stakeholder discussion spaces and participation in networks.
  • Empower youth: empowerment and leadership training and direct involvement in local project activities as advocates against GBV.
  • Improve availability and access to services: mapping of existing services, securing MOUs among project sub-recipients and service providers, the establishment of a referral system and multi-stakeholder case management system.

In particular, these interventions aim to strengthen the capacity of local actors to provide GBV prevention and response services to survivors of abuse, improve available data on the services that are already put in place and reduce socio-cultural attitudes that lead to GBV.  The project also aims to strengthen civil society and local governments’ abilities to improve access to GBV services and address GBV issues that result from the COVID-19 Pandemic.

The project will be implemented through small grants to local organizations in twelve Caribbean countries, namely:  Antigua and Barbuda, The Bahamas, Barbados, Dominican Republic, Dominica, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Saint Lucia, and the Republic of Trinidad and Tobago.

Editor’s notes:

In the Caribbean, available data shows a troubling panorama: three of the top ten recorded rape rates in the world occur in the Caribbean[1] , and in nine Caribbean countries, 48% of adolescent girls’ sexual initiation was forced or “somewhat forced”[2]. Some examples include the Dominican Republic and Haiti, which, according to the UNDP, are among the four countries with the most significant gender inequality in the Region. Kay Fanm, a Haitian women’s rights organization, has estimated that 72% of Haitian girls have been raped. In the Dominican Republic, there is an average of 177 femicides (killing of a woman or girl, in particular by a man and on account of her gender) per year since 2005.

[1] 2007 report by the United Nations Office on Drugs and Crime and the LAC region

[2] According to a survey that was pointed to in the 2007 report aforementioned.

Public Health Champion – Vishnu Singh, Medical Student, St. George’s University

Vishnu Singh is a medical student at St. George’s University, Grenada. In this edition of the PANCAP Newsletter, he discusses his experiences as a medical student during the pandemic.  

“In early January, I travelled to California to study for my medical examination. By mid-March, I was mentally exhausted from studying for long hours every day and was eager to take the exam and return home. On my scheduled date, I endured the gruelling 8-hour long test, all the while thinking it would be over soon and worth it once I got home to relax. However, life threw a curveball, and when my exam was done, I was informed that Guyana’s airport would be closed to all incoming flights on the following evening due to COVID-19. I panicked to search for flights that would arrive before the airport’s closure. When I realised that it was impossible to arrive in Guyana on time, I was deeply disappointed. I followed the news daily to learn of any plans for repatriation flights.

Considerable time was spent communicating with consulates, filling out the repatriation form and waiting for feedback and then making arrangements to take my PCR test. It was tough for me to deal with the uncertainties, and I felt as though I was slowly losing my mind while waiting for good news. I decided to use that period to achieve some of my personal goals that were long overdue and also to take up some new hobbies, like meditation.

Finally, in mid-June, I was informed of my placement on a repatriation flight to Guyana. The flight itself was difficult, especially having to wear my mask for the entire time, but I knew it was necessary to stay safe, and I made it home in one piece. Upon return, I spent the first week at home under self-quarantine. An official from the Ministry of Health called me daily to check on me. I spent the next month trying to balance virtual classes and assist with the family business.

In early August, I returned to the USA via another repatriation flight to begin my third year of medical school. I was hesitant to start my training at such an unprecedented time, but I realised that medical assistance is needed now more than ever, and I must play my part.

Although COVID-19 posed many challenges for me, I constantly remind myself that my life could be much worse, and I should be grateful for all that I have. We need to remind ourselves of the positives and focus on the good things. I want to encourage you all to do this, stay safe and keep playing your part in this fight against COVID-19”.

Caribbean Vulnerable Communities Coalition is the recipient of the Robert Carr Research Award

To be named as one of the 2020 winners of the prestigious Robert Carr Research Award is an incredible recognition of the work of the team at Caribbean Vulnerable Communities Coalition (CVC).

It demonstrates the critical role communities, and key populations can play in policy and research. It also validates the importance of collaboration between community groups and Academia. Such partnerships can only help to better serve the groups most affected by HIV and advance the regional HIV response.

The award is even more significant, given that it honours one of CVC’s founders, whose vision was for national programmes to have the relevant data to better understand the needs of our communities and design meaningful and targeted interventions.

The research, for which the award was presented will certainly provide important baseline data against which the success of any future interventions can be adequately measured.

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Editor’s note: PANCAP extends congratulations to the Caribbean Vulnerable Communities Coalition (CVC) for achieving this well-deserved honour.

The Robert Carr Research Award, presented every two years at the International AIDS conference, recognizes the collaboration between community organizations and academic researchers to improve outcomes for highly stigmatized and underserved populations. It is sponsored jointly by the International Council of AIDS Service Organizations, Human Rights Watch, the International AIDS Society and the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health.

Key takeaways from the UNAIDS Global AIDS Update 2020 launch

Key takeaways from the UNAIDS Global AIDS Update 2020 launch

UNAIDS Caribbean

  • The Caribbean lags behind global averages for testing and viral suppression. To close the gaps the region must expand proven methods of active case-finding, linkage to care and retention in care, including through community-based programmes.
  • Year after year the data tell the story of men’s inadequate access to HIV services. It is time for a comprehensive strategy to meet men where they are, increase demand and adapt service delivery to meet their needs.
  • HIV resource availability from domestic sources increased by 38% from 2010 to 2019. It is critical that Caribbean governments guard these investments, even during COVID19.

CARPHA

  • HIV response gains were guided by evidence. National authorities should make regional COVID-19 data-sharing a priority to facilitate analysis and inform decision-making at the level of CARICOM.
  • Health authorities must avoid crises among people living with HIV and non-communicable diseases. Continuous monitoring and re-evaluation of considerations for vulnerable populations at risk to COVID-19 are critical.

PANCAP

  • Ending AIDS requires a coordinated multisectoral regional response as articulated in the 2019 – 2025 Caribbean Regional Strategic Framework (CRSF). The CRSF is our blueprint towards ending AIDS and it highlights policies and programmes to accelerate progress for achieving the UNAIDS 90-90-90 Targets to test, treat and defeat AIDS.
  • Addressing the needs of Key Populations is critically important. Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination and violence, external and internal stigma, and limited health education.

CRN+

  • Strategic information gaps must be closed for the region to truly understand and respond to its epidemics. Governments must increase investments in data collection and analysis and forge collaboration with civil society to achieve this.
  • In the context of COVID-19 community organizations must continue to increase collaboration with national and regional partners to understand the challenges and advocate for beneficiaries across the Caribbean.

SCLAN

  • During COVID-19 women and girls face a higher risk of contracting HIV
    due to the extended confinement measures as well as economic and social stresses. Decisive action is needed to address the risk of gender-based violence and sexual abuse.

One in three new HIV Infections in the Caribbean last year was among young people ages 15 – 24. Evidence-based strategies to increase youth access to education and sexual and reproductive health services are critical.

JASL increases support for clients during COVID-19 Pandemic

Jamaica AIDS Support for Life (JASL) remained open to serve its clients during the COVID-19 pandemic. The organisation modified its treatment, care and support programme to respond to the needs of their clients and received assistance through soliciting donations and writing proposals for small grants to mitigate the impact of the pandemic.

COVID-19 resulted in clients losing their jobs and not being able to provide for themselves and their families. These clients needed money including a travel stipend to attend the clinic, nutritional support and care packages including sanitisation items. Loss of employment, lack of basic living support and depleting nutritional supplies are the main issues that undermined clients’ adherence to medication. To play its part and ensure that the gains made with adherence and viral suppression of its clients were not eroded, JASL quickly sprang into action and launched an initiative geared towards “Helping us to help People Living with HIV (PLHIV) during this time of crisis.” Specifically, it tried to assist clients by providing financial assistance, nutritional support and care packages.

JASL called local organisations and submitted proposals to international donor agencies to provide financial and other support. Executive Director of JASL, Kandasi Levermore expressed that “we cannot negate the importance of nutritional support in maintenance of optimal care and as such, JASL seeks to ensure that each of our clients is provided with holistic “love, action and support.” Many of these clients were not able to access the benefits from the Government of Jamaica’s CARE Programme.

Assisting JASL’s clients, including PLHIV has helped to address some of the clients’ socioeconomic challenges so that they were not distracted from continuing their ARV regime. PLHIV who are adherent to their ARVs will optimise their immune system and improve their chances to fight against the symptoms of COVID-19.

During the pandemic, JASL also engaged in other COVID-19 response efforts. The organisation developed its Infection Prevention and Control Protocol which was implemented to protect its staff and clients from COVID-19 and other infectious agents. Employees were adequately equipped with the requisite personal protective equipment (PPE) to protect themselves from contracting COVID-19 and clients were provided with masks, temperature checks and sprayed with hand sanitisers upon entering the treatment sites.

The organisation also suspended all community interventions and amplified one-on-one peer testing by appointments only at the organisation’s offices or at locations convenient to people who want to be tested.

JASL’s treatment, care and support programme remains grounded in the organisation’s strategic objective to improve the health outcomes of over 800 clients accessing services at three treatment sites in Kingston, St. Ann and Montego Bay.

JASL continues to provide relevant services for clients while the pandemic unfolds as the organisation is committed to improving their health outcomes.

The organisation is encouraging individuals and companies to support their work and the cause by calling its head office on 876-925-0021 or donating at NCB Knutsford Branch 351813768.

COVID-19 and its effect on vulnerable groups especially women and girls

The COVID-19 pandemic has disrupted lives globally, causing a significant struggle for vulnerable populations, particularly our women and girls.

This impact on our vulnerable groups only reinforces the inequity that exists, which we addressed during our United Nations General Assembly (UNGA) side event in September 2019. The inequalities were always present, COVID- 19 is only exposing them even more so now. Regardless of the situation, “women and girls are negatively and disproportionately impacted by disasters and conflict” (UNFPA and UN Women).

Moreover, COVID-19 has put the most vulnerable populations at higher risk due to the confinement measures and economic stresses that tend to reinforce abusive behaviour. According to UN Women, emerging data shows that since the outbreak of COVID-19, physical and sexual violence against women and girls (VAWG) has intensified.

Fortunately, despite challenges, there are immense opportunities: my experience as Belize’s Special Envoy for Women and Children and Chair of SCLAN has cemented my belief in the power of collaboration.

COVID-19 has shown us that there is still an urgent need for innovative targeted tools and comprehensive strategies to accelerate progress for our vulnerable populations. As we see positive efforts to fight COVID-19 in our region, we must use this dynamism to seek sustainable financing and reinforced partnerships that strengthen actions to protect women and girls.

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Over 10 000 persons benefit from PANCAP – PAHO Webinars

Since the beginning of the COVID-19 pandemic, the PAHO/WHO Sub-regional Office for the Caribbean collaborated with the Pan Caribbean Partnership against HIV and AIDS (PANCAP) on a series of webinars which aimed to provide effective, timely and relevant information to the Caribbean on a wide range of topics relating to COVID-19 and HIV. The webinars were aimed at diverse audiences and served to provide updates on new scientific evidence and to share evidence-based frameworks and strategies as well as successful and innovative implementation experiences for the prevention and management of COVID-19.

PANCAP and PAHO have been intentional in combining presenters who are experts in technical areas with regional presenters on successful Caribbean implementation experiences. This approach provided an understanding of evidence-based frameworks and how these can be applied to the local context.

The webinars conducted from March to May 2020 have reached over 10,000 persons.  Participants have the option of joining the live sessions or viewing the recording on the PANCAP and PAHO Facebook pages as well as the PANCAP website and YouTube Channel.  Participants’ engagement with the webinars has been high. Organisers have received positive feedback on the relevance of the knowledge shared and the expertise of the presenters. A recent post-webinar survey revealed that 98.5% of participants gained new knowledge, while 100% indicated that the information presented was useful to their work.  In addition, 95% of participants stated that they would utilise the new knowledge in the execution of their work programmes.

The two entities will continue this successful collaboration with the overarching aim of providing critical knowledge for the Region’s response to COVID-19.