HIV self-testing good for Guyanese, says NAP Manager

15 January 2021 (Georgetown, Guyana)  While the government’s recent announcement that Guyanese would be allowed to self-test for HIV has attracted criticism from stakeholders, the new Programme Manager of the National AIDS Programme Secretariat (NAPS), Dr Tariq Jagnarine believes it is a good thing for Guyanese.

In a recent interview with the News Room, Dr Jagnarine welcomed the announcement by Minister of Health, Dr Frank Anthony, and used the opportunity to quell the fears of those involved in the domestic HIV and AIDS response.

He said self-testing has proven to be a best practice in many developed countries. He is confident that with the appropriate guidelines, it can work in Guyana as a majority contributor to helping the government reach its targets, among which, is ending AIDS by 2030.

“It is doable…before the programme is implemented, there will likely be a guided policy on how it will be rolled out and monitored,” Dr Jagnarine assured.

He acknowledged that Guyana has its own challenges with the remoteness of some regions. Still, He said that with proper Standard Operating Procedures (SOPs), self-testing could be effectively done in Guyana.

Asked about the possibility of some persons testing positive and failing to report it to the authorities in keeping with the government’s push to not only have persons on treatment but to ensure viral suppression, Dr Jagnarine said self-testing would not be done in an isolated manner.

He said it would go hand-in-hand with all the other programmes at NAPS which will allow for proper tracking and monitoring of persons.

“It will be highly scrutinised and tracked…I personally wouldn’t want to see somebody tested and we missed them and can’t put then on ARVs,” he added.

The government has not said when self-testing would start in Guyana. The announcement to start self-testing coincides with the launch of a new National HIV Strategic Plan 2021- 2025.

With roughly 8,000 persons living with HIV in Guyana, statistics from the Health Ministry show that at the end of 2020, 90 per cent of those infected knew their status, while 72 per cent were on antiretroviral therapy and 75 per cent of those receiving antiretroviral therapy were virally suppressed.

SASOD lauds HIV self-testing, interested in rendering services

The Society Against Sexual Orientation Discrimination (SASOD) has lauded the Government’s decision to implement self-testing for HIV. At the launch of the National HIV Strategic Plan, on 5 January 2021, Minister of Health, Dr Frank Anthony, announced that the government is looking to implement HIV self-testing in Guyana.

During an interview with the Guyana Chronicle on Wednesday, Managing Director of SASOD Guyana, Joel Simpson, commended the initiative and noted that SASOD is ready and willing to support the initiative by providing counselling services to persons impacted.

“It’s a laudable initiative because HIV self-testing is showing results in other parts of the world.  It encourages persons that would not normally utilise HIV health services, to test in the privacy of their homes and know their HIV status,” Simpson explained.

Simpson highlighted that self-testing would increase HIV testing coverage since it can be made available to persons far and wide.  “This will inevitably help curtail the spread of HIV”, stated the SASOD Director.

“It’s a very innovative and effective prevention strategy; it could be targeted to those groups that are not reaching out to health services to get an HIV test,” he said. He explained that persons generally have concerns about stigma and discrimination and are usually unsure about the confidentiality of information they share during the HIV testing process.

Further, he highlighted that studies have revealed that Caribbean men are less likely to utilise health services until they are severely affected.

“HIV self-testing provides an opportunity to improve confidentiality and reach persons that are not coming forward. If targeted to the right groups, it can increase HIV testing coverage in Guyana,” Simpson explained.

MISUNDERSTANDING

Responding to the criticism of the initiative by some persons that Guyana is not equipped and ready for such an endeavour, primarily because persons would not be able to access counselling services when self-testing, Simpson opined that this is a misunderstanding.

He explained that the World Health Organization (WHO) guiding principles on HIV testing and counselling stipulates that testing and counselling should be voluntary and must adhere to the five Cs. The five Cs are consent, confidentiality, counselling, correct test results and connections to care, treatment and prevention services. The SASOD Director noted that the organisation is ready and willing to provide counselling services and render psycho-social support to persons of all genders and sexual orientation when the initiative commences.

“SASOD would be interested in providing counselling services.  We want to ensure that persons have counselling to prepare for the results after taking an HIV test.  It’s important that persons have psycho-social support if they test positive,” Simpson related. He is also hopeful that in rolling out the initiative, the government will implement different methodologies in relation to counselling to ensure the initiative’s success, such as a hotline number.

Simpson noted that organisations such as SASOD would play a significant role in creating awareness about the initiative through relationships established with persons who utilise their services. He urged the ministry to connect with these groups that already provide social support and counselling to develop partnerships.

“I would encourage the ministry and national programme to conduct extensive consultations with civil society groups that work in the HIV response to establish these groups as partners in the HIV self-testing initiative,” Simpson said.

Global Fund signs a record-breaking $8.54 billion in grants to fight HIV, TB and Malaria

GENEVA – In 2020, the Global Fund signed 157 grants for a total of US$8.54 billion for lifesaving HIV, Tuberculosis (TB) and malaria programs and to strengthen systems for health. This is the highest amount of grants ever signed in a single year by the Global Fund. The grants will begin implementation this month.

“This is an exceptional achievement that will help more than 100 countries continue the critical fight against HIV, TB and malaria – epidemics that kill more than 2.3 million people every year,” said Peter Sands, Executive Director of the Global Fund. “As the COVID-19 pandemic overwhelms health systems around the world, it is now more important than ever that we ensure countries have the resources they need to fight HIV, TB and malaria and to strengthen the systems for health needed to respond to all four diseases.”

The Global Fund has a total of US$12.71 billion available in funding allocations for the three-year funding cycle that runs from 2020-2022. Of these funds, the Global Fund had planned for US$8.9 billion in grants to be approved in 2020, with the remaining funds scheduled for later start dates. However, the Secretariat accelerated its grant-making efforts and exceeded the original target, approving US$9.2 billion of funding in 2020. As of 31 December 2020, US$8.54 of the approved grants had been signed and begin implementation this month; two countries were still in the process of signing the remaining finalized grants worth US$660 million.

“Even in the midst of a new global pandemic, during an extraordinarily challenging year, the Global Fund partnership has supported countries to develop grants more quickly and effectively than ever before,” said Donald Kaberuka, Global Fund Board Chair. “A record-breaking 67% of grants for the 2020-2022 funding cycle have now been signed, compared to 50% of grants signed at the same time in the last funding cycle, representing a remarkable increase in performance.”

In comparison, at the same time in the 2017-2019 funding cycle, the Global Fund had signed US$5.2 billion in grants out of a US$10.3 billion funding allocation.

Over the past year, the Global Fund has supported implementing partners and Country Coordinating Mechanisms (the committee of local community, government and health experts that develop and guide Global Fund-supported programs in a country) to develop detailed funding requests for programs to respond to the epidemics at the country level. As part of the Global Fund’s grant-making process, all funding requests are reviewed by an independent Technical Review Panel and then by the Grant Approvals Committee for quality and comprehensiveness before going to the Global Fund Board for final approval. Once the Global Fund and the implementing partners sign the grant, implementation of programs can begin.

The Global Fund is extremely appreciative of the continued support of donors for its core funding, as pledges made at the record-breaking Replenishment Conference in Lyon in October 2019 are converted into cash contributions. Sustaining funding levels for the fight against HIV, TB and malaria is vital at a moment when disruptions related to the COVID-19 pandemic threaten to reverse many years of progress against the three diseases.

On top of the new grants awarded to fight HIV, TB and malaria, the Global Fund has approved US$980 million in additional funding to 106 low- and middle-income countries and 14 multicountry programs to respond to COVID-19 in 2020. The Global Fund has estimated that it needs a further US$5 billion on top of its core funding to support countries in responding to the pandemic by reinforcing national COVID-19 responses; mitigating the impact of COVID-19 on lifesaving HIV, TB and malaria programs; and making urgent improvements to health and community systems.

Attaining UNAIDS’ proposed societal and legal barrier targets could stop 440 000 AIDS-related deaths 

UNAIDS has called on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets for 2025.

An analysis was performed focused on available studies that have quantitatively measured the negative impact of stigma and discrimination and the criminalization of sex work, drug use and same-sex sexual relationships on HIV prevention, testing and treatment efforts.

The analysis suggests that failure to make any progress on HIV-related stigma and discrimination would undermine efforts to reach the HIV testing, treatment and viral suppression targets, resulting in an additional 440 000 AIDS-related deaths between 2020 and 2030, and that failure to make any progress across all societal enablers would undermine efforts to reach HIV prevention targets, resulting in 2.6 million additional new HIV infections over the same period.

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Guyana to end mother-to-child transmission of HIV, further reduce new infections by 2025

On Tuesday, Guyana recommitted itself to the Global AIDS Strategy, which hopes to end AIDS by 2030, launching a new National HIV Strategic Plan 2021- 2025.

The new plan puts Guyana on track with global momentum but sets achievable benchmarks for the country and strengthens its national HIV and AIDS response.

By 2025, Guyana hopes to reduce new HIV infections among key populations and other vulnerable groups by 95 percent.

Also, by 2025 all babies are expected to be born free of HIV and other Sexually Transmitted Infections (STIs), ending mother-to-child transmission.

Guyana wants to also reduce AIDS-related deaths by 95 percent within the next five years.

In the past seven years, the national fight against HIV and AIDS was guided by the National HIV Vision document, which came to an end last year.

During the virtual launch of the innovative and progressive plan to achieve epidemic control on Tuesday, Guyana also boasted being the first Caribbean country to achieve the First 90 of the UNAIDS 90-90-90 goals.

This means that at the end of 2020, 90% of all People Living with HIV in Guyana knew their status.

Guyana falls short on the other two indicators where 72 percent of Guyanese with a diagnosed HIV infection are on antiretroviral therapy and 75 percent of those receiving antiretroviral therapy being virally suppressed.

Minister of Health Dr Frank Anthony acknowledged these shortcomings with the ambitious treatment target of 90 percent needed to be achieved.

Dr Anthony said while Guyana aspires to end AIDS by 2030, there are many other targets along the way.

He said Guyana had set its own target of 95 percent on several key indicators by 2025.

“There is a lot of underlying work that needs to be done to ensure the targets are met. While we fix exiting problems, we have to look to improve other targets,” he said.

The Minister said the political will exists to introduce a more comprehensive program with PrEP (Pre-exposure prophylaxis) – a medicine people at risk for HIV take to prevent getting HIV.

Guyana had only been making this medication available to couples where one partner has tested positive for HIV.  Dr Anthony now says that the country intends to make it available for all citizens who are considered at risk.

The Minister said policies would be put in place to push self-testing among the population.

The new National HIV Strategic Plan was developed, revised and finalized through a process that included all stakeholders over the past year. It commenced in January 2020.

Acknowledging that there has been little change in the epidemic over the last five years with a small decline in 2018, Consultant Dereck Springer said there is now a strong political commitment and enabling environment to accelerate the national AIDS response.

He said that while there have been achievements, the response is still faced with numerous challenges that the new strategy addresses.

Springer said there continues to be dysfunctional coordination, high levels of stigma and discrimination and frequent stock-outs of medication.

These shortcomings, he says, will be addressed in the new plan.

Guyana to roll out HIV self-testing

(Via Demerara Waves, Georgetown, Guyana)  Health Minister Dr Frank Anthony on Tuesday announced that Guyanese would be allowed to self-test for HIV and that more at-risk persons would be given preventative drugs.

“Another area we want to look at is self-testing. This is relatively new, and it has been advocated around the world, and some countries have implemented it with relatively good success.  This is one of the measures we would like to put in place here in Guyana,” he said.

The Health Minister gave no specific time-frame by which self-testing would start in Guyana.

He made the announcement in an address to stakeholders at the launch of the HIV National Strategic Plan, which aims to bridge past achievements to end the disease by 2030. The Minister also disclosed that Guyana would be submitting a proposal to the Global Fund for support to fight the disease.

The Health Minister said a “more comprehensive” Pre-exposure Prophylaxis (PrEP) programme would be rolled out this year to build on the programme introduced last year to target couples, one of whom is HIV positive and the other is not. “We want to take that further so that anybody at risk can access PrEP.  Next year we will see a better roll-out of PrEP to ensure that this is at all of our clinics.  We will work with all stakeholders to ensure that this is also available with the services they provide,” he said.

Dr Anthony said Guyana has been suffering from a lag in two of the three areas identified globally by UNAIDS for bringing the disease under control.  This included knowing one’s status, receiving Antiretroviral Therapy and suppressing the disease by 2020.

He said statistics show that 94 percent of HIV positive persons in Guyana know their status, 73 percent of them have been tested and on treatment and the virus has been suppressed in 75 percent of them.  In that regard, he remarked that “we still have a lot of work to be done over the next five years”.

The Health Minister noted that weaknesses in the fight against HIV included stock-outs of reagents that have adversely affected testing, treatment and care. He hoped that this could be remedied through proper quantification by clinical staff and procurement. “While we fix existing problems, we also have to look forward to how we can improve and also use new methodologies to ensure that we can get to those targets by 2025,” he said.

Dr Anthony said “more effective” antiretroviral therapies were being rolled out along with co-morbidities such as Tuberculosis to fight other sexually transmitted diseases, including the Human-Papilloma Virus that causes Cervical Cancer.

Global Fund Board Appoints Tracy Staines as Inspector General

4 December 2020 | GENEVA − The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has appointed Tracy Staines, a distinguished auditor and seasoned executive, as Inspector General. Staines brings over 20 years of multi-sectoral experience in audit and risk management, including eight years at the Global Fund.

Promoted to Head of Audit in 2015, she has been serving as the Acting Inspector General since August 2020, after the departure of former Inspector General Mouhamadou Diagne. Staines is the first woman to hold the position of Inspector General, which reports directly to the Board.

“We are pleased to name Tracy to this critical role,” said Dr Donald Kaberuka, Global Fund Board Chair.

“Tracy’s long experience, robust knowledge of the Global Fund, commitment to the mission and a strong sense of professionalism will be central to leading the Office of the Inspector General to support the organization in the evolving global health environment,” said Lady Roslyn Morauta, Vice-Chair of the Board.

An independent, well-resourced and transparent Office of the Inspector General (OIG) is essential for the success of the Global Fund, Dr Kaberuka added. The Global Fund is committed to the highest standards of accountability in all matters, including the audits and investigations produced by the OIG. The Global Fund’s OIG is composed of 52 auditors, investigators, and other professional staff.

Staines replaces Mouhamadou Diagne, who announced in May 2020 that he would resign to take on the position of Vice-President of Integrity for the World Bank Group.

Staines’ appointment comes as a result of a robust global selection process that started in August 2020, led by a Board-appointed Inspector General Nomination Committee and supported by a search firm. A total of 145 applications were received by the application deadline of 11 September 2020, reflecting a diversity of gender, professional backgrounds and sector, and geographical locations. The Nomination Committee conducted a merit-based, competitive and apolitical process, informed by due diligence and background checks, and with due attention to diversity of candidate profiles, particularly diversity of gender, geographic background, and professional experience. Assessing candidates against Board-approved Terms of Reference, the Nomination Committee also paid particular attention to candidates’ track record with respect to Global Fund strategic issues including human rights and key populations affected by the three diseases.

During her tenure at the Global Fund, Staines has led an impactful audit unit, renowned for its solid, data-driven products. She has directed a comprehensive program of complex, high-profile reviews that have driven positive change, resulting in enhanced portfolio performance and significant improvements in accountability and risk management frameworks. She and her team have refocused the OIG’s annual assessment to maximize coverage of key risk areas including grant size, residual risk and disease burden. She leads on the delivery of a comprehensive annual opinion, setting out ambitious development areas, which have informed a series of enduring improvements at the Global Fund.

Staines has also led the development of an advisory capability within the OIG, evolving the unit into a value-adding strategic advisor. OIG advisory reports provide data-led and thoughtful analysis to senior management to drive improvements throughout the partnership. In addition, under her leadership, the OIG has cultivated strategic partnerships with Supreme Audit Institutions to build capacity and leverage local knowledge. She liaises closely with like-minded oversight functions and the United Nations Representatives of Internal Audit Services (UN-RIAS) community.

Prior to joining the Global Fund, Staines led audit and investigations teams at one of Europe’s largest banks and the UK Civil Service. She began her career with Deloitte, the world’s largest professional services firm, in London and Sydney. She is a Fellow of the Institute of Chartered Accountants in England and Wales, a Chartered Internal Auditor and a qualified member of the Chartered Institute for Securities and Investments.

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Launched: Caribbean Roadmap for Adolescent and Youth Health

Image: Participants of the Caribbean Congress on Adolescent and Youth Health (CCAYH), November 2019

Caribbean youth advocates have called for action on areas of priority for their peers with the launch of the Caribbean Roadmap for Adolescent and Youth Health:  Championing Our Wealth: Promoting the Health and Well-Being of Adolescents and Youth in the Caribbean.

Approximately two hundred Youth congress participants, including policymakers, international and regional partners were involved in three days of discussion in November 2019, which culminated with the launch of the Roadmap on Monday 19 October 2020.  The launch showcased the involvement of young advocates in the design, moderation and content of the event. It was hosted by the United Nations Population Fund (UNFPA) and the Pan American Health Organization (PAHO).

Dr Frank Anthony, Minister of Health (Guyana), officially launched the Roadmap and commended the young people and partners for the collective wisdom encapsulated in the Roadmap. “I want to thank PAHO/WHO, CARICOM and UN Partners for their leadership in this process. I urge you to continue the advocacy for political prioritisation and the integration of these recommendations into national development plans.  While COVID-19 compounds the challenges before us, we have an opportunity of using this Roadmap to usher future generations into a cleaner and healthier Caribbean.  Can we do it? Yes, we can!” stated Dr Anthony.

Nothing for us, without us!

Five Caribbean youth advocates including Pierre Cooke Jnr., Christopher Gilkes, Michelle Belfor, Jean Sano Santana and Renatta Langlais, took part in the launch and focused their discussions on the four tracks contained in the Roadmap: mental health, substance use, violence and injuries; sexual and reproductive health and rights, HIV and STI; nutrition, physical activity, sports and youth development; and climate change and the environment.

The purpose of the Roadmap is to provide strategic guidance on actions Member States should take to address adolescent health in their local setting

SASOD Guyana Pivots its Human Rights Response Online, Adapting to the COVID-19 Pandemic

Between April and September 2020, and amidst the height of the COVID-19 pandemic locally, the Society Against Sexual Orientation Discrimination (SASOD) Guyana has documented 30 cases in the Shared Incident Database (SID) with support from the Caribbean Vulnerable Communities Coalition (CVC) through the multi-country Caribbean Global Fund Grant, “Sustainability of Services for Key Populations in the Caribbean.” Among the documented cases, 30% involve cyber-bullying against women, girls, LGBTQ+ persons, Persons Living with HIV, and marginalised youth, as compared to 0 reported cases of cyber-bullying for the same period in 2019, under the SID project supported by CVC. Client intake, as well as counselling services, are now being done virtually to reduce the exposure risk to COVID-19. SASOD Guyana developed a protocol for virtual client intake and case management in keeping with the SID protocol, that was approved by CVC, considering the pandemic.

As at 31 October 2020, SASOD Guyana has resolved 70% of these 30 client cases for the 6-month period through referrals to pro-bono lawyers, filing and serving of restraining orders, seeking public assistance, land applications, securing emergency housing, permanent relocation, among other forms of redress.

In June 2020, SASOD Guyana launched a social media campaign dubbed #IssaCyberCrime to increase public knowledge on the Cyber Crime Act of Guyana, information on penalties for cyber offences, as well as support and access to justice for victims. This campaign, supported by the SID project, reached approximately 30,000 persons on social media between June and August 2020. Anecdotal evidence, especially feedback from new clients, indicates that this accessible form of human rights education allowed them to recognise cyber-crimes, know they are illegal and appreciate that redress and support services are available through SASOD Guyana. The campaign is especially critical since vulnerable populations find police processes very intimidating.

Equals Barbados continued vital community services during pandemic

Written by Dr Nastassia Rambarran, Public Health Consultant, Researcher and Physician

The onset of the COVID-19 pandemic coincided with the ending of USAID/PEPFAR funding in Barbados to create a perfect storm of potentially huge disruption of HIV service provision by the key population-led civil society organisation, Equals Inc.

At the time, Equals, with USAID/PEPFAR funding and under a shared care paradigm with the Barbados Ministry of Health and Wellness, provided wide-reaching and national HIV and STI testing, treatment and HIV PrEP at their community site. With the onset of lockdown in late March, on-site services were shut down, but persons on PrEP and receiving antiretrovirals for treatment were followed up via phone calls and messaging by the Equals team, who arranged delivery of multi-month medication supplies, telemedicine consults and donated food hampers sourced from donations and an external grant.

Outreach workers intensified online engagement (which has always been a strong point of the organisation) and psychosocial counselling, which was especially needed, moved online. After approximately three months of lockdown, these measures enabled the site to reopen with testing uptake almost on par with pre-pandemic levels and continued alliance with the vulnerable community served.



Editor’s note:
EQUALS is an LGBTQI+ organisation that helps communities to access services through rights-based advocacy. The goal of Equals is to educate and empower the LGBTQI+ community to foster unity by providing a safe, discrimination-free environment.  In this environment, Equals encourages safe sexual practices and access to services in areas such as sexual health, general health and mental health. Equals also serves as an educational outlet by providing general information that is catered to the community. In addition, Equals works to improve the quality of everyday life for the LGBTQI+ community by tackling stigma and discrimination through sensitisation training and human rights violations case recording. The organisation strives to achieve its goals through community empowerment, education, networking and rights-based advocacy.

For more information visit https://equalsbarbados.com/