Release Type: News Article

Image: Participants at SASOD’s Ninth Annual HIV and AIDS Candlelight Memorial

Even though the availability of treatment for HIV and AIDS has increased in Guyana over the years, Programme Manager of the National AIDS Programme (NAPS), Dr. Rhonda Moore has bemoaned that pervasive stigma and discrimination continue to hinder the fight.

Speaking at the ninth annual HIV and AIDS Candlelight Memorial organized by the Society Against Sexual Orientation Discrimination (SASOD) and held at the organization’s Lamaha Springs office, Dr. Moore stressed the need for greater societal involvement in tackling the disease.

According to her, Guyana has made strides in approving the accessibility of treatment for Human Immunodeficiency Virus infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) and making this treatment affordable, even free of cost, yet persons are unable to access these services. “The elephant in the room continues to be stigma and discrimination,” the Programme Manager said.

Adding to her sentiments was Managing Director of SASOD, Joel Simpson, who spotlighted the fact that while persons are discriminated against for having HIV/AIDS, the Lesbian Gay Bisexual Transgender (LBGT) community continues to be further discriminated against and marginalized.

While the provision of medical services is critical, Dr. Moore also posited that cognizance of people’s rights regardless of their sexual orientation, ethnicity, creed or other attributes is tantamount.

Dr. Moore nevertheless noted that persons living with HIV, though discriminated against and are marginalized, are “the greatest teachers” in the efforts to reduce the scourge.

“Without the involvement of persons living with HIV, policymakers will never understand what needs to be done,” she noted.

And despite dwindling donor funding internationally to reduce the HIV/AIDS-related cases, Moore assured that the government remains committed to funding treatment and testing through its National Health Strategy.

The overarching international goals that Guyana has aligned itself with include the elimination of AIDS by 2030 and the achievement of the United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 target of diagnosing 90% of all HIV-positive persons; providing Anti-retroviral Therapy (ART) for 90% of those diagnosed; and achieving viral suppression for 90% of those treated by 2020.

“All Guyanese have a right to quality care,” Moore highlighted but stressed, “This can only be achieved through working together.”

On a macro-level, a Sustainability Oversight Steering Committee has been established by the Public Health Ministry to guide the sustainability plan for continuing the gains already made vis-a-vis the goals outlined. The Committee is chaired by Public Health Minister, Volda Lawrence and includes Junior Health Minister, Dr. Karen Cummings; Dr. Moore; representatives from civil society organizations; representatives from faith-based organizations; and representatives from government ministries, among others.

SASOD has been the local organizer for the annual AIDS Candlelight Memorial in Guyana since 2010. Also in attendance at the Memorial was UNAIDS Country Director, Dr. Martin Odiit; UN Resident Coordinator and UNDP Resident Representative for the Cooperative Republic of Guyana, Mikiko Tanaka; and members and supporters of SASOD.

UNAIDS’ 90-90-90 targets focus on three global goals to be achieved by the year 2020: 90 percent of all people living with HIV will know their status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression. To successfully reach this goal, key populations (KPs) most at risk for HIV – including men who have sex with men, people who inject drugs, sex workers, and transgender people – need to be at the center of prevention, care, and treatment programs.

Tracking KPs’ successful access to these services is an essential part of the process of reaching 90-90-90. This is achieved by using a systematic approach to data collection and analysis through a strategic information (SI) system. SI is designed to support and shape long-term strategies for program planning and implementation, responding to stakeholder’s needs, and supporting innovations. More specifically, SI in KP programs generates data so that the decisions made in planning clinical, behavioral, and structural interventions are rooted in evidence.

SI in KP programming

HIV programs that focus on KPs require a specialized SI system to monitor the changes that occur within each population during a program’s implementation. KPs face special challenges in accessing HIV prevention, care, and treatment including their legal status, stigma and discrimination, and the influence of power structures. The information generated by an SI system can be used to identify and manage structural barriers to service uptake and understand the dynamic nature of KP individual’s behavior.

With an SI system, data are collected to ensure that KP programs are monitored from all fronts. Ideally, the system collects information beyond the standard PEPFAR indicators to ensure that data are helping shape program strategies. In the LINKAGES project, an SI system is used to collect data relating to structural interventions, including activities related to violence, stigma and discrimination, advocacy, sensitization, and peer navigation for HIV-positive KPs to ensure improved adherence to care and treatment. It also tracks activities that affect KPs in their day-to-day life and influence their behaviors. This SI system can be further customized based on country or regional needs. The SI system helps program teams with routine monitoring of the quality of their services along the HIV cascade and their progress toward reaching 90-90-90 targets.

The SI system for any KP program includes carefully tailored monitoring tools used to collect data at the grassroots level and subnational level and track the trends and gaps within a program. Data are then aggregated and used for analysis at the national level. The SI system also includes simple analytical tools that show site-level statistics on the various services provided to KPs, including behavioral, clinical, and structural interventions. SI provides the evidence needed to establish and maintain a program-wide approach to data collection, data analysis, data use, and action-oriented program planning processes.

Resources on SI

Many efforts are underway to ensure that SI systems being developed are KP-friendly and help KP-specific programs make effective use of data for strategic planning. Listed below are resources that can be used for systematic monitoring of KP programs through an SI system:

• Monitoring guide and toolkit for key populations HIV prevention, diagnosis, treatment, and care programs
• Operational guidelines for monitoring and evaluation of HIV programs for sex workers, men who have sex with men, and transgender people: Vol. I, national and sub-national levels (2013, UNAIDS/PEPFAR/Global Fund)
• Operational guidelines for monitoring and evaluation of HIV programs for sex workers, men who have sex with men, and transgender people: Vol. II, service delivery providers (2013, UNAIDS/PEPFAR/Global Fund)
• Use it or lose it: How Avahan used its data to shape its HIV prevention program in India (2008, Bill & Melinda Gates Foundation)
• ACQUA: Aastha Continuous Quality Assessment (FHI 360/Aastha, India)

Image: A member of Brothers for Life in Cote d’Ivoire

Written by: Stephanie Desmon

Director of Public Relations and Marketing, Johns Hopkins Center for Communication Programs

Not enough men in Cote d’Ivoire, a coastal nation with the highest HIV prevalence in West Africa, are being tested for HIV.

Getting tested is the first step to being treated, and treatment is a vital step in reducing the spread of the virus. People who are tested can almost immediately receive treatment here – for free. But Johns Hopkins Center for Communication Programs researchers and others have long known that fear is keeping men from learning their HIV status.

“The question here is: Why are men so afraid?” says Danielle Naugle, PhD, a research and evaluation officer at CCP. “Our new research has given us an answer: Being diagnosed with HIV threatens everything men hold dear. You’d be hard-pressed to find something that threatens them on so many levels. Some say they would rather die of AIDS than be tested and know they have HIV.”

Research conducted in late 2016 in Cote d’Ivoire with nearly 300 HIV-positive men, men who don’t know their status and health workers found that the masculinity of men, their sense of self, hinges on five domains: Family, social status, sexuality, work and health. And all of these can be impacted if a man is diagnosed with HIV. For example, if others learn about a man’s HIV diagnosis, he fears the serious stigma associated with the virus, including the potential loss of a job, the worry that future children could be infected, the loss of freedom to pursue multiple sexual partners – all of this without even thinking about the actual impact of being sick.

The most recent data, from 2012, found that 75 percent of men in Cote d’Ivoire had never been tested for HIV compared to 62 percent of women.

In many instances, men in Cote d’Ivoire aren’t tested until it’s the last resort, until after they are showing signs of illness. Naugle says that men are often making what can be considered “rational calculations,” that the loss of these other domains outweighs the potential upside of seeking treatment for the benefit of their health.

“If you know your status, there is the potential for other people to know and the potential that the news spreads and threatens these other aspects of your life,” Naugle says.

Said one young man in a focus group in Bouake, Cote d’Ivoire’s second-largest city: “I would not be respected like before and I could not bear that.”

“It is obvious why people hide,” said one young man from the southwestern port of San Pedro, “Because we know that it is a shameful disease, we know how it is caught.”

The antidote to this, Naugle says, is that antiretroviral treatment is available at no cost and that it can restore most people to the picture of health. HIV is no longer a death sentence and people are living longer and healthier lives. “But many men have images in their head of 30 years of fear-based messaging,” she says. “It’s hard to compete with that.”

This information collected by CCP under its former Health Communication Capacity Collaborative (HC3) project is being used to inform programming being undertaken in Cote d’Ivoire by CCP’s new USAID-funded Breakthrough ACTION project. Breakthrough ACTION is overseeing a support group called Brothers for Life that brings together at-risk men to discuss issues including HIV. The curriculum has been tweaked to address some of the team’s findings on masculinity and the threats posed to it by HIV.

Preliminary evaluations of these tweaked programs have shown that some men, learning that HIV is not the life-threatening virus it once was, are being tested after attending Brothers for Life, says Natalie Tibbels, MSPH, a senior research assistant at CCP.

“When I take the treatments, it gives me the strength to go about my business,” a man living with HIV in San Pedro told researchers. Said another from the capital Abidjan, the country’s main urban center: “With treatment, I feel normal, as if I did not have the disease.”

Naugle says she hopes the new insights she and her colleagues have made into the fear men have about testing can be used to make the process much less threatening.

“We want to be able to develop messages that can help men feel comfortable knowing and acting upon their HIV status,” she says.

Image: Ms. Laura A. Griesmar, Deputy Chief of Mission of the U.S. Embassy in Barbados, the Eastern Caribbean and the OECS, Barbados Minister of Health Honorable John D. E. Boyce, M.P., Honorable Midori de Habich, Former Minister of Health of Peru, Julia Henn, Director, Health and HIV/AIDS Office, USAID/Eastern and Southern Caribbean, Lisa Tarantino, Principal Associate, Governance Specialist, Eastern & Southern Caribbean Region, HFG Project/Abt Associates, Dr. Marty Makinen, Health of Health, HFG Project/Results for Development and health finance officials from Ministries of Finance and Health of Barbados, Guyana, Suriname and Trinidad & Tobago AND leaders of respective National AIDS Programs, national coordinating bodies, PAHO/WHO, UNAIDS, and USAID

Recently, the Health Finance and Governance Project (HFG) organized a two-day workshop to support policymakers from Ministries of Health (MOH) and Ministries of Finance (MOF) in preparing concrete strategies for mobilizing domestic resources for health, with a specific focus on HIV programming. Representatives of Country Coordinating Mechanisms and National AIDS Coordinating Committees also participated. The workshop convened thirty-two health and finance experts from Barbados, Guyana, Suriname, Trinidad and Tobago, Peru, the United States, and various global and regional institutions in Bridgetown, Barbados.

Over the course of the workshop, MOH and MOF participants identified commons priorities and objectives related to HIV programming sustainability and heard presentations from global experts on strategies to achieve domestic resource mobilization (DRM).

Three key priorities were identified as foundational to the implementation of sustainable DRM plans to achieve goals for HIV programming:

Prioritizing and allowing sufficient time for quality communication between health and finance agencies is essential to building sustainable, long-term plans. This means starting resource planning early and developing strategies to adapt to an evolving resource environment. When discussing health sector outcomes, it can be helpful to adopt a medium-term planning mindset to set realistic expectations for how investments in health will be realized. The former Minister of Health of Peru, Honorable Mrs. Midori de Habich advised participants to always have a well-developed back-up plan to quickly absorb any funding that becomes available. Proactive and timely planning were important themes that underscored many of the goals and milestones discussed.

Implementing strategies to improve shared understanding between Ministries of Health and Finance, as these two institutions don’t always speak the same “language”. A lack of common indicators, nuanced dialogue, and infrequent opportunities to cross-collaborate increases the divide between the Ministry of Health and Finance. Bringing these two institutions together—through personnel exchanges for brief secondments or by investing in personnel with backgrounds in cross-disciplinary learning, can help establish a common foundation of understanding on which to base resource planning.

Building on existing political will can allow teams to strategically position resource mobilization efforts for health to address the gaps that exist, and will arise, in HIV programming. Workshop facilitators and participants discussed the unique opportunity created by this funding transition period to bring the topic of resource mobilization for HIV to the forefront of public and political conversation. Maintaining a dialogue at high-levels while engaging with the public about issues most meaningful to them are two important tactics to driving long-term, sustainable change. Simple, key messages and the need for continuous feedback were two strategies outlined to build on, and sustain, political will.

Barbados Minister of Health, Honorable John D. E. Boyce, called upon the workshop attendees to “play an important role in creating advocacy messages that put health at the top of our governments’ agendas… continued improvements rest on the responsibility of us as stakeholders to make change happen.” He emphasized the importance of demonstrating how DRM for HIV connects to overall health system strengthening as a way to ensure that political will is cultivated and sustained. By the end of the workshop, each country team presented a thorough and ambitious action plan, incorporating one or more the tools they learned about, and made commitments to work towards implementing these actions.

Image: Ms Terianna Bisnauthh of SWAG makes a presentation to a representative of the Night Shelter, Georgetown Guyana. 

As part of its community service efforts to support vulnerable women, the Society Against Sexual Orientation Discrimination: Women’s Arm Guyana (SWAG) concluded its feminine hygiene and sexual health drive by presenting 30 gift bags to the women of the Night Shelter in Georgetown, Guyana on Thursday, May 10, 2018, ahead of Mother’s Day celebrations.

SWAG representatives distributed the gift bags to both the female residents and staff at the 24-hour homeless shelter. Aimed at promoting body safety, good hygiene, and healthy lifestyles, the gift bags contained feminine hygiene products, sexual and reproductive health commodities and informational brochures.

Gift items were donated by Massy Distribution Guyana Inc., Terianna Bisnauth, Dr. Nastassia Rambarran and Her Excellency, First Lady of the Cooperative Republic of Guyana, Mrs. Sandra Granger. The sexual health commodities and brochures were provided by the National AIDS Programme Secretariat of the Ministry of Public Health.

Established in 2017, SWAG seeks to work towards the equality, safety, and protection of lesbian, bisexual and transgender women and other vulnerable women.

Image: Ms. Victoria Nibarger, PEPFAR Coordinator, Caribbean Regional Programme

The PANCAP Newsletter is one of the first digital publications to interview Ms. Victoria Nibarger, the new PEPFAR Coordinator for the Caribbean Regional Programme based at the Office of the Global AIDS Coordinator and Health Diplomacy (S/GAC), U.S. Embassy Kingston, Jamaica. 

Here, Ms. Nibarger discusses the new PEPFAR direction for HIV and AIDS in the Caribbean and the significant changes occuring within the programme.  The following is an in-depth conversation with Ms. Nibarger and the Editor of the PANCAP Newsletter.

Editor: PEPFAR is on a new course of redefining its presence within the Region. Can you provide details on the new PEPFAR direction?

Victoria Nibarger:  This is a time of transition for PEPFAR efforts in the Caribbean.  At present, our PEPFAR Caribbean Regional Program covers our bilateral assistance in Barbados, Guyana, Jamaica, Suriname, and Trinidad & Tobago.  To better position ourselves to address the higher HIV burden in Jamaica, we have moved our regional headquarters from Barbados to Jamaica.  Over the next two and a half years, we will wind down our bilateral programs in Barbados, Trinidad & Tobago, Suriname, and Guyana.  At the same time, we will continue to provide regional technical assistance from Jamaica.  In terms of bilateral country programming, after fall 2020 we will focus on the HIV response in Jamaica, where there is a greater prevalence and incidence of HIV.  This will help PEPFAR maximize its efforts at controlling the HIV epidemic in the region.

Editor: Can the region expect any significant changes from PEPFAR?

Victoria Nibarger: As mentioned above, our program is changing significantly.  Change is never easy, and we understand that our decision-making on PEPFAR affects many others, including government partners, NGOs, multilateral organizations, and of course, the people living with HIV throughout the region.  While we will not be able to provide bilateral assistance to each country in the regional program, we have started planning for regional assistance that could be offered from our new home in Jamaica.  For example, I am excited about possibilities to use existing PEPFAR-supported technological platforms to support clinicians by providing continued training and in turn, help ensure people living with HIV have access to high-quality medical care.

Editor: As your tenure begins, what is your vision for PEPFAR’s contribution to achieving the International targets for ending AIDS including the 90-90-90 Targets and the Sustainable Development Goals 2030 Target?

Victoria Nibarger:  I am new to the PEPFAR world, and I feel fortunate that I am joining the team at a time when globally, we have the best practices for reaching the 90-90-90 targets and achieving epidemic control.  I believe we can fine-tune our approach in the Caribbean and inch closer to the goals.  In Jamaica, while the majority of people know their HIV status, less than 40 percent are on antiretroviral treatment (ART) and around 20 percent are virally suppressed.  In Jamaica and in the region, I envision our PEPFAR support as strategically helping the governments to bring more patients from key populations into care, retain them on treatment, and achieve viral suppression. To do so, we must continue to spread awareness of the policy shift to Treat All, so that every person who tests positive will rapidly initiate ART – ideally that same day.  We must also combat stigma and discrimination, so that HIV/AIDS is treated as other ailments such as diabetes, cancer, the flu.  All are health issues, not moral ones.

Editor: How does PEPFAR intend to collaborate with the region on resource mobilization in the context of declining external support?

Victoria Nibarger:  Sustainability is at the heart of our transition planning. We are working with the goal of responsibly turning over PEPFAR-supported activities to host governments, civil society partners, and other donors.  We have a tool called the “Sustainability Index Dashboard” that offers a sort of snapshot of a country’s sustainability landscape; this and other analysis is helping to inform our discussions.  For some countries, we have funded stakeholder planning meetings, and more are scheduled.  We are also trying to enhance donor coordination at a regional level, where entities such as PANCAP will continue to play key leadership roles.

Editor: How important is the role of civil society in achieving the 90-90-90 Targets?

Victoria Nibarger:  Civil society is absolutely critical to achieving epidemic control in the Caribbean, and I am heartened to see so many incredible organizations working to affect positive change.  The epidemic is localized in a few key populations, and these groups face serious stigma and discrimination.  In my view, civil society’s role is essential on two main fronts:  1.) to help patients safely initiate treatment and stick with their regimens; and 2.) to promote policy change and government support to ensure equal rights and equal access to healthcare.  Jamaica AIDS Support for Life (JASL) is doing remarkable work in Jamaica, and I understand that its model is now being replicated throughout the wider region.  Simply put, PEPFAR assistance could not have the impact that it does without our civil society partners.

Editor: Do you have any further thoughts you would like to share with the Partnership?

Victoria Nibarger:  It is a pleasure to once again be working in the Caribbean, this time in a regional capacity.  I am grateful for the warm welcome I have received from those involved in the region’s HIV/AIDS response, and I look forward to meeting as many colleagues as possible in the coming months.  I am a career U.S. diplomat, meaning I move every few years to a new country and topic of assignment; my prior assignment entailed work related to the armed conflict in eastern Ukraine, for example.  To be back in the Caribbean, working on HIV/AIDS policy issues that I studied as a graduate student, is an unexpected, and most welcome, “full circle” moment for me.

PANCAP extends congratulations to Ms. Nibarger and wishes to express sincere gratitude for her insight into the new PEPFAR pivot and other essential information highlighted in this interview.  The Partnership anticipates further successful collaborations with Ms. Nibarger.

Click here to read the original congratulatory message from Mr. Dereck Springer, Director, PANCAP on Ms. Nibarger’s appointment.

The “TB Laboratory Network Strengthening” Program, financed by the Global Fund to fight against AIDS, Tuberculosis and Malaria, is based on and fully aligned with the Global End TB Strategy and the Americas Regional Action Plan for Tuberculosis. The aim is to strengthen the three supranational research laboratories (SRLs) located in Argentina (National Institute of Infectious Diseases, Buenos Aires), Chile (Institute of Public Health, Santiago) and Mexico (Institute of Epidemiological Diagnosis and Reference, Mexico City) that serve the majority of the TB national laboratory networks (NLNs) in Latin America and Caribbean, in order to increase the diagnosis capacities in twenty TB national laboratory networks (NLNs) from Argentina, Belize, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Guyana, Honduras, México, Nicaragua, Panamá, Paraguay, Peru, Dominica Republic, Uruguay and Venezuela.

Program activities started on January 2017 and will extend until December 2019, including interventions such as procurement of diagnostics equipment and supplies to improve capacity in the three SRLs as well as establishing quality control through an annual external assessment of drugs sensitivity in order to define MDR/XDR-TB resistance patterns in samples provided by NLN to the pertinent SRL.

In addition, the SRLs improved role as technical assistance providers to the NLNs through at set of technical assistance activities conducted by their professional staff to seventeen countries during 2017. Furthermore, NLNs professionals will be participating in the internship programmed activities at their respective SRLs in 2018.

“With regard to the program activities implementation, we are trying to contribute to achieving the Global End TB Strategy Targets, supporting countries commitments that represent an ambitious challenge. That is why the program activities include high-level TB advocacy efforts not only at national level but also at the regional and Sub-regional level to achieve political and technical sustainability” said, Lourdes Kusunoki Fuero, Project Coordinator.

During the first year of the Program, complementary to other research studies performed by international organizations, three studies were conducted to obtain suitable information about timely measures to be addressed in order to support activities included in their TB control programs.

The studies were:
•“Structure and functioning of TB National Laboratory Network in the Americas Region”
•“Supranational research laboratories functioning related costs within the TB National Laboratory Network”
•“Situation analysis of the Information Systems in the Supranational Research Laboratories, National Laboratory of Reference and TB National Laboratory Network”

The Andean Health Organization (Organismo Andino de Salud – Convenio Hipólito Unanue / ORAS-CONHU) was selected as Principal Recipient in charge of financial resource management. This entity was created in 1971 in order to integrate the Health sector of the Andean Sub-Region. The ORAS-CONHU is co-chaired by six Ministers of Health from Andean countries (REMSAA) and the Executive Secretary is located in Lima, Peru. PAHO, with its technical expertise, and the Dominican Republic and Central America Ministries of Health Council (COMISCA), with head office in San Salvador, El Salvador, were selected as Sub-recipients.

“Main identified challenges within the project are related to the prioritization of the Laboratories TB Control Programs through their financial sustainability and human resources capacity building, solve huge inequities in wealth distribution, address the problem through a universal access and right to health approach, strengthened health governance, increased ministries leadership and intersectoral work to address social determinants related to health and the structural roots that exceed TB” highlighted Kusunoki Fuero.

J-FLAG, the Jamaican human rights and social justice organisation for LGBT people, said it is happy that Prime Minister Andrew Holness has spoken publicly in a positive way about the need to end discrimination against persons who are LGBT (lesbian, gay, bisexual, and transgender).

Prime Minister Holness, at a Jamaica diaspora meeting in Brussels yesterday, declared that he does not subscribe to a view expressed in 2008 by then Prime Minister Bruce Golding, who said he would not appoint gays to his Cabinet.

The current prime minister added that Jamaica is increasingly tolerant of homosexuals, and the State protects the human rights of all citizens regardless of their sexual orientation or inclination.

In response, Executive Director of J-FLAG Jaevion Nelson told Jamaica News Online: “I am happy to hear the prime minister speak publicly about LGBT issues in such a positive light. Key individuals in government, at different levels, have been open to conversation with J-FLAG and LGBT people, and do as much as they can to ensure greater respect for human rights and to make Jamaica a more hospitable place for LGBT people.”

Nelson also stated that a number of churches have been of great assistance to members of his organization; a declaration that supports Prime Minister Holness’ view that local churches are no longer all united against homosexuals.

“J-FLAG continues to benefit tremendously from key allies in a number of churches/denominations over the years who use their influence to facilitate respectful dialogue among their congregants, promote respect for human rights and provide pastoral care for LGBT people who require their services,” Nelson explained. “Some of these individuals [from the churches] have made public statements while others have provided an open door for continued dialogue with us.”

Nelson also expressed hope that LGBT people will be celebrated locally, adding that the country is nowhere near where it should be in that regard.

“I am optimistic that there will come a time when LGBT people in Jamaica are respected and celebrated, [and] that there will be a time when one’s sexual orientation or gender identity isn’t used to persecute or deny them opportunities to live to their fullest potential,” he said.

Nelson added: “We are nowhere near where we need to be, but I understand and appreciate that change is often a slow and gradual process. Notwithstanding, Government must recognize that it has a duty to more systematically participate in engendering that gradual change by doing its part to protect and promote respect for human rights in its broadest sense. All of us have a responsibility to do what we can in our sphere of influence to help make the country a more hospitable place for its citizens and visitors who are LGBT.”

The National AIDS Commission (Belize) and the Ministry of Health through the United Nations Development Programme hosted a three-day training entitled “Guidelines for the Comprehensive Care of Gay Men and Other Men who have Sex with Men” from 11- 13 April 2018.

The programme focused on improving the health services offered to this key population and meeting the UNAIDS 90-90-90 Treatment Target by 2020. This sensitization workshop trained a total of 25 Health Care Providers presenting a variety of medical settings countrywide.

Dr. Lydia Guerra was the lead facilitator of the three-day training along with the following invited facilitators: Ms. Martha Carrillo (MC Consultancy), Mr. Kevin Mendez (Ministry of Health), Mr. Karl Wade (Empower Yourself, Belize Movement) and Mr. Aston Chavarria (Belize Youth Empowerment for Change).

The activity is part of the National AIDS Commission’s strategic programme in response to HIV and AIDS in Belize.

Image: Alberto Nieves, Director de ACCSI.

On the World Health Day, Corresponsales Clave (LAC Key Correspondent Team) spoke with Alberto Nieves, Executive Director of Acción Ciudadana Contra el SIDA (ACCSI), a CSO from Venezuela, about the setbacks that health has had in that country that takes him away from the well-known slogan promoted for this year by the World Health Organization: “Health for All”.

Alberto is an activist who lives with HIV and who continues to defend the rights of people living with HIV in this Caribbean country and told us that “by March 2018, the shortage of antiretroviral drugs reached 100% in Venezuela, which It is affecting more than 80 thousand people with HIV. This is the conclusion of the monitoring process carried out by the country-wide Focal Points of the Venezuelan Network of Positive People (RVG +), with the technical support of Acción Ciudadana Contra el SIDA (ACCSI). They have been monitoring the specialized pharmacies for the delivery of antiretroviral drugs (ARV) located in the Venezuelan states and attached to the public health system. ” Alberto Nieves, director of ACCSI.

We do nothing with only some drugs.

In the monitoring carried out, says Nieves, it was identified that in some pharmacies there were still 4 types of antiretrovirals, of the 27 that the Venezuelan National AIDS Program, but that cannot be delivered. “The few (medicines) that exist have not been able to be provided to people with HIV, since these drugs need to be taken with other antiretrovirals that are in short supply, which prevents compliance with the technical standard of the Ministry of Health and recommendations International Organizations of the World Health Organization (WHO), how is it that “ART schemes must be based on a combination of at least 3 ARVs”.

To illustrate the situation, Alberto gives us an example: “this is the case of the antiretroviral Darunavir that must be given together with ritonavir to complete the therapy. Since 2017, the Ministry of Health maintains a total of 12,000 bottles in its stores, but they have not been able to be delivered to people with HIV who require it, given that ritonavir is not available. By November 2017 there were 850 people with HIV who required this antiretroviral regimen, many of them reported that they had more than six (6) months without taking it. Darunavir is a medicine that is part of the rescue treatment, which is prescribed to those people with HIV who have presented multiple failures or failures in at least two different antiretroviral regimens. For many of these people, this is the only scheme left for them to continue living, according to the opinion of their treating physicians. “
The list of 100% unsuppressed drugs is long: abacavir, abacavir / lamivudine, efavirenz, efavirenz / tenofovir / emtricitabine, etravirine, tenofovir, tenofovir / emtricitabine, lamivudine, lamivudine / zidovudine, lopinavir / ritonavir, nevirapine, raltegravir, reyataz, rilpivirine / tenofovir / emtricitabine, ritonavir, and zidovudine are some of them.

No solutions for the short-term.

For several years, the Venezuelan Network of positive people has reported episodes of stockouts. Very large episodes that put the health and lives of thousands of people at risk, but episodes that were overcome with last-minute measures. But the current situation is more serious; Nieves tells us that, due to the accumulation of debt with the Strategic Fund for Medicines of the Pan American Health Organization (PAHO), which would reach 20 million dollars, they have not been able to continue supplying medicines to the country. A similar situation happens with other drug suppliers who are reluctant to sell to Venezuela due to the large debts that the country maintains.

According to Nieves, the national investment to guarantee the supply of medicines and reagents for follow-up tests for 80 thousand people does not exceed 12 million dollars and, nevertheless, the country spent 25 million dollars in the purchase of weapons for the army in the year 2016.
Alberto does not miss the opportunity to call attention to us: “This crisis of the shortage of antiretroviral drugs could have been avoided if we had attended to the different and timely alerts made almost a decade ago by the RVG +, ACCSI and other NGOs with work in HIV in our country. Several reports prepared by ACCSI and RVG + prove it.”

Deterioration of health, a 20-year retreat

The social and economic deep crisis of Venezuela has caused millions of people to see their health at threat. It begins to report that the population on average has lost about 11 kg of their weight in the last two years. In the population of people with HIV this weight loss contributes to a worse their health, coupled with the lack of medication, can cause death.
Most antiretrovirals have a 100% stook out.

“The lack of antiretroviral drugs has caused thousands of deaths due to AIDS, hundreds and hundreds of people have suffered health relapses (…). In the last two years, there has been an increase in cases of people with Kaposi Sarcoma, a type of skin cancer that was eradicated at the beginning of the year 2000, thanks to the access of antiretroviral therapy that Venezuela had at that time. It is also observed that in public health centers people are arriving in very critical health states and in a terminal face, when evaluating doctors consider them AIDS cases, they return them to their homes, because they lack the medicines and clinical equipment that can rescue them to live. “
Abandoned by the government and the international community

The director of ACCSI is energetic in pointing out that “people with HIV are totally abandoned by the government of President Nicolás Maduro, who is mainly responsible for his inaction and omission in the face of situations of threats and risks to their lives and health, with irreversible damages in the aspects of health, psychological and moral “.
The crisis has reached such a point that no one is saved: “100% of people with HIV and AIDS, of all ideologies, with different economic and educational status, are being affected in the same way, they are violating their human rights” says Nieves.
Humanitarian Aid, now!

The only way to do something for Venezuelans at this time is through humanitarian aid from international cooperation and Nieves makes an immediate demand: “There are international protocols for those countries that are in emergency, as is the case of Venezuela, which must be implemented immediately, since otherwise thousands of deaths will continue to occur. We can not understand what are the reasons why the agencies of the United Nations system or the Global Fund do not apply humanitarian emergency protocols in Venezuela. We wonder how many more deaths will be required for the United Nations to implement such mechanisms in our country? “

On April 19th the Venezuela Crisis Group will organize a meeting with Venezuelan Civil Society

Join the meeting in this link: https://global.gotomeeting.com/join/33502939