The road to PrEP in Guyana

21 January 2021 (Georgetown, Guyana)  This year, Guyana will roll out a comprehensive plan for Pre-exposure Prophylaxis (PrEP). Dr Frank Anthony, Minister of Health, Guyana announced that the national strategy would be implemented in collaboration with clinics across the country and nongovernmental organizations.

“We want to expand to ensure anyone who is at risk for HIV would have access,” Dr Anthony said. “We believe that with a comprehensive programme for PrEP we can prevent many infections.”

This move marks the culmination of years of advocacy and partial PrEP implementation. The existing PrEP policy is a programme for serodiscordant partners only, so couples in which just one person is living with HIV have been able to access PrEP through the public health-care system to avoid transmission to the HIV-negative partner.

Since 2015, the World Health Organization (WHO) has recommended that “people at substantial risk of HIV infection” should be offered PrEP. Several countries have prioritized key populations, including gay men and other men who have sex with men, sex workers and transgender people, for PrEP programming. In Guyana, those groups also have higher HIV prevalence: 8% for transgender women, 6% for sex workers and 5% for gay men and other men who have sex with men.

Last year, Guyana’s Society against Sexual Orientation Discrimination (SASOD Guyana) moved from calling for a more inclusive PrEP programme to offering the service itself. The group teamed with the Midway Specialty Care Centre to fill this gap in the country’s HIV prevention response.

“We want combination prevention to take the front burner,” said Joel Simpson, Managing Director, SASOD Guyana. Through this private sector/civil society partnership, for the first time, people in Guyana from any population group were able to elect to initiate PrEP. The medicine was sold to clients at cost price, and those accessing the service through the nongovernmental organizations paid no consultation fees.

A 2018 SASOD Guyana assessment of gay men and other men who have sex with men and transgender people supported by the International HIV and AIDS Alliance (now called Frontline AIDS) found that, when sensitized, there was a high level of interest in taking PrEP. However, just around 60% of focus group participants were willing to pay to do so.

“We need politicians and technical people to base decisions on science and research. At times we have encountered a moralistic approach to setting public policy,” Mr Simpson reflected. “It’s not about whether you belong to a particular population group. It’s about responding to reality and lowering risk.”

Guyana’s HIV programme results are among the Caribbean’s best. The country surpassed the 2020 testing target, with 94% of people living with HIV diagnosed in 2019. Seventy-three per cent of people who knew their status were on treatment. Of those, 87% were virally suppressed. Over the past 20 years, new HIV infections have been reduced by half in the South American nation.

“HIV treatment has come a long way, and not just for people living with HIV. To close the gaps and ensure that no one is left behind it is critical that best practices for prevention and treatment are implemented fully,” said Michel de Groulard, UNAIDS Country Director, a.i., for Guyana and Suriname. “This is why we are pleased about the direction the Health Ministry is taking this year to ensure that PrEP is made available to all who need it. We have the tools to end AIDS. Now we must use them.”

Guyana focusing on COVID-19 vaccines through COVAX – Dr Anthony

(Georgetown, Guyana) Health Minister, Dr Frank Anthony yesterday stated that Guyana’s main focus for procuring COVID-19 vaccines is through the COVAX facility.

Dr Anthony was at the time responding to a question posed by Stabroek News during his daily COVID-19 update.

COVAX is one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator, which was launched in April by the World Health Organization (WHO), the European Commission and France in response to the pandemic. It strives to ensure that people in all corners of the world get access to COVID-19 vaccines once they are available, regardless of their wealth.

Barbados – Eight persons, including Prime Minister Mia Amor Mottley, have received their first round of the COVID-19 vaccine

Eight persons, including Prime Minister Mia Amor Mottley, have received their first round of the COVID-19 vaccine.

Prime Minister Mottley disclosed this last evening during a COVID-19 update to the nation from Ilaro Court, where she spoke about the level of public education that would occur to educate the population on the importance of getting the vaccine.

Stressing that she would not encourage anyone to do something she would not, the Prime Minister said: “I’m happy to report that therefore, in the course of the last few days that there were five of our medical people at the front line who have taken the vaccination – the first dose, and myself, the Minister of Health and the Attorney General also, were the other three people who took it. My arm is a little sore, but other than that I am in good shape; you see me talking with you and I’m due to take the second dose in a few weeks time as are they.”

While noting that there is concern not just in Barbados but throughout the world about receiving the vaccine, Prime Minister Mottley stated that in order to ensure that the country gets back to a level of normalcy a level of herd immunity would need to occur.

“There will be some people who are a little ambivalent or anxious, and over the course of the next few weeks, we will engage to be able to answer people’s questions, not just in these formal processes, but also through public education that we will do in different media and at the community levels in order to give people the comfort that they need,” the Prime Minister explained as the way forward, in carrying out public awareness on the importance of receiving the COVID-19 vaccine.

Watch the video below.

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.

Message from Dr Rosmond Adams, Director, PANCAP – November 2020

PANCAP joined the global community as we observed World AIDS Day on 1 December. Several activities were held across the Region to bring awareness to HIV, recognize the work that has been done and to strategize on how we can sustain the HIV response in the future.

We recognize the work at all levels, especially that of our global partners such as the Joint United Nations Programme on HIV and AIDS (UNAIDS), World Health Organisation (WHO), Pan American Health Organisation (PAHO), President’s Emergency Plan for AIDS Relief (PEPFAR) and others. Governments, National Programmes, Civil Society Organizations, People Living with HIV (PLHIV), Faith-Based Organizations, Communities and individuals have also played a central role in getting us to where we are today and have always been supportive to the PANCAP partnership.

Over the years, we have seen a record number of PLHIV receiving antiretroviral treatment.  We have also seen progress with “Undetectable = Untransmittable” (U=U), meaning that people who adhered to treatment and achieved an undetectable viral load cannot pass the virus on to others. New Infections and AIDS-related deaths in our Region have also decreased, and there have been bold actions to address issues such as stigma and discrimination around the disease.

Indeed, we have come a long way. When HIV was first recognized four decades ago, fear and death were the keywords that defined this disease as the world faced a new and unknown virus. Today, scientific advances, such as the development of antiretroviral drugs, have enabled people to access treatment to live long and healthy lives.

As we reflect on the 2020 theme for World AIDS Day, “Global Solidarity, Shared Responsibility”, it is essential to view it as a call to action for all of us to work together to end AIDS and to support our brothers and sisters living with HIV.

The road ahead is long, but once we work together, I am confident that we can end AIDS.