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Washington, DC, May 2019 (PAHO) – Countries are moving towards the elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas, but progress has been uneven, according to a new report from the Pan American Health Organization (PAHO).

The report “New generations free of HIV, syphilis, hepatitis B and Chagas disease in the Americas 2018”, which compiles data from 52 countries and territories in the Americas, shows that since 2010, 30,800 children were born without HIV thanks to interventions to prevent mother-to-child transmission.

“Significant progress has been made towards ensuring a generation free from AIDS and syphilis, and now efforts are also being made to stop children from being born with hepatitis B and Chagas,” said PAHO Director, Carissa F. Etienne. “We must intensify and integrate the response and expand access to health services if we want to end transmission of these four diseases,” she added.

In 2017, 20 countries and territories of the Americas reported data indicating the elimination of mother-to-child transmission of HIV, seven of which received validation from WHO. However, it is estimated that each year, 3500 children are either born with HIV or contract HIV from their mothers in Latin America and the Caribbean.

In the Region, 73% of pregnant women underwent at least one HIV test, 73% of those that tested positive went on to access treatment. This is an increase from 2010 but still lower than the 95% testing and treatment goal.

Increase in cases of congenital syphilis

According to the new report, in 2017, 15 countries also reported data indicating the elimination of congenital syphilis, seven of which received validation from WHO. However, the report also shows that cases of congenital syphilis are on the rise. In 2017, 37 countries reported more than 28,800 cases, 22% more than in 2016, although 85% of reported cases are concentrated in just one country in the Region.

The report also shows other unequal results. While the screening of pregnant women for syphilis has decreased, the treatment of those who have had the test and are found to be positive has increased.

Vaccination, key to preventing hepatitis B

The countries of the Americas have vaccinated against hepatitis B for more than 20 years. This has enabled the Region to achieve the goal of eliminating mother-to-child transmission of this disease (estimated regional prevalence of hepatitis B in children aged 5 years of 0.1%). Individually, it is estimated that several countries have also achieved this goal.

However, it is estimated that 6000 children contract the hepatitis B virus each year in the Region. In order to prevent this, PAHO recommends giving four doses of the vaccine to all children under the age of 1, the first one during the first 24 hours of life, which is a key time for preventing transmission.

In 2017, vaccination coverage with the third dose for children under the age of 1 was 87% and 25 countries and territories introduced the vaccine dose during the first 24 hours after birth to all newborns. This latter coverage increased from 61% in 2010 to 76% in 2017. Efforts are needed to continue increasing hepatitis B vaccination coverage in children.

Vertical transmission of Chagas accounts for 20% of new cases

It is estimated that each year, around 9000 babies are born with Chagas disease in Latin America and the Caribbean, accounting for more than 20% of all new cases in the Region. However, in 2017 countries notified PAHO of just 280 new cases, which highlights the urgent need to improve detection and notification systems.

The screening of Chagas disease in pregnant women also varies significantly, from 7% to 55% in the few countries that report data. The PAHO elimination initiative establishes the goal of testing at least 90% of pregnant women and newborns of HIV-positive mothers.

“Eliminating mother-to-child transmission of these four diseases presents a huge challenge”, said Dr Marcos Espinal, Director of the Department of Communicable Diseases and Environmental Determinants of Health at PAHO. “However, implementing an integrated approach in addressing this issue is an opportunity to ensure that advances towards elimination are equitable,” he added.

The new PAHO report is the first to address the four diseases together, following the 2014 renewal of a commitment made in 2010 by Ministers of Health in the Region, to eliminate mother-to-child transmission of HIV and syphilis, which was then expanded to include the other two diseases.

In order to support its Member States in achieving this, in 2017, PAHO launched the Framework for the Elimination of Mother-to-child Transmission of HIV, Syphilis, Hepatitis and Chagas Disease (ETMI-PLUS). This is a roadmap outlining strategies and interventions aimed at women before and during pregnancy, as well as for postpartum women and their newborns, in a Region with 15 million pregnant women per year and a high rate of prenatal care, but where inequalities in access to health persist, and lost opportunities remain, between and within countries.

Helpful Link:

Report – New generations free of HIV, syphilis, hepatitis B and Chagas disease in the Americas 2018

The Jamaican Network of Seropositives (JN+) welcomes Dane Lewis to their mission of advocating for People living with and affected by HIV. Dane will serve the organisation in the capacity of Programme Manager.

He previously served as Regional Programme Manager at CariFLAGS and is the former Executive Director of JFLAG, Jamaica’s premier human rights and social justice advocacy organisation for lesbian, gay, bisexual and transgender (LGBT) persons from 2008 – 2018.

In his capacity as Programme Manager, Dane intends to improve JN+’s peer-to-peer support strategies as a means of reducing the number of Jamaicans diagnosed with HIV who are not on treatment.

The National HIV/AIDS Commission (NHAC) Barbados launched its latest report on HIV knowledge, attitudes, beliefs and sexual practices (KABP) survey.

The NHAC, in collaboration with the Ministry of Health, conducted the KABP survey to assess risks associated with acquiring HIV and Sexually Transmitted Infections (STIs) among individuals ages 15 to 49 from January 2016 – November 2017.

The survey also aimed to determine the risk reduction practices and the health-seeking behaviours of individuals regarding HIV and STIs.

The analysis revealed relatively high levels of HIV knowledge, moderate levels of STI knowledge, low HIV testing uptake among the general population, high levels of inconsistent condom use particularly with regular partners and existence of multi-partnering.

HIV-related stigma and discrimination

There were generally positive attitudes towards People living with HIV with at least 8 in 10 persons being willing to care for a sick family member in their household, support the presence of HIV+ teachers and students in the school environment provided they were not ill and work alongside a co-worker living with HIV. Respondents also stated that they would visit the home of a community member who has HIV and socialise with an HIV-positive community member.

Conversely, about 44.0% had no desire to conceal the HIV+ status of a family member while roughly 1 in 3 persons was willing to buy food from an HIV positive person. About 1 in 4 persons felt that landlords and co-workers should be informed of the HIV positive status of tenants and workmates, respectively.

Download or view the full analysis here.

Image: US Ambassador Sarah-Ann Lynch (second from left) delivers opening remarks while US Deputy Chief of Mission Terry Steers-Gonzalez (left), First Lady Sandra Granger (second from right) and SASOD Guyana’s Managing Director Joel Simpson (right) listen from the stage.

In observance of the International Day Against Homophobia, Transphobia and Biphobia (IDAHOTB) on May 17, the United States Embassy in collaboration with Guyana’s Society Against Sexual Orientation Discrimination (SASOD Guyana) hosted a reception at Aura Sky Lounge, Pegasus Hotel Guyana, on Wednesday, 15 May, 2019, to celebrate recent victories.

Guyana’s lesbian, gay, bisexual, transgender and queer (LGBTQ+) movement has had some small triumphs over the past year. Guyana was the first country in the English-speaking Caribbean to host a Pride Parade in early June last year. And then in November, the Caribbean Court of Justice, Guyana’s highest court, delivered a landmark decision declaring a colonial-era law against ´cross-dressing’ unconstitutional and striking it down.

On World Day for Social Justice on 20 February this year, SASOD Guyana closed its first phase of two-day training workshops where 153 police officers from all across the country were trained in Gender, Sexuality and Human Rights.

In her opening remakes Her Excellency Sarah-Ann Lynch, US Ambassador to Guyana, posited, “In Guyana and many other parts of the world, members of the LGBT community have sometimes faced violence, harassment, intimidation and disregard of their basic human rights. More troubling is the fact that despite being signatories to the many United Nations human rights agreements, many governments still seem far from establishing real legal protections for members of the LGBT community.” “[However,] Gay rights are human rights [and] If we as a society are committed to ensuring that all people are respected and treated equally, then it is imperative to remember that this includes the LGBT community as well. Justice and protection must be for all.”

The Ambassador commended SASOD Guyana for leading the effort to bring about judicial and legislative change to ensure justice and protection for all Guyanese. “We are encouraged by the small triumphs for the gay community in Guyana recently,” Ambassador Lynch added. “The Government of Guyana has signalled a softer tone towards the LGBT community, permitting the first gay pride parade in June 2018.

We commend the government for its support.  And last November, the Government said that it respects the Caribbean Court of Justice’s landmark decision that found that the Guyanese law against cross-dressing was unconstitutional.  These are slow but promising changes in attitude at the national level,” Ambassador Lynch remarked.

Speaking on behalf of SASOD Guyana, Managing Director Joel Simpson echoed Ambassador Lynch that IDAHOTB 2019 was a moment for Guyana to celebrate the recent LGBTQ+ victories. Simpson, however, noted that the struggle for non-discrimination and equality still continues as LGBTQ+ Guyanese face violence and discrimination in every sector of their lives. He reminded the gathering that Guyana’s laws still criminalize same-sex intimacy between consenting adult men and that colonial-era “small crimes” like vagrancy and loitering target “the poorest of the poor” in society.

Simpson mentioned the social and economic challenges that LGBTQ+ persons face accessing public transportation, education, healthcare and work in the formal economy. He noted that the IDAHOTB 2019 theme which is “Justice and Protection for All” is timely as SASOD Guyana is proposing a simple amendment to the Prevention of Discrimination Act 1997 to include sexual orientation, gender identity and gender expression as categories of protection from discrimination.

While alerting the gathering that the 1997 Act only deals with discrimination in relation to the right to work, Simpson posited that just adding those three terms would be an important first step in providing legislative protection from discrimination for LGBTQ+ Guyanese who face social and institutional discrimination and have no specific recourse under the law.

Image: Prime Minister of Barbados, Mia Mottley meeting employees of the National HIV/AIDS Commission (NHAC) Barbados

Prime Minister of Barbados, Mia Mottley commended employees of the National HIV/AIDS Commission (NHAC) Barbados on their innovative educational tools during the Barbados Labour Day observance (1 May), which acknowledges the contributions of workers on the island.

The Prime Minister was impressed with the popular interactive game, “UPS AND DOWNS”, which was created by the NHAC as an HIV educational tool for Barbadians of all ages.

The Prime Minister visited the NHAC booth and interacted with several members of staff who were conducting HIV awareness and education with colleagues of the Barbados Workers’ Union and the International Labour Movement.

The NHAC also utilised the opportunity to extend its reach with condom distribution and demonstrations. Use of the female condom was emphasized to foster more awareness.

The Prime Minister recommended registering a patent for the digital educational tool and challenged NHAC employees to develop more interactive games and software for HIV education.

Image: Dr Sir Prince Ramsey, PANCAP Award Recipient 2012 (centre), with guests and special invitees

Dr Sir Prince Ramsey, who died on 3 May 2019, will be remembered as a stalwart in the Region’s response to HIV.  The Antiguan doctor played a pivotal role in advocating for HIV patients at the height of the AIDS crisis in the 1980s and contributed significantly to ground-breaking work for HIV services for pregnant women.

In recognition of his remarkable contributions, he received the PANCAP Award in 2012 for “excellence in advancing the Caribbean’s response to HIV and AIDS”.  During the ceremony, colleagues, friends and family members recounted not only his contributions to public health but his generosity, love for humanity and passion for life.

His work as a humanitarian has earned a wealth of recognition in the Region and beyond including an Honorary Doctor of Science Degree from the Open Campus of the University of the West Indies. Just last year he was awarded the 2018 United Nations Population Award, which recognises individuals who have made outstanding contributions to population and reproductive health solutions.

Colleagues have described Dr Sir Prince Ramsey as a professional motivated by service to those in need rather than financial gain.  This is evidenced by his voluntary contributions to public health.  He was a volunteer medical officer, lecturer and examiner for the Red Cross and St. John’s Ambulance Society.

He was a past president of the Antigua and Barbuda Medical Association and former treasurer of the Caribbean College of Family Physicians. He was Vice President of the Antigua and Barbuda Planned Parenthood Association; a board member of the Caribbean Family Planning Affiliation and the International Planned Parenthood Federation.

Dr Sir Prince Ramsey was the founder and chairman of the Friends of Fiennes Institute. He was the recipient of a Queen’s Commission as Major and Medical Officer of the Antigua & Barbuda Defence Force and was an Honorable Member of the Association of Military Surgeons of the USA. Sir Prince was the recipient of three National awards: The Order of Merit, The Order of Distinction, and The Knight Grand Cross of the Most Distinguished Order of the Nation.

His passion for service to his country extended beyond public health as Dr Sir Prince Ramsey was also a patron of Antigua and Barbuda’s culture including art and calypso music.

Indeed, the Region has lost a son of the soil who has contributed significantly to health care and better health outcomes for People Living with HIV.

Perhaps Dr Ramsey’s remarkable life is best captured in the words of H.E. Gaston Browne, Prime Minister of Antigua and Barbuda, who stated, “Dr Prince Ramsey was a superb physician who frequently delivered services to his patients at no cost. He was recognized as a very generous and thoughtful caregiver. Dr Ramsey was also a servant of the calypso community; his contribution to the art-form was surpassed by no-one.  His contribution to nation-building, to wellness, and to the development of the cultural life of Antigua and Barbuda are applauded by all”.

Guyana has drafted a significant 116-page nutrition strategy targeting persons living with HIV and others co-infected with Tuberculosis (TB).

The document is also a first for Caribbean countries.  The draft document, the ‘National Nutrition and HIV/AIDS Guidelines’ is “comprehensive and relevant” said Mr Somdatt ‘Amar’ Ramessar, Senior Social Worker and Nutritionist attached to the National AIDS Programme Secretariat [NAPS].

The document is one that seeks to assist various categories of infected patients, including adults, pregnant and lactating women, adolescents, severely malnourished adults and children, and people on medication.  The nutritional guidelines target health-care providers including physicians, counsellors, social workers, policymakers, teachers and trainers. The guidelines “are intended for practical application as well as policy formulation and implementation,” outlines the 116-page document. It said the historic strategy provides a standardised approach to nutrition care and support for people living with HIV [PLHIV] in diverse conditions throughout the country.

It also notes that “each service provider needs to adopt the recommendations to her/his context and client population.”

It is further explained that good nutritional status is key from the onset of infection with HIV. Moreover, the document states that “Nutrition education at this early stage gives the person a chance to build up healthy eating habits and to take action to improve food security in the home, particularly as regards the cultivation, storage and cooking of food.”

“A healthy and balanced diet, early treatment of infection and proper nutritional recovery after infection can reduce this weight loss and reduce the impact of future infection,” the draft document continues.

The momentous move by the Ministry of Public Health to help protect the nutritional status of PLHIV has attracted wide private sector support, which is also a first in the Caribbean, said Dr Nicolette Boatswain, NAPS Deputy Programme Manager.  More than 20 local private firms have been backing the initiative since it commenced more than a decade ago.  Globally, ‘fatigue’ usually steps in and overtake firms supporting these types of enterprises after five years. However, after 13 years in Guyana, the consistent engagement of the private sector agencies in the HIV national nutritional response has helped widen the approach to tackling the problem.

“The partnership has opened greater channels for HIV awareness and information flows to employees of the private sector agencies. Communication materials, condoms and lubricants are all accessible to these employees for self-empowerment and for safe sexual practices,” Ramessar told a Regional conference in Trinidad and Tobago earlier this year.  In the first 11 years of the programme [2007-2017], 34,357 hampers which comprised 10 food items, were given to some of the most vulnerable patients from all strata of society living and affected with HIV and those co-infected with TB.

The beneficiaries include in and out-of-school youths, unemployed young adults, HIV positive single parents, persons living with disabilities and senior citizens, Dr Boatswain said.

For 2017, official NAPS figures show 404 new patients benefited from nutritional support from the Food Bank. This is a 40 percent increase over 2016 figures. The NAPS 2018 Food Bank Annual Report is expected soon. However, under the 2017 review period it was found that 62.8 percent of HIV positive single parents accessed the Food Bank services which is the highest figure in its first 11 years, the 2017 Annual Report stated.  “This represented a 24.12 percent increase when compared to 2016 and 18.6 hike over 2007 when the Food Bank began its operations in Guyana,” the report added.

It said the greatest number of beneficiaries from the food distribution programme was residents living in Essequibo Islands/West Demerara [Region Three]. The annual report states that 66.67 percent were from that predominantly-farming Region while 39.7 percent were from Demerara/Mahaica [Region Four] the most populous of the 10 Administrative Regions.

On the gender front, more women than men benefit from the food bank’s resources. Of those receiving hampers, 53 percent are women and 47 percent, men.  “Females were always the greater proportion of beneficiaries for nutritional support since the programme commenced,” the NAPS report adds.

The socio-economic challenges experienced by PLHIV are numerous and globally food banks are viewed as safety nets for them. Information out of the Public Health Ministry suggests that “when the programme started, Global Fund and the local private sector were the main arteries of the support. Since then, the charitable organisation, Food For the Poor and government, through the Ministry of Public Health, joined the list in 2017.”  Typically, food insecurity affects people who are socioeconomically disadvantaged. Some, because of changing fortunes, move in and out of food insecurity. However, the 2017 Annual Report noted that “increasingly, PLHIV do experience chronic food insecurity.”

Disturbingly, it has been observed that food insecurity has become a barrier to adherence to care and treatment recommendations for those living with HIV/AIDS, especially “pregnant women and their HIV-exposed infants as well as children and adolescents living with HIV infection,” the report said.

It said too that “Food Banks no doubt act as a buffer to the vicious cycle of food insecurity and HIV, which can be regarded as ‘syndemic’, that is, there is a positive biological and social interaction in which one exacerbates the negative health effects of the other. It is increasingly recognised that food insecurity both heightens vulnerability to HIV infection and at the same time exacerbates poor clinical outcomes among PLHIV.”

According to the document, the Food Bank handed out the highest number of hampers to patients between the years 2009 and 2013. The figure tapered off between 2014 and 2016 rising marginally again in 2017.

Among its recommendations, the 2017 NAPS Food Bank Annual Report underscored the need to accelerate support for hinterland residents; research undertaken to verify the efficacy of the support programme to its beneficiaries and “addressing the rising numbers of PLHIV who are 55 years and older accessing support mechanisms.