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The United States Government has renewed its support towards the fight against HIV in Guyana with a grant of US$1.5 million geared at assisting the country in crossing the finish line in controlling the HIV epidemic here.

The grant is part of the US President Emergency Plan for AIDS Relief (PEPFAR), under which Guyana has already benefitted from some US$185 million for HIV prevention, testing, care, and treatment programmes since 2004.

Speaking at a press conference on Friday, US Ambassador to Guyana, Sarah-Ann Lynch, said the partnership between the two countries on the HIV epidemic has saved lives.

Ambassador Lynch noted that this new grant would support the Ministry of Health and civil society partners until September 2022 in their fight against HIV.

She noted that Guyana had made significant strides on this front, with over 90 per cent of persons living with HIV knowing their status, which is critical for them to have access to life-saving HIV treatment. However, in the same breath, she pointed out that much more needs to be done in the area of treatment.

“With treatment, individuals’ health can be sustained, and the levels of the virus can be reduced so low that the virus cannot be transmitted to others.

However, of every four individuals diagnosed, only three are on treatment. This is not enough – and lives are at stake. Therefore, our priority must be to increase treatment coverage, aiming to ensure that everyone diagnosed with HIV is immediately linked to life-saving treatment services. We believe strongly that services must be client-centred, meeting individuals where they are, with what they need. Our PEPFAR support will help strengthen this, including for the most vulnerable,” the US diplomat posited.

Against this backdrop, Health Minister Dr Frank Anthony reassured the US diplomat that this US$1.5 million grant would be injected into addressing HIV treatment and other critical areas, where efforts have been lagging due to the COVID-19 pandemic.

“We have developed a strategy of introducing self-testing, and so we want to roll that out, and we’re going to do more on that to roll it out. But this is going to ensure that we get more people to test and to know their status… We are aiming to get more people into treatment, and therefore, we are going to work – using some of the resources from this grant – to get some of the people who were on treatment and fell off to get them back on treatment. And also, for some of the people who know their status but were not linked to treatment sites, we’ll be able to do some of that as well. So, we’ll be able to increase those numbers to get closer to the desired numbers that we’re looking for… but that’s going to take a lot of work,” the Minister posited.

Dr Anthony explained that another area they will be using this grant for is to ensure that those HIV persons on treatment become virally suppressed and unable to transmit the infection.

But the Health Minister noted that one of the challenges they have been facing is not being able to do viral loads for all the patients who need it. As such, he said monies would be directed into addressing the viral loads needs.

Additionally, efforts are also afoot to eliminate mother-to-child HIV transmission. He explained that there are still a few cases of HIV transmission from mothers to their unborn child, and one way they are looking to eliminate this by testing exposed babies with dry blood spots.

“For a number of years, Guyana was not able to do that properly, and so we are now introducing this process of dry blood spots. And this grant is also going to help us with that. We also have decided to provide PrEP (medicine people at risk take to prevent getting HIV) for all persons who want PrEP. Before, this was quite limited to discordant couples, so we want to now make sure that anyone who feels at risk could come into any one of our clinics and get PrEP. Again, we’re going to get some assistance through this grant,” Dr Anthony stated.

On this note, the Health Minister acknowledged that a lot of work has to be done for Guyana to achieve its 90-90-90 UNAIDS goal, which aims to ensure that 90 per cent of all people living with HIV will know their status, 90 per cent of all people diagnosed will receive sustained antiretroviral therapy (ART), and 90 per cent of all people receiving ART will have viral suppression, all by 2020.

However, Minister Anthony said because of the COVID-19 pandemic, Guyana could not achieve all three of the 90s.

“In terms of testing, getting people to know their status, about 93 per cent of those persons who have been tested know their status… We want 90 per cent of those patients who know their status to be on treatment, and unfortunately, when we look at our 2020 statistics, we only have about 74 per cent of those patients who have been on treatment. And of those who have been on treatment, we want at least 90 per cent of them to be virally suppressed, and in 2020, we’re seeing only about 69 per cent of those patients have been virally suppressed,” he noted.

The Minister further added, “So for us to really work to achieve the 90-90-90, and even to get to the 95-95-95 by 2025, there is still a lot of work to be done. And that’s why it’s so important that this grant is coming at this time… It is going to help us to focus on all three of these 90s and try to get us close to where we ought to be and even aspire to get to the 95s.”

Dr Anthony went on to laud the partnership between Guyana and the US because local capacity has been tremendously enhanced to fight against the HIV epidemic.

The Caribbean has achieved another significant milestone in the fight to end AIDS.  The Commonwealth of Dominica was certified by the World Health Organisation (WHO) for the Elimination of Mother-to-Child Transmission of HIV and Syphilis (EMTCT) in 2020.  The certification was granted following a thorough in-country validation assessment by the Regional Validation Committee, an independent body responsible for EMTCT certification.

Dominica joins six Caribbean countries that have been validated for EMTCT, including Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and Nevis. In April 2015, Cuba became the first country in the World to achieve EMTCT validation and was recertified on 1 December 2017.

The Pan American Health Organisation/World Health Organisation (PAHO/WHO), the Caribbean Community (CARICOM) and other regional stakeholders have extended congratulatory messages to Dominica on the achievement.

A virtual ceremony highlighting the country’s achievement is scheduled for 14 May 2021.  Key stakeholders from PAHO/WHO, UNAIDS and CARICOM, are expected to deliver remarks at the virtual event.

For more information on the certification ceremony, visit the PANCAP event web page here.  To register for the event, click here.

Poorer countries are set to see their access to HIV self-tests increase dramatically following a deal to slash prices in half and boost production, Unitaid said Wednesday.

The international health agency said it had closed a deal with US-based global healthcare company Viatris that will see blood-based HIV self-tests made available for under $2 across 135 low and middle-income countries.

HIV self-tests are seen as vital tools to help people more easily discover their status and move towards the treatment they need, and thus also to reducing the HIV burden globally.

This is particularly relevant in poorer countries, where concerns around stigma and difficulties accessing healthcare can create significant barriers, said Unitaid, which works on innovations on major diseases.

“Access to self-tests has been recognised as a key factor in meeting the global goal of 90% of people knowing their HIV status,” Unitaid spokesman Herve Verhoosel said in a statement.

In just the past six years, that rate has nearly doubled, from 45 to 81 percent, he said.

But achieving broader testing has been hampered by the fact that the market for HIV self-tests in low- and middle-income countries has been dominated by a single affordable oral HIV test, the OraSure.

That test is sold at cost in a limited number of poorer countries for $2, but elsewhere the price is higher, and other options have cost significantly more.

– Eight million unaware of status –

To try to fix that problem, Unitaid and US non-profit Population Services International (PSI) launched a call for proposals last July on ways to drive forward access to the tests.

The result was the Viatris deal, which Unitaid said should significantly expand the market and give countries more choice when it comes to self-tests.

This, Verhoosel said, would make “it easier to acquire the products and embed them in health systems, with the ultimate aim of helping the eight million people estimated to be unaware of their HIV status know they are infected and get treatment.”

Meg Doherty, who heads the World Health Organization’s global HIV, hepatitis and STI programmes, hailed “the wider availability of affordable HIV self-testing kits to increase access to testing.”

She said Wednesday’s announcement was timely at a time when the Covid-19 pandemic had in many places complicated access to a range of HIV services.

Self-testing allows “people to test when other options are difficult to access or restricted,” she said.

In addition to Viatris, Unitaid said another recently developed blood-based HIV self-test from US-based health care company Abbott Laboratories, which is currently undergoing regulatory review, would also be part of the expanded Unitaid programme, which would see around one million tests distributed “to stimulate in-country demand”.

Caribbean business leader and entrepreneur, Angela Lee Loy, has been selected from more than 500 nominations globally to be part of the Multi-Stakeholder Task Force for the 2021 United Nations High-Level Meeting on HIV. Ms Lee Loy is the lone private sector representative in a group comprised of civil society members from 16 countries.

The High-Level Meeting on HIV will be held virtually from 8–10 June 2021 and will review the progress made in reducing the impact of HIV 40 years since the first cases emerged. The General Assembly expects to adopt a new Political Declaration to guide the future direction of the response and bring the world closer to ending the AIDS epidemic as a public health threat as part of the 2030 Sustainable Development Agenda.

The role of the Multi-stakeholder Task Force is to ensure the involvement of civil society and an open, transparent and participatory process before and during the High-Level Meeting.

Ms Lee Loy, a Trinidad and Tobago national, is the Chairperson and Founder of Aegis Business Solutions Limited, the largest business outsourcing and advisory company in the English-speaking Caribbean and Chairman of Eve Anderson Recruitment Limited, the longest standing recruitment agency in the region. She is a Fellow of the Association of Chartered Certified Accountants and has over forty years’ experience in auditing and business advisory services.

The former Chairperson of the Trinidad and Tobago National AIDS Coordinating Committee has an outstanding track record of public service. Among her current corporate social responsibility priorities are coordinating private sector support to provide meaningful employment for Venezuelan refugees, an international campaign to increase COVID-19 vaccine confidence and COVID-19 vaccine procurement for the Caribbean.

“I am honoured to represent the Caribbean on this Task Force,” Ms Lee Loy said. “In a context of dwindling donor funding for HIV in our region, it is critical that we speak up to shape a strategy that ensures our governments, health sector, private sector and people do not become complacent and lose hard-won gains.”

At the last High-Level Meeting on HIV the community of nations agreed to ambitious targets including ensuring 90% of people living with HIV are aware of their status, putting 90% of diagnosed people on antiretroviral therapy and achieving viral suppression among 90% of those on treatment by 2020.

By the end of 2019 77% of people living with HIV in the Caribbean were aware of their status. Four of five (81%) diagnosed Caribbean people were on treatment while 80% of them were virally suppressed. National, regional and global data for the year 2020 will be available soon but it is clear that the goals adopted in the 2016 Political Declaration were not met.

“In the Caribbean, as with the rest of the world, AIDS is unfinished business,” said Dr James Guwani, UNAIDS Caribbean Director. “Progress has been highly uneven. Stigma and discrimination and the marginalization and criminalization of entire communities continue to fuel the epidemic.”

Ms Lee Loy’s representation of the private sector on the Task Force underlines the critical importance of corporate engagement in the HIV response. Some Caribbean business entities and leaders have made key contributions. For example, since 2019 people living with HIV in Jamaica who are fully compliant with their treatment regime have been able to access life insurance coverage through Sagicor Life Jamaica.  Scotiabank, in conjunction with regional and international partners, has coordinated a Regional HIV Testing Day across 17 Caribbean countries for several years, starting in 2007.

“It is in corporations’ interest to secure the health of their workers and customers by updating their knowledge about HIV and playing an active role in eliminating stigma and discrimination,” Ms Lee Loy said. “We have the tools to end AIDS but we need to support people to prevent HIV, get tested and access treatment.”

Stakeholders of the Caribbean HIV response have launched the In Your Hands HIV self-testing campaign, which advocates for self-testing policies to be developed and implemented as part of a comprehensive strategy to ensure that HIV diagnosis does not decline during the COVID-19 pandemic.

Even before COVID-19, the Caribbean was not on track to achieve the 90% testing target due at the end of 2020. In 2019, 77% of all people living with HIV in the Caribbean knew their HIV status. A survey conducted by the Pan Caribbean Partnership against HIV and AIDS (PANCAP) and the Pan American Health Organization (PAHO) showed that during 2020 facility- and community-based HIV testing services were reduced in 69% of countries due to COVID-19.

“This decline means that people with undiagnosed HIV are not getting life-saving antiretroviral treatment and, of course, continue to be unaware of their HIV status, with the risk of potentially exposing others,” said Sandra Jones, PAHO’s Technical Advisor for HIV/STI, TB & Viral Hepatitis in the Caribbean.

“The COVID-19 pandemic has presented the opportunity for us to explore new and innovative approaches that are result-oriented,” Rosmond Adams, the PANCAP Director, said.

According to James Guwani, the UNAIDS Caribbean Sub-Regional Office Director, it is particularly important to increase testing uptake among men, who are more likely to be diagnosed late. In 2019, 85% of Caribbean women living with HIV were aware of their HIV status, compared to just 72% of men. There is also a need to increase testing coverage among members of key populations who have reduced access to HIV services due to stigma and discrimination.

The World Health Organization recommends that HIV self-testing be offered as an additional approach to facility- and community-based services. Evidence shows that self-testing is safe and accurate and increases testing uptake among people who may not test otherwise.

Through the campaign, partners are advocating for national policies to include a communication package with information to link testers to HIV prevention and treatment services and minimum standards for the procurement and distribution of HIV self-testing kits in the private and public sectors.

“We strongly believe that HIV self-testing can help close the gap in the first 90. It can be targeted to individuals not being reached by existing HIV testing services, particularly those populations with low testing coverage and at high risk of HIV. It’s not a replacement for all testing services, but it should be included in the toolbox,” said Victoria Nibarger, the Caribbean Regional Programme Coordinator for the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

Under a Global Fund to Fight AIDS, Tuberculosis and Malaria project for the region, work is underway to conduct verification and feasibility assessment to introduce HIV self-testing across countries. Already, Guyana has announced plans to roll out HIV self-testing this year, while several countries have either committed to developing policies or are now doing so.

UNAIDS is helping to coordinate the campaign in the Caribbean, focusing on supporting a knowledge management strategy that ensures all stakeholders have the information, messages and tools they need to lobby at the national level successfully. A key priority is ensuring civil society engagement and addressing community concerns about how self-testing policies will be implemented.

While representatives of communities of people living with HIV and key populations endorsed the call for HIV self-testing, they have advised that increased investments are needed in post-test counselling and adherence counselling for the entire HIV response.

Deneen Moore, a Caribbean representative of the International Community of Positive Women, said, “We need to improve peer navigation so that when people test positive, they have someone there to help them. We also need more social contracting so that civil society organizations can help reach people who test positive. There is definitely a need for us to be involved in the process.”

The advocacy initiative is jointly endorsed by UNAIDS, PAHO, PANCAP, PEPFAR and the Caribbean Med Labs Foundation.