AIDS Committee warns against complacency in fight against HIV
Posted By Stabroek staff On December 4, 2010
While the availability of anti-retroviral therapies (ART) has transformed HIV from a killer to a chronic condition, there are no grounds for complacency as such an attitude is most likely to undermine gains made in recent years in the fight against the epidemic, according to the National AIDS Committee (NAC).
In the meantime, the NAC contended that certain conclusions can be drawn from recent trends. The body pointed to "the need for legal and social action to de-criminalize outdated buggery laws and equally outdated religious attitudes to homosexuality; and operationalizing the need for more effective, evidence-based strategies to stop the feminization of HIV.
It added also the need for a resurgence of prevention strategies targeting young people, with an emphasis on relationships and respect as well as sexual and reproductive health.
After almost 30 years the HIV epidemic in the Caribbean has hit something of a plateau with numbers of People Living with HIV (PLHIV) slowly increasing as a result of the dramatic decline in AIDS-related deaths due to availability of ART, the NAC stated in a press release.
The body also pointed out that the most pressing priority under the universal access theme in Guyana must be reduction in new infections and this issue requires the Guyana government to finally face up to needed legal and social reforms, having secured universal access to treatment.
Transforming the virus from a killer to a chronic condition has been possible for an estimated 51% of PLHIV in the Caribbean, and owing to substantial overseas support made available by international funders, Guyana can make the claim of universal access to ARTs for PLHIV in need of them, the NAC noted.
These developments, however, offer no grounds for complacency.
These developments, however, offer no grounds for complacency.
In a recent speech, according to the release, former Surgeon-General of the United States (1982-1989) Dr Charles Everett Koch, also a keen advocate of sex education in schools, identified complacency as the attitude most likely to undermine gains made in recent years in the fight against HIV.
"This warning is particularly appropriate in the Caribbean which remains the region with the highest incidence of HIV after sub-Saharan Africa," the NAC stated.
Feminization
Feminization
Meanwhile, in Guyana and the English-speaking Caribbean in general, the areas of concern which ought to dispel any inclination towards complacency remains the feminization of the epidemic, stubborn resistance to introducing legal reforms in areas relating to men-who-have-sex-with-men (MSM) and emerging problems with in-school youth.
Heterosexual women are slowly being recognized as a priority category, the NAC noted, while international priorities have in the past year began listing women as a vulnerable sector along with MSM, injecting drug users, and sex workers.
Heterosexual women are slowly being recognized as a priority category, the NAC noted, while international priorities have in the past year began listing women as a vulnerable sector along with MSM, injecting drug users, and sex workers.
Unlike the other categories, however, no strategic priority is assigned programmatically to addressing women despite the feminization of the epidemic.
Women in Guyana are calculated, according to PANCAP, as 59% of the PLHIV.
Women in Guyana are calculated, according to PANCAP, as 59% of the PLHIV.
Programmatically this is reflected nowhere and the Prevention of Mother-to-Child Transmission (PMTCT) programme, much lauded for its effectiveness, is inspired by protection of the unborn child, not the mother as a woman, the NAC observed.
Unlike categories such as security guards, miners, prisoners and blood donors, the real prevalence rate among heterosexual women is hard to find in the Guyana UNGASS Country Report. Of the estimated 58% of infected women a percentage is presumably accounted for by female sex workers whose prevalence rate is estimated at 16.6% (Guyana UNGASS Country Report) or 27% (PANCAP).
And the UNGASS Report has no statistics for condom use in heterosexual relations with a regular partner, "although it contains the most meaningless statistic on the indicator: the percentage of men and women who had more than one partner in the past twelve months and reported use of a condom during the last sexual encounter." (UNGASS 2009)
The vital link between coercive sexual activity within settled partnerships and the extent to which this contributes to new HIV infections can only be speculated upon, the NAC said.
Regular partners
"The fact that the number of women sexually active with more than one partner in the previous year was extremely low at 1.3% (Guyana UNGASS Report 2009) suggests that the great majority of women in Guyana acquire HIV from regular partners," the NAC stated.
The absence of such information compared to that available for small, even micro-sectors, "reinforces the impression that half of the population is virtually invisible to the priority-setting of both international agencies and national governments." Despite the rhetoric, therefore, there is no information in the Guyana UNGASS Report which sheds light on the feminization of HIV in Guyana.
For different reasons official statistics on MSM are equally unsatisfactory, the NAC said. Guyana's official statistics, for example, on the prevalence of HIV among men who have sex with men (MSM) is 19.4%, UNAIDS refers to between 20-32% and PANCAP does not provide a figure.
Sodomy laws
Figures for Jamaica and Trinidad are also estimated to be of a similar high order. Earlier this year UNAIDS drew a comparison between these high prevalence rates in the English-speaking Caribbean and the low prevalence rates in the Dominican Republic (6.1%) and Cuba (1%), deducing that the abolition of sodomy laws in the Spanish-speaking Caribbean has led to reduced prevalence of HIV among MSM.
A more logical reaction to the disparity between the English-and-Spanish-speaking MSM rates might be that the decriminalizing of homosexual activity allows for more accurate statistics to be collected.
In this case, the NAC said, the speculative rates in the English-speaking Caribbean would seem to be inflated. This suggestion is also supported by the information in the Guyana UNGASS Report 2009, to the effect that MSM have a 95% awareness of the link between condom use and risk of infection, and 75% levels of condom use.
"However, as long as homosexual activity remains criminalized and homophobia is fuelled by bigoted religious attitudes, speculation will continue to substitute for evidence in assigning HIV priorities," the NAC asserted.
The body noted also that Guyana, along with the rest of the English-speaking Caribbean, continues to reduce MSM to a technical issue, thereby avoiding taking steps to correct the reality of discrimination on the ground. And international agencies are not prepared to condition their financial assistance on law reform on this issue.
In-school children
The NAC said further that it is alarming to note the significant lowering of the age of first sexual experience reported in the Guyana 2009 UNGASS Country Report for the category of in-school children under the age of 15 years. Moreover, the category also manifested decreased knowledge of HIV prevention.
In-school children
The NAC said further that it is alarming to note the significant lowering of the age of first sexual experience reported in the Guyana 2009 UNGASS Country Report for the category of in-school children under the age of 15 years. Moreover, the category also manifested decreased knowledge of HIV prevention.
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