Order 187973: Public Health informatics informed approaches for monitoring or managing HIV in sex workers in Guyana (South America)

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MINISTRY OF HEALTH

GUYANA NATIONAL HIV/AIDS STRATEGY 2007-2011

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Government of Guyana National HIV/AIDS Programme http://www.hiv.gov.gy

CONTENTS

PREFACE p4

LIST OF ACRONYMS AND ABBREVIATIONS p6

SECTION 1. INTRODUCTION p9 1.1 Strategic Goal p9 | 1.2 The National Strategic Plan 2007-2011 p10

SECTION 2. HIV/AIDS IN GUYANA p13 2.1 The Unfolding Story of HIV/AIDS of Guyana p17 | 2.2 The Impact of HIV/AIDS p31 | 2.3 Determinants and Dynamics of the Epidemic p33

SECTION 3. RESPONDING TO HIV/AIDS CHALLENGE IN GUYANA: EXPERIENCES AND LESSONS LEARNT p35 3.1 Institutional Structure For The Response p35 | 3.2 Political Leadership, Development Policies and Resources, Management Structure and Mulit-Sectorial p35 | 3.3 Financing the Response to HIV/AIDS in Guyana p39 | 3.4 Building a comprehensive Prevention, Care and Treatment programme p40 | 3.5 Challenges For The Future p41

SECTION 4. STRATEGIC FRAMEWORK p43 4.1 General Review of Previous Plans 1999-2001, 2002-2006 p43 | 4.2 The Strategic Planning Process p43 | 4.3 Guiding Principles p44 | 4.4 Priority Objectives and Strategies p45

STRATEGIC PRIORITIES | Priority #1: Strengthening the National Capacity to Implement a Coordinated, Multi-sectoral Response p48 | Priority #2: Clinical and Di- agnostic Management and Access to Care, Treatment and Support p51 | Priority #3: Clinical and Diagnostic Management and Access to Care, Treatment and Support p57 | Priority #4: Strategic Information p62

SECTION 5. MONITORING & EVALUATION p65

SECTION 6. NEXT STEPS – THE WAY FORWARD p69

REFERENCES AND DOCUMENTS CONSULTED p69

ACKNOWLEDGEMENTS p71

Guyana National HIV/AIDS Strategic Plan 2007-2011

PREFACE

HIV/AIDS is both a National and International crisis. Together with nuclear war, global warm-

ing, chronic and sustained armed conflicts in various parts of the world and inequitable inter-

national finance and trade policies, HIV/AIDS constitute one of the world’s most challenges.

HIV/AIDS today represents one of the greatest potential threat to achieving the Millennium

Development Goals (MDGs).

Guyana has boldly pursued polices and programs intended to reverse the impact that HIV/

AIDS has had on our country. In putting together a 2002-2006 National Strategy, we embarked

on an ambitious program at a time when all programs were being supported only by the Central

Government and at a time when few local or international NGOs were willing to be involved in

the Guyanese fight against HIV/AIDS.

Fortunately, soon after the introduction of the 2002-2006 National Strategy, Guyana became a

recipient of significant amount of funds from various sources – PEPFAR (the US Emergency

Fund to fight against HIV/AIDS), CIDA (the Canadian Development Agency), the World

Bank, the Global Fund to Fight Against HIV/AIDS, TB and Malaria. Significant assistance

was derived, too, from traditional technical partners, which all increased their involvement in the

fight. These included PAHO, UNICEF, UNFPA and UNAIDS and CAREC and CDC.

The result was that Guyana has been able to make significant progress in the fight against HIV/

AIDS. The Guyana program includes all components in the fight against HIV/AIDS and the

new national strategy is designed so as to roll-out the various programs. Ultimately, the major

theme of the new strategy is UNIVERSAL ACCESS.

Most of the tools to fight against HIV/AIDS are known and are available for use. The limitation

is often access to these tools. National access is determined by several factors, including availabil-

ity of funds and human resource capacity and recognition that lifestyle is a major determinant of

the disease and consequently, major lifestyle changes are required.

But new tools are also becoming rapidly available and a country’s ability to quickly access these

new tools, including new drugs and vaccines is also important for a successful; fight against

HIV/AIDS. Our strategy must be designed to take immediate advantage of new tools and not

have to wait several years, long after the introduction of these prevention and treatment, care and

support tools in developed countries, to be able to access them in our country.

Guyana has made significant progress in our fight against HIV/AIDS. We have a chance to

successfully reduce the impact of HIV/AIDS in our country. We have a chance to be a model

for how to combat this scourge.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[5I commend the 2007-2011 National Strategy and urge every one to work diligently to imple- ment the various programs. It is again an ambitious program and we faithfully implement the

various activities outlined in the strategy, we are bound to succeed.

Even as I express our profound gratitude to all those who have worked on this document, I urge

everyone that only a robust effort to provide universal access to all the prevention, treatment, care

and support programs quickly to people will suffice.

Thank you.

Dr. Leslie Ramsammy

Minister of Health, Guyana

Guyana National HIV/AIDS Strategic Plan 2007-2011

LIST OF ACRONYMS AND ABBREVIATIONS

ABC Abstinence, Be Faithful, Correct, Consistent, Condom Use AIDS Acquired Immunodeficiency Syndrome AIS AIDS Indicator Study ANC Ante-natal clinic ART Anti-retroviral therapy ARV Anti-retroviral BCC Behaviour change communication BSS Behavioural surveillance survey CAREC Caribbean Epidemiology Centre CARICOM Caribbean Community CBO Community-Based organisation CCM Country Coordinating Mechanism CHART Caribbean Regional HIV/AIDS Training CIA Central Intelligence Agency CIDA Canadian International Development Agency CIOG Central Islamic Organisation of Guyana CMC Central Medical Centre CSIH Canadian Society for International Health CSW Commercial Sex Workers CT Counselling and Testing DDC Department of Disease Control DHHS/CDC United States Centers for Disease Control and Prevention DOD Department of Defence DOTS Direct Observation Therapy Strategy EP Emergency Plan EU European Union FBO Faith-based organisation FTE Full Time Equivalent G+ The Network of Guyanese Living with HIV and AIDS GDF Guyana Defence Force GDP Gross Domestic Product GECOM Guyana Elections Commission GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GHARP Guyana HIV/AIDS Reduction and Prevention Programme GOG Government of Guyana GPC Guyana Pharmaceutical Corporation GTUC Guyana Trades Union Congress

Guyana National HIV/AIDS Strategic Plan 2007-2011

[7 GTZ German Agency for Technical Cooperation GUM Genito-urinary Medicine HBC Home-based care HDI Human Development Index HFLE Health and Family Life Education HIPC Heavily Indebted Poor Countries Initiative HIS Health Information System HIV Human Immunodeficiency Virus HMIS Health Management Information Systems HRM Human Resource Management HSDU Health Sector Development Unit ID Identification IDB Inter-American Development Bank IDEA Institute for Democracy and Electoral Assistance IEC Information, Education and Communication IHV Institute of Human Virology ILO International Labour Organization

IMF International Monetary Fund

JHPIEGO Johns Hopkins Program for International Education in Gynaecology and Ob- stetrics

LIDC Low Income Developing Country LMIDC Low Middle-Income Developing Country M&E Monitoring and Evaluation MARPS Most at Risk Populations MCH Maternal Child Health MDR Multi Drug Resistance MMU Materials Management Unit MOH Ministry of Health MSM Men who have sex with men NAC National AIDS Committee NAPS National AIDS Programme Secretariat NBTS National Blood Transfusion Service NDC Neighbourhood Democratic Council NGO Non Governmental Organisation NLID National Laboratory for Infectious Diseases NTCC National Training Coordination Centre

Guyana National HIV/AIDS Strategic Plan 2007-2011

OIS Opportunistic infections OPEC Organisation of Petroleum Exporting Countries OVC Orphans and vulnerable children PAC Presidential AIDS Commission PAHO Pan American Health Organization PCVS Peace Corps Volunteers PEPFAR President’s Emergency Plan for AIDS Relief PLWHA People living with HIV and AIDS PMIS Patient Management Information System PMTCT Prevention of Mother to Child Transmission PNC-R People’s National Congress-Reform RAC Regional AIDS Committee RDC Regional Democratic Council QI Quality improvement S&D Stigma and discrimination STI Sexually Transmitted Infection SOP Standard Operating Procedures TA Technical Assistance TB Tuberculosis TIMS Training Information Management System TTIS Transfusion-transmitted infections UK United Kingdom UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Program UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development USDOL United States Department of Labour USG United States Government WHO World Health Organization

Guyana National HIV/AIDS Strategic Plan 2007-2011

[9 1INTRODUCTION The Government of Guyana has declared HIV/AIDS a National Priority and has made this

priority an important plank in its Poverty Reduction Strategy Program (PRSP). The Govern-

ment has committed itself to an accelerated, comprehensive, multi-sector, multi-level response

and has declared that only through a well – coordinated partnership with local and international

partners could Guyana respond effectively to the challenge of HIV/AIDS. The Government is

convinced that HIV/AIDS is a barrier to development.

The Plan that follows is based on a number of Government commitments and policy positions:

■ Universal access to HIV testing for all citizens: know you status campaign.

■ Universal access to PMTCT: ensure that all women of reproductive age and their families

have access to PMTCT through antenatal clinics (public and private).

■ Universal access to ARV-based treatment and CD4 based management to all PLWHA.

■ Link all relevant public health programmes to HIV services: just as all TB patients are tested

for HIV, similarly a VCT programme will be located within the Hanson, Malaria and other

relevant programmes.

■ Move to an “opting out” programme for HIV testing: starting with the PMTCT programme

an “opting out” procedure will be introduced and will be used in conjunction with VCT

■ Promote legislation to prevent stigma and discrimination based on HIV status

■ Provide foster care as part of OVC.

■ Develop curricula for HIV/AIDS as examination subject in school.

1.1_STRATEGIC GOAL

The overall strategic goal of the 2007 -2011 NSP for HIV/AIDS remains the same as that of

the NSP 2002-2006:

“To reduce the social and economic impact of HIV and AIDS on individuals and

communities, and ultimately the development of the country”.

Overall Strategic Objective

The overall strategic objective is to reduce the spread of HIV and improve the quality of life

of PLWHAs.

Specific Objectives:

Some of the specific objectives are to:

SECTION

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Guyana National HIV/AIDS Strategic Plan 2007-2011

■ Empower citizens by providing universal access for HIV/AIDS care, support, education and

awareness program. ■ Promote behaviour changes that reduce risks among all people, especially vulnerable groups. ■ Enable each citizen to know his or her HIV status by providing easy accessible counselling

and testing and by promoting an “opt-out” strategy. ■ Provide easily accessible universal PMTCT services to all pregnant women and their fami-

lies. ■ Ensure safe blood supply. ■ Provide treatment, care and support for OVC. ■ Provide treatment, care and support for all PLWHA. ■ Create space for the involvement of all citizens and groups in the multi-sector fight against

HIV/AIDS, including space for the involvement of PLWHA. ■ Reduce stigma and discrimination through BCC program, supported by an adequate legal

framework. ■ Build capacity for the overall response. ■ Improve the information system and strengthen the surveillance program. ■ Strengthen the overall coordination of the HIV/AIDS response program.

1.2_THE NATIONAL STRATEGIC PLAN 2007-2011

Guyana is at a critical point in its HIV/AIDS response where its National Programme is faced

with new challenges. As a result the National Response has to be scaled-up to deliver more

programmes, services and activities that reach a wider cross section of people. Over the last two

years, through a combination of strong political leadership and the use of National HIV/AIDS

Strategic Plan 2002 -2006, the Government has been able to mobilize significant financial re-

sources to support the HIV/AIDS programme. It is therefore important that these new resourc-

es are used efficiently and effectively over the next four years if the country is to attain universal

access and achieve its long-term goal of reducing the social and economic impact of HIV/AIDS

on individuals and communities and ultimately the development of the country.

As we prepare to launch the new program, there is also the question of the adequacy of resources

to implement the strategy outlined. The plan being articulated in this document clearly dem-

onstrates that Guyana will need to use present resources productively and must also mobilize

more resource in order to fully implement the ambitious program planned for 2007-2011. The

exceptionality of the HIV/AIDS pandemic requires that the resources must be mobilized and

Guyana must not be forced to curtail its plan in order to fit available resources.

Cognisant of the problem of donor coordination, earlier this year at a Care and Treatment

Workshop in April 2005, the Minister of Health, Dr. Leslie Ramsammy, in his address said:

“The time had come to collectively review these various work plans, to identify the gaps, and

to decide on the allocation of responsibilities for implementing the new strategic plan which

was to be developed. It was hoped that a work plan for the next two years could be drafted

which would promote collaboration among the various agencies and avoid duplication.”1

This issue of harmonisation put forward by the Minister is important and timely. In February

2003, at a meeting in Rome, a Declaration on Harmonisation was signed by a number of donor

1 PAHO Workshop Report, The Guyana HIV/AIDS Care and Treatment Plan, May 2005.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[11

agencies2. The agreement encourages donor agencies to improve coordination among them-

selves and with countries when responding to national priorities.

The National Strategic Plan 2007-2011 seeks to harmonise and align the resources and responses

of all its partners to ensure that they meet Guyana’s National Priorities. It is intended to strategi-

cally guide the future direction of Guyana’s National HIV/AIDS Response since it outlines the

basic approaches, principles, strategic priorities, objectives and strategic activities. The formula-

tion of the plan will also be aligned with one National Monitoring and Evaluation Plan.

The new Plan also seeks to build on the good work that was carried out during the development

of the 2002-2006 National HIV/AIDS Strategic Plan that was designed using a participative

process, involving the National AIDS Programme and the major partners within the public,

private and donor communities.

This 2007-2011 Plan aims to provide the following benefits:

■ A structured framework that will allow Government to continue to its leadership and to build

the capacity to manage and implement the programmes, interventions and activities of the

National response across the various sectors. ■ A structured framework that can be used to make optimal use of the financial and technical

resources. ■ An opportunity to strengthen the leadership and management initiatives that began with the

Presidential Commission on AIDS. ■ A structured framework that encourages harmonisation and alignment among partners in the

achievement of the National priorities of Guyana’s HIV/AIDS response. ■ An opportunity to coordinate and streamline the HIV/AIDS work plans of the various agen-

cies based on common arrangements, procedures and systems. ■ A chance to build capacity for a monitoring and evaluating system so that the GOG can

measure the impact of its multi-sectoral national HIV/AIDS response. ■ An effective vehicle for encourage the involvement and empowerment of all the stakeholders

and partners reaching all vulnerable populations.

A National Monitoring and Evaluation plan complements this framework so the information

can be used to measure progress and impact and to inform actions that will need to be taken to

strengthen the response during implementation.3

The National Strategic Plan 2007-2011 takes into consideration a number of declared public

policy statements by the Government. Those are detailed in Section: 4.4

The plan also takes into consideration a number of national and regional development plans.

These include:

■ The National Development Strategy (NDS) ■ The Poverty Reduction Strategy Program (PRSP) ■ The National Health Plan 2003-2007 ■ The National AIDS Policy Document ■ Caribbean Charter on Health II (CCH II) ■ The CARIBBEAN Regional HIV/AIDS Strategic framework, and

2 The Rome Declaration on Harmonization, High Level Forum on Harmonization, 24-25 February ,2003, where senior officials from more than 20 bilateral and multi-lateral development organizations and approximately 50 countries reaffirmed their commitment to achieving the Millennium Development Goals and agreed to harmonize their policies, procedures and practices.

3 National M&E Plan outlines the detailed indicators and targets that will be used to monitor and evaluate the HIV/AIDS response.

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Guyana National HIV/AIDS Strategic Plan 2007-2011

■ PAHO/WHO Regional HIV/STI Plan

The Plan further takes cognizance of partnerships programs, such as:

■ The World Bank HIV/AIDS Reduction Program ■ The Global Fund HIV/AIDS Program ■ PEPFAR (GHARP) ■ CIDA’s HIV/AIDS/STI Program

The plan is also consistent with international declarations and commitments that Guyana is a

part of these include:

■ MDGs ■ UNGASS Declaration 2001 ■ The 3 Ones ■ 3x5 Initiative ■ UNAIDS Declaration of universal access.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[13

SECTION

2 HIV/AIDS IN GUYANA Guyana (215,000 square km), a developing country, located on the northeast coast of South

America, is bordered by the Atlantic Ocean, Suriname, Brazil and Venezuela. It is considered

part of the Caribbean and is a member of the Caribbean Community (CARICOM). However,

Guyana is today pursuing stronger political, economic and social engagements with its South

American sister countries, particularly, the neighbouring countries of Brazil, Suriname and Ven-

ezuela.

Political context: Guyana is a fledgling democracy, having reversed a period of non-democratic

rule between 1968 and 1992. The strengthening and expansion of democratic institutions, cou-

pled with recent constitutional and parliamentary reforms, have resulted in greater participation

of parliament and civic society in decision-making and fiduciary oversight.

This former British territory gained independence on 26th May 1966 and became a republic

in February 1970. An executive president is both the head of state and government. There are

several levels of elected government ranging from parliament and Regional Democratic Coun-

cils (RDCs) to Neighbourhood Democratic Councils (NDCs) and Community Development

Committees (CDCs). Members of parliament comprise members, representing national slates

and geographic regions, elected by a system of proportional representation. The local govern-

ment system consists of ten RDCs, seven mayoralties and sixty-five NDCs. There are also Am-

erindian village councils that operate under separate legislation. The RDCs are administratively

responsible for delivery of services – health, education, etc - to their populations.

A NDS was formulated in 2000 by a civic group, consisting of more than 150 professionals and

Private Sector Individuals, with financial support from the Government and with the Carter

Center of the USA playing a facilitating role. The NDS was formally adopted by Parliament

on December 15, 2005 and a mechanism was established for its updating and monitoring of its

implementation.

Economic Context: Guyana is HIPC, with a per capita GDP of US$ 869 in 2004. From 1991-

97, GDP grew at an average of 7.3% per annum but, following internal political turmoil, unfa-

vourable weather conditions and external shocks, this growth trend has been difficult to sustain

in the period 1998-2004 (-1.8% to +3.0%). Guyana is today categorized as Low Middle-Income

Developing Country (LMIDC). It graduated from its position as a Low Income Developing

Country (LIDC), where it was for the whole of the 1970s, 1980s and most of the 1990s.

Debt Servicing: Between 1970 and 1992, Guyana accumulated one of the highest debt burdens

in the world as the debt rose from 30% to 470% of GDP. By 1992, 94% of its earnings had to go

towards servicing interests on its debt. Since then, through prudent fiscal management, grow-

ing economy and debt relief, Guyana has succeeded in significantly reducing this burden. As a

satisfactory-performing country, Guyana has benefited from significant debt-relief.

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Guyana National HIV/AIDS Strategic Plan 2007-2011

Social Context: A national population census was conducted in 2002.The census recorded a

multi-racial population of 751,223 (up from 723,673 from the 1991 Census). The sex distribu-

tion of the population shows that 50.1 % were males and 49.9% were females. Approximately

35.5% of the population was under 15 and 7% over 60 years old. The age group mostly af-

fected by HIV/AIDS (15-49) represents 51.3% of the population. Approximately 28.4% of the

population lives in urban areas and 71.6% live in rural areas. The coastal Regions 2 (49,253),3

(103,061),4 (310,320),5 (52,428) and 6 (123,695) account for 85.1% of the population. The

rural interior (Regions 1, 7, 8 and 9) is very sparsely populated with 9.4%. East Indians represent

approximately 43.5% of the population, African/Black 30.2% and the Amerindian population

9.2%. Mixed-heritage accounted for 16.7% of the population. Other ethnic groups in the coun-

try include 0.26% Portuguese (whites) and 0.2 Chinese. The Christian (various denominations)

population is 55.4%, the Hindus make up 28.4% and the Muslims make up 7.2%. Very small

groups include the Bahai and the Rastafarians. Adult literacy is estimated as 98%4. The gross

enrolment rate at the secondary level is 76% and at the primary level 99%. These represent

significant increases from a decade ago. There are also increasing numbers of students at the

University of Guyana and in various vocational institutions in the country.

Guyana is gradually recovering from debilitating poverty circumstances. The difficult economic

circumstances of the 1970s and 1980s culminated in poverty rates of between 65 and 86% for the

period 1988 and 1991. In 1993, after the restoration of democracy, absolute and critical poverty

fell to 43.2 and 27.2%respectively and this further improved in 1999, when approximately 36.3%

of the population lived in absolute poverty (US$ 510 per year or US$1.40 per day) and 19.1%

in critical poverty (US$ 364 per year or US$1 per day). Guyana was declared eligible for debt

relief under the HIPC in 1997 and is now part of the enhanced HIPC program. Guyana is in the

third year of its Poverty Reduction Strategy. Funds from debt relief are allocated to expenditures

in the social sectors (education, health, housing and water) and to poverty alleviation programs.

The PRSP budget is expected to increase allocation to health by about 30% of recurrent budget.

In 2005, Guyana ranked 107th on the Human Development Index 2005 Report. The Gender-

related Development Index (GDI) for Guyana is 79th in 2005. The GDP Index increased from

0.59 (2002) to 0.64 (2003) and 0.7 in 2005.

TABLE 1_KEY MORTALITY INDICATORS, ADJUSTED FOR UNDER-REPORTING5

INDICATOR REPORTED RATE PER THOUSAND

ESTIMATED RATE ADJUSTED

Stillbirth rate 17.1-18.2 19.5-34

Neonatal mortality rate 13.5-18.1 26-36

Infant mortality rate 18-54 30-54

Under five mortality rate 31.3 –72 40-72

Maternal mortality/100,000) 101-133 168

Crude death rate 5.4 7.5

4 Human development Report 2005, UNDP.

5 National Health Plan 2003-2007.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[15

TABLE 2_MAJOR CAUSES OF DEATH BY AGE GROUP NATIONALLY

AGE GROUP LEADING CAUSES OF DEATH

Under 5 Perinatal, ARI1, ADD1, accidents/injuries, HIV/AIDS

5-15 Accidents/injuries, ARI1, ADD1, cancer, malnutrition/anaemia

15-44 HIV/AIDS, accidents/injuries, suicide, ARI2/ADD2

45-64 Heart disease3, cerebrovascular disease (stroke), diabetes, cancer

TABLE 3_DISTRIBUTION OF HEALTH SERVICES BY REGIONS

NATIONAL TOTALS

COASTAL REGIONS HINTERLAND REGIONS

3 4 5 6 10 TOTAL 1 2 7 8 9 TOTAL

Health Post 182 25 10 2 1 13 51 31 17 15 16 52 131

Health Centre 112 13 25 14 24 10 86 4 12 3 4 3 26

District Hospital 18 3 0 3 3 2 10 3 1 1 1 2 8

Regional Hospital 4 1 0 0 1 1 3 0 1 0 0 0 1

National Hospital 5 0 4 0 1 0 5 0 0 0 0 0 0

Totals 321 42 39 18 30 26 155 38 31 19 21 57 166

% total population

100 13.3 81.0 7.1 19.7 5.4 86.5 2.5 6.0 2.0 0.8 2.1 13.4

Private Hospitals 5 - 5 - - - 5 - - - - - -

Private Doctors 115 5 80 5 20 4 114 0 0 0 0 1 1

Total Beds 2,187 183 951 37 554 146 1,871 85 107 56 28 40 316

Public Acute Beds

1,631 183 615 37 334 146 1,315 85 107 56 28 40 316

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Guyana National HIV/AIDS Strategic Plan 2007-2011

TABLE 4_HEALTH NEEDS & PREDICTED CHANGES FOR THE GUYANESE POPULATION

CONDITION E S

T IM

A T

E D

U M

B E

R S

P R

E D

IC T

E D

O C

H A

N G

A G

E S

F F

E C

T E

D IS

T R

IB U

T IO

N A

T IO

N A

P R

O G

R A

P R

IM A

R Y

A R

IN V

O LV

E D

INFECTIOUS

HIV/AIDS 25,000 Increase <5; 15-44 All Yes Yes

Malaria 30,000 Stable All Hinterland Yes Yes

TB 600 Increase All All Yes Yes

Syphilis/other STIs 15,000 Increase 15-64 All No Yes

Filariasis 20,000 Decrease 1-44 Urban Yes Yes

NUTRITION AND ANAEMIAS

Anaemia 320,000 Decrease All All Planned Yes

Malnutrition 10,000 Decrease <5 All Planned Yes

Intestinal Worms 12,500 Stable All All No Yes

Vascular

Hypertension 65,000 Increase >45 All, Higher Afro

Guyanese

Planned Yes

Diabetes 40,000 Increase >45 All, Higher in East Indians

Planned Yes

MISCELLANEOUS

Accidents and Injuries 17,000 Stable All All No Yes

Suicide 100 Stable All All, Higher in East Indians

Planned Yes

Risk factors

Smoking 130,000 Increase >15 All Planned Yes

Obesity 125,000 Increase All All Planned Yes

Diet All - All All Planned Yes

MATERNAL AND CHILD HEALTH

Antenatal and Postnatal Care

Pregnant women

- >12 All Yes Yes

EPI All infants - 0-2 All Yes Yes

Guyana National HIV/AIDS Strategic Plan 2007-2011

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Sector financing: health care services in the public sector are free. Total public sector expendi-

ture is estimated at US$ 33m or about $US48.5 per capita for 2003. It is believed that public

sector expenditure accounts for more than 80%, with out-of-pocket and insurance contributions

(private sector expenditure) accounting for less than 20% of the total health care cost in the

country (figure 2). In 2002, health expenditure amounted to 8.4% of total government expen-

diture (10.1% if debt payments are excluded) and trends for this are shown in table 7. While

it is obvious that the health sector requires a greater injection of financial resources, it must

also be obvious that the ability of government to do so in the foreseeable future is restricted.

Note that the government already commits more than 37% (table7) of its total expenditure on

the social services and that with debt servicing, more than 50% of public sector expenditure is

accounted for. In addition, the country’s revenues are usually significantly below budget projec-

tions (>-15%). The country receives significant technical cooperation support for the health

sector and in 1999, donors accounted for 5.22% of government health spending (compared with

11% in 1997). All the funds are grants. The principal sources of external financing in 1999 and

2000 were the Inter American Development Bank, UN agencies, PAHO, USAID and GTZ.

Guyana’s immunization program benefits significantly from GAVI.

TABLE 5_SECTOR EXPENDITURE 1992-2001

1991 1993 1994 1995 1996 1997 1998 1999 2000 2001

Per Capita GDP ($US)

350 531 612 680 766 808.3 777.5 770.3 773 737.9

Social Sector Exp. as % of Total Expenditure

8.9 20.4 25.6 22.2 29.7 28.7 29.6 31 32.5 35.2

Public expenditure on health ($GY,000,000)

703 2,022 2,737 2,214 2,686 2,769 2,951 3,550 4,423 4,402

Public expenditure on health as % of total public expenditure

3.6 7.9 9.0 6.3 6.8 7.6 6.8 7.6 7.4 6.9

Total per capita health expenditure in US$

8 29.1 34 39 43.4 45.4 45.4 46 48 48

2.1 THE UNFOLDING STORY OF HIV/AIDS IN GUYANA

There appears to be a stabilization of the epidemic

The first documented case of HIV/AIDS in Guyana was in 1987. Since this documented first

case, UNAIDS estimated that Guyana has an adult prevalence of HIV infection of about 2.5%

(range 0.8% to 7%) at the end of 2004.

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Guyana National HIV/AIDS Strategic Plan 2007-2011

Surveillance studies among some vulnerable populations seem to suggest a stabilization of the

epidemic. The following Table supports this assertion:

TABLE 2.1.1: HIV PREVALENCE AMONGST VULNERABLE POPULATIONS

POPULATION GENDER YEAR PREVALENCE (%) REMARKS

Blood Donors All 2001 2004

1.0 0.8

Blood Bank survey

Pregnant Women Female 1993 1995 2000 2002 2003 2004 2004 2005

3.7 7.1 5.6 3.9 3.1 2.5 2.6 2.1

ANC Survey PMTCT Sites PMTCT Sites PMTCT Sites ANC Survey

PMTCT Report

STI Patients Male 1992 2002 2004 2005

13.2 15.1 19.8 17.3

Clinic Records Clinic records Clinic Records Clinic Records

Female 1993 2002 2004 2005

6.5 12.0 15.8 16.9

Clinic Records Clinic Records Clinic Records Clinic Records

CSW Female 1992 1997 2004

25.0 45.0 26.6

CSW Survey CSW Survey BBSS, 2004

MSM Male 2004 21.25 BBSS, 2004

TB Patients All 1997 2003 2005

14.5 30.2

Clinic Records Clinic Records Clinic Records

Miners Males 2000 1999 2004

6.5 11.9 3.9

1 mine 1 mine

22 mines

Guyana has officially recorded 7,512 cases up to the end of 2004. The data in Table 2.2.2 be-

low provides further evidence that the epidemic has stabilized. With greater accessibility to

VCT and Treatment and Care Centers, more testing for HIV is being done by the public and

private sectors and NGOs. Under-reporting was a serious problem in the early years and while

significant under-reporting is still a problem, this issue is being gradually addressed. In spite of

increased testing, the number of new recorded cases has remained relatively stable between 2001

and 2005 as seen in Table 2.1.2 and Fig. 2.1.1

Guyana National HIV/AIDS Strategic Plan 2007-2011

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Fig. 2.1.1_HIV/AIDS in Guyana 1987-2004

Reported Cases & Incidence

TABLE 2.1.2: HIV AND AIDS CASES FROM 1987 – 2004 BY GENDER (2000-2004)

CLASSIFICATION 1987-1999 2000 2001 2002 2003 2004

HIV Male 348 174 301 339 368 Female 300 226 268 368 408

Unknown 0 9 39 55 61 Total 648 409 608 762 837

AIDS Male 175 232 243 232 117 Female 132 185 146 163 204

Unknown 0 18 26 22 27 Total 307 435 415 417 348

HIV/AIDS Year Total 955 844 1023 1179 1185

Cumulative (All cases from 1987)

2326 3281 4125 5148 6327 7512

Young people are disproportionately affected and there is an increasing feminization of the epidemic

The data demonstrate that while the early epidemic affected more men than women, there is

an increasing feminization of the epidemic and more women are recorded with HIV today than

men, especially in the age groups of 15 and 24. More than 90% of the recorded cases occur

among the age groups of 15 to 49.

In ci

de nc

e/ 10

0, 00

180

160

140

120

100

900

800

700

600

500

400

300

200

100

1 9

8 7

1 9

8 8

1 9

8 9

1 9

9 0

1 9

9 1

1 9

9 2

1 9

9 3

1 9

9 4

1 9

9 5

1 9

9 6

1 9

9 7

1 9

9 8

1 9

9 9

2 0

0 0

2 0

0 1

2 0

0 2

2 0

0 3

2 0

0 4

Year

C as

HIV / AIDS /Rate

20]

Guyana National HIV/AIDS Strategic Plan 2007-2011

TABLE 2.1.3_DISTRIBUTION OF AIDS CASES BY GENDER AND AGE GROUPS (1999-2004)

AGE GROUP

1999 2000 2001 2002 2003 2004 TOTAL TOTAL

M F M F M F M F M F M F M F

<1 3 0 2 2 7 3 0 0 0 0 0 0 12 5 17

1-4 10 1 6 5 9 4 9 5 7 5 1 4 42 24 66

5-14 1 2 3 0 6 4 5 5 2 5 5 5 22 21 43

15-19 4 7 3 4 1 9 4 3 0 2 4 2 16 27 43

20-24 19 14 16 16 20 28 9 16 13 13 9 14 86 101 187

25-29 30 53 35 23 32 24 43 30 28 21 20 17 188 168 356

30-34 51 20 25 30 48 28 48 27 54 37 42 19 268 161 429

35-39 32 14 30 24 33 14 37 26 38 28 40 17 210 123 333

40-44 20 9 26 9 19 20 24 11 25 19 26 9 140 77 217

45-49 20 8 11 6 15 15 15 8 20 11 15 7 96 55 151

50-54 6 3 3 7 5 7 14 2 16 7 11 3 55 29 84

55-59 3 2 3 4 4 3 4 3 2 0 5 2 21 14 35

60+_ 3 2 8 2 6 4 13 0 2 1 3 1 35 10 45

NS 2 2 4 0 27 22 18 10 23 14 25 17 99 65 164

204 137 175 132 232 185 243 146 232 163 204 117 1290 880 2170

Treatment is Working

Guyana has moved from a centralized treatment program to providing treatment nation-

ally. Treatment with ARVs started in April 2002 at one treatment centre (the GUM Clinic).

Since then several new centres have been introduced in the public and private sector. At the

end of 2005, there were eight (8) public health centres offering treatment and care, including

the provision of ARVs and CD4 testing. These centres are located in Regions 2,3,4,6,7 and

10. In addition, treatment is being provided in Regions 1, 8 and 9 through visiting specialist

teams. The St. Joseph’s Mercy Hospital is a private hospital that also offers treatment and care

under the Ministry of Health’s program. These treatment and care programs are offered freely

to PLWHA. Private physicians and hospitals also provide treatment, but these private arrange-

ments have not yet become part of the national surveillance.

The numbers of person accessing the treatment program has accelerated since the begin-

ning of 2005. Fig. 2.1.2 shows the number of PLWHA who were initiated into the treatment

program by quarter in 2005. During the first quarter of 2005, the number of PLWHA that were

initiated into the treatment program was 13 per month. This increased to 23 per month in the

last quarter of 2005. At the end of 2005, there were 1202 on treatment in the national program,

exceeding the 3 by 5 target of 1,000 for the end of 2005.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[21

Fig. 2.1.2_Number of Persons Initiated on Treatment by Quarter in 2005

The immunological status of PLWHA and who are on treatment has significantly improved.

Immunological monitoring of PLWHA started in September 2004 with the introduction of

CD4 testing. This has been one of the factors that have led to the increased initiation of per-

sons on ARV treatment. Clinical decisions on when to start ARV treatment is now based on a

protocol that include the use of CD4. When the ARV treatment program started in 2002, the

decision was based on a sydromic model, without CD4. At the start of the program, a cut-off of

CD4 count of 200 was used. Since September 2005, the CD4 cut-off has been increased to 350.

Treatment with ARVs has resulted in significant clinical and immunological improvement for

PLWHA. For example, the average CD4 count for PLWHA at initiation for ARV treatment in

2005 was 113. The CD4 count improved significantly by 3,6 and 9 months after treatment with

ARV started, as seen in Fig. 2.1.3

Fig. 2.1.3_CD4 Monitoring

39 43

0 1 2 3 4

N um

be r

of p

at ie

nt s

Series1 / Linear (Series1)

Quarter

350

300

250

200

150

100

C D

4 ce

lls

Date

Initaition 3 months 6 months 9 months

175

241

288

113

22]

Guyana National HIV/AIDS Strategic Plan 2007-2011

Viral Load Status of PLWHA has also shown indication that treatment is working: Viral load

testing was introduced through the Ministry’s program with St. Joseph’s Mercy Hospital. This

program is through the sponsorship of PEPFAR and is being implemented in collaboration with

CRS and the Baltimore-based Institute of Human Virology (IHV ). Preliminary analysis shows

that PLWHA and who are on HAART are generally doing well based on viral load testing. In

a survey of 114 PLWHA on HAART for up to six months, 26.3% had a viral load of under

400 and 68.6% had viral load of <1,000. When the 114 PLWHA were grouped into two groups

(those doing well and those not doing well, the viral load status was as follows:

Group Mean Viral Load Median Viral Load 75th Percentile VL

Clinical Failure 28,950 5,175 45,770

Doing Well 1,165 600 811

AIDS-Related Deaths have stabilized (Table 2.1.3 and Fig. 2.1.4). In the 1990s, there were in-

creasing numbers of persons whose deaths were directly attributed to HIV/AIDS. The number of

deaths per year has slowed down and appears to have been stabilized. This may be directly because

increasing numbers of persons are accessing treatment and care and survival time is increasing.

TABLE 2.1.3: MORTALITY RATE OF AIDS IN GUYANA (1999 – 2003)

1999 2000 2001 2002 2003

M F M F M F M F M F

AIDS Deaths 302 312 171 240 165 284 191 206 168

39.2 81.5 43.3 62.2 41.4 75.5 50.9 54.8 44.7

Crude Death Rate

39.2 62 51.6 63.2 49.8

Fig. 2.1.4_Guyana HIV/AIDS Crude Death Rate 1999-2004

Year

100

1999 2000 2001 2002 2003 2004

R at

e/ 10

0, 00

Male /Female /All

Guyana National HIV/AIDS Strategic Plan 2007-2011

[23

Voluntary Counseling and Testing:

Lack of knowledge of VCT impedes the Government’s effort for Guyanese to know their sta-

tus. Thus, only 17% of MSM, 28% of CSW, 32% of GUYSUCO employees, 34% of uniform

services personnel, 55% of out of school youths and 66% of In-school youths knew of the avail-

ability of VCT (BSS 2004). By 1998, only 2 VCT sites were operating in Guyana by the Public

Sector (New Amsterdam in Region 6 and at the GUM clinic). By the end of 2005, VCT was

available in Regions 2, 3, 4, 5, 6, 7, 9 and 10. Besides the 56 PMTCT sites, which all offer VCT,

there are 28 fixed sites, including 10 sites operated by NGOs. Mobile teams also provide VCT

in un-served areas and a number of NGOs now also offer VCT in Regions 2, 3, 4, 6 and 10. One

private sector site, operated by St. Joseph’s Mercy Hospital, is also providing VCT. A rapid test

algorithm has been developed, field tested and validated and is in use at all VCT sites.

Reversing the Trend of HIV Infections among Pregnant Women

Limited studies and limited surveillance results are available for the period prior to 2001. Several

small surveillance studies among pregnant women done between 1993 and 2000 showed an

increasing HIV prevalence, reaching about 7% in 2000. The emergence of a PMTCT program

in 2001 have since provided a better picture of the HIV situation among pregnant women in

Guyana. An ANC surveillance Survey in 2004 confirmed the picture provided by an analysis of

PMTCT data from ANC Centers around the country.

The PMTCT program was initiated in 2001 at 11 pilot sites and has since grown to 56 sites in

8 of the 10 geographical regions of the country by the end of 2005. Since November 2001, more

than 21,000 women have been offered testing and more than 18,000 have accepted testing. In

2002, there was a 67% uptake and since then this has increased to 94.6% in 2005. During 2000,

almost 3,000 women accepted testing for HIV. This increased to 4,800 in 2004 and has exceeded

7,000 in 2005. With about 16,000 deliveries on an annual basis, this translates to almost 50% of

pregnant women having access to PMTCT in Guyana.

Program Uptake_2002- Sept 2005

100

2002 2003 2004 2005

24]

Guyana National HIV/AIDS Strategic Plan 2007-2011

Sero-prevalence_2002 – September 2005

Behavioral and Attitudinal Characteristics of the population remain major challenges in

the prevention and management of HIV/AIDS in Guyana and it is imperative that programs

to effect behavior changes become an integral part of the response to HIV/AIDS. Guyana has

recently (2004/2005) completed both a BSS and an AIDS Indicator Survey (AIS). While these

surveillance tools have shown improvement in behavior and attitudes, the surveys also indicate

that the population is at significant risk because of certain behavior and attitudinal patterns.

There is still too wide a gap in comprehensive knowledge of the methods for prevention

of HIV among the population, especially among the young people. Table 2.1.4 demonstrates

that there are still between 14% and 38% of In-school and out-of-school youths who lack a

comprehensive knowledge of the methods of prevention for HIV. Male has less knowledge of

the prevention methods than female. More than 50% of the rural population, more than 30% of

CSW and MSM and 15% of the uniform services lack this knowledge.

TABLE 2.1.4_COMPREHENSIVE KNOWLEDGE OF THREE (3) METHODS OF HIV PREVENTION – ABSTINENCE, FAITHFULNESS AND CONDOM USE

POPULATION BSS AIS

In School Youths (% who knew all three methods) 62.0 75.9

Out of School Youths (% who knew all three methods) 71.1 85.6

Age Group 15 -24 In and Out-of School (% who knew all three methods) Age group 15-19 (% who knew all three methods) Age group 20-24 (% who knew all three methods)

59.5 67.8

63.7 74.0

M 47.3 42.5 54.3

F 52.6 50.3 55.3

GUYSUCO Workers - (% who knew all three methods) 75.3 Not done

Female Sex Workers - (% who knew all three methods) 63.1

MSM - (% who knew all three methods) 67.1

Uniform Services - (% who knew all three methods) 84.0

Region 5 - (% who knew all three methods) Region 6 - (% who knew all three methods)

M 22.1

F 49.1 43.2

1995 2000 2002 2003 2004 2005

Guyana National HIV/AIDS Strategic Plan 2007-2011

[25

Risky sexual practices constitute a major challenge in Guyana’s prevention efforts. The

sexual experience and sexual attitudes of young people and of some vulnerable groups, especially

in the debut age for sex, the involvement in pre-marital sex, number of sex partners, involve-

ment with CSWs and in the use of condoms, place the population at great risk for HIV. A good

example is to look at the uniform services personnel, a group considered to be an at-risk group.

Condom use by uniform personnel with non-regular partner is only 48% of the time. Table 2.1.5

shows that the sexual practices of the population place the population at great risk for HIV.

TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI AWARENESS OF THE POPULATION

SEXUALLY ACTIVE POPULATION BSS AIS

M F M F

In School Youths – Sexually Active (%) [30.6]

Mean Age of First Sex (Years)

Mean age of first sex partner

% Sexually active who had sex in last 12 months

Mean number of non-commercial sex partners last 12 months

Mean number of commercial sex part- ners last 12 months

% Who have had sex with a CSW last 12 months

% Male who have had sex with another male

% Aware where to obtain condoms

% Who used a condom at first sex

% Used condom with a non-commercial partner last sex

% Used condom every time with non- commercial partner

% Who has used condom with a CSW at last sex

% Used condom every time with CSW last 12 months

% Think condoms have holes and do not work

% Awareness of STDs

% With abnormal discharge last 12 months

% Sexually active with genital ulcer last 12 months

43.5

14.2

14.8

59.9

2.5

0.89

29.6

1.9

89.6

51.0

75.7

57.4

55.0

57.1

40.1

72.8

4.5

7.4

22.3

15.0

19.9

68.1

1.2

0.34

18.7

64.2

64.1

69.3

47.5

50.0

14.3

45.5

74.9

9.7

8.5

18.0

17.8

61.3

0.8

91.4

84.6

18.4

56.1

80.3

Age Group 15-19 20—24 15-19 20-24

26]

Guyana National HIV/AIDS Strategic Plan 2007-2011

TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI AWARENESS OF THE POPULATION

OUT-OF SCHOOL YOUTHS –

% Sexually Active [58.7 of total]

Mean Age (years) of First Sex [All – 15.98]

Mean age (years) of first sex partner [All- 18.6]

% Sexually active who had sex in last 12 months [72.8]

Mean number of non-commercial sex partners last 12 months

Mean number of commercial sex part- ners last 12 months

% Who have had sex with a CSW last 12 months [3.0]

% Male who have had sex with another male [1.2]

% Aware where to obtain condoms [81.4,M=90.5 F=72.8]

% Who used a condom at first sex [60.7]

% Used condom with a non-commercial partner last sex

% Used condom every time with non- commercial partner

% Who has used condom with a CSW at last sex

% Used condom every time with CSW last 12 months

% Think condoms have holes and do not work

% Awareness of STDs [90.1, M-90.2 F=90.1]

% With abnormal discharge last 12 months [2.4]

% Sexually active with genital ulcer last 12 months [1.1]

52.6

14.9

15.6

64.3

2.7

2.0

59.3

72.8

70.0

75.0

100

39.9

15.9

20.6

73.4

0.7

71.8

47.8

68.8

100

84.8

16.1

16.9

77.6

6.8

0.6

59.5

53.7

69.8

91.7

90.9

73.5

17.1

21.5

76.1

1.2

54.0

34.5

58.9

50.0

37.5

75.7

0.9

87.6

68.3

75.8

100.0

1.5

0.3

26.2

55.5

77.4

51.0

70.0

4.3

0.9

80.3

17.8

79.6

1.4

96.9

45.9

64.7

100.0

1.2

0.7

56.1

18.4

78.7

83.7

89.1

56.7

1.6

1.4

GUYSUCO EMPLOYEES M F

% Sexually active

Mean Age of First Sex (Years)

Mean age of first sex partner

% Sexually active who had sex in last 12 months

Mean number of non-commercial sex partners last 12 months

Mean number of commercial sex part- ners last 12 months

% Who have had sex with a CSW last 12 months

90.8

17.0

92.3

0.08

2.4

90.8

19.3

78.7

Continued from p25

Guyana National HIV/AIDS Strategic Plan 2007-2011

[27

TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI AWARENESS OF THE POPULATION

GUYSUCO EMPLOYEES M F

% Male who have had sex with another male

% Aware where to obtain condoms

% Who used a condom at first sex

% Used condom with a non-commercial partner last sex

% Used condom every time with non- commercial partner

% Who has used condom with a CSW at last sex

% Used condom every time with CSW last 12 months

% Think condoms have holes and do not work

% Awareness of STDs

% With abnormal discharge last 12 months

% Sexually active with genital ulcer last 12 months

2.6

85.8

51.4

25.8

52.4

91.7

2.6

59.6

93.3

0.9

UNIFORM SERVICES: - % SEXUALLY ACTIVE

MALE FEMALE

Mean Age of First Sex (Years)

Mean age of first sex partner

% Sexually active who had sex in last 12 months

Mean number of non-commercial sex partners last 12 months

Mean number of commercial sex part- ners last 12 months

% Who have had sex with a CSW last 12 months

% Male who have had sex with another male

% Aware where to obtain condoms

% Who used a condom at first sex

% Used condom with a regular partner last sex

% Used condom every time with a regular partner

% Who has used condom with a CSW at last sex

% Used condom every time with CSW last 12 months

% Think condoms have holes and do not work

97.6

16.6

92.0

0.56

0.04

1.7

97.3

19.4

10.7

100.0

87.5

48.5

97.5

17.7

84.7

0.58

0.03

91.6

13.3

7.8

47.7

Continued from p26

28]

Guyana National HIV/AIDS Strategic Plan 2007-2011

TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI AWARENESS OF THE POPULATION

UNIFORM SERVICES: - % SEXUALLY ACTIVE

MALE FEMALE

% Awareness of STDs

% With abnormal discharge last 12 months

% Sexually active with genital ulcer last 12 months

96.3

2.0

1.8

98.1

1.3

FEMALE COMMERCIAL SEX WORKERS

MALE FEMALE

Mean Age of First Sex (Years)

Mean age of first sex partner

% Sexually active who had sex in last 12 months

Mean number of non-commercial sex partners last 12 months

Mean number of commercial sex part- ners last 12 months

% Who have had sex with a CSW last 12 months

% Male who have had sex with another male

% Aware where to obtain condoms

% Who used a condom at first sex

% Used condom with a non-commercial partner last sex

% Used condom every time with non- commercial partner

% Who has used condom with a CSW at last sex

% Used condom every time with CSW last 12 months

% Think condoms have holes and do not work

% Awareness of STDs

% With abnormal discharge last 12 months

% Sexually active with genital ulcer last 12 months mean age of FCSW

Mean Duration of sex work (years)

Median number of sex partners in the past week

Use of condom with last paying partner

Use of condom with non paying partner

94.0

72.7

44.0

93.8

8.2

11.0

28.6

4.35

3.0

89.3

68.6

Continued from p27

Guyana National HIV/AIDS Strategic Plan 2007-2011

[29

TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI AWARENESS OF THE POPULATION

MEN WHO HAVE SEX WITH MEN (MSM):

Mean Age of First Sex (Years)

Mean age of first sex partner

% Sexually active who had sex in last 12 months

Mean number of non-commercial sex partners last 12 months

Mean number of commercial sex part- ners last 12 months

% Who have had sex with a CSW last 12 months

% Male who have had sex with another male (anal)

% Aware where to obtain condoms

% Who used a condom at first sex

% Used condom with a non-commercial partner last sex

% Used condom every time with non- commercial partner

% Who has used condom with a CSW at last sex

% Used condom every time with CSW last 12 months

% Think condoms have holes and do not work

% Awareness of STDs

% With abnormal discharge last 12 months

% Sexually active with genital ulcer last 12 months

2.18 (0-20)

4.20 (0-58)

92.4

97.0

80.7

50.5

83.8

66.2

50.8

94.9

17.8

Too few people know their HIV status and many people are unaware of the availability of

ARV treatment: There are too few people who have taken advantage of free VCT across the

country. Further, most people still are unaware that treatment is available. The result of this

contributes to the low level of the population that have tested for HIV (Table 2.1.6).

TABLE 2.1.6: TOO FEW PEOPLE KNOW THEIR HIV STATUS AND KNOW OF

TREATMENT AVAILABILITY

% WOMEN AND MEN WHO HAVE TESTED AND RECEIVED RESULTS

BSS AIS

M F

Age Group 15-19: Ever tested and received results

Tested and received results in last 12 months

% Know of treatment availability (In-school youths)

% Know of treatment availability (Out-of-school youths)

17.6

41.6 12.9

5.4

4.2

14.6

9.0

Continued from p28

30]

Guyana National HIV/AIDS Strategic Plan 2007-2011

TABLE 2.1.6: TOO FEW PEOPLE KNOW THEIR HIV STATUS AND KNOW OF

TREATMENT AVAILABILITY

% WOMEN AND MEN WHO HAVE TESTED AND RECEIVED RESULTS

BSS AIS

M F

Age Group 20-24: Ever tested and received results Tested and received results in last 12 months

26.8 16.0

36.3 17.8

Age Group 25-29: Ever tested and received results Tested and received results in last 12 months

25.6 16.5

36.9 14.9

Age Group 30-39: Ever tested and received results Tested and received results in last 12 months

23.0 11.4

30.0 11.2

Age Group 40-49: Ever tested and received results Tested and received results in last 12 months

19.9 7.0

19.4 6.9

Married: Ever tested and received results Tested and received results in last 12 months

22.2 11.6

28.3 11.6

Formerly married: Ever tested and received results Tested and received results in last 12 months

28.1 8.8

37.4 14.2

Never married: Ever tested and received results Tested and received results in last 12 months

14.8 8.9

19.5 9.7

Urban: Ever tested and received results Tested and received results in last 12 months

29.5 15.1

38.5 16.3

Rural: Ever tested and received results Tested and received results in last 12 months

15.5 8.3

21.3 9.1

GUYSUCO: Ever tested and received results Tested and received results in last 12 months % Know of treatment availability

? ?

32.2

Uniform Services: Ever tested and received results Tested and received results in last 12 months % Know of treatment availability

48.2 48.2 63.3

CSW: Ever tested and received results Tested and received results in last 12 months % Know of treatment availability

85.2 64.3 70.8

MSM: Ever tested and received results Tested and received results in last 12 months % Know of treatment availability

43.8 87.6 66.5

Stigma and Discrimination are two factors that influence the spread of HIV in any country

and both stigma and discrimination are important factors in the Guyana HIV epidemic.

Table 2.1.7 shows that despite aggressive awareness and education programs in the last five years,

stigma and discrimination are still significant factors.

Continued from p29

Guyana National HIV/AIDS Strategic Plan 2007-2011

[31

TABLE 2.1.7: MEASURING PERCEPTIONS OF THE POPULATION

POPULATION BSS AIS

M F

Would buy food/goods from an infected shopkeeper • % of In-School Youths • % of Out-of-School Youths • % of GUYSUCO Workers • % of Uniform Services Personnel • % MSM • % of CSW

21.4 23.7 26.1 24.0 37.2 30.5

37.7 51.1

50.9 51.0

Perception of personal risk (none/low) • % of In-School Youths • % of Out-of-School Youths • % of GUYSUCO Workers • % of Uniform Services Personnel • % MSM • % of CSW

91.4 82.9 59.5 59.5

Persons with HIV should be quarantined • % of In-School Youths • % of Out-of-School Youths • % of GUYSUCO Workers • % of Uniform Services Personnel • % MSM • % of CSW

28.8 50.3 76.5 31.7 38.1

Practices in the health sector constitute potential risks: Blood safety, safe injection and waste

management practices are potential barriers in attempts to prevent the transmission of HIV/

AIDS. Although practices in Guyana tend to comply with safe practices, there are still areas for

strengthening. For example, a recent survey showed that:

■ Written procedures for PEP were found in only 14% of surveyed sites. ■ PEP prophylactic drugs were available in only 8 of the 39 surveyed sites ■ Needle stick injuries were reported by 21% of health care providers, but these were not re-

ported and documented ■ Only 16% of the surveyed sites had a formal ledger for the documentation of these injuries ■ Safety boxes are not routinely available

2.2_THE IMPACT OF HIV/AIDS

Socio-economic impact

The potential socio-economic impact of HIV/AIDS has already manifested itself in several

African countries where HIV prevalence rates are high. The potential that the socio-economic

impacts of HIV/AIDS seen in countries like Botswana, Swaziland, South Africa, Kenya etc. can

also be seen in Guyana is very real since Guyana is a country where:

■ HIV prevalence is already relatively high (2.5%) ■ Poverty rate of approximately 35% is significant

32]

Guyana National HIV/AIDS Strategic Plan 2007-2011

■ Migration restricts the pool of professional and skilled personnel eg A recent USAID study

estimated that 85% of qualified Guyanese migrate annually ■ High vacancy rate (greater than 40%) exists in the public sector ■ The economy is still largely dependent on labour-intensive industries such as agriculture, min-

ing and forestry which, as seen in African countries, are particularly vulnerable to prolong and

repeated periods of absenteeism due to chronic illness, disability and death due to HIV/AIDS.

In addition, the situation can be worsened as carers stay home to look after ill relatives suffer-

ing from HIV/AIDS.

The mortality pattern in Guyana clearly demonstrates that the burden is greatest in the 20-45

year age group. This is the economically active group in the country, which is expected to make

significant contributions to the state economy and support for the dependent population.

The BSS study clearly demonstrates that whilst knowledge is high amongst all professional

groups in the armed forces, teachers etc, little behaviour change has resulted. Whilst the preva-

lence of HIV/AIDS is not known in these groups, the lack of behaviour change and expressed

risky behaviour amongst these groups in an environment where the mortality is high in the

economically active age group clearly demonstrates the impact that HIV/AIDS can have in

Guyana.

The social burden from HIV/AIDS is already present. A study addressing the needs of orphans

and vulnerable children supported by UNICEF conducted in 2004 estimated that there are at

least 7,000 orphans and vulnerable children in Guyana. This number does not necessarily relate

only to children who are orphaned as a result of HIV/AIDS but due to other reasons. It will be

expected that if the epidemic is not controlled, the number will significantly increase as more

children become orphaned by HIV/AIDS or they become more vulnerable as parents who are

ill from HIV/AIDS become increasingly unable to support their children. The study clearly

demonstrates that of the children studied, many are in urgent need of social support as they

are looked after by relatives who are unable to provide the care which is needed to give these

children an opportunity in life. Establishment of mechanisms to address these issues pose a

significant burden on the social services support systems.

The costs of providing social safety nets to vulnerable groups, loss of economy and the costs of

provision of health services will be significant. Thus, unless the epidemic in Guyana is reversed,

morbidity and mortality associated with HIV/AIDS would significantly impact on:

■ The Economy: This scenario has not yet manifested itself in Guyana. But it has been seen in

several African countries and the potential of this scenario becoming manifested in Guyana

is very real. HIV/AIDS is the leading cause of death in working age people (15 to 44 years)

already in Guyana. Its effects are devastating, leading to increasing poverty, as breadwinners

die leaving their families struggling to make ends meet and many children parentless. The end

result is that the economy suffered from diminishing productivity. ■ National Demography: Countries with high HIV prevalence and deaths due to HIV/AIDS,

especially among young people are likely to suffer losses in life-expectancy which in turns

affects population growth. The overall structure (population pyramid), is shifted towards the

very young and the old. Such shifts have become dramatic in several African countries and has

already began to manifest it self in Guyana.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[33

■ Health: The National Health System, in countries with high HIV prevalence face signifi-

cant financial, infrastructure and human resource challenges in their HIV/AIDS responses.

Countries have been forced to shift resources to meet specific HIV/AIDS response needs.

This has manifested itself already and although Guyana has benefited from finical assistance

by partners, the human resources and infrastructural needs are becoming severe constraints as

both have began to be diverted away from other health problems to HIV/AIDS. ■ Orphans and vulnerable children: Already Guyana has seen an increase in the number of

children categorized as OVC because of the direct impact of HIV/AIDS.

The Government of Guyana has long recognized the potential negative impact of HIV/AIDS

and it is in this context that Guyana’s Poverty Reduction Strategy Paper (PRSP), endorsed by

the World Bank (WB) and the International Monetary Fund (IMF), identified HIV/AIDS as

a priority PRSP response.

2.3_DETERMINANTS AND DYNAMICS OF THE EPIDEMIC

Amongst the issues affecting the spread of HIV/AIDS in Guyana are stigma and discrimination,

poverty, risky behaviour, gender roles and relations, cultural and social norms and differences

among different generations. Stigma and discrimination play a significant role in driving the

epidemic underground in certain marginalised sub-groups such as MSMs, prison inmates and

CSWs. Many male-female relationships are still male dominated leaving women and girls in a

weaker position when it comes to determining their sexual relations, thus making them more vul-

nerable to HIV infection. In order to survive, poor and marginalised groups sometimes indulge in

risk-taking behaviours which also make them more susceptible to HIV infection. Amongst these

groups are the indigenous peoples who, while they live in largely isolated rural communities, are

amongst the poorest and do not easily access services. In addition, as the economy continues to

grow and work in the hinterland develops, travel and communication will create opportunities for

the spread of the epidemic if interventions and strategies are not put in place.

Determinants: The various significant determinants can be grouped as follows:

1. Behavioural

■ MULTIPLE SEX PARTNERS: The BSS (2004/2005) demonstrated clearly that the practice of

multiple sex partners in Guyana is significant and this clearly establishes a major risk for

HIV/AIDS. ■ INCONSISTENT USE OF CONDOMS: The 2004/2005 BSS showed that even though there is

high knowledge about the usefulness of condoms in reducing the risk for HIV/AIDS large

numbers of persons did not comply with advice to use condoms in risky situations. ■ SEX WITH CSWS: The 2004 surveillance among CSW demonstrated that the prevalence rate

for HIV among CSWs remain high (>25%). The BSS shows continued practice of sex with

CSWs and non-use of condoms. ■ SUBSTANCE ABUSE AND HIV (ALCOHOL AND GANJA): Thus far, this has not been a strong

determinant in Guyana. But there is growing risk in the Guyana context with excessive us of

alcohol and increasing concerns about substance abuse with ganja and cocaine.

6 World Bank HIV/AIDS Prevention & Control Project appraisal document for the Republic of Guyana, March 2004.

34]

Guyana National HIV/AIDS Strategic Plan 2007-2011

■ LACK OF PERCEPTION OF PERSONAL RISK: The BSS and the AIS both showed that Guya-

nese young people still have a perception of low risk and thus places themselves in harms way. ■ INCONSISTENCY BETWEEN KNOWLEDGE AND BEHAVIOUR MODIFICATION CHANGE: The

BSS and the AIS show that while public awareness programs have led to relatively high knowl-

edge about HIV and its transmission, this knowledge has not resulted in behaviour change. ■ MYTHS ON TRANSMISSION: There is still significant level of misinformation pertaining to

HIV transmission. For example, almost 25% of respondents in the BSS believe that HIV

could be transmitted by mosquitoes. ■ DISCUSSION OF SEX IS STILL TABOO: There needs to be greater openness in discussing sub-

jects around sex. Much of the discussion about sex among young people occurs in ad hoc and

uninformed settings.

2. Economic

■ INADEQUATE ECONOMIC GROWTH: Guyana has a GDP of approximately $US900 per capita.

While this represents almost a tripling of the GDP since 1990, Guyana remains as one of the

poorest countries in the Americas. ■ UNEMPLOYMENT AND UNDEREMPLOYMENT: Employment opportunities are limited still,

even though significant improvements have been made in employment for young people. ■ RURAL/URBAN MIGRATION: Because of several factors, including access to higher education

and access to certain kinds of employment, there is a continued growth of migration from

rural to urban settings. ■ MOBILE POPULATION IN SEARCH OF ECONOMIC OPPORTUNITIES (MINERS, LOGGERS,

TRUCK DRIVERS ETC.): There has been impressive growth in the mining and forestry in-

dustries. This has resulted in increased movement of people to the hinterland and within the

hinterland. ■ INCREASE IN CROSS BORDER TRAVEL, AND INTERNATIONAL TRAVEL: Guyana tourism indus-

try has grown, but there has also been increased international travel into and out of Guyana. In

addition, movement across the borders with Brazil, Suriname and Venezuela has intensified.

3. Tourism

■ PROSTITUTION: With an increase of people from other countries supporting the service in-

dustries in Guyana, CSWs have found a large market for their services.

4. Social and cultural

■ DISCRIMINATION AND STIGMATIZATION: This is a major barrier in the universal access to

prevention, care and treatment

5. Gender

■ Inequalities in male/female relationship ■ Trans generational gaps (sugar daddy syndrome) older men younger women ■ Domestic violence

Guyana National HIV/AIDS Strategic Plan 2007-2011

[35

SECTION

3 RESPONDING TO HIV/AIDS CHALLENGE IN GUYANA: EXPERIENCES AND LESSONS LEARNT

3.1_INSTITUTIONAL STRUCTURES FOR THE RESPONSE

After the first case of HIV/AIDS was diagnosed in 1987, the GOG responded by establish-

ing, within the Ministry of Health a National AIDS Programme in 1989 that comprised of

the GUM Clinic, the National Laboratory for Infectious Disease (NLID), the National Blood

Transfusion Service (NBTS), and the National AIDS Programme Secretariat (NAPS). The

NLID was responsible for carrying out all HIV testing done in the public sector.

A National AIDS Committee (NAC) was also established to make recommendations and advise

the MOH on HIV/AIDS policy advocacy issues, with representatives from other ministries,

NBOs, PLWHA, FBOs, and the private sector. A national AIDS the Regional Advisory Com-

mittees (RAC), were also organised to carry out an HIV/AIDS advisory role at the Regional

Level.

3.2_POLITICAL LEADERSHIP, DEVELOPMENT POLICIES, RESOURCES, MAN-

AGEMENT STURCTURE AND MULTI SECTORIAL

National leadership

Political commitment and leadership in Guyana have grown over the years to the point where

Guyana is a good example of strong political leadership. Initially, the response was led by the

Ministry of Health which has provided and continues to provide invaluable technical advice and

leadership in the HIV/AIDS response. But now leadership can also be seen at the highest level

from the Office of the President through the establishment of the Presidential Commission on

HIV/AIDS.

The National AIDS Committee (NAC), a multi-sectoral body, advises the MOH on all aspects

of the response to HIV/AIDS. The United Nations Theme Group (UNTG) on HIV/AIDS

also provides advice to the PCHA in resource mobilisation, strengthening, institutional capacity,

promoting and applying national policy and coordinating donor support.

In 1998, after a review by the HIV/AIDS/STI surveillance system and the work of the Legal and

Ethical Committee of the National AIDS Programme, a National HIV Policy was developed

and approved by Cabinet and later adopted by Parliament as Government policy. This policy

was revised in 2003 to reflect changes to the NAPS and to allow for the delivery of free care and

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Guyana National HIV/AIDS Strategic Plan 2007-2011

treatment for people living with HIV/AIDS. During that year, Cabinet also approved the NSP

2002-2006 which focused on a more expanded response involving the ministries, NGOs, Faith

Based Organisations (FBOs), the private sector and funding agencies.

Management structure – the presidential commission on HIV/AIDS (PCHA)

In order to strengthen the implementation and coordination of the multi-sectorial response

on HIV/AIDS, the GOG established the PCHA in 2004 under the aegis of the Office of the

President. The commission is chaired by His Excellency, the president of Guyana The composi-

tion of the PCHA include key Ministries, the Attorney General, the chair of the United Nations

Theme group (UNTG) on HIV/AIDS, and the Head of the Presidential Secretariat.

The GOG response to HIV/AIDS is supported by the activities of numerous NGOs, CBOs,

FBOs, the private sector, and civic organizations. The primary responsibility of the PCHA is

to coordinate, oversee, and support the national response to HIV/AIDS. Key functions of the

PCHA include the following:

■ Supporting the implementation of the National Strategic Plan; ■ Mobilizing multi-sector support for the national response; ■ Coordinating, preparing and assisting in the implementation of the line ministries’ work pro-

gram; ■ Advising the Cabinet on HIV/AIDS policies and strategies; ■ Mobilizing resources (national and international) for HIV/AIDS programming; ■ Presenting annual and quarterly reports on the progress of the national response;

The PCHA is intended to meet on a quarterly, wherein each Ministry is required to present on

key HIV/AIDS-related activities. The PCHA is to issue a report to the public annually.

The Multi-Sector Approach

The Ministry of Health has a pivotal role to play in the comprehensive response to HIV/AIDS.

But the implementation of a multi-sector approach is critical in the fight against HIV/AIDS.

All Government Ministries and agencies must become involved, with each sector taking re-

sponsibility for some aspects of the response, using their own resources. But the response must

also involve sectors outside of Government, including businesses, civil society organizations

(including FBOs, CBOs and NGOs), communities, PLWHA, those affected by HIV/AIDS.

The HIV/AIDS National Strategy 2007-2011 seeks to tap the comparative advantages of each

partner so that Guyana can truly mount a comprehensive and effective response against HIV/

AIDS.

Guyana’s National Response has always embraced the multi-sector approach in the fight against

HIV/AIDS. However, the previous HIV/AIDS National Strategies have always been mainly

formulated as a National Health Response. The National HIV/AIDS Strategy 2007-2011 is

different from the previous strategies in that it is designed as a comprehensive multi-sector

response and is intended to guide all Government Ministries and Agencies, International Agen-

cies and partners and civil society in designing and implementing programs as part of the na-

tional response in the fight against HIV/AIDS.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[37

The Guyana Government joined other governments from around the world in 2001 in the Dec-

laration of Commitment at United Nations General Assembly Special Session on HIV/AIDS

and agreed “to ensure the development and implementation of a multi-sectoral national strategies

and financing plans for combating HIV/AIDs”.

The Commonwealth Ministers of Health at their meeting in New Zealand in 2001 and the

Commonwealth Heads of Government in the Coolum Declaration in 2002 further committed

to these principles. A Commonwealth Think Tank Meeting in London in 2001 defined a multi-

sector approach as follows:

A multi-sectoral response means involving all sectors of society – governments, business,

civil society organizations, communities and people living with HIV/AIDS, at all levels

– pan-Commonwealth, national and community – in addressing the causes and impact of

the HIV/AIDS pandemic. Such a response requires action to engender political will, leader-

ship and coordination, to develop and sustain new partnerships and ways of working, and

strengthen the capacity of all sectors to make an effective contribution.

Some Guiding Principles for the Multi-Sector Response:

■ A comprehensive and effective response demands leadership and coordination by the Govern-

ment of Guyana in fostering a supportive environment for a multi-sector response, providing

a framework for planning and implementing actions by all sectors. ■ The response must be linked to Guyana’s international commitments, such as the MDGs and

UNGASS 2001. ■ The response must take cognizance of the direct and indirect causes of the HIV/AIDS epi-

demic. The response must consider efforts at behaviour change, but must also address the

vulnerability factors such as fear, denial, stigma and discrimination, gender equality and power

differentials, poverty and livelihood insecurity, internal migration for employment purposes,

social-cultural norms, values and practices, and the national legislative and policy environ-

ment. ■ It is imperative that there be a linkage of HIV/AIDS response to Guyana’s PRSP. ■ People living with HIV/AIDS (PLWHA) are central to the overall response, they need to be

empowered to enable them to take effective action themselves and with others. ■ Society at large needs to be mobilized to break the silence about HIV/AIDS, reduce discrimi-

nation and stigma, protect human rights of PLWHA, provide effective programs to prevent,

treat, care for and mitigate the impact of HIV/AIDS, and mobilize and make available re-

sources for civil society organizations engaged in prevention and care. ■ Recognizes the special needs of adolescents and young people, especially girls. ■ Recognizes the special needs of OVC. ■ Recognizes the special needs of other vulnerable and disadvantaged groups, such as women,

those living in poverty, street children, the disabled, migrants, sex workers, prisoners, men who

have sex with men. ■ Ensures 100% access to PMTCT. ■ Ensures that the needs of those caring for PLWHA are taken into account. ■ Empower communities to take effective action themselves and in collaboration with others to

prevent HIV transmission and to improve the quality of life of PLWHA.

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Guyana National HIV/AIDS Strategic Plan 2007-2011

■ Facilitate partnerships among Government Ministries and agencies (local and national), in-

ternational partners, civil society, FBOs and the private sector. ■ Expand efforts and improve access to programs for prevention, treatment and care, including

provision of testing and drugs, not only for HIV/AIDS, but also for TB and STIs. ■ Mobilize and train members of the community, FBOs, CBOs, NGOs and the private sector

to provide complementary services to add to those provided by health care providers in coun-

seling and testing and in general awareness programs for HIV/AIDS, TB and STIs.

FRAMEWORK FOR GUYANA’S MULTI-SECTOR RESPONSE

GOVERNMENT INTERNATIONAL PARTNERS

BUSINESS CIVIL SOCIETY

Actors • President • Ministers • MPs • Other Political

Leaders • Mayors and

Municipalities • Local Govern-

ment Leaders • Civil Servants

• UNDP • UNAIDS • PAHO/WHO • UNICEF • UNFPA • UNDCP • UNESCO • ILO • USAID • CDC • PEPFAR • Global Fund • World Bank • CIDA • EU • Red Cross • PANCAP

• Chief Executives • Managing

Directors • Boards of

Directors

• University of Guyana

• PLWHA • FBOs • CBOs • NGOs • Trade Union

Leaders • Professional

org • Women and

Youth Leaders • Vulnerable

groups

Sectors • Health • Education • Labor and

social security • Finance • Water and

Housing • Local Govern-

ment • Home Affairs • Defense • Youth, Sports

and Culture • Agriculture • Tourism • Gender and

Children

• Health • Education • Donor/Financing • Service

• GUYSUCO • Rice • Bauxite • Mining • Forestry • Beverage • Banking • Insurance • Construction • Human

Resources • Manufacturing • Service Industry • Retailing

• Charitable Org.

• Professional Bodies

• Religious Org. • Cultural org • Service • Community • Media • Prominent

personalities

Resources • Political will • Coordination • Mandates • Human

Resources • Physical infra • Technology • Funds

• Clout • Human Resources • Physical infra • Technology • Funds

• Human Resources

• Physical infra • Technology • Funds

• Human resources, families, friends

• Moral suasion • Volunteers

Guyana National HIV/AIDS Strategic Plan 2007-2011

[39

3.3_FINANCING THE RESPONSE TO HIV/AIDS IN GUYANA

Over the last two years Guyana has been successful in mobilising substantial external resources

to fund their 2002 – 2006 National Strategic Plan. However, even though the country has been

able to scale up the response certain gaps still remain in terms of human and technical capacity.

This will affect the ability to operationalized programme activities. A challenge that presents

itself is the number of donors who are now part of the response to HIV/AIDS and the co-ordi-

nation that that requires in order guaranteeing the optimum use of resources. It is crucial that the

country develops the capacity to harmonise and align its national strategic plan with the donors’

programme areas. Detailed annual operational plans translated from the NSP must be developed

to improve donor and partner alignment, coordination and harmonisation.

The international community that has placed the GOG in a powerful position to confront HIV

includes multilateral and bilateral organizations.

PARTNER MATRIX

DONOR/PARTNER MAJOR AREA OF ASSISTANCE ESTIMATED FUNDING

UNAIDS Coordinate HIV/AIDS activities of the UN Theme Group; strengthen capacity to UNGASS reporting

Ongoing

UNDP Limited activities; policy development Ongoing

UNICEF Strengthen coordination and M&E of PMTCT services; support knowledge of women, children and health care workers; support care treatment and support for HIV positive children; youth friendly health services

$1.5 (est) (2006-10)

PAHO/WHO Chair UNAIDS Theme Group; technical assistance for HIV/AIDS prevention, TB, and malaria control; small grants scheme management; surveillance and laboratory support

Ongoing

CIDA HIV/AIDS prevention; communicable disease con- trol; public health management system; stigma and discrimination; TB prevention and malaria

CN$5 mil (2003-07)

EU Strengthen national capacity to respond to HIV/ AIDS

Limited

Work Bank Grant for HIV/AIDS program; support institutional capacity strengthening; monitoring, evaluation and research

US$10 mil (2004-08)

UNFPA-OPEC Fund Caribbean-Central America project HIV prevention among youth as a part of adolescent health program

US$450,000 (2004-08)

GFATM Multifaceted support for HIV/AIDS prevention, treatment, care and support; training; HMIS; up- grade laboratory capacity; strengthen surveillance system; quality care for persons living with HIV/ AIDS; expand care and treatment; reduce stigma and discrimination; condom social marketing

US$27.2 mil (2004-08)

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Guyana National HIV/AIDS Strategic Plan 2007-2011

PARTNER MATRIX

DONOR/PARTNER MAJOR AREA OF ASSISTANCE ESTIMATED FUNDING

IDB Regional Support for HIV/AIDS US$6.7 mil (2004-08)

JICA Small Grant for HIV/AIDS Limited

GATC HIV/AIDS project targeting commercial sex work- ers, including condom social marketing campaign

Limited

The Emergency Plan (US)

Coordinated, comprehensive HIV/AIDS support for care and treatment, prevention, and laboratory sup- port. Main partners are CDC and USAID.

US$34 mil (2004-08)

3.4_BUILDING A COMPREHENSIVE PREVENTION, CARE AND TREATMENT

PROGRAMME

Guyana was one of the first developing countries to announce universal care and treatment for

people living with HIV/AIDS. The programme started in December 2001 with the MOH

providing drugs manufactured in Guyana. The programme aims to combine the synergies of

prevention, care, treatment and support on a continuum combining PMTCT, care and treat-

ment, a focus on orphans and vulnerable children, behaviour change communication and sup-

port counselling. Through the “Me to You: Reach One Save One Campaign” each Guyanese is

encouraged to get tested to know their status. Home-based and palliative care and the involve-

ment of NGOs, CBOs and FBOs to promote the reduction of stigma and discrimination in the

community are also part of the initiative.

In the mid-1990’s the MOH adopted the syndromic approach for the management of STIs.

Since then a number of interventions has occurred to strengthen the programme. The TB pro-

grammes have also been enhanced where all TB patients are now also offered HIV testing.

With continued political commitment and support GOG will strive to provide the following in

their care and treatment programme:

1_Increasing access to services to diagnose and manage STIs.

2_Strengthening services to diagnose and treat HIV/AIDS and related opportunistic and con-

current infection such as TB.

3_Increasing access to antiretroviral treatment and to other advanced HIV related treatments.

4_Providing a continuum of care from home to health facility, supported by a system of client

referral (e.g to nutritional support, psychosocial support and palliative care)7.

Summary of Achievements

■ The establishment of the PCHA demonstrates the Government’s strong political support and

leadership to HIV/AIDS. ■ A multi-sectoral response is being achieved but the coordinating structure needs strengthen-

ing in order to become operational.

7 WHO, Global Health- Sector Strategy for HIV/AIDS, Providing a Framework for Partnership and Action 2003-2007.

Continued from p39

Guyana National HIV/AIDS Strategic Plan 2007-2011

[41

■ External and internal resources have been mobilized to support the implementation of the

National HIV/AIDS response but the Presidential Commission and its Secretariat must en-

sure that the optimal use is made of these resources to avoid duplication. ■ The PMTCT Programme has been expanded to new Regions and the HIV prevalence rate

has declined from 7% prior to 2001 among the antenatal population to 2.4% in 2004. ■ The VCT services have been expanded into other Regions. ■ Expansion of care and treatment to seven government and two private site. HIV treatment is

available nationally and almost 1,000 persons are receiving ARV treatment. ■ The TB programme has been enhanced where by all TB patients are offered HIV testing and

all HIV clients are offered TB testing. ■ There has been greater involvement of NGOs, CBOs and FBOs over the last two years in the

delivery of HIV/AIDS prevention and care activities. ■ First Behavioural Surveillance Surveys and AIDS Indicator Survey have been completed.

3.5_CHALLENGES FOR THE FUTURE

■ Limited trained/qualified staff to fill the positions still poses a problem to providing and

implementing HIV/AIDS programmes and services. As Guyana’s economy faces more chal-

lenges many qualified professionals have migrated to seek employment and better wages. This

“brain drain” causes significant human resource constraints for the GOG and undermines

ability to provide quality health, education and social services and impedes government ad-

ministration and management. In some instances, some of the more qualified personnel have

been recruited by donors. ■ Insufficient training opportunities – no structured training, inadequate continuing education

(internal and external). Although training has been provided in the past from various sources,

there is a high turn over of trained personnel. Trained staff is always seek better opportunities

elsewhere, leaving a constant void in services.8 ■ Donor environment is very complex, with many reporting procedures and requirements.-

Many of these agencies have different administrative requirements for the approval and the

monitoring and approval of funds. This also complicates the delivery of activities for persons

working in the field, in the clinics, RAC, NGOs, CBOs, and other sectors. They also conduct

multiple planning and assessment missions, in most cases calling on the same in-country staff

members for assistance in the process. ■ Work plans of the Donor agencies overlap in some places and this could lead to duplication of

efforts and an inefficient use of resources. If efforts are not made to harmonise and streamline

the workplans it could affect the rate at which the response can be scaled up, and HIV/AIDS

activities and services implemented. ■ Creating an environment free from stigma and discrimination ■ Weakening of other health sector responses ■ Psychosocial counselling requirements for PLWHA and those affected ■ Long term sustainability of the National HIV/AIDS Response Guyana has already integrated

HIV/AIDS in its PRSP as an element of sustainable development in the interest of scaling up

its response. Guyana has also taken the initiative to accelerate implementation by building a

comprehensive multi-sectoral programme that combines prevention, care and treatment. To

8 CHRC- Evaluation of the National HIV/AIDS Programme of Guyana.

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Guyana National HIV/AIDS Strategic Plan 2007-2011

sustain this approach, Guyana has adopted the UNAIDS sustainable strategies that emphasise

sufficient resources to finance the response and where these resources are used effectively to

reverse the spread and impact of AIDS9.

To remove the bottlenecks that can develop in scaling up the response the following areas must

be addressed: empowering inclusive national leadership and ownership; building human capacity

harmonising and aligning the workplans of the donor agencies; strengthening the multi-sectoral

response; and ensuring proper accountability and oversight.

9 UNAIDS, Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries, Discussion Paper,‘ Making the Money Work’ The Three Ones in Action London, United Kingdom, 9 March 2005.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[43

SECTION

4 STRATEGIC FRAMEWORK 4.1_GENERAL REVIEW OF PREVIOUS PLANS 1999-2001, 2002-2006

The CHRC assessment report stated10 that the successes of the implementation of the 1999-

2001 Medium Term Plan, as identified in its successor 2002-2006 Plan, include the following:

increased awareness of HIV/AIDS through information, education and communication (IEC);

increased availability of voluntary counselling and testing (VCT) services; provision of safe

blood through careful screening of donors; increased availability of condoms and condom social

marketing for high risk groups; provision of treatment for sexually transmitted infections (STIs)

through syndromic management; provision of treatment for opportunistic infections; limited

provision of antiretroviral (ARV ) therapy; greater involvement of NGOs and private enterprises;

and introduction of the prevention of mother to child transmission (PMTCT) programme.

The assessment went on to outline the following limitations: insufficient human, technical and

financial resources; inadequate emphasis on coordination and management of programme by

the NAPS which focused mainly on implementation; lack of involvement of other sectors—the

Ministry of Labour, and the Ministry of Education were the only other two entities from the

public sector with some involvement in the response; stigmatisation and discrimination of HIV

infected persons; and limited geographical reach.

4.2_THE STRATEGIC PLANNING PROCESS

This Plan is a product of two distinct steps that were inextricably linked but separated in execu-

tion.

The first step

In 2004, a number of participatory consultations involving a wide cross section of stakeholders

involving NGOs, CBOs, FBOs, representatives from other government and private sectors, oc-

curred during the development of certain key HIV/AIDS funding proposals. The information

gathered during the formulation of these proposals is still relevant and provides insight into the

achievements and challenges faced by the National AIDS Programme.

In 2005, the MOH in consultation with other partners, requested the Pan American Health

Organization (PAHO/WHO) to coordinate the Strategic Planning Process. They took the lead

in coordinating a series of small consultations on various components within the HIV/AIDS

Programme between April and August of 2005. These consultations were built on the earlier

consultations that occurred in 2004 and covered the following areas: care and treatment, home

based care (HBC), prevention of mother to child transmission (PMTCT), voluntary counselling

10 CHRC Assessment Report of the National HIV/AIDS Programme of Guyana, 2004, prepared under “Strengthen- ing the Intuitional Response to HIV/AIDS/STIs in the Caribbean” Project managed by the Caribbean Com- munity and Common Market (CARICOM) Funded by the European Union (EU).

44]

Guyana National HIV/AIDS Strategic Plan 2007-2011

and testing (VCT), behaviour change communication, orphans and vulnerable children (OVC)

and laboratory diagnosis and blood safety. Key stakeholders from various sectors were invited to

participate in these consultations and asked to provide feedback on previous and current condi-

tions, conduct a SWOT analysis, a gap analysis, and outline some objectives and next steps.

The second step involved:

■ An in-depth review of the National HIV/AIDS Strategic Plan 2002-2006 that outlines the

overall strategic objective, the programme components and the activities ■ A review of national reports, the epidemiological data, the policies, programmes and inter-

ventions currently being implemented by the National AIDS Programme Secretariat and

Government Partners. ■ A review of the findings of the assessment of the National HIV/AIDS Programme of Guyana

that was conducted by the Caribbean Health Research Council (CHRC) in 2004. This review

was conducted by assessing data from written documentation, analysis of data from quantita-

tive indicators in key programme areas that were available at the time and interviews with

selected key informants who were knowledgeable with various components of the National

Response. ■ A review of international project agreements that outlined programme goals, objectives and

targets for the next four years to which the country had already made a commitment, such as,

the World Bank Project Appraisal Document 2004-2008, The Global Funds Project Docu-

ment-Guyana 2004-2008, and the President’s Emergency Plan for AIDS Relief 2004-2008

Strategy. The formulation of these documents involved a process of consultation with stake-

holders in Guyana during 2004. ■ A review of reports on selected programme areas such as AN ASSESSMENT: The Situation

of Children made Vulnerable or Orphaned in Guyana, Ministry of Labour, Human Services

and Social Security/ UNICEF, October 2004; The National Behaviour Change Communica-

tion Strategy of Guyana USAID/GHARP, 4th August, 2005; ■ A review of the reports from the consultations/workshops conducted in step 1; ■ Consultations with key individuals either by telephone or in person; ■ Presentation of the draft at a National Consensus meeting for comments and feedback;

The document is also developed in accordance with the principles outlined by WHO/UNAIDS

“3 by 5” Initiative and the “Three Ones” as guiding principles for improving the coordination of

the country’s response. This Plan falls under the First ‘One’ Principle: One agreed AIDS action

framework that provides the basis for coordinating the work of all partners.

4.3_GUIDING PRINCIPLES

The successful implementation on the plan is to be guided by a set of principles:

■ Ensuring strong political commitment at the highest level; ■ Continuing to strengthen and expand the coordinated and mulit-sectoral approach recognis-

ing HIV/AIDS as a development, society, education, security, economic, cultural issues, in

addition to being a health issue;

Guyana National HIV/AIDS Strategic Plan 2007-2011

[45

■ Mainstreaming HIV/AIDS into al government programmes to generate an effective re-

sponse; ■ Continuing to build the political support and commitment incorporating the line ministries,

NGOs, CBOs, FBOs and the private sector; ■ Empowering PLWHA to become involved in planning and implementing the response; ■ Creating an enabling environment for PLWHAs and other vulnerable groups, free from stig-

ma and discrimination; ■ Promoting respect for human rights and ensuring confidentiality at all levels; ■ Strengthening and accelerating efforts to prevent new infections, including all aspects of be-

haviour changes, safe sex and blood injections safety as well as vertical transmission; ■ Expanding efforts in prevention, care and support for orphans and vulnerable children; ■ Strengthening and expanding workplace, school and out-of-school education and common

social marketing programmes; ■ Expanding access to an availability of care and treatment services for all people living with

HIV/AIDS in Guyana.

4.4_PRIORITY OBJECTIVES AND STRATEGIES

The objectives and strategies of the NSP address the challenges faced by Guyana in controlling

the epidemic. They reflect Government’s policy, as previously stated and international commit-

ments such as the MDGs and the UNGASS Commitments.

As stated, the overall goal of the NSP 2007 -2011 is:

“To reduce the social and economic impact of HIV and AIDS on individuals and communi-

ties, and ultimately the development of the country”.

The strategic objective is to reduce the spread of HIV and increase the quality of life of persons

living with HIV/AIDS.

This will be achieved through four broad strategic priorities:

1_Strengthening the national capacity to implement and coordinate a multi-sectoral approach

to HIV/AIDS in Guyana.

2_Ensure all citizens, especially those most vulnerable, have access to information, preventative

services such as counselling and testing and live free of stigma and discrimination in order to

reduce transmission of HIV/AIDS.

3_Ensuring access to care and treatment for persons living with HIV/AIDS.

4_Strengthening of the surveillance system and monitoring and evaluation mechanisms to pro.

vide timely information for project management.

The specific objectives for each priority area are as follows:

1_Strengthening the national capacity to implement and coordinate a multi-sectroal ap-

proach to HIV/AIDS in Guyana

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Guyana National HIV/AIDS Strategic Plan 2007-2011

■ Strengthen institutional capacity to effectively coordinate the multi-sectoral response

through implementation of the Three Ones Principles (One Coordinating Body, One Na-

tional Strategy and One National Monitoring and Evaluation plan). ■ Strengthen human capacity to effectively coordinate and manage the mulit-sectoral re-

sponse. ■ Strengthen regional capacity to implement and manages HIV/AIDS interventions

2_Ensure all citizens, especially those most vulnerable, have access to information, preventa-

tive services such as counselling and testing and live free of stigma and discrimination in

order to reduce transmission of HIV. ■ Decrease misconceptions and discriminatory behaviours and increase knowledge and access

to prevention services. ■ Reduce sexual transmission of HIV infection with a focus on most at-risk populations and

their partners through delayed sexual debut, reduced partner change and number, increase

condom use. ■ Ensure universal access to prevention of mother-to-child-transmission services. ■ Reduce the risk for transmission in medical settings. ■ Reducing the socio-economic impact of HIV/AIDS on children and increase protection for

OVCs. ■ Ensure universal access to counselling and testing services.

3_Ensuring access to care and treatment for all persons living with HIV/AIDS. ■ Ensure universal access to quality diagnostic, care and treatment and support in an enabling

environment for all persons infected with HIV/AIDS, including access to ARVs and qual-

ity home based care services. ■ Expand comprehensive care for opportunistic infections, especially with greater links with

the TB control and monitoring. ■ Design and implement training programmes for HIV/AIDS treatment care and support for

services providers. ■ Ensure continued access to ARVs and other treatments supplied through improved pro-

curement and commodities management. ■ Established national public health reference laboratory.

4_Strengthening of the surveillance system and monitoring and evaluation mechanisms to

provide timely information for project management. ■ Strengthening of the HIV/AIDS surveillance system and the national health information

system. ■ Ensure one national system for monitoring and evaluating the response to HIV/AIDS. ■ Improve strategic information on HIV/AIDS by strengthening local capacity and identify-

ing priority studies and surveys.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[47

PRIORITY SPECIFIC OBJECTIVES

1_STRENGTHENING THE NATIONAL CAPACITY TO IMPLEMENT A COORDINATED, MULTI-SECTORIAL RESOURCE

1. Strengthen institutional capacity to effectively coordinate the multi-sectoral response through implementation of the Three Ones Principles

2. Strengthen human capacity to effectively coordinate and manage the multi-sectoral response

3. Strengthen regional capacity to implement and manage HIV/AIDS interventions

2_REDUCING RISK VULNERABILITY TO HIV INFECTION

1. Decrease misconceptions and discriminatory behaviors and increase knowledge and access to prevention services

2. Reduce sexual transmission of HIV infection with a focus on most at-risk populations and their partners through delayed sexual debut, reduced partner change and number, increase condom use, and promotion of treatment adherence

3. Reduce mother-to-child transmission of HIV infection 4. Ensure universal access to counseling and testing services 5. Reduce the risk for transmission in medical settings 6. Reducing the socio-economic impact of HIV/AIDS and increase

protection for OVCs

3_CLINICAL AND DIAGNOSTIC MANAGEMENT AND ACCESS TO CARE, TREATMENT AND SUPPORT

1. Increase access to diagnostic management and comprehensive treatment, care, and support in an enabling environment

2. Strengthen the service delivery system to provide uninterrupted supply of medications and commodities (Comprehensive care includes the scaled up coverage and access to care, provision of antiretroviral drugs, needed psychosocial care for those infected and affected, the option of home based care and treatment for OIs including TB and STIs.)

4_STRATEGIC INFORMATION

1. Increase local capacity to design and implement surveillance, monitoring and evaluation, special studies, surveys and research on HIV/AIDS according to national and international guidelines.

2. Strengthen capacity at the national and regional levels for the collection and use of data for decision making, planning, implementing, monitoring, and evaluating the local response to HIV/AIDS

48]

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P R

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T H

E N

IN G

T H

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A T

IO N

A L

C A

P A

C IT

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O I

M P

L E

M E

N T

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IN A

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(S )

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H A

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S e

m po

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to c

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e G

uy an

a’ s

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io na

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IV /A

ID S

m ul

ti- se

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es po

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be r

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ee tin

g s

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C H

A a

re po

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b y

H S

D U

a nd

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P S

1 .1

.1 S

tr en

g th

en t

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ad er

sh ip

a nd

og ra

m m

e m

an ag

em en

t ca

pa ci

of t

he P

C H

A , H

S D

U a

nd N

A P

M O

H /H

S D

U /W

B /G

F /U

N A

ID S

/P A

H O

D ev

el op

/U pd

at ed

T O

R s

fo r

P C

H A

, H

S D

U , N

A P

S 1

.1 .2

D efi

ne f

un ct

io ns

, r ol

es , r

es po

ns i-

bi lit

ie s

an d

re po

rt in

g r

el at

io ns

hi ps

tw ee

n H

S D

U , N

A P

S a

nd P

C H

A ,

as w

el l a

s H

ea lth

T he

m e

G ro

up /

P ar

tn er

sh ip

F or

M O

H /H

S D

U /W

B /G

F /U

N A

ID S

N um

be r

of N

G O

s re

pr es

en te

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A C

/R A

C s

1 .1

.3 R

ev ie

w /u

pd at

e TO

R s,

a nd

m em

- be

rs hi

p of

t he

N A

C a

nd R

A C

s in

lig

ht o

f th

e sc

al ed

u p

re sp

on se

M O

H /H

S D

U /W

B /G

1 .2

I nt

eg ra

te H

IV /A

ID S

in to

t he

og ra

m m

es a

nd s

er vi

ce s

of fe

re d

ot he

r M

in is

tr ie

N um

be r

an d

pe rc

en t

of li

ne m

in is

tr ie

s w

ith H

IV w

or k

pl an

s an

d bu

dg et

s 1

.2 .1

ro vi

de t

ec hn

ic al

a ss

is ta

nc e

pr og

ra m

m e

m an

ag em

en t

to t

lin e

m in

is tr

ie s

to d

ev el

op t

he ir

an -

nu al

s ec

to ra

l w or

k pl

an s

H S

D U

/W B

/U N

A ID

S /P

E P

FA R

R ep

or ts

f ro

m M

in is

tr y

of A

m er

in di

A ff

ai rs

1 .2

.2 S

up po

rt t

he im

pl em

en ta

tio n

of t

H IV

/A ID

S S

tr at

eg y

fo r

th e

A m

er in

- di

an p

op ul

at io

M in

is tr

y of

A m

er in

di an

A ff

ai rs

/ W

1 .3

H ar

m on

is e

an d

al ig

n re

so ur

ce s

to e

ns ur

e ef

fic ie

nt u

se o

f do

no r

fu nd

in g

D on

or C

oo rd

in at

io n

C om

m itt

ee f

un ct

io n-

in g

1 .3

.1 E

st ab

lis h/

st re

ng th

en m

ec ha

ni sm

s tr

ea m

lin e

th e

al lo

ca tio

n of

so ur

ce s

fr om

t he

d on

or a

g en

ci es

H S

D U

/W B

N um

be r

of r

ep or

ts p

ro du

ce d

1 .3

.2 M

on ito

r an

d ev

al ua

te t

he u

til is

at io

n of

r es

ou rc

es H

S D

U /W

B /G

F /U

N A

ID S

/P A

H O

Guyana National HIV/AIDS Strategic Plan 2007-2011

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C IT

Y T

O I

M P

L E

M E

N T

A C

O O

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IN A

T E

D , M

U LT

I- S

E C

T O

R A

L R

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P O

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P R

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S T

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S L

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D A

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Y A

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S T

R A

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G IC

A R

T N

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(S )

1 .3

H ar

m on

is e

an d

al ig

n re

so ur

ce s

to e

ns ur

e ef

fic ie

nt u

se o

f do

no r

fu nd

in g (

co n tin

u ed

)

N um

be r

of In

te rn

at io

na l p

ar tn

er s

in vo

lv ed

in im

pl em

en tin

g t

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hr ee

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s an

d G

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pl em

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r Th

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ct or

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or kp

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1 .4

.1 P

ro vi

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nc e

w ith

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w or

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in is

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or kp

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.4 .2

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ss is

ta nc

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th e

de ve

lo pm

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d 1

.4 .3

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W B

/P E

P FA

R /G

F /U

N A

ID S

/P A

H O

C on

tin ue

s on

p 5

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C IT

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O I

M P

L E

M E

N T

A C

O O

R D

IN A

T E

D , M

U LT

I- S

E C

T O

R A

L R

E S

P O

N S

B R

O A

D S

T R

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P R

O G

R A

M M

E A

R E

A S

IN D

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D A

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Y A

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(S )

1 .4

I nc

re as

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vo lv

em en

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il so

ci et

y or

g an

is at

io ns

a nd

t he

p riv

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se ct

or in

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s ca

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up r

es po

ns e

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be r

of N

G O

s tr

ai ne

d 1

.4 .5

B ui

ld c

ap ac

iti es

o f

ne w

ly f

or m

N G

O s

to d

ev el

op p

ro po

sa ls

a nd

ce ss

f un

di ng

H S

D U

/U N

A ID

S /U

N D

P /

P E

P FA

1 .5

A dv

oc at

e fo

r a

le g al

a nd

p ol

ic y

en vi

ro nm

en t

th at

p ro

te ct

s th

e rig

ht s

of p

eo pl

e liv

in g w

ith H

IV /A

ID S

a nd

ln er

ab le

g ro

up s

N at

io na

l C om

po si

te P

ol ic

y In

de x

N a-

tio na

l C om

po si

te P

ol ic

y In

de x

1 .5

.1 R

ev is

e ex

is tin

g le

g al

f ra

m ew

or k,

at io

na l H

IV /A

ID S

P ol

ic y

an d

pr ep

ar e

ne w

h ea

lth le

g is

la tio

n to

m ba

t al

l a sp

ec ts

o f

di sc

rim in

a- tio

n re

la tiv

e to

H IV

/A ID

M O

H /M

in is

tr y

of L

eg al

A ff

ai rs

,/ W

B /

P A

N A

C P

/U N

A ID

A m

ou nt

o f

na tio

na l f

un ds

s pe

nt o

n H

IV /A

ID S

1 .5

.2 C

re at

e m

ec ha

ni sm

s to

s tim

ul at

e ad

vo ca

cy b

y in

fo rm

in g s

en io

r de

ci si

on m

ak er

s of

t he

s oc

ia l a

ec on

om ic

im pa

ct o

f H

IV /A

ID S

o n

N at

io na

l D ev

el op

m en

G O

G /W

1 .6

R ev

ie w

t he

N at

io na

l R es

po ns

e to

IV /A

ID S

M id

-t er

m r

ev ie

w r

ep or

t av

ai la

bl e

1 .6

.1 C

on du

ct m

id t

er m

r ev

ie w

o f

th e

N at

io na

l S tr

at eg

ic P

la n

H S

D U

/U N

D P

/U N

A ID

S /P

A H

P ar

tic ip

at or

y re

vi ew

a va

ila bl

e 1

.6 .2

C on

du ct

a G

ov er

nm en

t- le

d pa

rt ic

i- pa

to ry

r ev

ie w

o f

th e

N at

io na

l A ID

R es

po ns

H S

D U

/N A

P S

/U N

A ID

S a

nd a

ll pa

rt ne

C on

tin ue

d fr

om p

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T O

H IV

I N

F E

C T

IO N

: S

tr a

te g

ic O

b je

ct iv

e s

B R

O A

D S

T R

A T

E G

IC P

R O

G R

A M

M E

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

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D A

G E

N C

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N D

S T

R A

T E

G IC

A R

T N

E R

(S )

2 .1

D es

ig n

an d

im pl

em en

t C

om m

un ic

at io

n P

ro g ra

m m

e on

IV /A

ID S

P er

ce nt

ag e

of p

eo pl

e ag

ed 1

5 -4

9 y

ea rs

pr es

si ng

a cc

ep tin

g a

tt itu

de s

to w

ar ds

op le

w ith

H IV

/A ID

2 .1

.1 D

ev el

op a

nd im

pl em

en t

N at

io na

l be

ha vi

ou r

ch an

g e

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te g y

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tig m

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d di

sc rim

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io n

re la

te d

to H

IV /A

ID S

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G /N

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s/ G

FA T M

/ P

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H O

P er

ce nt

ag e

of p

eo pl

e ag

ed 1

5 -2

4 w

co rr

ec tly

id en

tif y

w ay

s of

p re

ve nt

in g

th e

se xu

al t

ra ns

m is

si on

o f

H IV

a nd

w ho

je ct

t w

o m

aj or

m is

co nc

ep tio

ns a

b ou

t H

IV t

ra ns

m is

si on

2 .1

.2 U

se a

va ila

bl e

da ta

t o

de ve

lo p

m as

s m

ed ia

c am

pa ig

n to

e ns

ur e

th at

a ll

m em

be rs

o f

so ci

et y

ha ve

fo rm

at io

n on

p re

ve nt

io n,

c ar

e an

d tr

ea tm

en t

se rv

ic es

G O

G /G

FA T M

/P E

P FA

R /P

A H

2 .1

.3 E

nc ou

ra g e

th e

pa rt

ic ip

at io

n of

N G

O s,

C B

O s

an d

ot he

r pa

rt ne

rs in

t he

d ev

el op

m en

t an

d im

pl em

en ta

tio n

of t

he b

eh av

io ur

an g e

in te

rv en

tio ns

G O

G /P

E P

FA R

/P A

H O

A ve

ra g e

ag e

at fi

rs t

se x

(b y

g en

de r)

2 .1

.4 C

on du

ct a

ss es

sm en

t an

d te

m es

sa g es

t ar

g et

ed t

ow ar

ds g

en er

an d

hi g h

ris k

po pu

la tio

G O

G /P

E P

FA R

/N G

O /P

A H

2 .1

.5 T

ra in

s ta

ff t

o co

nd uc

t he

al th

om ot

io n

ac tiv

iti es

G O

G /P

A H

2 .2

D ev

el op

a nd

im pl

em en

t ta

rg et

be ha

vi ou

r ch

an g e

in te

rv en

tio ns

t o

in cr

ea se

p os

iti ve

s ex

ua l p

ra ct

ic es

d en

co ur

ag e

ea rly

S T I/

H IV

ag no

si s

an d

tr ea

tm en

t am

on g

m os

t vu

ln er

ab le

g ro

up s

2 .2

.1 D

efi ne

a nd

p rio

rit is

e po

pu la

tio ns

t o

be t

ar g et

G O

G /M

O H

/P E

P FA

R /U

N A

ID S

/ U

N F

P A

/P A

H O

C on

tin ue

s on

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H IV

I N

F E

C T

IO N

: S

tr a

te g

ic O

b je

ct iv

e s

B R

O A

D S

T R

A T

E G

IC P

R O

G R

A M

M E

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

S T

R A

T E

G IC

A R

T N

E R

(S )

P er

ce nt

ag e

of p

eo pl

e ag

ed 1

5 -4

ye ar

s re

po rt

in g u

se o

f a

co nd

om d

ur in

la st

s ex

ua l i

nt er

co ur

se w

ith n

on -r

eg ul

pa rt

ne r

2 .2

.2 U

se a

va ila

bl e

da ta

t o

de ve

lo p

ta rg

et ed

b eh

av io

ur c

ha ng

e in

te rv

en tio

ns f

or s

el ec

te d

hi g h

ris k

g ro

up s

M O

H /P

E P

FA R

/U N

A ID

S /U

N F

P A

/ P

A H

2 .2

.3 U

se m

es sa

g es

d es

ig ne

d to

in cr

ea se

e us

e of

V C

T s

er vi

ce s

an d

ea rly

ea tm

en t-

se ek

in g f

or S

T Is

a nd

IV /A

ID S

M O

H /P

E P

FA R

/P A

H O

2 .2

.4 D

ev el

op “

fr ie

nd ly

” se

rv ic

es f

or y

ou th

d m

os t

at r

is k

po pu

la tio

ns M

O H

/U N

IC E

F /U

N F

P A

/P A

H O

/ P

E P

FA R

2 .2

.5 D

ev el

op p

ee r

ed uc

at io

n pr

og ra

m m

es f

or h

ig h

ris k

yo ut

C S

W s

an d

M S

M s

N G

O /P

E P

FA R

/U N

F P

A /P

A H

2 .2

.6 D

ev el

op m

as s

an d

sm al

l m ed

in te

rv en

tio ns

t o

pr om

ot e

th e

us e

of r

is k-

re du

ct io

n se

xu al

h ea

lth

pr ac

tic es

M O

H /L

in e

M in

is tr

y/ P

E P

FA R

2 .3

Im pl

em en

t pr

ev en

tio n

ed uc

at io

n an

d be

ha vi

ou r

ch an

g e

re in

fo rc

em en

t ac

tiv iti

2 .3

.1 Im

pl em

en t

H F

L E

a t

pr im

ar y

an d

se co

nd ar

y le

ve ls

M O

E /U

N IC

E F

/P A

H O

2 .3

.2 D

ev el

op p

ee r

ed uc

at io

n pr

og ra

m m

es f

or y

ou th

O E

/N G

O /M

in is

tr y

of C

ul tu

re /P

E P

FA R

C on

tin ue

d fr

om p

5 1

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T O

H IV

I N

F E

C T

IO N

: S

tr a

te g

ic O

b je

ct iv

e s

B R

O A

D S

T R

A T

E G

IC P

R O

G R

A M

M E

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

S T

R A

T E

G IC

A R

T N

E R

(S )

2 .3

.3 C

on tin

ue t

o im

pl em

en t

th e

A bs

tin en

ce a

nd F

ai th

fu l p

ro g ra

m s

M O

H /F

B O

s/ P

E P

FA R

2 .3

.4 D

ev el

op a

nd im

pl em

en t

se ria

l co

m m

un ic

at io

n pr

og ra

m s

re in

fo rc

w ith

c om

m un

ity -l

ev el

e du

ca tio

M O

H /P

E P

FA R

/P A

H O

2 .4

E xp

an d

co nd

om s

oc ia

l m ar

ke tin

pr og

ra m

m e

P er

ce nt

ag e

of p

eo pl

e ag

ed 1

5 -4

9 y

ea rs

po rt

in g u

se o

f a

co nd

om d

ur in

g t

la st

s ex

ua l i

nt er

co ur

se w

ith a

n on

- re

g ul

ar p

ar tn

2 .4

.1 R

ev ie

w a

nd im

pl em

en t

st ra

te g y

an d

ex pa

nd p

ro g ra

m M

O H

/W B

2 .4

.2 In

cr ea

se t

he n

um be

r of

n on

- tr

ad iti

on al

o ut

le ts

t ar

g et

in g h

ig h

ris k

po pu

la tio

M O

H /P

riv at

e S

ec to

r/ P

E P

FA R

To ta

l n um

be r

of c

on do

m s

di st

rib ut

ed in

st 1

2 m

on th

s 2

.4 .3

D ev

el op

m on

ito rin

g a

nd e

va lu

at io

n pl

an t

o as

se ss

im pa

ct o

f th

e in

te rv

en tio

M O

H /W

2 .5

S ca

le u

p th

e P

M TC

T P

ro g ra

m N

um be

r of

p ub

lic f

ac ili

tie s

th at

o ff

P M

TC T s

er vi

ce s

2 .5

.1 S

tr en

g th

en s

er vi

ce d

el iv

er y

ca pa

ci ty

P M

TC T s

ite s

an d

ex pa

g eo

g ra

ph ic

c ov

er ag

e at

p rim

ar y

ca re

f ac

ili tie

M O

H /P

E P

FA R

/U N

IC E

F /

U N

F P

N um

be r

of p

re g na

nt w

om en

w ho

ce iv

e H

IV c

ou ns

el in

g a

nd t

es tin

g f

P M

TC T

2 .5

.2 S

tr en

g th

en c

om m

un ity

m ob

ili za

tio n

an d

re fe

rr al

n et

w or

ks t

o in

cl ud

e P

M TC

N A

P S

/U N

IC E

C on

tin ue

s on

p 5

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R A

B IL

IT Y

T O

H IV

I N

F E

C T

IO N

: S

tr a

te g

ic O

b je

ct iv

e s

B R

O A

D S

T R

A T

E G

IC P

R O

G R

A M

M E

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

S T

R A

T E

G IC

A R

T N

E R

(S )

N um

be r

of h

ea lth

c ar

e w

or ke

rs t

ra in

in t

he p

ro vi

si on

o f

P M

TC T

2 .5

.3 D

ev el

op s

ta nd

ar di

se d

sy st

em f

m on

ito rin

g a

nd t

ra ck

in g

N A

P S

/U N

IC E

P er

ce nt

o f

ba bi

es b

or n

to H

IV p

os iti

w om

en w

ho a

re t

es te

d be

fo re

a g e

1 8

on th

2 .5

.4 In

cr ea

si ng

t he

in vo

lv em

en t

of N

G O

s an

d C

B O

s in

t he

P M

TC T r

es po

ns e

N A

P S

/U N

IC E

P er

ce nt

ag e

of w

om en

w ho

r ec

ei ve

co m

pl et

e co

ur se

o f

A R

V p

ro ph

yl ax

is a

s pa

rt o

f P

M TC

2 .5

.5 S

tr en

g th

en in

g P

M TC

T s

er vi

de liv

er y

at la

b or

a nd

d el

iv er

y w

ar ds

N A

P S

/U N

IC E

2 .6

R ed

uc e

th e

vu ln

er ab

ili ty

o f

O V

C t

o H

IV /A

ID S

um be

r of

p er

so ns

t ra

in ed

in c

ar in

g f

O V

C s

2 .6

.1 M

ob ili

se a

dd iti

on al

C B

O ’s

N G

O ’s

b ec

om e

in vo

lv ed

in p

ro vi

di ng

pp or

t to

O V

C s

M in

o f

L ab

ou r/

U N

IC E

F /P

E P

FA R

2 .6

.2 E

xp ed

ite a

nd e

na ct

t he

le g is

la tio

n th

at p

ro te

ct s

th e

rig ht

s of

t he

m os

t vu

ln er

ab le

c hi

ld re

n an

d ap

pr ov

e na

tio na

l p ol

ic y

G O

G /U

N IC

E F

/M in

o f

L ab

ou r

P er

ce nt

o f

O V

C s

en ro

lle d

in sc

ho ol

s 2

.6 .3

E nc

ou ra

g e

th e

pa rt

ic ip

at io

n of

k ey

ak eh

ol de

rs f

ro m

a ll

se ct

or s

en su

re t

he p

ro vi

si on

o f

es se

nt ia

l se

rv ic

es , e

du ca

tio n,

h ea

lth c

ar e,

rt h

re g is

tr at

io n

et c.

W B

/U N

IC E

2 .6

.4 In

vo lv

e ch

ild re

n an

d yo

ut h

as p

ar tn

er s

in d

es ig

ni ng

a nd

pl em

en tin

g H

IV /A

ID S

te rv

en tio

U N

IC E

C on

tin ue

d fr

om p

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T O

H IV

I N

F E

C T

IO N

: S

tr a

te g

ic O

b je

ct iv

e s

B R

O A

D S

T R

A T

E G

IC P

R O

G R

A M

M E

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

S T

R A

T E

G IC

A R

T N

E R

(S )

P er

ce nt

o f

O V

C w

ho se

h ou

se ho

re ce

iv ed

f re

e of

c os

t ex

te rn

al s

up po

rt in

rin g f

or t

he c

hi ld

2 .6

.5 S

tr en

g th

en t

he c

ar e

an d

co pi

ca pa

ci tie

s of

f am

ili es

a nd

t he

m m

un ity

N A

P S

/W B

/U N

IC E

2 .7

E xp

an d

th e

V C

T s

er vi

ce s

N um

be r

of p

er so

ns r

ec ei

vi ng

t es

t re

su lts

in la

st t

w el

ve m

on th

s be

tw ee

n ag

es 1

5 -4

2 .7

.1 D

es ig

n an

d im

pl em

en t

op er

at io

na l

st ra

te g y

M O

H /P

E P

FA R

2 .7

.2 I

nc re

as e

av ai

la bi

lit y

to a

g re

at er

op or

tio n

of t

he p

op ul

at io

n, w

ith

a sp

ec ia

l fo

cu s

on s

er vi

ce c

en te

de liv

er in

g c

ar e

to h

ig h

ris k

g ro

up s

N A

P S

/N G

O /P

A H

2 .7

.3 I

nc re

as e

se rv

ic e

up ta

ke t

hr ou

g h

co m

m un

ity m

ob ili

za tio

n N

A P

S /W

B /N

G O

2 .7

.4 Im

pr ov

e Q

C a

nd r

ef er

ra l s

ys te

m N

A P

N um

be r

of in

di vi

du al

s tr

ai ne

d in

t he

ov is

io n

of V

C T a

cc or

di ng

t o

na tio

na l

g ui

de lin

2 .7

.5 C

on tin

ua lly

t ra

in a

nd u

pd at

e sk

ill s

fo r

he al

th c

ar e

pr ov

id er

s an

d la

b or

at or

ia ns

a cc

or di

ng t

o N

at io

na l

G ui

de lin

N A

P S

/C ID

A /P

A P

FA R

/P A

H O

2 .8

R ed

uc e

th e

vu ln

er ab

ili ty

t o

H IV

/ A

ID S

t hr

ou g h

id en

tifi ca

tio n

an d

tr ea

tm en

t of

S T I/

O Is

P er

ce nt

o f

m en

a nd

w om

en w

ith S

T Is

h ea

lth c

en te

rs w

ho a

re a

pp ro

pr ia

te ly

ag no

se d,

t re

at ed

a nd

c ou

ns el

2 .8

.1 In

cr ea

se t

he u

se o

f S

T I/

O I s

er vi

ce s

an d

ea rly

t re

at m

en t-

se ek

in g f

S T Is

a nd

H IV

/A ID

M O

H /C

ID A

/P E

P FA

R /P

A H

N um

be r

of p

er so

ns t

ra in

ed in

an ag

em en

t of

S T Is

a cc

or di

ng t

o N

at io

na l g

ui de

lin es

2 .8

.2 T

ra in

h ea

lth c

ar e

pr ov

id er

s S

T I/

O I

m an

ag em

en t

ac co

rd in

g t

o na

tio na

l g ui

de lin

N A

P S

/C ID

C on

tin ue

s on

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N E

R A

B IL

IT Y

T O

H IV

I N

F E

C T

IO N

: S

tr a

te g

ic O

b je

ct iv

e s

B R

O A

D S

T R

A T

E G

IC P

R O

G R

A M

M E

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

S T

R A

T E

G IC

A R

T N

E R

(S )

2 .9

E ns

ur e

sa fe

b lo

od s

up pl

y P

er ce

nt o

f tr

an sf

us ed

b lo

od u

ni ts

th e

la st

t w

el ve

m on

th s

th at

h av

e be

sc re

en ed

f or

H IV

a cc

or di

ng t

o na

tio na

l g ui

de lin

2 .9

.1 M

ai nt

en an

ce o

f sa

fe b

lo od

s up

pl y

M O

H /P

E P

FA R

/P A

H O

2 .1

0 Im

pl em

en t

pl an

t o

re du

ce h

ea lth

or ke

r an

d co

m m

un ity

r is

k of

H IV

an sm

is si

on t

hr ou

g h

co nt

am in

at ed

ar ps

N um

be r

of p

er so

ns t

ra in

ed in

in je

ct io

n sa

fe ty

a nd

as te

m an

ag em

en t

2 .1

0 .1

P ro

vi de

a n

at io

na l p

ol ic

y to

er se

e in

je ct

io n

sa fe

ty in

t he

p ub

lic

an d

pr iv

at e

se ct

M O

H /P

E P

FA R

N um

be r

of c

ur at

iv e

in je

ct io

ns P

er p

er so

n 2

.1 0

.2 B

ui ld

c om

pe te

nc y

of h

ea lth

or ke

rs t

o pr

ov id

e in

je ct

io ns

a nd

sp os

e of

s ha

rp s

ac co

rd in

g t

o st

an da

rd s

N A

P S

2 .1

0 .3

B ui

ld c

om pe

te nc

y of

w as

ha nd

le rs

t o

di sp

os e

of w

as te

co rd

in g t

o sa

fe w

as te

an ag

em en

t st

an da

rd s

N A

P S

2 .1

0 .4

A dv

oc at

e fo

r ra

tio na

l u se

o f

in je

ct io

N A

P S

2 .1

0 .5

R ed

uc e

de m

an d

fo r

in je

ct io

am on

g p

at ie

nt s

an d

co m

m un

ity

m em

be rs

N A

P S

C on

tin ue

d fr

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IN IC

A L

A N

D D

IA G

N O

S T

IC M

A N

A G

E M

E N

T A

N D

A C

C E

S S

T O

C A

R E

, T R

E A

T M

E N

T A

N D

S U

P P

O R

B R

O A

D S

T R

A T

E G

P R

O G

R A

M M

E A

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

T R

A T

E G

IC P

A R

T N

E R

(S )

3 .1

E xp

an d

ac ce

ss t

o A

R V

ea tm

en t

to s

ca le

t he

sp on

P er

ce nt

o f

pe rs

on s

w ith

a dv

an ce

H IV

fe ct

io n

re ce

iv in

g A

R T

3 .1

.1 S

tr en

g th

en e

xi st

in g t

re at

m en

t si

te s

an d

ex pa

th e

nu m

be r

of t

re at

m en

M O

H /G

FA T M

/P E

P FA

R /

P A

H O

N um

be r

of r

eg io

ns w

ith h

ea lth

f ac

ili tie

s th

at h

av e

th e

ca pa

ci ty

t o

pr ov

id e

H IV

/ A

ID S

c ar

e, t

re at

m en

t, an

d su

pp or

3 .1

.2 S

ta nd

ar di

se g

ui de

lin es

a nd

p ro

to co

ls f

or c

ar e

an d

tr ea

tm en

t M

O H

/G FA

T M

/P E

P FA

R /

P A

H O

N um

be r

of h

ea lth

c ar

e pr

ov id

er s

tr ai

ne d

to d

el iv

er A

R T s

er vi

ce s

ac co

rd in

g t

o na

tio na

l g ui

de lin

3 .1

.3 S

tr en

g th

en t

ec hn

ic al

c ap

ac ity

o f

he al

th c

ar e

w or

ke rs

in d

el iv

er in

g c

om pr

eh en

si ve

c ar

e to

LW H

A S

M O

H /G

FA T M

/P E

P FA

R /P

A H

N um

be r

of p

er so

ns r

ec ei

vi ng

A R

T 3

.1 .4

E st

ab lis

h pu

bl ic

-p riv

at e

pa rt

ne rs

hi p

in t

re at

m en

t an

d ca

re M

O H

/G FA

T M

/P E

P FA

R /P

A H

3 .1

.5 E

st ab

lis h

ne tw

or k

of P

LW H

A S

up po

rt g

ro up

s H

S D

U /P

E P

FA R

/U N

A ID

3 .1

.6 D

ev el

op N

at io

na l T

re at

m en

t an

d C

ar e

co m

m un

ic at

io ns

s tr

at eg

y M

O H

/P A

H O

3 .1

.7 S

tr en

g th

en h

um an

c ap

ac ity

t o

sc al

e up

t he

c ar

e an

d tr

ea tm

en t

re sp

on se

M O

H /P

A H

O /P

E P

FA R

3 .1

.8 D

ev el

op a

nd im

pl em

en t

na tio

na l a

dh er

en ce

ra te

g y

O H

/P A

H O

/P E

P FA

3 .2

C re

at e

C en

tr e

E xc

el le

nc e

at t

he G

U M

in ic

a nd

G P

H C

3 .2

.1 U

pg ra

de t

he f

ac ili

ty t

o pr

ov id

e sp

ec ia

liz ed

c ar

e an

d se

rv e

as a

r ef

er ra

l c en

tr e

M O

H /P

E P

FA R

3 .2

.2 D

es ig

n an

d im

pl em

en t

C on

tin uo

us Q

ua lit

y Im

pr ov

em en

t (C

Q I) pr

og ra

m m

e fo

r th

e C

en tr

e M

O H

/ P

E P

FA R

C on

tin ue

s on

p 5

58]

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P R

IO R

IT Y

# 3

_C L

IN IC

A L

A N

D D

IA G

N O

S T

IC M

A N

A G

E M

E N

T A

N D

A C

C E

S S

T O

C A

R E

, T R

E A

T M

E N

T A

N D

S U

P P

O R

B R

O A

D S

T R

A T

E G

P R

O G

R A

M M

E A

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

T R

A T

E G

IC P

A R

T N

E R

(S )

3 .2

.3 U

pg ra

de t

ec hn

ic al

c ap

ac ity

o f

th e

m ul

tid is

ci pl

in ar

y te

am t

o pr

ov id

e sp

ec ia

liz ed

c ar

e in

H IV

/A ID

M O

H /

P E

P FA

3 .3

E st

ab lis

h a

qu al

ity h

om e

ba se

d an

d pa

lli at

iv e

ca re

og ra

m m

e pr

ov id

in g

su pp

or t

to P

LW H

A a

th os

e af

fe ct

ed b

y H

IV /

A ID

N um

be r

of r

eg io

ns w

ith o

ut le

ts t

ha t

pr ov

id e

H P

C 3

.3 .1

D ev

el op

a nd

im pl

em en

t a

na tio

na l H

B C

s tr

at eg

y fo

r P

W L H

A a

nd t

ho se

a ff

ec te

d by

H IV

/A ID

S .

M O

H /G

FA T M

/N G

O (G

+ )

N um

be r

of o

ut le

ts t

ha t

pr ov

id e

H P

C 3

.3 .2

S tr

en g th

en a

nd e

xp an

d h

om e-

ba se

d ca

se rv

ic es

f or

P LW

H A

a nd

t ho

se a

ff ec

te d

H IV

/A ID

M O

H /G

FA T M

/N G

O (G

+ )

3 .3

.3 E

st ab

lis h

ne tw

or k

of h

om e-

ba se

d ca

vo lu

nt ee

M O

H /G

FA T M

/N G

O (G

+ )

3 .3

.4 E

st ab

lis h

pu bl

ic p

riv at

e pa

rt ne

rs hi

p in

h om

e ba

se c

ar e

O H

/G FA

T M

/N G

O (G

+ )

3 .3

.5 S

tr en

g th

en t

he t

ec hn

ic al

c ap

ac ity

o f

H B

w or

ke rs

in p

ro vi

di ng

q ua

lit y

ca re

O H

/G FA

T M

/N G

O (G

+ )

3 .3

.6 E

st ab

lis h

N at

io na

l r ef

er ra

l s ys

te m

f or

H om

e ba

se c

ar e

M O

H /G

FA T M

/N G

O (G

+ )

3 .3

.7 S

tr en

g th

en t

he c

ap ac

ity o

f th

e vo

lu nt

ee rs

pr ov

id in

g H

B C

s er

vi ce

M O

H /G

FA T M

/N G

O (G

+ )

3 .4

P ro

vi de

p sy

ch os

oc ia

l c ar

e an

d su

pp or

t to

P LW

H A

d th

os e

af fe

ct ed

3 .4

.1 In

cr ea

se t

he n

um be

r of

s oc

ia l s

er vi

pr og

ra m

m es

a va

ila bl

e to

P LW

H A

a nd

t ho

af fe

ct ed

O th

er L

in e

M in

is tr

ie s

C on

tin ue

d fr

om p

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IT Y

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IN IC

A L

A N

D D

IA G

N O

S T

IC M

A N

A G

E M

E N

T A

N D

A C

C E

S S

T O

C A

R E

, T R

E A

T M

E N

T A

N D

S U

P P

O R

B R

O A

D S

T R

A T

E G

P R

O G

R A

M M

E A

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

T R

A T

E G

IC P

A R

T N

E R

(S )

3 .3

.2 E

st ab

lis h

re fe

rr al

n et

w or

k fo

r ps

yc ho

so ci

su pp

or t

O H

/P E

P FA

3 .4

.3 E

nc ou

ra g e

pu bl

ic p

riv at

e pa

rt ne

rs hi

3 .5

D es

ig n

an d

im pl

em en

t in

st itu

tio n

tr ai

ni ng

og ra

m m

es f

or H

IV /

A ID

S t

re at

m en

t, ca

re a

su pp

or t

3 .5

.1 D

ev el

op a

nd im

pl em

en t

cu rr

ic ul

um f

or p

re -

se rv

ic e

H IV

t ra

in in

g p

ro g ra

m m

e an

d po

st -

g ra

du at

e tr

ai ni

ng p

ro g ra

m m

es a

t ce

nt ra

l a nd

g io

na l l

ev el

s fo

r th

e m

ul ti-

di sc

ip lin

ar y

te am

M O

H /P

E P

FA R

3 .5

.2 R

ev ie

w , r

ev is

e an

d im

pl em

en t

cu rr

ic ul

um o

f g ra

du at

e tr

ai ni

ng p

ro g ra

m m

M O

3 .6

E xp

an d

co m

pr eh

en si

ca re

f or

o pp

or tu

ni st

in fe

ct io

3 .6

.1 S

tr en

g th

en c

lin ic

al c

ar e

fo r

op po

rt un

is tic

fe ct

io ns

a t

pr es

en t

si te

s an

d ex

pa nd

t o

ne w

te s

M O

H /G

FA T M

/P A

H O

3 .6

.2 R

ev is

e/ re

vi ew

p ro

to co

ls f

or o

pp or

tu ni

st ic

fe ct

io ns

M O

H /G

FA T M

/P A

H O

3 .6

.3 D

ev el

op n

at io

na l c

om m

un ic

at io

n ca

m pa

ig n

fo r

tr ea

tm en

t an

d ca

re M

O H

/G FA

T M

3 .7

S tr

en g th

en t

he li

be tw

ee n

th e

T B

a nd

IV /A

ID S

/S T I

co nt

ro l

pr og

ra m

m es

3 .7

.1 S

up po

rt in

cr ea

se d

sc re

en in

g f

or T

B a

m on

g H

po si

tiv e

pa tie

nt s

M O

H /G

FA T M

/P A

H O

C on

tin ue

s on

p 6

60]

Guyana National HIV/AIDS Strategic Plan 2007-2011

P R

IO R

IT Y

# 3

_C L

IN IC

A L

A N

D D

IA G

N O

S T

IC M

A N

A G

E M

E N

T A

N D

A C

C E

S S

T O

C A

R E

, T R

E A

T M

E N

T A

N D

S U

P P

O R

B R

O A

D S

T R

A T

E G

P R

O G

R A

M M

E A

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

T R

A T

E G

IC P

A R

T N

E R

(S )

3 .7

.2 I

m pr

ov e

tr ai

ni ng

p ro

g ra

m m

e fo

r st

af f

M O

H /G

FA T M

/P A

H O

3 .7

.3 I

m pr

ov e

fa ci

lit ie

s an

d lo

g is

tic al

s up

po rt

M O

H /G

FA T M

3 .7

.4 S

up po

rt in

cr ea

se d

sc re

en in

g f

or H

IV a

m on

pa tie

nt s

w ith

T B

M O

H /G

FA T M

3 .8

I m

pl em

en t

ac tiv

iti es

t o

in cr

ea se

u se

o f

qu al

ity

S T I/

H IV

/A ID

S d

ia g no

st ic

d tr

ea tm

en t

se rv

ic es

P er

ce nt

o f

pe rs

on s

w ith

S T Is

w ho

a re

ag no

se d,

t re

at ed

, a nd

c ou

ns el

ed a

t tr

ea tm

en t

si te

s ac

co rd

in g t

o na

tio na

l g ui

de lin

3 .8

.1 S

tr en

g th

en S

T I s

er vi

ce s

to p

ro vi

co m

pr eh

en si

ve c

ar e

an d

sy nd

ro m

m an

ag em

en t

fo r

S T I

M O

H /H

S D

U /G

FA T M

N um

be r

of p

er so

ns t

ra in

ed in

t he

an ag

em en

t of

S T Is

u si

ng n

at io

na l

g ui

de lin

3 .8

.2 E

xp an

d th

e po

ol o

f he

al th

c ar

e w

or ke

rs t

ra in

in s

yd ro

m ic

m an

ag em

en t

O H

/H S

D U

/G FA

T M

/P E

P FA

R )

3 .8

.3 R

ev ie

w , u

pd at

e an

d di

ss em

in at

e g ui

de lin

es ,

pr ot

oc ol

s an

d tr

ai ni

ng , m

at er

ia l f

or S

T I

m an

ag em

en t

in b

ot h

th e

pu bl

ic a

nd p

riv at

e se

ct or

M O

H /H

S D

U /G

FA T M

/P E

P FA

3 .9

U pg

ra de

la b or

at or

y ca

pa ci

ty t

o di

ag no

se a

m on

ito r

H IV

/A ID

S a

as so

ci at

ed o

pp or

tu ni

st ic

fe ct

io ns

P er

ce nt

o f

pa tie

nt s

on A

R V s

w ho

r ec

ei ve

D 4

t es

tin g f

ol lo

w in

g n

at io

na l A

R V

ea tm

en t

g ui

de lin

3 .9

.1 U

pg ra

de G

P H

C ’s

f ac

ili ty

t o

un de

rt ak

e ad

di tio

na l

la b or

at or

y te

st f

or H

IV , h

ae m

at ol

og ic

al , T

B ,

S T I,

B io

ch em

ic al

, i m

m un

ol og

ic al

m ar

ke rs

a nd

ag no

si s

of o

pp or

tu ni

st ic

in fe

ct io

G P

H C

/W B

/ P

E P

FA R

/P A

H O

N um

be r

of p

er so

ns t

ra in

ed t

o co

nd uc

t C

D 4

t es

tin g

3 .9

.2 S

tr en

g th

en r

eg io

na l l

ab s

to c

on du

ct q

ua lit

y di

ag no

si s

of H

IV a

nd o

pp or

tu ni

st ic

in fe

ct io

an d

fo r

tr ea

tm en

t an

d m

on ito

rin g

P E

P FA

R /P

A H

C on

tin ue

d fr

om p

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IN IC

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D D

IA G

N O

S T

IC M

A N

A G

E M

E N

T A

N D

A C

C E

S S

T O

C A

R E

, T R

E A

T M

E N

T A

N D

S U

P P

O R

B R

O A

D S

T R

A T

E G

P R

O G

R A

M M

E A

R E

A S

IN D

IC A

T O

R S

S T

R A

T E

G IC

A R

E A

S L

E A

D A

G E

N C

Y A

N D

T R

A T

E G

IC P

A R

T N

E R

(S )

N um

be r

of r

eg io

na l l

ab s

w ith

c ap

ac ity

t o

do C

D 4

3 .9

.3 F

in al

is e

an d

im pl

em en

t L

ab S

tr at

eg ic

P la

n P

E P

FA R

/C A

R E

3 .9

.4 E

nh an

ce G

P H

C ’s

c ap

ac ity

t o

se rv

e as

a Q

A /

Q C

/Q I s

ite f

or t

es ts

P E

P FA

3 .9

.5 T

ra in

la b or

at or

y st

af f

to u

se s

pe ci

al is

ed m

et ho

fo r

di ag

no si

s an

d m

on ito

rin g o

f H

IV /A

ID S

a nd

la te

d is

su es

a t

th e

po st

g ra

du at

e le

ve l

M O

H /G

FA T M

3 .1

0 E

st ab

lis h

N at

io na

l P

ub lic

H ea

lth

R ef

er en

ce L

ab or

at or

3 .1

0 .1

C on

st ru

ct n

at io

na l r

ef er

en ce

la b or

at or

y M

O H

/ P

E P

FA R

tr en

g th

en t

he c

ap ac

ity o

f th

e qu

al ity

a ss

ur -

an ce

m on

ito rin

g c

om m

itt ee

3 .1

0 .2

R ev

ie w

/u pd

at e

sy st

em s

fo r

ce rt

ifi ca

tio n

3 .1

1 P

ro cu

re m

en t

an d

di st

rib ut

io n

of c

ar e

an d

tr ea

tm en

t su

pp lie

s im

pr ov

ed (

co m

m od

iti es

an ag

em en

3 .1

1 .1

E st

ab lis

h in

te r-

ag en

cy c

ol la

b or

at io

n to

e xp

e- di

te t

he p

ro ce

ss o

f pr

oc ur

em en

t th

ro ug

h th

e M

M U

M M

U /G

F /W

B /P

E P

FA R

3 .1

1 .2

tr en

g th

en t

he m

an ag

em en

t an

d m

on ito

rin g

ca pa

ci ty

o f

th e

M M

U (

C om

m od

iti es

M an

ag e-

m en

M M

U /G

F /W

B /P

E P

FA R

62]

Guyana National HIV/AIDS Strategic Plan 2007-2011

P R

IO R

IT Y

# 4

_S T

R A

T E

G IC

I N

F O

R M

A T

IO N

B R

O A

D S

T R

A T

E G

P R

O G

R A

M M

E A

R E

A S

M E

A N

S O

F V

IR IF

IC A

T IO

N S

T R

A T

E G

IC A

R E

A S

L E

A D

A G

E N

C Y

A N

D S

T R

A T

E G

P A

R T

N E

R (S

)

4 .1

S tr

en g th

en t

he H

IV /A

ID S

rv ei

lla nc

e sy

st em

s -

N um

be r

of s

ur ve

ill an

ce g

ui de

lin es

su ed

- N

um be

r of

s ta

ff t

ra in

ed in

rv ei

lla nc

e -

N um

be r

of r

eg io

ns w

ith c

ap ac

ity t

o co

nd uc

t su

rv ei

lla nc

e -

N um

be r

of r

ep or

ts d

is se

m in

at ed

4 .1

.1 R

ev ie

w a

nd u

pd at

e ex

is tin

g p

ro to

co ls

a nd

g ui

de lin

es f

or H

IV /A

ID S

s ur

ve ill

an ce

H S

D U

/M O

H /G

FA T M

/W B

/P A

H O

4 .1

.2 E

m pl

oy a

nd t

ra in

s ta

ff a

t na

tio na

l a nd

g io

na l l

ev el

s to

c on

du ct

H IV

/A ID

su rv

ei lla

nc e

H S

D U

/M O

H /G

FA T M

/W B

/P A

H O

4 .1

.3 R

eg io

na liz

e th

e H

IV /A

ID S

s ur

ve ill

an ce

st em

H S

D U

/M O

H /G

FA T M

/W B

/P A

H O

4 .1

.4 C

on du

ct r

eg ul

ar s

es si

on s

fo r

th e

re vi

of s

ur ve

ill an

ce a

nd o

th er

d at

a w

ith k

st ak

eh ol

de rs

H S

D U

/M O

H /G

FA T M

/W B

/P A

H O

4 .1

.5 P

re pa

re a

nd d

is se

m in

at e

re g ul

ar r

ep or

ts o

f th

e re

su lts

o f

H IV

/A ID

S s

ur ve

ill an

ce H

S D

U /M

O H

/G FA

T M

/W B

/P A

H O

4 .2

D ev

el op

a nd

im pl

em en

t a

sy st

em f

or m

on ito

rin g a

ev al

ua tin

g t

he r

es po

ns e

H IV

/A ID

- N

at io

na l p

la n

fo r

M &

E -

# o

f st

af f

em pl

oy ed

t o

co nd

uc t

M &

E -

# o

f pe

rs on

s tr

ai ne

d in

M &

E -

N at

io na

l a g re

ed u

po n

da ta

ba se

4 .2

.1 D

ev el

op a

nd d

is se

m in

at e

a na

tio na

l M &

P la

n M

O H

/W B

/G A

F TA

M /P

A H

O /U

N A

ID S

4 .2

.2 Id

en tif

y at

t he

n at

io na

l l ev

el a

u ni

t w

hi ch

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Guyana National HIV/AIDS Strategic Plan 2007-2011

[63

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64]

Guyana National HIV/AIDS Strategic Plan 2007-2011

P R

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Guyana National HIV/AIDS Strategic Plan 2007-2011

[65

SECTION

5 MONITORING AND EVALUATION To fully realize the strategic leadership of the GoG in reducing the spread of HIV/AIDS and in-

creasing the quality of life for PLWHA, a national monitoring and evaluation (M&E) plan has

been developed that will harmonise M&E efforts and ensure that the impact of the HIV/AIDS

epidemic and the effectiveness of the NSP are adequately monitored.* A set of core national

indicators that cut across all sectors and program areas has been established and will form the

basis of monitoring the national response to HIV/AIDS in Guyana.

The general purpose of the monitoring and evaluation plan is to:

■ Provide a framework that will be used to monitor and evaluate the coordinated national re-

sponse to HIV/AIDS; ■ Ensure consistent use of all indicators and appropriate linkages between all initiatives sup-

ported by the GoG, partners, and key stakeholders; ■ Ensure appropriate and sustainable linkages between data collection efforts by different stake-

holders.

The core indicators are summarized below in tabular form by program area. Consistent with

the NSP, the indicators have been grouped into the four key priority areas: Strengthen National

Capacity to Implement a Coordinated, Multi-Sectoral Response; Clinical and Diagnostic Man-

agement and Access to Care, Treatment, and Support; Reducing Risk and Vulnerability to HIV

Infection; and Surveillance and Research.

LEVEL & AREA INDICATORS REF DATA SOURCE

IMPACT

Proportion of all deaths at- tributable to AIDS

Imp1 Vital registration system and program reports

Percentage of adults and children with HIV alive and known to be on treatment 12 months after initiation of ART

Imp2 Vital registration system and program reports

HIV prevalence among women aged 15-24

Imp3 Sentinel surveillance at ANC sites

HIV prevalence among most- at-risk populations

Imp4 BSS/AIS with HIV testing and sentinel surveillance at STI and TB sites

Percent of infants born to HIV-infected mothers who are infected

Imp5 Program reports and facility surveys

* The national M&E plan is published as a separate document and is entitled the “National Monitoring and Evaluation Plan for the Multi-Sectoral Response to HIV/AIDS in the Co-opera- tive Republic of Guyana.”

66]

Guyana National HIV/AIDS Strategic Plan 2007-2011

LEVEL & AREA INDICATORS REF DATA SOURCE

PROGRAM OUTPUTS

Priority 1: Strengthen National Capacity to Implement a Coordinated, Multi-Sectoral

Response

Policy Formation National composite policy index

Nc1 NCPI questionnaire

Policy Formation Percent of schools with teachers who have been trained in life-skills based HIV/AIDS education and who taught it during the last academic year

Nc2 School survey

Partnerships/Multi- sectoral Response

Number of line ministries with HIV work plans and budgets

Nc3 Special survey of Line Ministries

Priority 2: Clinical and Diagnostic Management and Access to Care, Treatment, and

Support

Access to ART Percent of persons with advanced HIV infection receiving ART

Cts1 Program reports and facility surveys

Number and percent of regions with at least one service outlet providing ART services following national standards

Cts2 Program reports and facility surveys

VCT Percent of the general population aged 15-49 receiving HIV test results in the past 12 months

Cts4 AIS

Number of individuals trained in the provision of VCT according to national guidelines

Cts5 Program reports and facility surveys

Home and Palliative Care (HPC)

Number of regions with service outlets that provide HPC

Cts6 Program reports and facility surveys

Number of service outlets that provide HPC

Cts7 Program reports and facility surveys

Number of persons trained to provide HPC according to national guidelines

Cts8 Program reports and facility surveys

Number of persons who receive HPC following national guidelines

Cts9 Program reports and facility surveys

OIs and STIs Percent of men and women with STIs at health care facilities who are appropriately diagnosed, treated, and counseled

Cts10 Program reports and facility surveys

Guyana National HIV/AIDS Strategic Plan 2007-2011

[67

LEVEL & AREA INDICATORS REF DATA SOURCE

OIs and STIs Number of persons trained in the management of STIs according to national guidelines

Cts11 Program reports and facility surveys

Tuberculosis Percent of HIV-positive registered TB patients given ART during TB treatment

Cts12 Program reports and facility surveys

Percent of registered TB patients tested for HIV

Cts13 Program reports and facility surveys

Lab Support Percent of patients on ARVs who receive regular CD4 monitoring following national ARV treatment guidelines

Cts14 Program reports and facility surveys

Number of regional labs with the capacity to perform CD4 tests following national standards

Cts15 Program reports and facility surveys

Number of persons trained to conduct CD4 testing according to national guidelines

Cts16 Program reports and facility surveys

Priority Area 3: Reducing Risk and Vulnerability to HIV infection

IEC/BCC Percent of never-married youth aged 15-24 who ever had sex

Pv1 BSS & MICS

Percent of youth aged 15-24 reporting use of a condom during last sexual intercourse with a nonregular partner

Pv2 BSS & AIS & MICS

Percent of people aged 15-49 expressing accepting attitudes toward people with HIV/AIDS

Pv3 BSS & AIS & MICS

Percent of people aged 15-24 who correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

Pv4 BSS & AIS & MICS

Number of condoms distrib- uted in the past 12 months

Pv5 Program reports and facility surveys

PMTCT Number of service outlets that offer PMTCT services

Pv6 Program reports and facility surveys

Number of pregnant women who receive HIV counseling and testing for PMTCT and received their results

Pv7 Program reports and facility surveys

68]

Guyana National HIV/AIDS Strategic Plan 2007-2011

LEVEL & AREA INDICATORS REF DATA SOURCE

PMTCT Percent of HIV-infected pregnant women who receive a complete course of ARV prophylaxis as part of PMTCT

Pv8 Program reports and facility surveys

Number of health workers trained in the provision of PMTCT according to national guidelines

Pv9 Program reports and facility surveys

Percent of babies born to HIV-positive women who are tested before age 18 months

Pv10 Program reports and facility surveys

OVC Percent of OVC whose households receive free, ba- sic external support in caring for the child

Pv11 MICS

Number of providers trained in the provision of care for OVC

Pv12 Program reports and facility surveys

Ratio of current school at- tendance among orphans to that among non-orphans aged 10-14

Pv13 AIS

Priority Area 4: Surveillance and Research

Percent of service outlets with record-keeping systems to monitor HIV/AIDS care and treatment

Sr1 SPA

Number of persons trained in strategic information (moni- toring and evaluation and/or surveillance and/or HMIS)

Sr2 Program reports and facility surveys

Guyana National HIV/AIDS Strategic Plan 2007-2011

[69

SECTION

5 NEXT STEPS – THE WAY FORWARD To make this plan a reality and move the process forward a detailed workplan with its attendant

budget needs to be developed in partnership with the representatives from the various minis-

tries, the donors and other stakeholders. This document is crucial since the National Strategic

Plan will be of limited use until the donors can align their financial resources with the strategic

priorities. Once this occurs, then implementation can begin and the beneficiaries will receive

the support needed for their programmes and intervention activities. For Guyana to achieve its

goal and to achieve the optimum use of resources in support of the programme, harmonisation

has to occur at the national level with respect to the coordination and alignment of activities.

Co-ordination among partners is also essential to ensure the smooth implementation of the

Strategic Plan.

70]

Guyana National HIV/AIDS Strategic Plan 2007-2011

REFERENCES AND DOCUMENTS CONSULTED

■ PAHO Workshop Report, The Guyana HIV/AIDS Care and Treatment Plan, May 2005 ■ President’s Emergency Plan for AIDS Relief, Guyana 2004-2005 Strategy ■ CHRC Assessment Report of the National HIV/AIDS Programme of Guyana, 2004 ■ Guyana’s National HIV/AIDS Strategy Plan 2002-2006 ■ Francois-Xavier Bagnoud Center – University of Medicine & Dentistry of New Jersey (FXB)

Guyana Quarterly Activity Report, April-June, 2005, 1st Quarter FY05 ■ Facts Sheet on Care and Treatment, Guyana, updated April 2005 ■ Project Grant Agreement between The Global Fund to Fight AIDS, Tuberculosis and Ma-

laria and the Ministry of Health, “National Initiative to Accelerate Access to Prevention,

Treatment, Care and Support for Persons Affected by HIV/AIDS” GYA-304-G01-H ■ PAHO/MOH Workshop Report , The Guyana HIV/AIDS Care and Treatment Plan, April

28-29, 2005 ■ The National Behaviour Change Communication Strategy of Guyana (Draft) USAID/

GHARP, 4th August, 2005; ■ USAID/FHI Guyana HIV/AIDS Program implementing The President’s International

PMTCT Initiative (PPI) Final Report ■ Workshop Report, National HIV/AIDS- BCC Strategy for Guyana Georgetown, July 20-

22, 2005 Prepared by Sharda Ganga (Consultant to PAHO-Guyana office) ■ PAHO/MOH Workshop Report, Laboratory Support and Blood Safety, 2 – 3 August 2005 ■ PAHO/MOH Workshop Report, Orphans and Vulnerable Children, 10 August 2005 ■ World Bank Project Information Document (pid) Aappraisal Stage Report No.: AB458 Proj-

ect Name: HIV/AIDS Prevention & Control Project, Guyana, Prepared January 9, 2004 ■ PAHO/MOH Workshop Report, Guyana HBC Strategic Planning, 28-29 July, 2005. ■ PAHO/MOH Workshop Report, The Guyana Voluntary Counselling and Testing Gap

Analysis, 29 – 30 June 2005 ■ UN System Strategic Framework on HIV and AIDS 2006–2010, UNAIDS/PCB(17)/05.525

May 2005 ■ The Guyana Poverty Reduction Strategy Paper, International Monetary Fund, August 2002 ■ UNAIDS, Resource Needs for an Expanded Response to AIDS in Low and Middle Income

Countries, Discussion Paper,‘Making the Money Work’ The Three Ones in Action London,

United Kingdom, 9 March 2005 ■ Ministry of Education, HIV/AIDS Sector Plan, June 5, 2005 ■ Guidelines for Implementing a Multi-sectoral Approach to HIV/AIDS in Commonwealth

Countries, revised version, Commonwealth Secretariat, March 2003 ■ Global Health-Sector Strategy for HIV/AIDS 2003-2007; Providing a Framework for Part-

nership and Action, Department of HIV/AIDS, WHO,2003 ■ Human-capacity plan for scaling up HIV/AIDS treatment, Treat 3 million by 2005, WHO

2003; ■ Emergency scale-up of antiretroviral therapy in resource-limited setting: technical and opera-

tional recommendations to achieve 3 by 5, UNAIDS/WHO 2004.

Guyana National HIV/AIDS Strategic Plan 2007-2011

[71 The following persons participated in the development of the Guyana National Strategic Plan

2006-2010 from early on through the participation at the gap analysis workshops and by provid-

ing comments to the first draft of the Strategy.

■ Bernadette Abrams, Nurse, Hope for All ■ Clifford Accra, Administrator, Joshua Children Center ■ Audrey Adams, Director Health Visitor, Mayor Counsellor ■ Oswald Alleyne, M&E & Research Officer, GHARP ■ Nafeza Ally, Social Services Coordinator, Global Fund HIV/AIDS Prevention ■ Amanda Anderson, Counsellor/Tester, GPHC/VCT ■ Colleen Anderson, PMTCT/VCT Officer, GHARP ■ Dr. Frank Anthony, Executive Director, Health Sector Development Unit, MOH ■ Dr. Chuka Anude, Chief of Party, FXB/CDC ■ Dennis Arends, Programme Coordinator, UNICEF ■ Dr. Enias Baganizi, 3 by 5 Project Manager, PAHO/WHO ■ Trisha Bellamy, Medical Technologist, Woodlands Hospital ■ Basil Benn, Director, Linden Care Foundation ■ Lynette Berkeley, Laboratory Manager, CAREC ■ Kathryn Boryc, Youth Friendly Services Coordinator, Ministry of Health ■ Andrew Boyle, Director/Chairman, Eureka Laboratory/GAMLAP ■ Rita Brouet, Social Worker, Hope Foundation ■ Feyon Brumell, Social Worker, Lifeline Counselling Services ■ Chetram Budhu, Medical Doctor, Ministry of Health ■ Shondell Butters-Belfield, Project Coordinator, Hope For All ■ Mena Carto, Program Officer, Technical Services, CDC/FXB, Rapporteur for workshops ■ Shawndelle Charles-Gouveia, Project Coordinator, Comforting Hearts ■ Paulette Clarke, Deputy Chief Health Visitor, Mayor and City Council ■ Asiah Camacho, Social Worker/Counsellor, St. Joseph Mercy Hospital ■ Lucia Maria Costa Monteiro, Director, Adolescent Health, Ministry of Health ■ Emily Cumberbatch, Project Coordinator, CSIH ■ Allison Daniels, Senior Secretary, UNICEF ■ Dr. Dennison Davis, Director, Standards and Technical Services, Ministry of Health ■ Gloria De Caires, Chair, National Aids Committee ■ Michel De Groulard, Country Coordinator, UNAIDS ■ Dr. A. Devi, Medical Officer, St. Joseph’s Mercy Hospital ■ Bhoghkumarie Doodnauth, Medical Technologist, Mercy Hospital laboratory ■ Lilet Drepaul, Secretary/Treasurer, Canaan Children’s Home ■ Dr. Nybia Farinas, Scientific Laboratory Director, Central Medical Laboratory ■ Juliana Farley, Assistant Project Coordinator, Hope for All ■ Alex Foster, President, St. Francis Community Developers

LIST OF CONTRIBUTORS AND THEIR AFFILIATIONS

72]

Guyana National HIV/AIDS Strategic Plan 2007-2011

■ Catherine Fraser, Counsellor/Tester, St. Francis Community Developers ■ Edris George, USAID ■ Dr. Karen Gordon Boyle, Community and Clinical Care Officer, GHARP ■ Patricia Gray, Chief Probation and Welfare Officer (Ag.), Ministry of Human Services ■ Mohammed Hamid, Technical Officer, UNICEF ■ Onix Hackett, Counselor/Tester, Lifeline Counseling Services ■ Keerti Hardowar, Executive Council Member, Volunteer Youth Corps ■ Lynette Hardy, Senior Laboratory Technical, FBX/CDC ■ Youlanda Hendricks, Medical Student, St. Joseph’s Mercy Hospital ■ Debra Henry, Senior Health Visitor, Ministry of Health ■ Nicolette Henry, PDO Blood Safety, CDC/GAP ■ Shellon Henry, Prevention and Care Associate, GHARP ■ Dexter Holder, Counselor/Tester, Linden Care Foundation ■ Nazim Hussain, Community Mobilization Coordinator, HSDU/World Bank/Global Fund ■ Yvette Irving, National Coordinator/Laboratory Director, Medical Laboratory Service,

Ministry of Health ■ Dr. Bizuayehu Jeffrey, Deputy Chief Medical Officer, Mayor and City Council ■ Dr. Curtis La Fleur, Technical Coordinator, CSIH ■ Grace Layne-Pitt, Project Assistant, Lifeline Counselling Services ■ Dr. Douglas Lyon, Chief of Party, CDC ■ Susanne Marquis-Hamel, Project Manager, CSIH ■ Dr. Clement McEwan, Medical Director, National Blood Transfusion Service ■ Edgar McNab, Laboratory Manager, CDC/FXB ■ Ivor Melville, Director, Hope Foundation ■ Camach Mohammed, Clinical Supervisor (Ag.), Guyana Responsible Parenthood Associa-

tion ■ Dr. Mallika Mootoo, Pediatrician, St. Joseph’s Mercy Hospital ■ Dr. Jomo Osborne, Technical Officer, GHARP ■ Ms. Bhagmattie Persaud, Administrative Assistant, PAHO/WHO ■ Dr. Navindra Persaud, M & E Director, GHARP ■ Nicholas Persaud, HIV/STI Counselor, Ministry of Health ■ Dr. Shamdeo Persaud, Director of Disease Control Department, MOH ■ Charlotte Picard, Administsrative Manager, Red Cross Children’s Convalescent Home ■ Julia Rehwinkel, Population Nutrition & Health Officer, USAID ■ Dr. Colin Anthony Roach, Project Development Officer, Quality Assurance, CDC ■ Oonah Wendel Roberts, Counselor/Tester, GHARP ■ Samantha Rodrigues, Public Relations/Monitoring Officer, Guyana Responsible Parenthood

Association ■ Angela Ross, Counselor/Tester, Lifeline ■ Deserne Sandy, Counselor, Roadside Baptist Skills Centre ■ Lall Bahadur Singh, Senior Drug Inspector, Food and Drugs ■ Dr. Narine Singh, Medical Superintendent, Region 2 ■ Serena Singh, Laboratory Manager, Georgetown Medical Centre Inc. ■ Dr. Shanti Singh, Director, GUM Clinic

Guyana National HIV/AIDS Strategic Plan 2007-2011

[73

■ Derrick Springer, Orise Fellow, CDC ■ Jack Spencer, Management Consultant, CDC ■ Marlyn Subryan, VCT Coordinator, Hope Foundation ■ Paulette Sydney, Counselor/Tester, Linden Care Foundation ■ Nicola Taylor, Consultant, Trinidad & Tobago ■ Pamela Teichman, Regional Technical Advisor for LAC, USAID, Washington, DC ■ Lisa Thompson, OVC Officer, GHARP ■ Debra Vitalis, National PMTCT Coordinator, Ministry of Health ■ Keeran Williams, Linden Care ■ Thibaut Williams, Programme Manager, AIDS Relief/CRS ■ Alexis Wilson-Pearson, Senior Medical Technician, Central Medical Laboratory ■ Terry Witkus, Coordinator, Stemming the Tide Project, St. Joseph’s Mercy Hospital ■ Dr. Janice Woolford, Director, Maternal & Child Health Department, MOH ■ Sheila Yaw-Fraser, Program Director (Ag.), Guyana Responsible Parenthood Association

This document was produced and printed with technical and financial support from PAHO/WHO.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.G

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