Challenges of addressing HIV highlighted as 56th CHRC opens
By Sharmain Cornette
About 20,000 new HIV cases were recorded in the Caribbean last year and approximately 12,000 persons aged 15 – 44 have since died, according to Professor Peter Figueroa.
These sobering figures were included in his feature lecture at the opening of the 56th Annual Caribbean Health Research Council (CHRC) Scientific Meeting.
The forum which was held in the auditorium of the Princess Hotel, East Bank Demerara, saw Figueroa, a Professor of Public Health, Epidemiology and HIV/AIDS at the University of the West Indies in Jamaica, presenting his lecture entitled ‘The challenges of HIV Prevention in the Caribbean’ to a gathering of mainly medical professionals.
“We estimate that there are about a quarter million people living with HIV in the Caribbean and perhaps about a half of those are living in Haiti, and then nearly 60,000 are living in the Dominican Republic and 32,000 living in Jamaica…As you can see, between those three countries we have over 210,000 persons living with HIV of a total of a quarter of a million persons,” Professor Figueroa stated.
He emphasised that it is up to each country to have its own national response programme to address the challenges of HIV/AIDS, and this is complemented by the Pan-Caribbean partnership against AIDS.
In this regard, he noted that all the countries have introduced treatment programmes with antiretroviral therapy, which is very effective in improving the quality of life of persons living with HIV and has significantly reduced mortality from HIV.
“We have throughout the Caribbean, programmes to prevent the transmission of HIV from pregnant women to their unborn children, and in many of our countries now, over 90 to 95 percent of pregnant women who are HIV-infected are getting this therapy.”
The aim of such a programme, Professor Figueroa said, is to reduce transmission to less than five percent of babies born to women who are HIV-positive.
However, there remains a challenge, whereby although the population is aware of HIV/AIDS and is knowledgeable about prevention methods, there has not been consistent condom use. This problem, he noted, is compounded by the fact that in the Caribbean there are many persons who have multiple sexual partners.
“So it is with our prevention efforts that we need to do more, and especially among those who are most at risk, like Men who have Sex with Men.”
According to the professor, the rates of HIV infections among sex workers are far too high, thus the need for more effective programmes to reach more persons and empower them to take preventive action.
And while it is important to have the outreach days of HIV testing, such as the week of testing that Guyana offers annually, Professor Figueroa is of the belief that it is even more important to integrate HIV testing into the health services fully.
This, he said, is not only intended to have pregnant women have the HIV test, but also persons who develop another sexually transmitted infection and are being treated at a Sexually Transmitted Infection Clinic or are being attended to by a private practitioner.
“I would propose that, especially in urban centres, those persons who are coming to the accident and emergency department or who are being admitted as adults to hospitals need to be tested.
When adults are having their annual medical checkup and are doing an executive profile, we should offer an HIV test to these individuals, because nearly all of them are sexually active and could be at risk for HIV infection.”
He pointed out that many persons who are today living with HIV are in fact unaware that they are actually infected.
According to him, once HIV testing is introduced in the hospital setting, the approach is usually offered on an “opt-out” basis, whereby it is routinely offered to each person who is admitted, but they are not obligated to take the test.
He cautioned that patients must be aware of this service, adding that they should be able to ask any necessary questions, to an extent where counseling is also offered.
He nonetheless lamented that the reality is that sometimes it is very difficult for the health staff to do as much counseling as is required.
“As long as everyone is aware that when you are admitted to hospital or if you have come to the accident and emergency it is a routine opt-out test (being offered); if you really do not want to be tested…then you need to say I do not need the test.”
Professor Figueroa said that in light of the continuing scourge of HIV/AIDS, Caricom has been promoting a Health and Family Life Education Programme curriculum in the school system. He explained that many Caribbean countries have adopted this curriculum, which attempts to give young people life skills, sex education and promote individual responsible behaviour, including abstinence.
He noted that a problem is often linked to the fact that sex education does not become sufficiently real to young people, as they are not being taught safer sex skills in relation to how to negotiate interpersonal relations, and how to actually use a condom, or even the perspective of abstaining from sex.
“They still need to learn how to use a condom… by using condom demonstrations, when they become sexually active they know how to use it. What I am saying is that we need to get more explicit sex education and condom skills into the Health and Family Life Education among the young people and work out with them different approaches that they can take among themselves so that the education is more effective.”
Presenting examples as it relates to Jamaica, Professor Figueroa revealed that on average, boys begin sexually activities when they are 16 years of age, adding that over the last 15 years the first sexual encounter age for girls has decreased from 18 years old to under 17.
But while the findings presented may vary from person to person, he noted that there are many young people who are becoming sexually active and are experimenting from age 14 or even younger.
“The young people are going to have to make up their minds themselves whether the adults like it or not, so we have to encourage them to act responsibly, to understand the risks involved and to encourage them to abstain, but at some point they are going to become sexually active and are going to need safer sex skills to protect themselves.”
The conference, which will continue until tomorrow, is geared at promoting the use of operational health research which can be used to guide medical practice.
According to CHRC Director, Dr Donald Simeon, over 10 papers of research done in Guyana, by Guyanese, will be presented during the course of the conference. Among those identified to present papers are health professionals drawn from the Ministry of Health, the Georgetown Public Hospital Corporation and the University of Guyana. “These are excellent research which I myself am hoping will be used to guide policy development and medical practice in Guyana…,” Dr Simeon disclosed recently.
The annual conference, according to him, is very important in terms of sharing research findings with persons who can actually benefit from such materials.
He asserted that the CHRC is about the promotion of evidence to guide policy makers, programme managers and care providers as it relates to best practices, thus are used as guidance tools.
As such, he noted that such fora are designed to cater to a wide cross section of stakeholders including research scientists, care providers, policy makers and all other persons involved in producing and using the research findings.
“I think it is critical that it is being held in Guyana now, because of the support for research and for us to really increase the level of interest to conduct research.”