"We had to get to the state of occupying the second place in the world (in terms of the incidence of HIV/AIDS) before we are paid enough attention... we didn't have to do that to get attention" - President Bharrat Jagdeo
By Shirley Thomas
PRESIDENT Bharrat Jagdeo yesterday formally launched a Caribbean initiative to improve treatment and care for people living with HIV/AIDS in the region.

The two-day regional meeting, which focuses on accelerating access to treatment and care for persons living with the disease, is being held at Le Meridien Pegasus, Georgetown, and will pave the way for the provision of cheaper and more affordable treatment and supporting mechanisms for infected persons and their families.

The meeting, which is organised by the Caribbean Epidemiology Centre (CAREC), Pan-American Health Organisation, World Health Organisation and the Caribbean Community Secretariat, brings together a range of regional and international disciplines from government, private and public sector institutions and non-governmental organisations.

The planners essentially aim to:

** formulate a regional strategy and plan of action for attaining and consolidating a package of care and treatment for people living with HIV/AIDS

** develop a regional negotiating position with pharmaceutical companies regarding access to anti-retroviral drugs and other drugs against opportunistic infections.

** recommend action to support regional resource mobilisation for HIV/AIDS programmes, including resources from the United Nations Global Fund of HIV/AIDS.

** Advise the September caucus of Ministers of Health in Washington on the activities planned under a regional strategy for "accelerated access" to care for persons living with HIV/AIDS, and guidelines for the negotiations with pharmaceutical companies.

Addressing the distinguished gathering of regional participants, President Jagdeo noted that the meeting was being held some one-and-a-half decade after the epidemic struck the world and countries have moved forward with strategies and plans of action, some already reaping success. "Maybe we have not made the case strongly enough to the world and to the multilateral agencies," he noted.

"We had to get to the state of occupying the second place in the world (in terms of the incidence of HIV/AIDS) before we are paid enough attention... we didn't have to do that to get attention," the President commented.

He hopes the meeting would address the socio-economic impact of the disease, noting that Guyana is faced with a problem of affordability because it has been caught in the throes of a structural adjustment programme sanctioned by multilateral financial agencies.

President Jagdeo said that based on the amount of money spent on debt- servicing, Guyana has had the least net flows (US$3.3M per year) compared with other countries.

On the question of negotiating with pharmaceutical companies to make drugs more affordable for persons living with HIV/AIDS, the President proposed: "We should even go further, and maybe in collaboration with Brazil or one of the other countries, try to produce such drugs in the region."

Noting that there are pharmaceutical companies that should be able to produce the drugs within the region, he added: "For those who are here representing multilateral and bilateral agencies that are going to help us... I'd like to see everything sustainable.

"Our primary task is to help people," President Jagdeo said, noting that past experience has shown that when institutions get really caught up in planning, "they forget implementation and they forget people."

Minister of Health, Dr. Leslie Ramsammy, echoing the sentiments of Dr. Edward Greene, Assistant Secretary General , Human and Social Development of CARICOM, and Director of CAREC, Dr. James Hospedales, said "it's time for action".

He said that HIV/AIDS is a serious problem and not merely a public health issue. "It constitutes a developmental, and in some cases, security problem."

Ramsammy said finding an effective way of dealing with the problem becomes and imperative, rather than an objective, and alluded to the phenomenon as being the single most competitor to prevent the alleviation of the suffocating stranglehold of poverty.

Noting that Guyana has been ruthlessly frank about the problem and knows what it has to do, he said that the country is working towards building capacity and empowering the environment in order to wage a successful war against the disease.

Hospedales said that the end product of the efforts to achieve the desired objective set by the regional body, CAREC, could result in a dramatic change to the HIV/AIDS landscape in the region.

Greene said: "We see this initiative as an integral part of the strategic plan of action associated with the Pan Caribbean Partnership which CARICOM has the honour to coordinate.

He said that one of the essential features of any equitable programme for treatment and cure of HIV/AIDS must resolve around affordable anti- retroviral medicines and negotiations for supplies for CARICOM countries have already commenced.

Dr. Bilali Camara, Head of CAREC's Special Programme on Sexually Transmitted Infections (SPSTI), said that the decision-makers of the region, (including Hati, Cuba and the Dominican Republic) are facing the worst epidemic outside of Sub-Saharan Africa.

With some 500,000 persons in these parts living with the virus, the leaders now seem determined to reposition care and support for the infected as an integral component of HIV/AIDS prevention and control efforts.

Camara pointed out that CAREC, working with CARICOM, the Caribbean Regional Network of people living with HIV/AIDS (CRN), UNAIDS and the University of the West Indies, has been particularly anxious to bring hope and comfort to the 137,000 people living with AIDS in the 21 countries within the centre's purview. These are mainly the English and Dutch speaking territories in the Caribbean.

Meanwhile, CAREC said it is about to embark on a new five-year strategic plan on HIV/AIDS prevention and control with the support of its international partners - the Canadian International Development Agency, European Union, the French Technical Cooperation, the German Technical Cooperation, the United States Agency for International Development, the United States Agency for Disease Control and Prevention and the United Kingdom Department for International Development (DFID).

But Camara noted that as the Caribbean countries prepare to intensify this aspect of their battle against the epidemic, CAREC and other institutions are advising that they be quite careful not to give a programme that simply provides the anti-retroviral therapy that has not been making a difference in other HIV-dominated environments.

CAREC, according to Camara, wants the region to work towards comprehensive care and support, which will also deliver to the infected and their families, a range of complementary components.

Camara stressed, "these must include voluntary counselling and testing services, psychological support and creation of a supportive environment, legal and ethical frameworks to protect human rights, skills building, empowerment and reorientation of health services, including new laboratory technologies, social support and partnerships with non-governmental organisations"

He said that in some of the HIV countries, HIV/AIDS patients occupy up to 25 per cent of already premium hospital beds, yet the quality of care remains elusive. Case fatality rates have remained constant and high as 63 per cent over the last decade.

This, he said, has raised serious questions as to whether the region has the capacity to deal with the problem, or worse, whether there is not disinterest on the part of national systems to provide some lease on the life of the hundreds of thousands who are infected, or even to reduce their suffering and that of their families.

Access to care and support remains limited because the cost of the required therapy - US$1,000 monthly - could be many times the average salary of the average worker in the Caribbean.

Camara noted that most of the infected have to retreat underground because of entrenched stigmatisation and discrimination which impact more acutely on small societies such as the Caribbean countries.

And the infected fare no better even when they brave the health system in which, practitioners for the most part, are still afraid of HIV positive and AIDS patients. In many instances, some are negatively judgmental and even still lack the skills and experience for treating the infected.

The new Caribbean momentum, the officials say, seeks to address all of these issues with some intensity. The planners will be challenged to change a scenario which still sees most of the national programmes operating according to the old paradigm that focuses primarily on prevention, despite the experience, even on their doorstep in the Bahamas, which shows the need for balanced integrated prevention, care and support programmes.