Last week, doctors and nurses from a number of regions participated in a training programme on treating HIV/AIDS organised by the National AIDS Programme Secretariat (NAPS) and led by two overseas-based Guyanese Drs Balkaran and Ramgopal. The training represents a small but significant step in the fight against HIV/AIDS as the battle against this affliction can only be successfully fought if treatment is available in all parts of the country. NAPS and the doctors associated with the training programme should be congratulated on this effort and be urged to broaden it.

Several hundred persons are now being attended to following the government’s ground-breaking decision to treat HIV/AIDS patients using drugs produced locally by the New Guyana Pharmaceutical Corporation. The problem is that this treatment has been centralised at the Georgetown Hospital and patients who have no access to private health care and couldn’t afford it would have to journey to the city. This is highly infeasible. A young mother in an Essequibo village or an elderly man on the Corentyne could hardly be expected to make the trip to Georgetown regularly, particularly if they were chronically unwell.

While the government has made a bold move to begin treating HIV/AIDS patients it now needs to accelerate the implementation of a well-structured programme which will permit treatment to be administered in all parts of the country while at the same time educating patients and heightening public awareness of the disease. This is even more important in light of the expected disbursal of funds under President Bush’s HIV/AIDS initiative for Africa and the Caribbean and from other sources. Donors and NGOs willing to help tackle Guyana’s serious problem with this disease would want to see a viable programme in place.

The number one requirement is to get as many health care professionals in the regions trained to treat the disease. This will naturally take some time and necessitates a conscious decision by the Ministry of Health to set aside an appropriate sum of money for this. In tandem with this, a decision would have to be taken on where treatment should be made available and how to dispense it in an atmosphere that encourages persons to come forward and be treated. It could ideally be the health clinic in the community or a regional facility. It must however not be associated only with the treatment of HIV/AIDS as that serves as a deterrent to people coming forward. The best environment for treating patients is one in which general medical care is provided as long as the necessary precautions are taken.

Patient management is also a critical consideration. Countries like Brazil, Thailand and Uganda which have registered significant progress in treating patients with the various triple therapies know that success is dependent on the patient understanding precisely what he or she needs to do to make the treatment work. The medications have to be taken religiously as prescribed and continuously. Incorrect use of the medication can result in the development of resistant strains of the HIV virus and severe deterioration in the condition of the patient. Patients have to be painstakingly taken through this regimen until they fully understand it and show adherence.

In addition, there has to be frequent testing of patients to assess progress in reducing the viral load in the blood and to make decisions on whether therapies should be juggled. The current programme at the Georgetown Hospital and the mother-to-child pilot provide the opportunity for success of patient management to be analysed and to prepare for its replication in other regions.

Treatment has to be augmented by counselling of patients and preparing them for carrying on with their lives in changed circumstances. Where patients agree, their families should also be involved to lend support and to provide a healing and enabling atmosphere for treatment.

The special nutritional needs for HIV/AIDS patients, which has been the subject of a local seminar, also has to be built into patient care at all levels of the programme.

Inseparable components of this HIV/AIDS programme are the educating of the public on the disease and removing the stigma associated with it. The ultimate objective must be to ensure that the general populace is aware of how the HIV infection can be picked up and how it can be thwarted. Abstinence and safe sex methods should be taught in the senior levels of secondary schools and other institutions. And it is only when the awful stigma attached to having the disease is removed that those infected have the best opportunity to fight it and lead more normal, quality lives.

Making HIV testing more widely available and forming partnerships with the private sector in treating this scourge are other strands which have to be woven into the national fight.

Very soon, if the programme builds on the success of the current treatment at the Georgetown Hospital and in the mother-to-child pilot scheme, the government will have to make a decision on whether care will be offered across the board free of cost. If all those who are infected were to come forward it would be a very costly exercise and one which the government should start preparing for.

Because this disease has the potential to decimate large numbers of the productive labour force and to further rent the fabric of family life it is incumbent upon each and every one of us, NGOs, the government and other stakeholders to pool efforts to fight it and a well-thought out programme is the best response and more likely to attract donor support.