Background
Located in the northern part of the South American continent on the Atlantic Ocean, Guyana — an Amerindian word meaning “land of many waters” — is bordered by Brazil to the south and southwest, Suriname to the east and Venezuela to the west. Though located in South America, Guyana is considered, both culturally and economically, to be a Caribbean country. It is a member of the Caribbean Community and Common Market, or CARICOM.
Guyana gained independence from Great Britain in 1966 and became a cooperative republic in 1970. It is the only country in South America where English is the official language.
Guyana, which is divided into 10 administrative regions, is the third smallest independent country in South America after Suriname and Uruguay. The capital is Georgetown, which lies on the coast.
Guyana is a religiously and ethnically diverse country. The largest ethnic group in Guyana is East Indian, or Indo-Guyanese — descendants of East Indian indentured servants brought to Guyana in the early 19th century — followed by Afro-Guyanese, or Guyanese of African descent. Both groups live primarily along the coast. Guyana’s rural interior is populated by several groups of Amerindians, comprising about 7 percent of the population. The predominant religions are Christianity, Hinduism and Islam.
Although Guyana is a very poor country, it ranks higher on the U.N. Human Development Index — 103 out of 177 — than any other of the “focus countries” receiving funds from the President’s Emergency Plan for AIDS Relief (PEPFAR), the five-year, $15 billion U.S. initiative to combat AIDS abroad.
The face of HIV
The first case of AIDS in Guyana was diagnosed in 1987. That same year, the HIV infection rate was 1.3 per 100,000 inhabitants. By 2003, that number had ballooned to 56.2 cases per 100,000 inhabitants.
The highest HIV rates are in the urban coastal areas, where most of the population resides. As with most of the countries receiving PEPFAR money, the incidence of HIV is increasing faster among women than men. More women than men under the age of 24 are living with HIV/AIDS in Guyana.
Guyana is estimated to have the fourth-highest HIV prevalence rate in the Caribbean. The region as a whole is said to have the world’s second-highest HIV rates, exceeded only by sub-Saharan Africa, and AIDS has become the leading killer of Caribbean people between ages 15 and 44.
Challenges to fighting the HIV epidemic
Two of the biggest challenges facing the country are the social stigma the disease carries and difficulty reaching remote populations.
Stigmatization is high in Guyana. According to the Guyana HIV/AIDS Indicator Survey of 2005, which documents data and statistics relating to HIV, only 20 percent of Guyanese men and women exhibit accepting attitudes toward people living with HIV/AIDS.
The survey says that slightly more than half of the population holds “no incorrect beliefs” about AIDS, yet it later states that less than half have “comprehensive knowledge” of HIV/AIDS transmission and prevention methods.
The prominence of religion has also proved to be an obstacle to HIV/AIDS prevention and contribute to stigmatization. According to an Amnesty International report, a January 2006 newspaper article quoted clerics of Guyana’s major religions declaring they would not support use of condoms even for protection against HIV, because doing so would condone sex not exclusively for the purpose of reproduction. The clerics also said homosexuality is a sin (male homosexual activity is illegal there).
Because Guyana is small, privacy can also be an issue. Amnesty International says a patient is likely to meet a neighbor or a friend at a clinic, and the alternative of traveling long distances to reach a treatment facility is difficult to hide. Amnesty also reports claims of confidentiality being betrayed by doctors and health workers.
The interior region’s isolation is also problematic. “Once you get out of that coastline, it’s a very difficult country to travel and to deliver health care,” said Guyana’s PEPFAR coordinator, Julia Rehwinkel. “There are many places that don’t have communication contact, no roads; you have to take planes and boats into them.”
As a result, the expansion of health care programs throughout the country must be undertaken very deliberately and thoughtfully, Rehwinkel said. For example, counseling and testing services are premature if there aren’t resources to provide adequate medical care for HIV-positive people.
The hinterland areas are primarily occupied by indigenous Amerindians, many of whom work in gold mines. Reaching out to the indigenous communities has proved difficult, as evidenced by the Amnesty International report, which found that by the end of 2005, there were no HIV/AIDS informational materials available in indigenous languages.
Because a majority of Amerindians live in remote regions, they are not politically connected. The major decision-making bodies for HIV/AIDS policy, with the exception of the minister for Amerindian affairs, have little representation from the indigenous communities.
Guyanese government response
In 1987, the Guyanese government established the National AIDS Program to coordinate the country’s response to the burgeoning epidemic. In 1989, the National AIDS Committee was formed to advise the Ministry of Health on prevention and control of HIV/AIDS. From 1992 to 2002, before the advent of PEPFAR, Guyana had several strategic plans to fight HIV, and in 2004, a Presidential Commission on HIV/AIDS was created to coordinate national efforts.
In 1998, the Guyanese Parliament passed the National AIDS Policy, which establishes the right of people living with HIV/AIDS to access treatment and care. It bans mandatory testing and emphasizes privacy and confidentiality (although no law specifically protects a patient’s privacy).
Guyana is implementing a National Strategic Plan for HIV/AIDS (2002-2006), which seeks, among other things, to promote sexual health and improve the quality and lengthen the lifespan of individuals living with HIV/AIDS. Its strategies include marketing condoms for high-risk groups, providing voluntary counseling and testing services and targeting youth with prevention programs.
Guyana has also established several voluntary counseling and testing sites through the country, which the government heavily promotes. Health care is free to those who need it, and Rehwinkel, the PEPFAR coordinator, says services are widely used.
In 2005, the Ministry of Health implemented the Guyana HIV/AIDS Indicator Survey as part of the national HIV/AIDS response. The survey was supported by PEPFAR and conducted by the Guyanese Responsible Parenthood Association.
U.S. government response
“I think from a technical point of view, Guyana was at the cusp or is currently at the cusp of a generalized [HIV] epidemic, but still has relatively low levels of national prevalence,” Rehwinkel said in explaining why she thinks Guyana was chosen as a PEPFAR focus country. “It’s a situation where a strong program can really make a difference, and a visible difference.”
Guyana is a data-poor country, so one of the endeavors that PEPFAR has undertaken is gathering statistical data and strengthening surveillance and information systems. “PEPFAR has increased the amount of valuable information that’s available tremendously,” Rehwinkel said. Because questions about contraceptive security, maternal and child health, tuberculosis and malaria were included in PEPFAR surveys, “we know more about the health of the Guyanese population than we did before.”
In fiscal 2005, PEPFAR committed just over $7 million to HIV prevention activities in Guyana — or 44.6 percent of prevention, care and treatment funding for the country. According to Amnesty International, no PEPFAR funds were used to purchase condoms in Guyana in 2005. Just under one-third of the funding, or $5.3 million, was targeted for treatment programs, while care programs received $3.6 million, just over 20 percent of the total funding. Because until recently only brand-name drugs could be purchased with PEPFAR funds, the Guyanese government decided to buy only second-line and pediatric drugs with PEPFAR money and to buy generics with money from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Yet, despite the money pouring into Guyana from the U.S. government, there are still areas that lack sufficient funding. PEPFAR will not fund organizations that provide abortions or advice about abortions, which means many sexual and reproductive health groups that provide comprehensive sexual health services are barred from receiving funds. According to Amnesty International, comprehensive reproductive health services are vital to decrease the risk of contracting HIV.