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HIV in Sex Workers in Guyana 9

Public Health Informatics

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Introduction

HIV/AIDS is a national catastrophe as well as an international crisis. HIV/AIDS is one of the leading worldwide challenges alongside others such as global warming, nuclear war, continuing conflicts and international trade and fiscal policies. This catastrophe represents one of the utmost possible dangers to attaining the Millennium Development Goals (MDGs). Many people are more vulnerable and more exposed to HIV/AIDS as compared to others. A good example is the sex workers, comprising of all those employed in the sex industry from the staff helping curb HIV/AIDS to those doing the act to earn money. One of the countries faced with this problem is Guyana which is a country in South America. This nation has confidently established programs and policies that are intended to reduce the effect that HIV/AIDS has had on the country. Between 2002 and 2006, a national strategy was laid to board on go-getting programs which were being reinforced by the Central Government during the time when very few local and international NGOs were prepared and enthusiastic to get involved in the fight against HIV/AIDS in Guyana. The country’s response and fight against HIV/AIDS started initially the first case was reported in the year 1987 (Dr. Shanti Singh, 2012, pg. 13). Since that time, the country worked hand in hand with its stakeholders towards the public threat.

In this report, we shall discuss various aspects surrounding HIV/AIDS in sex workers of Guyana and the Public Health Informatics informed approaches for monitoring or managing HIV in sex workers in the country. Apart from description of the problem above, this report shall focus on existing statistics describing this issue, the traditional government or institutional data sources that could help to shed light on its prevalence or patterns, and explain why these might not be sufficient and suggest non-traditional information sources and methods of data capture that might be useful. We shall also give suggestions on how the data could be analyzed and visualized to support public health intelligence or to inform interventions and services.

The country of Guyana has an HIV/AIDS prevalence of about 1.1%. This is a proof of the significant strides in fighting the epidemic in Guyana which is recognized locally and also globally. The HIV/AIDS infection has been on the increase since the first case was reported in 1987 with an accumulation of 1899 AIDS cases and 9473 HIV cases between 2002 and 2011 (Ministry of health, 2007-2011, pg. 18). However, the number of new AIDS infection decreased progressively since 2004 with 972 and 62 cases of HIV and AIDS respectively reported in 2011(Republic of Guyana, 2014, pg.9-10). In 2003, adult HIV prevalence in Guyana was estimated to be 2.5% with extremes of 0.8% and 7.7% for low and high extremes respectively (Esther, 2013, pg. 35). According to UNAIDS in research done in 2013, the adult prevalence was estimated to be 1.4% which was a great decrease from 2.5% and 2.4% of 2003 and 2004 respectively (Keith et al, 1997). Since 2010, the ratio of AIDS infection male-female has been on the increase for the female side with a ratio of 1:4 in 2014 (Republic of Guyana, 2014, pg.9-10). In 2014, the highest number of HIV/AIDS cases was reported in individuals between the age of 25-49 and it accounted for 61.7% of all cases. In 2014, the Biological and Behavioral Surveillance Survey (BBSS) exhibited a sharp reduction in the HIV prevalence amongst female sex workers (FSWs) as compared to 26.6% in 2005 and 5.5% in 2014. However, amongst the MSMs the prevalence decreased from 21.1% in 2005 to 4.9% in 2014 according to the BBSS report. In the juniors’ prevalence reduced from 6.5% in 2000 to 1% in 2014.

Guyana’s most recent Biological Behavioral Surveillance Survey (BBSS) described HIV risk shapes and vulnerabilities for KPs; hot spots for transmission; and estimated size of key subpopulations. Key findings of the BBSS 2014 include (Advancing Partners and communities, 2015, pg. 5):

• 34% of female sex workers (FSW) and 28% of male sex workers (MSW) were found in Region 4; 22% FSW and 33% MSW were found in Region 6

• 44% of FSW and 48% MSW have comprehensive HIV knowledge

• Information on the risks of anal sex has not reached the right people. Condom use and anal sex needs to be renewed focus

• 52% of FSW and 35% MSW felt that their risk of becoming infected was high

• 54% FSW reported finding clients in discos, 49% said finding customers in hotels, 47% reported finding clients on the street and 21% reported finding clients in brothels

• 40% FSW and 39% MSW reported consistent condom use with regular partner while 68% FSW and 52% MSW reported the same with clients and consistent condom use by FSW with its customers declined by 12% between 2009 and 2014

• 82% of FSW had been tested at least once compared to 60% MSW

• 11% of FSW reported being reached by “Keep the Lights On” Peer Educator within the past 12 months compared to 39% in 2009

• 24% of MSM reported being reached by “Keep the Lights On” or “Path for Life” Peer Educator in 2014

• Partner violence and rape are major problems that need to be addressed in all key populations

• Boys less than 18 years who identified as transgender (TG) involved in transactional sex were consistently less aware of available services than other youth engaged in sex work.

Such data like the one provided by BBSS helps future generations to keep track of the epidemic in sex workers of Guyana. HIV/AIDS being a killer epidemic increase the prevalence of the disease needs to be increased by providing good and reliable data sources that will create awareness to all ages of people and most importantly a source that will reach the sex workers efficiently. The sources that provide such data are either supported by the government or NGOs and private institutions. These two sectors provide the data either in traditional data sources or non-traditional data sources. Traditional data sources comprise of reports and press releases but majorly reports (Marin et al., 1983, pg.65-80). These sources though not enough help shed light on the prevalence and patterns of HIV/AIDS infection in sex workers of Guyana. According to research, the sex workers of Guyana are not as much resistant to change as we may think. From the statistics above it is clear that the rate of HIV infection went down since 2000 and this was as a result of vigorous awareness created by the sex workers (Marin et al., 1983, pg.65-80). The traditional use sources of data to the government helped the government of Guyana to establish bold measures to help the sex workers and to reduce the rate of spread of the epidemic in the country. The disadvantage with these sources is that they might not reach the people directly and that very few people will be achieved.

However, these traditional methods might not be sufficient, and that’s when I would suggest the use of non-traditional information sources and methods of data capture that might be useful (Marin et al., 1983, pg.65-80). The non-traditional data sources comprise of social media and news reports such as Twitter, YouTube, Instagram amongst others. For instance, in Guyana, Twitter has become a major and modern media communication platform for the citizens, government, agencies among others to get information on sensitive issues such as the HIV/AIDS epidemic. Non-traditional data sources on HIV/AIDS includes all relevant information that is collected from sources that are out of the scope of the current methods of data collection in the country. These sources cover a broad spectrum, from small sources such as smartphones to combined metadata from the social media. Non-traditional sources are an ideal source for statistical agency use as it is provided controlled and designed by the agency (Marin et al., 1983, pg.65-80). This implies that any identified errors will be controlled under one control such as a first-class likelihood survey fixed by the agency. Furthermore, such data sources can be controlled by more than one NGO or even several local governments in Guyana. Some of the sources include traffic cameras. Non-traditional sources result from autonomous choices, and it is not easy to conceptualize, and errors are few.

As such I would recommend the use of the following non-traditional sources as useful in enhancing high HIV/AIDs prevalence in Guyana and especially information on HIV/AIDS sex workers in the country. One of these sources is the news report that captures raw information in the form of spoken or verbal information where the media can interview the Sex workers and pass the information or through taking pictures (Marin et al., 1983, pg.65-80). This can help by pushing the government to offer health and sex workers rules that work in reducing the spread of the epidemic. Another source I would recommend is the use of local government, news and citizen tweets about HIV/AIDS in sex workers of Guyana. The local government tweeting involves posting reported information in Twitter providing information and warnings about the spread of the epidemic, giving the right advice to the sex workers and ideology of use of a condom. The news tweet involves the information posted on Twitter by news organizations while citizen tweeting involves real-time information which is publicly posted on Twitter by individuals who do not represent any news agency. These individuals may be the sex workers themselves tweeting real-time information about the epidemic.

This information is paramount in providing public support to health intelligence or even to inform interventions and services through analysis and visualization. The best method of analysis is a secondary analysis which implies the use of available information to find the solutions to health issues such as the HIV/AIDS epidemic. The advantage of this method is that it can be used to solve significant data from surveys. However, there is an overall agreement involved in sharing the results if the data is large scale. The fundamental ethical issues related to secondary data analysis remain similar; they are more persistent with the introduction of innovative technologies. Sharing, storage and compiling of data have become easier and quicker. Similarly, there are developing concerns and challenges with data security and confidentiality. However, the serious concerns about secondary data analysis revolve around possible harm to personal matters and the problem of return for an agreement. This analysis depends on the quantity of the information at hand. In case the data does not have any classifying information or it is entirely coded such that the researcher lacks the access to the codes; the data will not require full review by the board of ethics. The board should only confirm if the data is unsigned. Nevertheless, in case if the data has some signed information about the sex worker participants or any information that can lead to recognizing the members, the board will have to make a complete review of the proposal (Boryc, 2010, pg.482-491). The researcher or the source of the data should thus explain why it is inevitable to have enclosed information to reply to the research question and should also entitle how the sex workers’ discretion and the confidentiality of the information will be secured. Upon certification of the data provided, the data is then analyzed to provide health solutions on how to prevent or reduce the spread of HIV/AIDS amongst the sex workers in the country.

To monitor and manage this epidemic in Guyana, the use of informatics-informed approaches is crucial to ensure the true prevalence is enhanced. HIV/AIDS being one of the causes of death in Guyana, which is a nation with a high prevalence of the epidemic, the use of an informatics-informed approach will be very efficient. SIDATRAT is one of the informatics systems which are widely utilized in the Caribbean region. It ensures proper monitoring and follows of drug administration (Aragoné et al, 2012, pg. 5-9). The system functions on the web platform and uses a MySQL, PHP and Apache server and helps in recording the overall information of the patient. SIDATRAT can compile AIDS information, classification, infection rates, HIV subtype and resistance studies, drug regimen, follow-ups, any side effects from drugs, survival rate, and also the number of patients under treatments. The system follows the client-server philosophy and allows the access by authorized users through the health informatics networks (Aragoné et al, 2012, pg. 5-9). The system can offer daily support care for HIV/AIDS patients and universal access to antiretroviral therapy.

References

Advancing Partners and communities, 2015, Advancing Partners & Communities (APC) Guyana Project Solicitation No. GH-0 21 Delivering Effective HIV Prevention, Testing and Care Services for Key Populations in Guyana:

https://www.advancingpartners.org/sites/default/files/apc_gh-021_solicitation_

07_17_2015_0

Aragonés, C., Campos, J.R., Pérez, D., Martínez, A. and Pérez, J., 2012. SIDATRAT: informatics to improve HIV/AIDS care. MEDICC review, 14(4), pp.5-9.

Boryc, K., Anastario, M.P., Dann, G., Chi, B., Cicatelli, B., Steilen, M., Gordon‐Boyle, K.,

Dr. Shanti Singh, 2012, End Of Term Review Guyana National HIV/AIDS Strategy2007-2011:

http://hivhealthclearinghouse.unesco.org/sites/default/files/resources/Guyana_End_of_T rm_Review_May_9_2012

Esther M McIntosh et al., 2013, A Qualitative Research Study on HIV Vulnerability among Young Key Affected Populations in Guyana: https://www.unicef.org/guyana/YKAP_Final_Report_31_July_2013

Guyana Operational Plan Report FY 2012, :

http://www.pepfar.gov/documents/organization/212144

Keith H. Carter Bhiro P. Harry Michael Jeune and Devian Nicholson, 1997, HIV risk perception, risk behavior, and seroprevalence among female commercial sex workers in Georgetown, Guyana: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49891997000600005

Marin, B.V.O., Marin, G., Padilla, A.M. and De La Rocha, C., 1983. Utilization of traditional and non-traditional sources of health care among Hispanics. Hispanic Journal of Behavioral Sciences, 5(1), pp.65-80.

Ministry of health, 2007-2011, Guyana National HIV/AIDS Strategy 2007-2011:

http://www.pancap.org/docs/NSP/Guyana_NSP

Republic of Guyana, 2014, Guyana Aids Response Progress Report Republic Of Guyana:

http://www.unaids.org/sites/default/files/country/documents/GUY_narrative_report_201

.

Singh, S. and Morris, M., 2010. A Needs Assessment of Clients With HIV in a Home Based Care Program in Guyana. Public Health Nursing, 27(6), pp.482-491.

Important note: this will be a graded assignment!

This will serve as an online discussion forum for many of the issues and questions and specifics from the novel that are important and we will not have time in class to discuss.  Thus, this assignment will help guide you through some of the major themes in the novel. 

Complete the assignment using the following guidelines:

1) Choose a quote from the one of the first three sections of the novel.

2) Write it out, and post it on the forum as a discussion thread.  Write out the full quote, include the page number.  The quote should be only one or two lines long.  Do not post a full paragraph.

3) Write a paragraph explaining the significance of the quote.  Use the following questions to guide you, but do not simply answer the questions in order.  Why did you choose this quote?  What makes it important?  How does it connect or relate to the rest of the novel?

4) Do this twice as two separate postings.

5) Do not post the same quote as someone else. 

6) Make sure your own quotes are from two separate chapters of the novel.