PaperInstructions_Topic xSexTransmInfectFMaleSexWorkersinGUY Sexually_transmitted_infection_service_u HIVRiskPerceptionbehaviourfmalesexworkersinGUY GUYNatlHIVAIDSM_EPlan2007-2011 GUY_NatlHIVAIDSStrategy07-11 GUY_EoT_GuyanaNatlHIVAIDSStrategy_2012 GUY_AIDSResponse_report_2015 QualRsrchonHIVamongYKAPopinGUY2013 GUYUNICEF_Sit_Ans_ChildrenandWomen_2016
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TOPIC:
Public Health Informatics written assignment Task – 2000 words
Imagine that you are a public health informatician. You have been asked to produce a report for the government of your chosen country, describing one of the following public health problems or threats, and proposing informatics-informed approaches for monitoring or managing it.
· HIV in sex workers in Guyana (South America);
The report should –
· Outline the problem and any existing statistics describing it
· Consider what traditional government or institutional data sources could help to shed light on its prevalence or patterns
· Explain (where appropriate) why these might not be sufficient and suggest non-traditional information sources and methods of data capture that might be useful
· Suggest how this information could be analysed and visualised to support public health intelligence, or to inform interventions and services
· Consider data challenges such as accessibility, quality, and governance/ethics
INSTRUCTIONS:
There are three core criteria by which the essay will be assessed:
· Knowledge and understanding of concepts: Do you use concepts that were introduced in the course correctly*? Do you use relevant concepts?
· Knowledge and use of the literature: Are you using relevant key literature (books, papers, etc.) Are you using relevant literature that you have found yourself? How well integrated is the literature in your assignment?
· Constructing academic discourse: Do you present a coherent argument? Does your paper have a clear aim and a clear structure? How well are your conclusions motivated from the evidence that you have assembled? Do you discuss problems and limitations of the evidence that you have found?
Assignments should not exceed a total of 2,000 words and may, where appropriate, include drawings or diagrams, which will not be included in the word count. References (10 to 15) should be cited in an appropriate manner using a conventional and consistent citing method (Harvard referencing style must be used). Submitted papers are acceptable in single spacing, but double spacing is preferred.
Country Background & Program Context
Guyana’s most recent Biological Behavioural Surveillance Survey (BBSS) described HIV risk profiles and vulnerabilities for KPs; hot spots for transmission; and estimated size of key subpopulations. Key findings of the BBSS 2014 include:
• 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 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% reported finding clients 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 clients 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 under 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
Sexually transmitted infections, drug use, and risky sex among
female sex workers in Guyana
Introduction
In Guyana, a steep increase in HIV sero-
prevalence was observed among female com-
mercial sex workers (CSWs) during the last
decade; from no evidence of HIV infection in
1988, to 25% in 1993, and 46% in 1997.1–3
The dynamics of transmission as well as the
distribution and determinants of high risk sex
among them are poorly understood. The aim
of this survey was to describe factors that may
facilitate HIV transmission in this popula-
tion.
Method
Ethical clearance was obtained from the min-
istry of health. In 1997, a survey was
conducted among 73 street based and 51
brothel based female CSWs. Following verbal
consent, a pretested questionnaire was ad-
ministered by trained interviewers to collect
data on sociodemographics, condom use,
sexually transmitted diseases (STDs), and
drug use (alcohol, “crack” cocaine, and mari-
juana). Drug use was classified as “ever” ver-
sus “never.” Condom use was dichotomised
as consistent (always) or inconsistent (some-
times or never). Logistic regression was used
to determine independent predictors of high
risk sex.
Results
Their mean age was 30.6 years (SD 7.2 years)
and their median time in sex work was 3.0
years. The street based and brothel based
CSWs were similar with respect to age, mari-
tal status, and time in sex work.
Sixty four per cent reported a history of at
least one STD; 45% had genital discharge,
16% had vaginal ulcer, 25% had syphilis, and
16% had other STDs. In addition, 33 had
salpingitis. Drug users were more likely to
report STDs.
None of the women admitted injection drug
use. Fifty one CSWs reported marijuana use
and 27 admitted using crack cocaine. All of the
crack cocaine users, except one, reported they
smoked marijuana. Forty one (34.5%) indi-
cated that they were always under the influ-
ence of alcohol while having sex with their last
10 clients. Brothel based CSWs were more
likely to have been under the influence of alco-
hol while having sex with their last 10 clients
(59.2% v 17.1%; p<0.001) and less likely to
use marijuana (30% v 49%; p=0.03) and crack
cocaine (15.7% v 26%; p=0.169).
Forty four (36%) CSWs reported incon-
sistent condom use with clients and 88% use
condoms inconsistently with their stable
partner. Seventy nine CSWs reported sex
during menstruation. No significant diVer-
ences were found between the brothel based
and street based women with respect to sex
during menstruation and frequency of con-
dom use with clients. Factors that were
significantly associated with inconsistent con-
dom use with clients and sex during men-
struation are shown in table 1. Crack cocaine
use predicted inconsistent condom use while
marijuana predicted sex during menstrua-
tion.
Discussion
The absence of injection drug use suggests
that unsafe sexual intercourse may be the
major risk behaviour for acquisition of HIV.
The simultaneous presence of high levels of
STDs, inconsistent condom use, and multi-
drug use, should be a cause for concern, as
they may interact to provide fertile conditions
for sexual spread of HIV. In addition to their
role in enhancing HIV transmission,4 STDs
may also be an indicator of the extent of their
potential exposure to HIV infection. Consist-
ent with research that was conducted
elsewhere,5 6 we found that drug users were
more likely to engage in high risk sex. The
exact reason for this relation in this popula-
tion is unclear. The low rate of condom with
stable sex partners suggests that future stud-
ies should investigate the role of these
partners both as a source of HIV/STDs for
the CSWs, as well as a potential bridge for
HIV transmission into the community.
This study was funded by the National AIDS
Program in Guyana and the Fogarty International
Training Program, University of Miami.
NAVINDRA E PERSAUD
Fogarty International Training Program,
University of Miami and Ministry of Health,
Guyana
WINSLOW I KLASKALA
MARIANNA K BAUM
Fogarty International Training Program,
University of Miami
ROBERT C DUNCAN
Department of Epidemiology and Public
Health, University of Miami
1 Carter KH, Harry BP, Juene M, et al. HIV risk
perception, risk behavior and seroprevalence
among female commercial sex workers in
Georgetown, Guyana. Pan Am J Public Health
1997;1:451–9.
2 Persaud N, Klaskala K, Tiwari TSP, et al. Drug
use and syphilis: cofactors for HIV transmis-
sion among commercial sex workers in Guy-
ana. West Indian Med J 1999;48:52–6.
3 UNAIDS. Epidemiological Fact Sheet on HIV/
AIDS and STDs. UNAIDS, 1998. Available
from http://www.unaids.org.
4 Cohen MS. Sexually transmitted diseases en-
hance HIV transmission: no longer a hypoth-
esis. Lancet 1988;351(suppl 111):5–7.
5 Simeon DT, Bain BC, Wyatt GE, et al. Charac-
teristics of Jamaicans who smoke marijuana
before sex and their risk status for sexually
transmitted diseases. West Indian Med J 1996;
45:9–13.
6 Messiah A, Bloch J, Blin P, et al. Alcohol or drug
use and compliance with safer sex guidelines
for STD/HIV infection. Results from the
French national survey on sexual behavior
(ACSF) among heterosexuals. Sex Transm Dis
1998;25:119–123.
Table 1 Factors associated with inconsistent condom use with clients and sex during menstruation—female sex workers in Guyana
Risk behaviour
Inconsistent condom use Sex during menstruation
Univariate eVect
OR (95% CI)
Multivariate eVect*
OR (95% CI)
Univariate eVect
OR (95% CI)
Multivariate eVect*
OR (95% CI)
(1) Cocaine use 4.4 (1.9, 10.5) 5.59 (2.04,15.3) 18.5 (3.8,87.0) 6.3 (0.7, 57.6)
(2) Marijuana use 1.3 (0.6, 2.70) — 8.10 (3.1,20.9) 4.3 (1.4, 13.5)
(3) Being married 7.4 (1.8, 30.8) 11.14 (1.92,64.7) 1.48 (0.3,7.70) —
(4) Condom possession 0.3 (0.1, 0.90) 0.38 (0.11,1.32) 0.58 (0.2,1.50) —
(5) Street walker 2.2 (1.0, 4.70) 2.10 (0.83,5.10) 1.63 (0.8,3.60) —
(6) Secondary education 2.1 (1.01, 4.5) 2.30 (0.94,5.47) 1.96 (0.9,4.40) —
OR = odds ratio; CI = confidence interval.
*Only variables that were significant on univariate analysis were placed in the multivariate model.
318 Global views
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risky sex among female sex workers in Guyana
Sexually transmitted infections, drug use, and
Duncan
Navindra E Persaud, Winslow I Klaskala, Marianna K Baum and Robert C
doi: 10.1136/sti.76.4.318
2000 76: 318 Sex Transm Infect
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Sexually Transmitted Infection Service Use and Risk
Factors for HIV Infection Among Female Sex Workers
in Georgetown, Guyana
Caroline F. Allen, MA, PhD,* Morris Edwards, MB ChB, MSc,Þ Lisa M. Williamson, BA, MPhil,*
Wendy Kitson-Piggott, MSc,þ Hans-Ulrich Wagner, MD, MTropMed,§ Bilali Camara, MPH,||
and C. James Hospedales, MBBS, MFPHMþ
Objectives: To identify risk factors for HIV and sexually transmitted
infection (STI) service use patterns among female sex workers in
Georgetown, Guyana.
Design: A cross-sectional study was conducted among 299 female
commercial sex workers.
Methods: HIV prevalence was assessed using an oral fluid test, and
sociodemographic and behavioral data by interview administered by
sex workers and women’s group members.
Results: HIV prevalence was 30.6% [95% confidence interval (CI)
24.9Y36.3]. Multivariate logistic regression found a significant
association between HIV infection and having a vaginal ulcer in
the last 12 months [odds ratio (OR) 4.0, CI 1.4Y12.0]. Having had a
vaginal ulcer was associated with use of cocaine. Multivariate
logistic regression on STI service use variables found significant
associations between HIV infection and getting condoms from public
sector STI services (OR 3.1, CI 1.6Y5.8), not going back for HIV test
results (OR 3.4, CI 1.1Y10.1), and last getting tested for HIV more
than 6 months ago (OR 2.8, CI 1.3Y6.2).
Conclusions: An active program of screening and treatment of
ulcerative STIs should be combined with substance abuse services for
sex workers (SW). Condom promotion services are reaching SW at
high risk, but HIV stigma may prevent SW at high risk from ac-
cessing HIV test results.
Key Words: risk factors, HIV/AIDS, sex workers, Caribbean,
sexual behavior, health service use, drug users
(J Acquir Immune Defic Syndr 2006;43:96Y101)
Guyana has a population of 767,000, with more than 56%of the population in the age group 15 to 49 years. Gross
domestic product per capita was US $1093 in 2001, making
this the poorest country in the Caribbean, after Haiti.
1
More
than a third of the population lives in the urbanized coastal
region, mostly in the capital city Georgetown. Although
located on the northeast coast of South America, Guyana is
generally considered part of the Caribbean region, sharing a
similar colonial and political history and being a member of
the Caribbean Community. South America differs from the
Caribbean in characteristics of the HIV epidemic, having lower
HIV prevalence and a concentrated epidemic, notably among
intravenous drug users.
2
Twelve Caribbean countries have adult
HIV prevalence exceeding 1%, indicating a generalized
epidemic.
3
Surveys among men who have sex with men and
sex workers (SW) show substantially higher prevalence. Adult
HIV prevalence in Guyana in 2003 was estimated to be 2.5%,
with a range between the Blow^ and Bhigh^ estimates of 0.8% to
7.7%.
2
In 1996, HIV prevalence among pregnant women was
found to be 7.1%, illustrating the Caribbean pattern of vul-
nerability among sexually active women.
4
Although several Caribbean governments are directing
HIV prevention interventions toward groups generally
recognized as high risk, opportunities to improve effective-
ness may have been missed because data are lacking on risk
factors and to monitor achievements. There have been few
studies to identify factors associated with HIV status in the
Caribbean.
5
Exceptions are SW surveys in Montego Bay,
Jamaica,
6
and in Georgetown, Guyana, where SW seem to be
highly vulnerable to HIV, with surveys showing prevalence
of 25% in 1993
7
and 46% in 1997.
8,9
Our study extends the
analysis of the Guyana surveys by studying SW across the
whole of Georgetown, including a larger number of possible
explanatory variables, and examining synergies between
variables found to be associated with HIV in bivariate and
multivariate analyses.
Since 1996, the Guyana National AIDS Programme
Secretariat (NAPS) has implemented a risk reduction
strategy: the Georgetown SW Project. A network was
established for the distribution of condoms via brothel
owners, street distributors, the genitourinary medicine
(GUM) clinic, and health centers. The NAPS and GUM
clinic collaborated to improve access to sexually transmitted
infection (STI) screening, voluntary counseling and testing
for HIV (VCT), and STI/HIV treatment services for SW.
Fifteen SW were trained to conduct outreach, during which
they distributed condoms, educated SW about HIV/STIs and
condom negotiation and other safer sex skills, and referred
SW to health services. We report on a survey that aimed to
EPIDEMIOLOGY AND SOCIAL SCIENCE
96 J Acquir Immune Defic Syndr & Volume 43, Number 1, September 2006
Received for publication June 8, 2005; accepted May 1, 2006.
From the *MRC Social and Public Health Sciences Unit, University of Glasgow,
Glasgow, UK; †Caribbean Comunity (CARICOM)/Pan Caribbean AIDS
Project (PANCAP), Georgetown, Guyana; ‡Caribbean Epidemiology Centre,
Port of Spain, Trinidad and Tobago; §Deutsche Gesellschaft fuer Technische
Zusammenarbeit (GTZ), Eschborn, Germany and ||Pan American Health
Organisation/World Health Organisation, Washington DC.
Funding for this study was provided by the Caribbean Epidemiology Centre/
German Technical Co-operation (CAREC/GTZ), Port of Spain, Trinidad and
Tobago.
Reprints: Caroline F. Allen, MA, PhD, Medical Research Council Social
and Public Health Sciences Unit, University of Glasgow, 4 Lilybank
Gardens, Glasgow G12 8RZ, UK (e-mail: caroline@msoc.mrc.gla.ac.uk
or carolineallen@tstt.net.tt).
Copyright * 2006 by Lippincott Williams & Wilkins
Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.
TABLE 1. Characteristics and Behavior of Sex Workers by HIV Status
Characteristic
Percentage (%) With This Characteristic
Of Those HIVj
(n = 164)
Of Those HIV+
(n = 77)
Of Those With Known
HIV Status (n = 241)
Interviewed downtown† 76.2 92.2 81.3
Find clients on street or in hotels/brothels† 69.5 88.3 75.5
Union status
No regular partner 56.7 50.6 54.8
Regular partner 21.3 28.6 23.7
Married 3.7 6.5 4.6
Cohabiting 17.7 14.3 16.6
Highest level of education
Never attended school 4.3 1.3 3.3
Primary 41.5 51.9 44.8
Secondary or above 53.6 46.8 51.4
Ethnicity
Afro-Guyanese 40.2 49.4 43.2
Indo-Guyanese 22.0 16.9 20.3
Native American 3.0 0 2.1
Mixed 34.8 33.8 34.4
Nationality of clients
All Guyanese 36.6 42.9 38.6
All foreigners 9.8 1.3 7.1
Some Guyanese and some foreigners 53.0 54.5 53.5
Currently living in Urban Demerara (Georgetown area) 66.5 71.4 68.0
Grew up in Urban Demerara 56.1 59.7 57.3
Ever did this work outside Georgetown 30.5 37.7 32.8
Other places worked
Somewhere else in Guyana 15.2 20.8 17.0
Suriname 5.5 13.0 7.9
Trinidad and Tobago 4.3 1.3 3.3
Barbados 1.8 1.3 1.7
French Guyana 3.0 1.3 2.5
St. Martin 0.6 0 0.4
Ever used anything to prevent pregnancy with partner* 64.0 49.4 59.3
Currently using nothing to prevent pregnancy* 20.2 34.2 24.7
Frequency of condom use with clients
Always 82.9 81.8 82.6
Sometimes 15.9 16.9 16.2
Never 0.6 1.3 0.8
Used a condom at last sex with a client 92.1 85.7 90.0
Frequency of condom use with boyfriend, husband, or regular partner
Has no regular partner/husband/boyfriend 28.7 19.5 25.7
Always 29.9 26.0 28.6
Sometimes 11.0 19.5 13.7
Never 29.9 35.1 31.5
BDo you have a condom with you now? Can you show it to me?^
Showed condom to Interviewer 37.8 46.8 40.7
Group sex*
Do not do groups 70.6 58.4 66.7
Client changes condom during group sex 12.3 10.4 11.7
Client does not always change condom during group sex 17.2 31.2 21.7
Injected self with drugs in last 12 months 1.2 0 0.8
Regularly smoke marijuana 6.7 11.7 8.3
Regularly get high on alcohol† 12.7 27.6 17.5
Ever tried cocaine† 16.3 36.8 23.1
(continued on next page)
J Acquir Immune Defic Syndr & Volume 43, Number 1, September 2006 HIV Risk Among Sex Workers in Guyana
* 2006 Lippincott Williams & Wilkins 97
Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.
identify risk factors for HIV among SW in Georgetown and
assist with the orientation of the SW Project.
METHODS
In July 2000, respondents participated in anonymous
structured interviews and provided oral fluid samples for HIV
testing. Eight fieldworkers were recruited, comprising sex
workers who had received peer educator training and
members of a women’s organization with experience of
working with SW.
The NAPS and fieldwork team mapped locations of sex
work by visiting sites and talking to people in the locality.
Aiming to cover all main sex work locations, fieldwork
included more prosperous areas in the north of Georgetown as
well as the poorer, Bdowntown^ areas where the 1997 survey
was conducted.
8
Respondents were accessed by snowballing
starting by including SW at known sex work sites, with re-
searchers seeking information on other SW from the workers
themselves.
10,11
The survey took place over 3 weeks and was
conducted at night and during the day to enhance coverage of
the sex worker population.
The major risk from this research was of social harm: that
HIV-positive status would be revealed with resulting discrimi-
nation. Respecting the choices of research subjects, we
consulted sex workers in the process of research design.
Although they were first informed of standard procedures
planned to safeguard anonymity, they maintained that they
would not accept research that involved collection of personal
identifiers that may have enabled HIV status to be revealed.
They advised that research participants be counseled to seek
VCT and be guided on how to access it and other sexual and
reproductive health services. Fieldworkers provided this
counseling, thus enhancing access to publicly available services,
and provided condoms. Each potential respondent was informed
of the nature of the study and the procedures to safeguard
confidentiality; consent was obtained for all participants.
Respondents were paid a fee of around US $8 as compen-
sation for opportunity cost of participating in the survey.
Oral fluid samples were collected from each study
participant with the FDA-licensed Orasure sampling device
manufactured by Epitope Inc (Beaverton, OR). Procedures for
collection of gingival/oral fluid followed manufacturer’s
instructions. Laboratory work was conducted at the Caribbean
Epidemiology Centre (CAREC). Oral fluid extract was
screened with the Organon Teknika (Boxtel, the Netherlands)
Vironostika Uniform 11 + O HIV 1 & 2 enzyme-linked
immunosorbent assay. Reactive specimens were confirmed
with the Epitope oral fluid Western Blot confirmatory assay. A
system of consecutive study numbers enabled prevalence and
interview data to be matched by respondent while maintaining
respondent anonymity.
Data analysis was conducted using Epi Info 6 (Centers
for Disease Control, Atlanta, GA) and SPSS version 9 software
(SPSS Inc, Chicago, IL). The Pearson W
2
test was used for
bivariate comparisons of categorical data. Means of continuous
data were compared using t tests. The statistical significance
level was set at 5%. Multivariate logistic regression was used to
produce adjusted odds ratios (ORs) and to assess their
significance, where numbers permitted (some variables were
excluded where numbers were too small for statistical analysis).
Ethical approval for the study was obtained from
the Ministry of Health, Guyana, and the CAREC Ethics
Review Committee.
RESULTS
All women approached for interview agreed; there were
no refusals. The volume of the oral fluid samples from
47 women (of sample N = 299) was inadequate for testing. Of
TABLE 1. (continued) Characteristics and Behavior of Sex Workers by HIV Status
Characteristic
Percentage (%) With This Characteristic
Of Those HIVj
(n = 164)
Of Those HIV+
(n = 77)
Of Those With Known
HIV Status (n = 241)
Has exchanged sex for drugs in the last 12 months* 4.3 13.0 7.1
Ever take anal sex* 11.3 24.3 15.6
Had a vaginal ulcer or sore in the last 12 months† 6.7 20.8 11.3
Had treatment for syphilis in the last 12 months† 9.8 23.4 14.2
Visited the GUM clinic for services in the last 12 months† 31.3 49.4 37.1
BWhere do you usually get your condoms?^‡
GUM clinic, health center, NAPS, street distributor, or brothel 37.7 68.0 47.3
Drugstore, shop, clients, or other 62.3 32.0 52.7
Date of last test
Up to 6 months ago 42.7 29.9 38.6
More than 6 months ago 20.7 33.8 24.9
Never tested 36.6 36.4 36.5
Know result of the last test†
Yes 86.0 65.4 79.2
No 6.5 11.5 8.2
Did not go back for results 7.5 23.1 12.6
Note: Valid percentages are used where there are missing data.
Pearson W2.
*P G 0.05; †P G 0.01; ‡P G 0.001.
Allen et al J Acquir Immune Defic Syndr & Volume 43, Number 1, September 2006
98 * 2006 Lippincott Williams & Wilkins
Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.
those who were tested (n = 252), 30.6% were HIV positive
[95% confidence interval (CI) 24.9Y36.3], 65.1% HIV
negative (CI 59.2Y71.0), and 4.4% indeterminate (CI 1.9Y6.9).
Table 1 provides a profile of characteristics and be-
havior of respondents for selected categorical variables.
Reported condom use was high; but with the exception of
condom use during group sex, variables indicating condom
use and attitudes toward condoms by self or clients were not
associated with HIV status.
Respondents’ ages ranged from 16 to 50 years, with
median age of 29. HIV-positive respondents were significantly
older, at average age of 31, than HIV-negative women, at
average age of 28. The length of time that respondents reported
doing sex work ranged from 1 to 20 years. The average number
of years women had been doing sex work was 5.2 among those
who were HIV positive and 4.2 among those who were HIV
negative; the difference was not significant (P = 0.08). Most
women interviewed in the poorer downtown area usually found
their clients on the streets or in hotels/brothels (83%) (as
opposed to in discos, on ships, via referral, or other), whereas
48% of uptown women found clients in these locations.
Unadjusted ORs were calculated for factors possibly
associated with HIV status. Variables found to be significant at
the bivariate level were entered into 2 multivariate models.
Table 2 shows ORs for HIV risk factors. Table 3 shows ORs
for health service use factors associated with HIV status. Age
and location of interview (an indicator of socioeconomic
status) were entered into both multivariate models because it
was hypothesized that they may be associated both with other
risk factors and with service use patterns.
TABLE 2. Risk Factors Associated With HIV+ Status (Unadjusted ORs and Multivariate Logistic Regression) (n = 235)
Variable
Unadjusted Multivariate
OR 95% CI OR 95% CI
Older age 1.05† 1.01Y1.09 1.04 1.00Y1.08
Interviewed downtown 3.69† 1.49Y9.15 2.02 0.66Y6.18
Find clients on street or in hotels/brothels 3.25† 1.50Y7.03 1.83 0.75Y4.45
Ever used anything to prevent pregnancy with partner 0.53* 0.31Y0.92 0.64 0.32Y1.31
Currently using nothing to prevent pregnancy 2.05* 1.11Y3.77 1.82 0.81Y4.07
Most clients would see in a day 1.16*§ 1.03Y1.30 1.03 0.85Y1.24
Least clients would see in a day 1.36*§ 1.07Y1.72 1.36 0.97Y1.92
Ever take anal sex 2.53* 1.22Y5.27 1.40 0.56Y3.49
Regularly get high on alcohol 2.63† 1.32Y5.24 2.07 0.89Y4.79
Ever tried cocaine 2.99‡ 1.59Y5.63 1.11 0.45Y2.71
Has exchanged sex for drugs in the last 12 months 3.28* 1.20Y8.99 1.37 0.37Y5.04
Group sex
Do not do groups 1 V 1 V
Client changes condom during group sex 1.02 0.42Y2.49 0.69 0.23Y2.07
Client does not always change condom during group sex 2.19* 1.15Y4.18 1.63 0.74Y3.56
Had a vaginal ulcer or sore in the last 12 months 3.62† 1.59Y8.26 4.04* 1.36Y11.98
*P G 0.05; †P G 0.01; ‡P G 0.001.
§OR per additional client seen. Most clients seen in a day ranged from 1 to 20, least clients seen per day from 1 to 13.
TABLE 3. STI Service Use Factors Associated With HIV+ Status (Unadjusted ORs and Multivariate Logistic Regression) (n = 235)
Variable
Unadjusted Multivariate
OR 95% CI OR 95% CI
Older age 1.05† 1.01Y1.09 1.03 0.99Y1.08
Interviewed downtown 3.69† 1.49Y9.15 2.46 0.91Y6.65
Had treatment for syphilis in the last 12 months 2.80† 1.34Y5.86 1.33 0.56Y3.14
Visited the GUM clinic for services in the last 12 months 2.14† 1.23Y3.73 1.51 0.75Y3.03
Get condoms from GUM clinic, health center, NAPS, street distributor, or brothel 3.52‡ 1.97Y6.28 3.09‡ 1.63Y5.78
Date of last test
Up to 6 months ago 1 V 1 V
More than 6 months ago 2.33* 1.16Y4.66 2.82* 1.28Y6.23
Never tested 1.42 0.74Y2.72 1.23 0.15Y10.10
Know result of the last test
Yes 1 V 1 V
No 2.31 0.73Y7.39 2.32 0.54Y10.04
Did not go back for results 4.06† 1.53Y10.79 3.41* 1.14Y10.12
*P G 0.05; †P G 0.01; ‡P G 0.001.
J Acquir Immune Defic Syndr & Volume 43, Number 1, September 2006 HIV Risk Among Sex Workers in Guyana
* 2006 Lippincott Williams & Wilkins 99
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In the multivariate risk factor model, only having a
vaginal ulcer or sore in the last 12 months remained significant
when combined with other variables. In the health service use
model, last having an HIV test more than 6 months ago; not
going back for the results of the last HIV test; and getting
condoms from the GUM clinic, health center, NAPS, street
distributor or a brothel (ie, from public sector STI services)
remained significant.
We explored interaction effects on HIV status between
these variables and those found significant in bivariate anal-
yses, but confidence intervals were too wide to draw firm
conclusions given the small number of cases. Tests of asso-
ciation between variables found significant in the multivariate
model and the bivariate analyses revealed the following as
significant. Having had an ulcer or sore on the vagina in the
last 12 months was associated with having ever tried cocaine
or crack and having had treatment for syphilis in the past
12 months. Ever having been tested for HIV (whether within
the last 6 months or longer) was associated with having visited
the GUM clinic in the past 12 months. Getting condoms from
public sector STI services was associated with being in-
terviewed in the downtown (poorer) area, currently using
nothing to prevent pregnancy, ever having tried cocaine or
crack, having visited the GUM clinic in the past 12 months,
having been treated for syphilis in the last 12 months, and
having larger numbers of clients per day. Not knowing the
results of the last HIV test was associated with having larger
numbers of partners per day or night and never using
contraception (P G 0.05).
DISCUSSION
Findings from Guyana, including our own, suggest that
the profile of the HIV/AIDS epidemic is similar to that in West
Africa, where prevalence in the general adult population is
lower than that in East and Southern Africa (e7%),
transmission is largely heterosexual, and high prevalence
(930%) is found among SW. In such circumstances, SW
constitute a Bcore group^ for HIV transmission.12,13 At this
stage in the epidemic, HIV prevention interventions with SW
are particularly important to public health.
In contrast with other studies,
14Y16
SW mobility was not
a risk factor for HIV. International mobility in our sample
was within the Caribbean and other nonYSpanish-speaking
American countries, reflecting the social links of Guyana and
implying links of the HIV epidemic with these countries rather
than with Spanish Latin America.
Our bivariate analyses identified a number of factors
such as age, number of clients, anal sex, low socioeconomic
status, and STI, which other studies have also identified as risk
factors for HIV among SW.
6,12,14,16Y27
Condom use was not
related to HIV status, in contrast with other studies
14,16
and
suggesting some overreporting. In our study, only genital
ulceration was independently associated with HIV status in
multivariate analysis. The cross-sectional design of this study
prevents a judgement of whether vaginal ulceration was a risk
factor for HIV or a result of HIV immunosuppression.
28
Either way, it indicates the need for an active program of
screening and treatment of ulcerative STIs.29Y31
Sexual behavioral risk factors (nonuse of contraception,
anal sex, alcoholic inebriation, cocaine use, not changing
condoms during group sex) applied to minorities of the
women studied. Nevertheless, they suggest areas where health
education messages should focus and that it is important to
identify and reach highly vulnerable minorities. Nonintrave-
nous drug use has rarely been identified as a risk factor, but
Caribbean SW studies confirm associations between crack
cocaine use and risky sexual practices,
32,33
and that cocaine
use is a risk factor for HIV.6,8 We also found that 34% of
respondents had ever used marijuana; and in the last year, 7%
had exchanged sex for drugs and 1% had injected themselves
with drugs. Locations of cocaine and other illicit drug trade/
consumption should be targeted, as should sex workers with
alcohol or cocaine addiction. The association between
reported vaginal ulceration and crack cocaine use emphasizes
the need for the development of joint strategies between
substance abuse and STI services targeting SW.
34
The
importance of drug use in the HIV epidemic may increase
with the expansion of the drug trade in the Americas.
The inclusion of health service use factors enabled the
appraisal of how well services were targeting women at high
risk. The association of HIV status with source of condoms
indicates that the Georgetown SW Project, which includes
condom distribution via the GUM clinic, health centers,
brothels, NAPS and street distributors, was successfully
reaching women with HIV. The association between where
condoms were obtained and factors such as drug use and
number of partners shows women with high rates and high risk
of infection were apparently heeding health education mes-
sages and accessing condoms from the project. Comparison
with the 1997 study conducted in the downtown area of
the city
8
suggests the project may have led to a drop in
HIV prevalence downtown from 45.8% to 36.2% (CI 29.8%Y
43.2%) in our study.
Women with HIV were more likely to report that they
did not go back for their HIV test results and that their test was
not within the last 6 months. Not going back for results was in
turn associated with indicators of vulnerability such as higher
numbers of partners and nonuse of contraception. Women
who did not seek their results may have feared the con-
sequences of finding out they are HIV positive at a time when
antiretroviral treatment was not available to SW. Our results
suggested that sensitively designed follow-up services should
be strengthened, along with building trust in the confiden-
tiality of services, to encourage women to discover their HIV
status and adopt preventive measures.
Initiatives conducted since our study include a program
to make antiretroviral treatments available to all people living
with HIV/AIDS in Guyana, without discrimination (since
April 2002). In 2003, the NAPS initiated the training of
doctors throughout Guyana in HIV/AIDS care and support.
The Pan-Caribbean Partnership on HIV/AIDS and the
Caribbean Community have established a program on HIV/
AIDS law, ethics, and human rights, leading to national
policies and proposals for law reform in Guyana and other
countries.
35
These initiatives may assist in reducing discrimi-
nation against sex workers, particularly those with HIV, and
enhance their access to and use of STI services, including
Allen et al J Acquir Immune Defic Syndr & Volume 43, Number 1, September 2006
100 * 2006 Lippincott Williams & Wilkins
Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.
VCT. However, no further measurement of HIV epide-
miology among Georgetown sex workers has been conducted
since our study. An assessment by the Canadian HIV/AIDS
Legal Network reported that there is still a widespread
perception of discrimination harbored by persons living with
HIV/AIDS, and some health care workers remain reluctant
to work with them.
36
In these circumstances, initiatives to
reduce discrimination and improve care and support may
take some time to affect HIV risk behavior and access to
services among sex workers and other vulnerable groups.
ACKNOWLEDGMENTS
Thanks to the survey participants, and to Karen De
Souza and Dusilley Cannings of Red Thread Women’s
Development Programme for their contributions to survey
design and management. Shirley Goodman, Phil Pilgrim,
Olinda Jacobs, Cora Belle, Vanessa Ross, Halima Khan,
Jacqueline Delph, and Cheryl Benjamin collected the data.
We are grateful to the Ministry of Health, Guyana, and to
CAREC for permitting publication and for the contributions of
staff to design, data entry, and administration. The research
was funded by the CAREC German Technical Cooperation
project. The office of the PAHO/WHO representative in
Guyana kindly administered and disbursed funds for the local
components of the research.
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* 2006 Lippincott Williams & Wilkins 101
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ITABLE
OF CONTENTS
ACRONYMS
…………………………………………………………………………………………………….2
FOREWORD
……………………………………………………………………………………………………4
CHAPTER 1. INTRODUCTION……………………………………………………………………..6
1.1 HIV AND AIDS IN GUYANA………………………………………………………………………… 6
1.2 THE PRESIDENTIAL COMMISSION ON HIV/AIDS …………………………………………. 10
1.3 RATIONALE FOR A NATIONAL M&E PLAN …………………………………………………… 11
1.4 GOALS AND OBJECTIVES OF THE NATIONAL M&E PLAN ……………………………….. 12
1.5 METHODOLOGY OF M&E PLAN DEVELOPMENT ………………………………………….. 13
CHAPTER 2. MONITORING AND EVALUATION CONCEPTS AND
PRINCIPLES………………………………………………………………………………………………….14
2.1 MONITORING AND EVALUATION DEFINITIONS ……………………………………………. 14
2.2 LEVELS OF DATA IN HIV AND AIDS MONITORING AND EVALUATION ……………. 14
2.3 PRINCIPLES OF A GOOD MONITORING AND EVALUATION SYSTEM ………………….. 16
CHAPTER 3. NATIONAL LEVEL HIV AND AIDS INDICATORS ………………..17
3.1 IMPACT …………………………………………………………………………………………………… 17
3.2 STRENGTHEN NATIONAL CAPACITY……………………………………………………………. 18
3.3 CLINICAL AND DIAGNOSTIC MANAGEMENT AND ACCESS TO CARE, TREATMENT,
AND SUPPORT ………………………………………………………………………………………………. 18
3.4 REDUCING RISK AND VULNERABILITY TO HIV INFECTION ……………………………. 20
3.5 SURVEILLANCE AND RESEARCH………………………………………………………………….. 21
CHAPTER 4. NATIONAL MONITORING AND EVALUATION
IMPLEMENTATION STRATEGY …………………………………………………………………22
4.1 DATA COLLECTION STRATEGY OVERVIEW ………………………………………………….. 22
4.2 DATA SOURCES ……………………………………………………………………………………….. 22
4.3 INSTITUTIONAL ROLES AND RESPONSIBILITIES …………………………………………….. 25
4.4 REPORTING LEVELS AND INFORMATION FLOWS …………………………………………… 26
4.5 DATA DISSEMINATION PLAN……………………………………………………………………… 28
4.6 RESOURCE REQUIREMENTS ……………………………………………………………………….. 28
CHAPTER 5. NATIONAL INDICATOR REFERENCE SHEETS ………………….30
5.1 IMPACT INDICATORS …………………………………………………………………………………. 30
5.2 PRIORITY AREA 1: STRENGTHENING NATIONAL CAPACITY……………………………… 34
5.3 PRIORITY AREA 2: CLINICAL AND DIAGNOSTIC MANAGEMENT AND ACCESS TO
CARE, TREATMENT, AND SUPPORT ………………………………………………………………….. 40
5.4 PRIORITY AREA 3: REDUCING RISK AND VULNERABILITY TO HIV INFECTION ……. 54
5.5 PRIORITY AREA 4: SURVEILLANCE AND RESEARCH ……………………………………….. 66
REFERENCES
……………………………………………………………………………………………….69
APPENDICES
………………………………………………………………………………………………..71
Guyana National HIV M&E Plan
2 of 76
ACRONYMS
AIDS Acquired Immunodeficiency Syndrome
AIS AIDS Indicator Survey
ANC Antenatal Clinic
ART Anti-retroviral Therapy
ARV Anti-retroviral
BCC Behavior Change Communication
BSS Behavioral Surveillance Study
BBSS Bio-Behavioral Surveillance Study
CAREC Caribbean Epidemiology Center
CARICOM Caribbean Community
CBO Community-based Organization
CDC US Centers for Disease Control and Prevention
CD4 Cluster Designation 4 (T-helper cell antigen)
CHRC Caribbean Health Research Council
CIDA Canadian International Development Agency
CRIS Country Response Information System
CSO Civil Society Organization
DHS Demographic and Health Survey
EU European Union
FBO Faith-based Organization
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GoG Government of Guyana
GPC Guyana Pharmaceutical Corporation
GUM Genito-Urinary Medicine Clinic
HBS Household Budget Survey
HDI Human Development Index
HMIS Health Management Information System
HPC
Home and Palliative Care
HIV Human Immunodeficiency Virus
HSDU Health Sector Development Unit
IDB Inter-American Development Bank
IEC Information, Education, Communication
ILO International Labor Organization
JICA Japanese International Cooperation Agency
MARP Most At-Risk Population
M&E Monitoring and Evaluation
MERG Monitoring and Evaluation Research Group
MDG Millennium Development Goals
MICS Multiple Indicator Cluster Survey
MOH Ministry of Health
MSM Men Who Have Sex with Men
NAC National AIDS Committee
NAP National AIDS Program
NAPS National AIDS Program Secretariat
NBTS National Blood Transfusion Service
NGO Non-Governmental Organization
NSP National Strategic Plan
OI Opportunistic Infection
Guyana National HIV M&E Plan
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OPEC Organization of Petroleum Exporting Countries
OVC Orphans and Vulnerable Children
PAHO Pan-American Health Organization
PCHA Presidential Commission on HIV/AIDS
PEPFAR US President’s Emergency Plan for AIDS Relief
PLHIV Persons Living With HIV
PMTCT Prevention of Mother-to-Child Transmission (of HIV)
PMU Program Management Unit
PRSP Poverty Reduction Strategy Paper
RAC Regional AIDS Committee
RHA Regional Health Authority
SMART Specific, Measurable, Attainable, Realistic, and Time-Bound
SPA Service Provision Assessment
STD Sexually Transmitted Disease
STI Sexually Transmitted Infection
SW Sex Worker (or Sex Work)
TB Tuberculosis
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Program
UNGASS United Nations General Assembly Special Session
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
UNTG United Nation Theme Group
USAID United States Agency for International Development
VCT Voluntary Counseling and Testing
WB
World Bank
WHO World Health Organization
Guyana National HIV M&E Plan
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FOREWORD
The Republic of Guyana is severely affected by the HIV epidemic. HIV affects all
levels and sectors of society and is currently the leading cause of mortality in young
adults in Guyana. Following the first reported case of AIDS case in Guyana in 1987,
a national institutional infrastructure was established to coordinate the response to
AIDS and provide strategic leadership to address the challenges of HIV and AIDS
at the national, regional, and sub-regional levels. A national policy on HIV and
AIDS was passed by parliament in 1999 and in 2005, the Government of Guyana
(GoG) established the Presidential Commission on HIV/AIDS (PCHA) to provide
the leadership to and oversight of inter-sectoral coordination of the national
response. The National AIDS Programme Secretariat (NAPS) was established to
coordinate the overall national AIDS response.
To fully realize the strategic leadership of the PCHA and the coordination role of
the NAPS, a national monitoring and evaluation plan has been developed that will
harmonise monitoring and evaluation (M&E) efforts and ensure that the impact of
the HIV epidemic and the effectiveness of the national response are adequately
monitored.
The general purpose of this monitoring and evaluation plan is to:
Provide a framework that will be used to monitor and evaluate the coordinated
national AIDS response;
Ensure consistent use of all indicators and appropriate linkages between all
initiatives supported by the GoG, partners, and key stakeholders;
Ensure appropriate and sustainable linkages between data collection efforts by
different stakeholders.
The M&E Plan for the national response to the HIVepidemic in Guyana has been
designed with the recognition that there are a number of global commitments, goals,
and internationally harmonized indicators that require due attention. International
and national commitments that inform this M&E Plan include the Millennium
Development Goals (MDGs); the United Nation’s General Assembly Special
Session on HIV/AIDS ‘Declaration of Commitment;’ (UNGASS 2001) the
movement towards universal access to HIV prevention, treatment, care and support,
and the key funding mechanisms: the US President’s Emergency Plan for AIDS
Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria
(GFATM).
Monitoring and evaluation of the Guyana National Strategy for HIV/AIDS (2007 –
2011) is based on the inputs-processes-outputs-outcomes-impact framework. A set
of core national indicators that cut across all sectors and program areas has been
established and will form the basis of monitoring the national response and routine
reporting. Annual and quarterly national reports with data produced by regional and
local bodies will be presented by the GoG. The PCHA and NAPS will play an
Guyana National HIV M&E Plan
5 of 76
integral role in establishing and maintaining the flow of data from the regions, line
ministries, and international and local agencies. The Regional Health Authorities
(RHA) or Regional Health Department will coordinate all actors working in
HIV/AIDS at the regional and sub-regional levels.
Resources will be provided to collect all the data that is required through the
mechanisms that have been identified in this document. The main challenges will be
to improve the validity, reliability and national representativeness of the data
collected and enforcing reporting requirements. For each core indicator in the
monitoring and evaluation framework, the quality of data collected through the
indicators will be assessed periodically and appropriate action will be taken to make
the necessary improvements.
The core indicators are reported by program area in a matrix. The criterion for
indicator selection was based on the 2007 – 2011 Guyana National Strategic Plan
(NSP) for HIV/AIDS, technical and financial feasibility of collection,
comprehensiveness, and simplicity. The indicators have been grouped into four key
priority areas: Strengthen National Capacity; Clinical and Diagnostic Management
and Access to Care, Treatment, and Support; Reducing Risk and Vulnerability to
HIV Infection; and Surveillance and Research. For each core indicator, details have
been included in tabular form to show indicator characteristics, such as data
collection tool, frequency of data collection, and responsible agency. The main
report and appendices provide details for each indicator and program area.
Guyana National HIV M&E Plan
6 of 76
Chapter 1. Introduction
1.1 HIV and AIDS in Guyana
Guyana has a population of about 750,000 inhabitants (Bureau of Statistics 2002)
with a landmass of 215,000 km2 extending along the northeastern shore of South
America. It is the only English-speaking country in South America and it is a
member of the Caribbean Community (CARICOM). Most of the population (86
percent) is concentrated in the coastal areas and approximately 70 percent of the
population lives in rural communities. Per capita GDP is estimated to be about
$597 (2000), among the lowest in the Americas, and its 107 rank in the Human
Development Index (HDI) Report is the lowest of the English-speaking Caribbean
(UNDP 2005). Administratively, Guyana is divided into 10 regions, with three
coastal regions (3, 4, and 6) collectively accounting for 72 percent of the household
population.
The first AIDS case in Guyana was reported in 1987. From 1987 to 2002, a
cumulative total of 3163 cases have been reported to the National Surveillance Unit
(CAREC 2004). The most recent UNAIDS estimates suggest that Guyana currently
has one of the highest prevalences of HIV infection in the Latin American and
Caribbean region, second only to Haiti. Adult prevalence is estimated to be about
2.5 percent and, consistent with trends in other Caribbean countries, the epidemic is
generalized because more than 1 percent of ante natal women are infected. From
1997 to 2002, there has been a 3.2 fold increase in the number of reported HIV
cases, with the sharpest overall increase from 2001 to 2002 (due in part to increased
case detection). Since 1989, males have experienced a six-fold increase in HIV cases,
and females have experienced a five-fold increase in HIV cases (CAREC 2004).
AIDS is currently the leading cause of death for young adults aged 25-49 years
(MOH 2002a). This age group accounted for 70 percent of the reported AIDS cases
in 2002. While the latest data from 2002 suggests that there are more male HIV
infections, the number of female infections continues to grow. The current sex ratio
is 1.1, down from 2.8 in 1989 (CAREC 2004). Since the first reported case, there
has been a progressive increase in the prevalence of HIV in Guyana; however, the
true rate of infection and absolute number of infected individuals is largely unknown
because under-reporting is estimated to be as high as 60 percent and AIDS data are
incomplete (CAREC 2004; CHRC 2004). UNAIDS estimates for Guyana suggest
that at the end of 2003, there were about 11,000 people living with HIV and about
1,100 AIDS-attributable deaths annually (UNAIDS 2004).
HIV continues to affect all segments of the population and all regions of Guyana.
The highest HIV prevalence has been documented in female sex workers (SW) in
the capital of Georgetown (46 percent; Persaud, et al. 1999) and gold miners
working in the interior regions (6.5 percent; Palmer, et al. 2002). Data for HIV and
AIDS have been reported from all regions of Guyana, with regions 4 and 10
reporting the highest incidence rates. Region 4, which includes the capital of
Georgetown, is the most populous and region 10 includes the major mining town of
Guyana National HIV M&E Plan
7 of 76
Linden. While the overall prevalence is believed to be low in the indigenous
Amerindian community, this group is potentially at risk of increased exposure to
HIV as the interior regions become more developed and formal links to commercial
interests become tighter.
Since the first reported case of AIDS in 1987, the GoG has been cognizant of the
devastating effects that HIV can have on national development and poverty
reduction efforts. Toward this end, the GoG has demonstrated strong political will
in combating the HIV epidemic and responded by establishing the National AIDS
Program (NAP) under the Ministry of Health (MOH) in 1989. This subsequently
led to the establishment of the National AIDS Committee (NAC), the Genito-
Urinary Medicine (GUM) Clinic, the National Laboratory for Infectious Diseases
(NLID), and the National Blood Transfusion Service (NBTS). In 1992, the National
AIDS Program Secretariat (NAPS) was established and charged with the role of
coordinating the overall national response to the HIV epidemic. NAPS worked with
the NAC, a voluntary body composed of representatives from many sectors and
organizations, to plan and implement the NSP. NAC’s primary role was to advise
the MOH on HIV/AIDS policy and advocacy issues. Regional AIDS Committees
(RAC) were also established to coordinate and implement HIV activities at the
regional level. Following the success of the 1999-2001 National Strategic Plan for
HIV/AIDS and the successful parliamentary passage of the national HIV/AIDS
policy paper in 1999, the successive 2002-06 Plan was written. The 2002-06
National Plan was guided by the following principles: the use of a multi-sectoral and
inter-disciplinary response to HIV; greater involvement of persons living with HIV
(PLHIV) in the planning and implementation of the response; information,
education, and communication (IEC) strategies to empower persons to prevent
further HIV transmission; guarantee confidential voluntary counseling and testing
(VCT); care and support for persons living with HIV in health and social service
delivery systems; and minimizing and eliminating inequalities in HIV and AIDS
services across the regions. The national HIV/AIDS policy document was revised
in 2003 to reflect proposed changes in the coordinating mechanisms within the NAP
and to provide a policy framework for providing access to free care and treatment
for all persons living with HIV..
The 2001 Guyana Poverty Reduction Strategy Paper (PRSP) identified HIV as an
important focal area and proposed a number of multi-sectoral actions to respond to
HIV. A pilot of prevention of mother-to-child-transmission (PMTCT) services was
conducted at eight sites in November 2001 and the GoG committed to an
expansion of PMTCT services to 65 sites by December 2005. A treatment program
with ARVs has been available at the Genito-Urinary Medicine (GUM) Clinic since
April 2002 and the MOH has committed to a plan to scale up antiretroviral
treatment (ART), with a targeted enrollment of about 6400 people by the end of
2008.
The 2002-06 National Strategic Plan (NSP) identified several components of a
comprehensive national HIV/AIDS prevention program, which include the
following:
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IEC/Behavior Change Communication (BCC)
Condom Distribution
VCT
Prevention and Control of STI
Prevention of Mother-to-Child-Transmission (PMTCT)
Laboratory Control and Blood Safety
The 2002-06 NSP was conceived with the anticipated financing of donors rather
than what was actually required (estimated at US$20,577,903 over five years)
(GFATM 2005). Since its implementation, the resource requirements to expand
services throughout the country have become clearer and external financing for HIV
has greatly increased (see Table 1). Since 2000, it is estimated that external financing
for HIV has surpassed domestic sources of funding by 50 percent (USAID 2004).
A new NSP (2007-11) has been developed with the following objectives:
• Empower citizens by providing a universal HIV and AIDS care, support,
education and awareness program;
• Promote behaviour changes that reduce risks among all people;
• Enable citizen to know his or her HIV status by providing easy accessible
counselling and testing;
• Provide easily accessible PMTCT services to all pregnant women and their
families;
• Ensure blood safety supply;
• Provide treatment, care and support for OVC;
• Provide treatment, care and support for all persons living with HIV;
• Create space for the involvement of all citizens and group in the multi-
sector response to HIV, including space for the involvement of persons
living with HIV
• Reduce stigma and discrimination;
• Build capacity to the overall response;
• Improve the information system and strengthen the surveillance program;
• Strengthen the overall coordination of the HIV response program.
The overall strategic goal of the 2007-11 NSP is to reduce the social and
economic impact of HIV and AIDS on individuals and communities, and
ultimately the development of the county.
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Table 1. Donor Matrix
Donor/Partner Major Area of Assistance Estimated Funding
UNAIDS Secretariat
Coordinate HIV activities of the UN
System; Strengthen capacity for
UNGASS reporting; Facilitate donor
coordination; Broker technical support
and capacity investment needs to reach
the targets for universal access (2018
and 2010)
Ongoing
UNDP
Limited HIV-related activities; Mainly
related to poverty reduction and policy
development
Ongoing
UNICEF
Strengthen coordination and M&E of
PMTCT services; support knowledge of
women, children, and health care
workers; support care and treatment
and support for HIV positive children;
youth-friendly health services
$1.5 mil (est)
(2006-10)
PAHO/WHO
Technical assistance for HIV
prevention, TB, and malaria control;
small grants scheme management;
surveillance and laboratory support .
Chair UN Theme Group on HIV
Ongoing
ILO
Joint ILO, Ministry of Labour and US
Department of Labour Project for HIV
in the workplace
Ongoing
CIDA
HIV prevention; communicable disease
control; public health management
system; stigma and discrimination; TB
prevention and malaria
CN$5mil
(2003-07)
EU Strengthen national capacity to respond to HIV
Limited
World Bank
Grant for HIV program; support
institutional capacity strengthening;
monitoring, evaluation, and research
and mainstreaming of HIV in key line
ministries
US$10 mil
(2004-08)
UNFPA-OPEC Fund
Caribbean-Central America project for
HIV prevention among youth as part of
adolescent health program
US$450,000
(2004-08)
GFATM
Multifaceted support for HIV
prevention, treatment, care and support;
training; HMIS; upgrade laboratory
capacity; strengthen surveillance system;
US$27.2 mil
(2004-08)
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quality care for persons living with
HIV; expand care and treatment; reduce
stigma and discrimination; condom
social marketing
IDB Regional support for HIV US$6.7mil (2004-08)
JICA Small grant for HIV Limited
GATC
HIV project targeting sex work,
including condom social marketing
campaign
Limited
The President
Emergency Plan for
AIDS Relief (US)
Coordinated, comprehensive
HIVsupport for care and treatment,
prevention, and laboratory support.
Main partners are CDC and USAID
US$34mil
(2004-08)
1.2 The Presidential Commission on HIV/AIDS
In order to strengthen the implementation and oversee coordination of the various
components of the NAP, the GoG established the Presidential Commission on
HIV/AIDS (PCHA) in 2005 under the aegis of the Office of the President. The
Commission is chaired by the President of Guyana. The GoG response to HIV is
augmented by the independent activities of numerous NGOs, CBOs, faith-based
organizations (FBOs), the private sector, and civic organizations. The primary
responsibility of the PCHA is to oversee, and support the national response to HIV.
The members include key Ministers, the Attorney General, chair of the NAC, the
chair of the United Nations Theme Group (UNTG) on HIV, USG, the UNAIDS
Country Coordinator, donor and multilateral partners, and the Head of the
Presidential Secretariat. Key functions of the PCHA include the following:
Supporting the implementation of the National Strategic Plan;
Mobilizing multi-sector support for the national response;
Coordinating, preparing and assisting in the implementation of the line
ministries’ work program;
Advising the Cabinet on HIV policies and strategies;
Mobilizing resources (national and international) for HIV programming;
Presenting annual and quarterly reports on the progress of the national
response.
Sessions are held quarterly, wherein each Ministry presents on key HIV-related
activities. A report to the public will be presented once a year to the National
Assembly.
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Figure 1. Guyana multi-sectoral response mechanism for HIV
1.3 Rationale for a National M&E Plan
Consistent with the goals of the 2007-11 National Plan for HIV/AIDS, and the
Three Ones” principles, there are a number of reasons for the development of a
National Monitoring and Evaluation Plan for HIV:
To strengthen the national, multi-sectoral response to HIV, by guiding the
systematic collection, processing, and analysis of data at all levels;
To inform national HIV policies and procedures to better serve those affected
by HIV;
To track progress and evaluate the response of the national plan;
To facilitate the standardization of M&E methodologies so as to allow
meaningful comparisons over time at all program levels and across all actors;
To serve as a platform for partnership, collaboration, and networking for all
stakeholders involved in the national prevention and controls program;
To meet the reporting requirements of the international donor community in
order to secure consistent funding for the HIV response.
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Box 1. The Three Ones
On 25 April 2004, the representatives of major donor organizations
and of many developed countries met to agree on a common
framework to better coordinate the scale-up of national AIDS
programs and related activities. All meeting participants agreed to
the following “Three Ones Principles”:
• One AIDS action framework that provides the basis for
coordinating the work of all partners and stakeholders
• One national AIDS coordinating authority, with a broad-based
multi-sectoral mandate
• One national monitoring and evaluation (M&E) system
A strong M&E system will ensure that: 1) relevant, timely, and
accurate data are made available to program leaders and managers;
2) select quality data can be reported to national program leaders;
and 3) the national program is able to meet donor and international
reporting requirements under a unified global effort to combat the
HIV pandemics.
(Source: Global Fund Monitoring and Evaluation Toolkit 2004)
1.4 Goals and Objectives of the National M&E Plan
There is a broad need to provide strategic information that will enable tracking of
progress, with the specific aim of enhancing decision-making at all program levels in
the implementation and coordination of the 2007-11 National Strategic Plan for
HIV/AIDS in Guyana.
The specific purpose of the National M&E Plan include the following:
To promote the importance of routine monitoring and systematic data
collection to better inform decision making in the further planning of HIV-
related activities;
To better understand program trends and impacts as they relate to the NSP;
To secure future funding for HIV interventions by successfully meeting
reporting requirements of partners.
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1.5 Methodology of M&E Plan Development
The M&E Plan was developed through a collaborative venture between the MOH
and its in-country partners working in the area of HIV. Support was also provided
by technical experts in the M&E field. Meetings were conducted with various
stakeholders, and consultations were performed with outside technical experts. The
methods used include the following:
Review of GoG national strategic objectives and targets and the creation of a
logic model for achievement of results (Appendix 1);
Creation and support of the Monitoring and Evaluation Reference Group
(MERG) in November 2004;
A review of national and international documents regarding priority program
areas, suggested indicators, and regional and global standards and goals;
Consultative discussions with key stakeholders and development partners to
assess current capacity and needs for M&E for HIV and AIDS;
Assessment of key national-level surveys and reports with population-based
indicators relevant to the monitoring and evaluation of the national HIV
response;
National consultative workshop to compliment activities.
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Chapter 2. Monitoring and Evaluation Concepts and
Principles
2.1 Monitoring and Evaluation Definitions
Monitoring and evaluation (M&E) efforts are aimed at the collection of information
at all program levels in order to determine the progress of a program towards it
goals. M&E is an integral part of good program management and provides
information on the scope, quality, scale/coverage, and success of programs.
Monitoring generally refers to the routine collection of information across time and
sites in order to track a program’s ongoing activities. Monitoring permits program
managers to use this data to inform program modifications and answer the question:
What is being done? Policy makers use monitoring to track key health-related
indicators, often without attributing change to any particular program or set of
programs.
Evaluation involves the assessment of program implementation in order to
determine the worth or value of a program in terms of its success in achieving
predetermined outcomes/goals. Evaluation is usually achieved through a detailed
analysis of the program’s process and outcomes or impacts. Evaluation lends itself
to the linkage of outcomes to the program process, as well as rule-out non-program
effects on outcomes.
Indicators are qualitative or quantitative units of information that provide
information on change in a specific condition over time. A good indicator should
be SMART.
Specific – An indicator must be related to the conditions that the program
wishes to change
Measurable – An indicator must be quantifiable and allow for statistical
analysis of the data. Certain development process indicators are difficult to
quantify so qualitative indicators can and should be used
Attainable – An indicator must be attainable at a reasonable cost using
appropriate collection methods
Relevant – An indicator must be necessary to measure and have relevance to
the management information needs of the persons who will use it
Time-bound – An indicators must have a time period for collection clearly
stated
2.2 Levels of Data in HIV and AIDS Monitoring and Evaluation
There are several different levels of data in M&E. Program-based data typically
provides process M&E (program inputs, program activities, program outputs).
Outcome and impact M&E is usually derived from population-based behavioral,
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biological, and social data. The M&E framework typically has the following levels of
data:
Inputs are the financial, human, and material resources that are necessary to
produce the intended output of a particular program;
Activities/ Process refer to the steps in the implementation of the program. The
data suggest that an activity is or is not being conducted;
Outputs are the immediate results of the program activities. Outputs are expressed
separately and directly in terms to the activity with which it is associated;
Outcomes are the medium-term or intermediate results of the program activities.
Outcomes are often expressed in terms of a set of activities, as opposed to single
activities. These indicators often require separate surveys to measure;
Impact refers to the long-term results expected of a program. These indicators are
often the overall goals of a program.
Figure 2. Levels of Monitoring and Evaluation
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2.3 Principles of a Good Monitoring and Evaluation System
For this M&E plan, the following principles will be employed:
Presence of an M&E Unit – Establishment of an M&E unit with adequate
budget and trained and qualified staff. The Unit needs to be linked to all the
key stakeholders, including NGOs, FBOs, sector and line ministries, and
national and regional staff;
Clear goals and objectives – Well-defined national program goals, targets, and
objectives where regular reviews and evaluations of the implementation are
conducted. Guidance and guidelines also need to be in place at the regional
level and across all sectors;
Core set of indicators and targets – A set of national core/priority indictors
needs to be selected that cover all of the program inputs, processes, outputs,
outcomes, and impact. Indicator selection should be made through full
participation of all stakeholders and with an aim of maintaining relevance and
comparability. The process also needs to incorporate past and future data
collection efforts in order to properly assess national trends;
A plan for data collection and analysis – An overall data collection plan should
be implemented at all levels of the program;
A clear plan for data use and dissemination – A clear plan for scheduled
reports of the M&E Unit and annual meetings with policy-makers and
planners should be in place;
M&E should be proportional to program resources (ideally about 7-10 percent
of program budget);
To minimize data collection burden and maximize limited resources, M&E
activities need to be well-coordinated and utilize ongoing data collection and
analysis, where appropriate, in preference to designing new instruments or
stand-alone systems.
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Chapter 3. National Level HIV and AIDS Indicators
The National HIV M&E framework relies on data collected from surveys and
routine data collection methods. All data obtained through routine reports will be
standardized through the development of uniform forms distributed to all partners
and stakeholders. The national indicators were selected based on the goals and
objectives of the NSP and grouped according to priority intervention areas identified
by the NSP. Four principles guided the selection of the national indicators for
monitoring and evaluating the national HIV response. First, the indicators must be
consistent with the objectives of the NSP. Second, the indicators should allow for
international and regional comparisons. Third, the indicator can be feasibly
collected from an existing or potential source and are SMART. Fourth, the
indicators have a baseline measure (where feasible).
A number of key indicators have been selected for which ambitious targets have
been set towards universal access to HIV prevention, treatment, care and support,
by 2010. (National Level indicators below marked with an asterisk*)
3.1 Impact
The overall strategic goal of the NSP is to reduce the social and economic
impact of HIV and AIDS on individuals and communities, and ultimately the
development of the country.
Key Objective(s)
Reduce the spread of HIV in Guyana and increase the quality of life for
persons living with HIV
Indicators
Imp1 Proportion of all deaths attributable to AIDS
Imp2* Percentage of adults and children with HIV still alive 12 months after
initiation of antiretroviral therapy
Imp3 HIV prevalence among women aged 15-24
Imp4 HIV prevalence among most-at-risk populations
Imp5 Percentage of infants born to HIV-infected mothers who are infected
Imp6 Ratio of current school attendance among orphans to that among non-
orphans age 10-14
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3.2 Strengthen National Capacity
3.2.1 Policy Formation
Indicators
Nc1* Amount of national funds allocated by Government for HIV prevention
and care.
Nc2* Implementation of the “Three Ones” principles
Nc3 National Composite Policy Index
Nc4 Percentage of schools with teachers who have been trained in life-skills
based HIVeducation and who taught it during the last academic year
3.2.2 Partnerships / Multi-sectoral Response
Indicator
Nc5 Number of line ministries with HIV work plans and budgets
3.3 Clinical and Diagnostic Management and Access to Care, Treatment, and
Support
3.3.1
Access to ART
Indicators
Cts1* Percentage of women, men, children with HIV infection receiving ART,
who are eligible according to national guidelines
Cts2 Number and percentage of regions with at least one service outlet providing
ART services following national standards
Cts3 Number of health workers trained on ART delivery according to national
guidelines
3.3.2 VCT
Indicators
Cts4* Percentage of the general population aged 15-49 receiving HIV test results
in the past 12
months
Cts5* Number of individuals trained in the provision of VCT according to
national guidelines
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3.3.3 Home and Palliative Care
Indicators
Cts6 Number of regions with service outlets that provide HPC
Cts7 Number of service outlets that provide HPC
Cts8 Number of persons trained to provide HPC according to national guidelines
Cts9 Number of persons who receive HPC following national standards
3.3.4 OI and STI
Indicators
Cts10 Percentage of men and women with STI at health care facilities who are
appropriately diagnosed, treated, and counseled
Cts11 Number of persons trained in the management of STI according to national
guidelines
3.3.5 Tuberculosis
Indicators
Cts12 Percentage of HIV-positive registered TB patients given ART during TB
treatment
Cts13 Percentage of registered TB patients tested for HIV
3.3.6 Lab Support
Indicators
Cts14 Percentage of patients on ARVs who receive regular CD4 monitoring
following ARV national treatment guidelines
Cts15 Number of regional labs with capacity to perform CD4 tests following
national standards
Cts16 Number of persons trained to conduct CD4 testing according to national
guidelines
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3.4 Reducing Risk and Vulnerability to HIV Infection
3.4.1
IEC/BCC
Indicators
Pv1* Percentage of young men and women aged 15-24 who have had sex before
age 15
Pv2 Percentage of youth aged 15-24 reporting use of a condom during last
sexual intercourse with a non-regular partner
Pv3 Percentage of people aged 15-49 expressing accepting attitudes towards
people living with HIV
Pv4* Percentage of people, aged 15-49, who correctly identify ways of preventing
sexual transmission of HIV and who reject major misconceptions about
HIV transmission (male/female)
Pv5* Number of condoms (male and female) distributed in the past 12 months
Pv6* Number of targeted prevention programmes for vulnerable groups
Pv7* Percentage of members of most-at-risk populations who report condom use
at last sexual encounter with regular or non-regular partner – a) Men who
have sex with men; b) sex workers; and c) mobile and hard-to-reach
populations
3.4.2
PMTCT
Indicators
Pv8* Number of service outlets that offer PMTCT services
Pv9* Number of pregnant women who receive HIV counseling and testing for
PMTCT and receive their test results
Pv10 Percentage of HIV-infected pregnant women who receive a complete
course of ARV prophylaxis as part of PMTCT
Pv11 Number of health workers trained in the provision of PMTCT according to
national guidelines
Pv12 Percentage of babies born to HIV-positive women who are tested before
age 18 months
3.4.3 OVC
Indicators
Pv13* Percentage of OVC whose households received free, basic external support
in caring for the child
Pv14 Number of providers/caretakers trained in the provision of care for OVC
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3.4.4 Blood Safety
Indicators
Pv15 Percentage of transfused blood units in the public and private sector
screened for HIV
3.5 Surveillance and Research
Indicators
Sr1 Percentage of service outlets with record-keeping systems to monitor HIV
and AIDS care and treatment
Sr2 Number of persons trained in strategic information (monitoring and
evaluation and/or surveillance and/or HMIS)
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Chapter 4. National Monitoring and Evaluation
Implementation Strategy
4.1 Data Collection Strategy Overview
A comprehensive monitoring and evaluation plan ensures that indicators and
sampling methodologies are standardized and comparable over time, minimizes
duplication of effort, and ultimately leads to more efficient use of data and
resources. It is important to note that M&E activities have been conducted in
Guyana, and pre-date the development of this Plan. Therefore, the aim of this plan
is not to invent new systems, but to employ systems that are already in place while
recognizing that there may be certain weaknesses and gaps that will need to be
addressed in order to create a more comprehensive M&E system that will ensure
high quality data in the long term.
Monitoring and evaluation of the national response to HIV will be facilitated under
the leadership of the Presidential Commission on HIV/AIDS and a national HIV
M&E Unit within the Ministry of Health (NAPS). The national indicators for each
HIV and AIDS intervention area, the data source, the frequency of data collection,
measurement tool, and the method of measurement are clearly defined in the
national M&E plan so as to assist the ease of data collection by the various actors.
Care has been taken to be consistent with the principles of a good M&E system
outlined in Chapter 2.
The NAPS will work with all stakeholders and partners to collect data for the
completion of reports on the national response. National indicators have been
selected, where appropriate, from existing routine data collection systems in
preference to new surveys or stand-alone systems. The MOH is working with
donors and partners to strengthen program monitoring and evaluation through the
foreseen implementation of a Country Response Information System (CRIS) and the
strengthening of paper-based facility / service level reporting (World Bank 2004).
4.2 Data Sources
Because anticipated resources are limited, data generated by the national M&E plan
should serve the needs of multiple stakeholders. These include Ministries, donors at
the national and international level, the Regional Health Authorities and
Departments at the regional level, and program managers and facility heads at the
service delivery point level, and all government and non-government implementers
to provide evidence-informed strategic information to guide action. Data sources
for Guyana’s M&E plan are from the following: HIV and AIDS surveillance;
population-based surveys, special studies, and operations research; the health
management information system (HMIS); and program monitoring and reporting.
It is anticipated that data will be available through the following sources:
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HIV and AIDS Surveillance
Bio-Behavioral Surveillance Survey (BBSS) targeting MSM and FSW
(biological markers for HIV and other STI were included)
Behavioral Surveillance Survey (BSS) targeting school-aged children, out-of-
school youth, the police, the military, and sugar workers
Sentinel surveillance at ANC sites
Routine AIDS case reporting
Routine STI and OI reporting
Routine NBTS reports
Mortality data for AIDS-related deaths
Population-based surveys, special studies, and operations research
AIDS Indicator Survey (AIS) portion of the DHS
Multiple Indicator Cluster Survey (MICS) of households (for OVC-related
data)
Qualitative assessment of successful and unsuccessful PMTCT program
completion among pregnant women
Study of the prevalence and risk factors for HIV and syphilis among Guyana’s
gold miners
Service provision assessment (SPA), a facility-based survey to assess the
capacity of health facilities to provide needed services
Epidemiological report synthesizing national reports and population-based
surveys on HIV and AIDS
HMIS (facility-based reporting)
HMIS assessment report
Routine facility reports
Program monitoring and reporting
Routine program reports
4.2.1 HIV and AIDS Surveillance
Surveillance describes an epidemic and its spread over time. Surveillance also
contributes to predicting future trends and identifies potential high-risk groups,
which can inform the design of prevention programs. There are five main types of
HIV and AIDS surveillance:
Biological surveillance – specimens such as blood are collected and tested
for HIV. This may include repeated population surveys with biomarkers for
HIV such at the AIS or BSS, screening of blood donors, and testing of
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pregnant women or STI clinic patients. Biological surveillance, by tracking
HIV prevalence, measures impact;
AIDS case surveillance – counts the number of new AIDS cases (HIV-
infected persons that became ill with AIDS according to national or
international standards);
Behavioral surveillance – collects information about individual’s behavior
that may or may not put them at risk for acquiring HIV infection. Behavioral
surveillance, by tracking HIV-related behaviors, measures outcomes;
Surveillance of HIV-related infections – for example STI or OI such as TB;
Surveillance of HIV and AIDS -related mortality – HIV andAIDS-
attributable deaths in the general population.
In Guyana, HIV and AIDS surveillance activities have been conducted in all the
above areas; however the quality of data from each source should be continuously
monitored to ensure that high-quality data are employed for monitoring and
evaluating the national response to HIV. For example, CAREC requires public and
private facilities in all CAREC countries to report AIDS cases using a standardize
CAREC format. Facilities compile monthly reports, which get sent to the Director
of Disease Control within the MOH. One weakness of this system is the lack of
enforcement mechanisms if facilities fail to report. This is a key issue in the private
sector. Since there is not a unique patient tracking system, another key issue is
double counting of HIV cases. Despite some clear limitations, these systems should
be employed, but efforts should be made to achieve improvements over time.
For a generalized epidemic, a surveillance system should monitor the HIV epidemic
in the sexually active population. Surveys of the population have been conducted in
2004 (BSS and AIS), but most are too difficult and expensive to perform on a
routine basis. Instead it is easier to put under surveillance a sub-group of population
that is more or less representative of the sexually active population, such as pregnant
women. These sub-groups are called sentinel populations. HIV surveillance
employing a sentinel population is called HIV sentinel surveillance. The objective of
HIV sentinel surveillance is to follow the trend of HIV infection in the selected
sentinel population by the use of sentinel sites. These sites are chosen because they
offer easy access to the sentinel population such as pregnant women (sentinel site:
antenatal clinics in most countries but regional laboratories in Guyana), STI patients
(sentinel site: STI clinics), or blood donors (at blood banks).
4.2.2 Population-based surveys, special studies, and operations research
Population-based surveys are usually performed every 3-5 years, and are designed to
provide national estimates of behaviors, risk factors, and demographic trends related
to HIV/AIDS. The most common population-based surveys for HIV andAIDS
include the DHS, AIS, and MICS. Bio-behavioral data are particularly important in
countries with concentrated or low-level epidemics. In general, large population-
based surveys are expensive to conduct and may not be feasible in certain settings;
therefore, they are useful when employed to establish baseline, and should be
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repeated as resources allow. Special studies and operations research applies
systematic research techniques to address particular research or evaluation questions
or improve service delivery. Operations research is designed to assess the
accessibility, availability, quality, and sustainability of program. Both aim to improve
programs and inform decisions about future resource allocations.
4.2.3 HMIS (facility-based reporting)
The ability to manage and monitor health services at the central level depends on the
availability, completeness, and validity of data generated at the service level. Health
management information systems (HMIS) are designed to collect, analyze, and use
routine patient or facility data. They are also designed to identify the major health
information and data subsystems that are required to support the programs of the
national health system and to enhance the accountability of the health service to
carry out essential public health functions. Data collected through this system will
be employed to engage in service performance assessment, planning, and monitoring
national trends.
4.2.4 Program monitoring and reporting
Routine program reporting includes systems to collect, analyze, and use data that is
not facilities-based, e.g., OVC, community-based care, or BCC interventions. In
general, program managers should collect and collate data, and systems should be
designed to ensure that programs are routinely reporting on their HIV/AIDS-related
activities in coordination with other relevant actors.
4.3 Institutional Roles and Responsibilities
This M&E Plan will be implemented through and institutional structure that will
permit the wide participation of all public and private sector actors, civil society, and
the international donor community. The roles and responsibilities of the institutions
that are part of the GoG governance structure for the National M&E Plan are
presented in this section.
Presidential Commission on HIV/AIDS (PCHA) – The PCHA is the GoG body
responsible for supporting, coordinating, and providing oversight of the national
HIV response under the aegis of the Office of the President. The overall
responsibilities of the PCHA have been outlined in Chapter 1.
Health Sector Development Unit (HSDU) programmatic responsibilities include
(World Bank 2004):
Advising the PCHA through the Minister of Health on new policies or
changes in existing policies;
Provide guidelines for preparing annual work plans and sub-projects;
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Receiving evaluated sub-projects recommended by the Ad Hoc Committee for
Reviewing Civil Society Proposals;
Consolidating work plans and sub-projects and forwarding them to the PCHA
for ratification;
Ensuring that all technical needs and resources for implementing agencies are
met;
Ensuring transparency and adequate national coverage of interventions;
Coordinating research, behavioral surveys, and revising and preparing relevant
legal documents;
Monitoring input and process indicators on a monthly basis and evaluating
project outcomes and impact on a periodic basis;
Liaise with the World Bank and GFATM for overall project management
including fiscal monitoring and procurement.
The National AIDS Program Secretariat (NAPS), is the technical body of the
Ministry of Health responsible for the Ministry of Health’s response and for the
coordination and technical oversight for the Line Ministry and Civil Society
component overall response.
MOH will through the National AIDS Programme Secretariat provide technical
assistance and guidance to other implementing agencies. Line department, units at
the central level, and regional health authorities will have the responsibility of
implementing MOH HIV programs and activities. Assigning implementation to the
line units will increase the capacity of the MOH line departments
UN Theme Group on HIV will provide advice to the PCHA and NAPS on HIV
policies and operations. The Theme Group represents the multilateral community
and, through the UNAIDS Secretariat will continue its role of serving as
coordinating donor support, ensuring that the national policies are promoted and
applied by all implementing partners, mobilizing resources and strengthening
institutions, encouraging research and including its results in programs, and
evaluating the results of interventions and provide solutions as appropriate.. An
important role of the UN System in Guyana is to facilitate the identification of
technical resource and capacity investmement needs to reach the targets that have
been set towards universal access
The National AIDS Committee (NAC) is an independent advocacy body for civil
society and the private sector. The body will provide the Minister of Health
recommendations and advise on HIV/AIDS policies; on educational, training and
public information activities; and on measures to improve programs and the
effectiveness of national response.
4.4 Reporting Levels and Information Flows
All partners and stakeholders will be required to report monthly or quarterly to the
national HIV M&E Unit on program indicators for activities that they are
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conducting in this sector. Data collection formats and requirements will be
developed and disseminated in the M&E operations manual. Strategic information
flows from the regional level to the national level are summarized in Figure 3. Most
health related indictors will originate from health facilities (health posts and health
centers) and private health institutions will be expected to report to the RAC or
directly to the MOH.
Figure 3. Strategic Information Map
4.4.1 Coordination Functions – Mechanisms and Roles
An important role of the NAPS is to coordinate data from multiple levels and
sources; track the progress of the national response for national and international
reporting; and provide regular feedback to actors at the sub-national levels.
National
Coordination of the multi-sectoral national response to HIV is the core function of
the NAPS. The PCHA is charged to facilitate this task by bringing together all key
implementers of HIVprograms to disseminate reporting requirements of the
National M&E plan and generate support for its implementation. Efficient
implementation of the national strategic plan requires well-coordinated mechanisms
at all levels of monitoring and evaluation.
Regional
The indicators included in the National M&E framework were selected to measure
and evaluate the National HIV/AIDS Plan. Program indicators should be
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aggregated at the regional level where they are collated and sent to the National
M&E Unit. It is anticipated that additional program indictors will be required at the
regional level in order to track the progress of programs at this level. Therefore,
harmonization of indicators collected to track progress at the national and regional
levels should be coordinated by the Regional Health Authorities or Regional Health
Departments.
Donor Support
Donor and partner support will be very important to ensure effective and efficient
implementation of the National M&E framework. Notably, most donors require
more information than is required for monitoring the national HIV/AIDS Plan.
The national M&E Unit, working in collaboration with the donor coordination the
UNAIDS Secretariat, will ensure the integration of donor reporting requirements
into the national plan.
4.5 Data Dissemination Plan
The NAPS is responsible for the dissemination of monitoring and evaluation data in
quarterly and annual national surveillance reports, HIV and AIDS fact sheets,
brochures, and periodic stakeholder workshops. To facilitate information sharing,
the GoG has implemented a national HIV website and electronic resource center,
which will serve as a donor coordination mechanism and clearinghouse for official
HIV and AIDS-related reports and documents from the GoG. Dissemination of
M&E results will serve to inform planning of HIV interventions, provide feedback
on the resource requirements for HIV and AIDS, and increase public commitment
to reducing HIV and AIDS.
4.6 Resource Requirements
There is a need to strengthen national capacity for monitoring and evaluation at all
levels in terms of both personnel and resource requirements. This is partly the result
of HIV being relatively new to the development sector, hence nationally agreed
upon indicators for monitoring and evaluating HIV interventions have not been
available. Furthermore, there have been few people involved in implementing M&E
activities. At the national level there is little institutional knowledge of M&E
systems and this highlights the need to build capacity for M&E activities at all levels.
The NAPS will address the issues related to capacity building and develop training
strategies and will attempt to make sure all regions have M&E staff for HIV-related
activities. The NAPS also will work with all partners to strengthen the HIV and
AIDS M&E system in the country.
Implementation of the national M&E framework will require a great deal of
resources to support M&E capacity building, finance for data collection, analysis and
dissemination, and technical support for population-based and facility-based surveys.
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This requires due emphasis at all levels for strong management support and
allocation of enough budget for M&E. International standards suggest about 7-10
percent of total program costs should be allocated to M&E activities. Details on the
amount of resource requirements will be included in the M&E Operations Manual.
The remaining items are required to implement the M&E system:
Development of an M&E Operations Manual. The manual will include
specific details of the measurement tools of indicators included in the M&E
framework;
A M&E training should be organized and a training manual based on the
M&E plan should be developed.
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Chapter 5. National Indicator Reference Sheets
5.1 Impact indicators
Imp1: Proportion of all deaths attributable to AIDS
Definition The number of deaths that are attributable to AIDS
(disaggregated by gender, age, region, and
urban/rural), expressed as a proportion of all deaths
annually
Calculation Numerator: AIDS-related deaths in the resident
population aged 18-59 in the past 12 months
Denominator: All-cause mortality in the resident
population aged 18-59 in the past 12 months
Rationale and what is
measured
To assess progress in reducing AIDS-related
mortality
Measurement tool Vital registration system and program reports
Method of measurement National mortality statistics. The vital statistics
department should routinely report data and AIDS
deaths should be medically-certified, where possible
Data collection frequency Baseline, then annually
Frequency of reporting Annually
Responsible body MoH
Remarks/notes This indicator is calculated using data from vital
registration systems
Indicators recommended by MOH
Imp2: Percentage of adult and children with HIV still alive 12 months after
initiation of antiretroviral therapy
Definition This is the number of HIV positive adults and
children receiving ART and still alive 12 months
after HIV positive diagnosis (disaggregated by
gender, age, region, and urban/rural), expressed as a
proportion of all HIV adult and children who test
HIV positive in the last 12 months
Calculation Numerator: Number of adults and children
continuously on ART at 12 months after initiation
of treatment
Denominator:
(a) Minimum survival: Total number of adults
and children who initiated ART in the ART
start-up group 12 months earlier, including
those who have stopped ART, those who
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have transferred out, and people lost to
follow-up
(b) Maximum survival: Total number of adults
and children who initiated ART in the ART
start-up group 12 months earlier, excluding
those who have stopped ART, those who
have transferred out, and people lost to
follow-up
Rationale and what is
measured
To assess progress in increasing survival among
infected adults and children by maintaining them on
antiretroviral therapy
Measurement tool Vital registration system and program reports
Method of measurement This indicator is obtained from the patient registrars
(HMIS) by tallying several monthly cohorts, each
tabulated after they have received a positive HIV
test result and post-test counseling. Data should be
collected continuously and aggregated
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Ministry of Health/NAPS
Remarks/notes This indicator is calculated using data from vital
registration systems
Indicator recommended by
UNGASS
Imp3: HIV prevalence among women aged 15-24
Definition Number of women aged 15-24 infected with HIV
(disaggregated by 5 year age groups and region),
expressed as a proportion of all women aged 15-24
Calculation Numerator: Number of ANC attendees (aged 15-24)
tested whose test results are positive
Denominator: Number of ANC attendees (15-24)
tested for their HIV infection status
Rationale and what is
measured
To assess progress toward reducing HIV infection.
At younger ages, trends in HIV prevalence are a
better indication of recent trends in HIV incidence
and risk behavior than prevalence in older ages
Measurement Tool Sentinel surveillance at ANC sites
Method of measurement This indicator is calculated using data from pregnant
women attending ANCs
Data collection frequency
Biennial
Frequency of reporting Annual
Responsible body Ministry of Health
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Remarks/notes Parallel behavioral surveillance (BSS) data should be
used to aid interpretation of trends in HIV
prevalence
Indicator recommended by UNGASS; MDG
Imp4: HIV prevalence among most-at-risk populations
Definition Prevalence of HIV infection among most-at-risk
populations (MSM, CSW, mobile and hard-to-reach
populations, STI patients, TB patients)
Calculation Numerator: Number of people in most-at-risk
populations tested whose test results are positive
Denominator: Number of people in most-at-risk
populations tested for their HIV infection status
Rationale and what is
measured
To measure prevalence of HIV infection among
most-at-risk populations (MSM, SW, STI patients,
TB patients). Countries with generalized epidemics
can have concentrated sub-epidemics among one or
more most-at-risk populations
Measurement tool BBSS and AIS with HIV testing and sentinel
surveillance at STI and TB clinics
Method of measurement This indicator is calculated using data from
population-based surveys and routine sentinel
surveillance at STI and TB clinics
Data collection frequency Every 2-3 years
Frequency of reporting Every 2-3 years
Responsible body Ministry of Health
Remarks/notes
Indicator recommended by MOH
Imp5: Percentage of infants born to HIV infected mothers who are infected
Definition Number of HIV positive infants born to HIV
infected mothers expressed as a proportion of all
infants born to HIV infected mother
Calculation The indicator can be calculated by taking the
weighted average of the probabilities of MTCT for
pregnant women receiving and not receiving
antiretroviral; the weights being the proportions of
women receiving and not receiving ARV,
respectively. Expressed as a simple mathematical
formula:
Indicator score = { T*(1-e) + (1-T) } * v
where:
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T = proportion of HIV-positive pregnant
women provided with antiretroviral treatment
v = MTCT rate in the absence of any treatment
e = efficacy of treatment provided
T is simply a national indicator {Pv8}. Default
values of 25% and 50%, respectively, can be used
for v and e. However, where scientific estimates of
the efficacy of the specific forms of antiretroviral
treatment (e.g., nevirapine) used in the country are
available, these can be used in applying the formula.
When this is done, the values of these estimates
should be recorded.
The most common forms of treatment provided
during the last 12 months should be noted
Rationale and what is
measured
To assess progress towards eliminating mother-to-
child transmission
Measurement tool Program records and facility surveys
Method of measurement
Data collection frequency Every 2 years
Frequency of reporting Every 2 years
Responsible body Ministry of Health
Remarks/notes This indicator ignores the effect of breastfeeding on
MTCT of HIV and may yield poor estimates for T
when usage of ANC services are low
Indicator recommended by UNGASS
Imp6: Ratio of current school attendance among orphans to that among non-
orphans aged 10-14
Definition Ratio of the current school attendance rate of
children aged 10-14 both of whose biological parents
have died to the current school attendance rate of
children aged 10-14 both of whose parents are still
alive and who currently live with at least one
biological parent
Calculation Orphan school attendance:
Numerator: Number of children who have
lost parents and are still in school
Denominator: Number of children who have
lost both parents
Non-orphan school attendance:
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Numerator: Number of children, both of
whose parents are still alive with at least one
parent and who are still in school
Denominator: Number of children both of
whose parents are still alive and who live
with at least one parent
Calculate the ratio of orphans to non-orphans
Rationale and what is
measured
Assesses the progress towards preventing relative
disadvantage in school attendance among orphans
versus non-orphans
Measurement tool AIS
Method of measurement
Data collection frequency Every 4-5 years
Frequency of reporting Every 4-5 years
Responsible body Ministry of Labour, Human Services and Social
Security/Ministry of Health
Remarks/notes This indicator score is required for all children aged
10-14 years and for boys and girls, separately.
Where possible, the indicator should be calculated
by single year of age
Indicator recommended by UNGASS; MDG
5.2 Priority Area 1: Strengthening national capacity
5.2.1 Policy formation
Nc1: Amount of national funds allocated by government for HIV prevention
and care
Definition The amount of money allocated in national accounts
for spending on HIV prevention and care programs
per adult aged 15-49
Calculation Numerator: The total amount of funding allocated in
national accounts for spending on HIV prevention
and care programs
Denominator: Total number of adults aged 15-49 in the
resident population
Rationale and what is
measured
Measures of expenditure provide an indication of the
government’s willingness to back up policy with
resources that enable policies to be implemented.
This indicator measures resources made available by a
government in its budget and national accounts for
the response to the HIV epidemic. It also develops a
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common framework for tracking HIV-targeted
allocations and expenditure in the national budget and
indicates prioritization of interventions.
Note: This indicator is restricted to spending and
budgetary allocations from national accounts. It
includes money loaned by international institutions,
which may in effect amount to money borrowed at 30
percent or less of current money market rates. This
may be influenced by the priorities of lending
institutions as well as borrowers, but since the money
must eventually be paid back by national taxpayers, it
is included for the purposes of this indicator.
Spending by bilateral donors, non-governmental
organisations and the private sector are not included.
It is recognised that in many countries, spending from
these sources far outweighs spending from national
accounts. It is important to bear in mind, however,
that this indicator is not intended as a measure of
resource availability, but as an indicator of political
commitment to responding to HIV on the part of
national governments. All governments reflect their
political priorities in their spending and allocation of
internal resources. Changes in funding allocated to
HIV prevention and care is therefore a good indicator
of the political importance that responding to the
epidemic is accorded, compared with other priorities
such as defence, education or infrastructure
development.
Measurement Tool National AIDS Spending Assessment (NASA)
Method of measurement The National AIDS Spending Assessment
examines primary and secondary data sources from
relevant government ministries and agencies.
Allocations are disaggregated according to the type of
services provided, highlighting priorities in the
government’s response to the epidemic.
Data collection frequency Annual
Frequency of reporting Annual
Responsible body Ministry of Finance/Ministry of Health
Remarks/notes
Indicator recommended by UNAIDS
Nc2: National commitment – The “Three Ones” Principles Indicator
Definition This is a composite indicator that includes the
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following elements:
1. One agreed HIV action framework that provides
the basis for coordinating the work of all partners
2. One national HIV Coordinating Authority, with a
broad-based multi-sectoral mandate
3. One agreed country-level monitoring and
evaluation system
Calculation
Rationale and what is
measured
The first component seeks to assess whether one
Action Framework exists that would provide the legal
basis for coordination among all partners and a
‘costed’ plan of Action;
The second component relates to the legal mandate
of an overarching national authority to coordinate a
broad-based multi-sectoral response;
The third component seeks to assess whether key
elements of a country-level M&E system are in place,
including the following:
• Presence of an M&E Unit
• Clear program goals, targets, and objectives
• A set of national core/priority indicators
• Allocation of financial resources (7-10%) of
the HIV budget for M&E
• A plan for data collection and analysis
• A clear plan for data use and dissemination
• M&E activities are well-coordinated and
utilize ongoing data collection and analysis,
where appropriate, in preference to designing
new instruments or stand-alone systems
Measurement Tool Questionnaire
Method of measurement Score of respondents
Data collection frequency Annual
Frequency of reporting Annual
Responsible body Ministry of Health
Remarks/notes
Indicator recommended by UNAIDS
Nc3: National composite policy index
Definition The National Composite Policy Index is a
UNGASS national commitment and action
indicator designed to assess progress in the
development and implementation of national level
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HIV/AIDS policies and strategies
Calculation
Rationale and what is
measured
To assess progress in the development and
implementation of national-level HIV/AIDS
policies and strategies. It also aims to estimate the
amount of effort put into national HIV/AIDS
programs by national level government, NGOs,
and international organizations
Measurement tool National Composite Policy Index country
assessment questionnaire
Method of measurement The composite index covers the following broad
areas of policy: strategic plan, political support,
prevention, care and support, monitoring and
evaluation, human rights, and civil society
involvement. A number of specific policy indicators
have been identified for each of these areas
Data collection frequency Biennial
Frequency of reporting Biennial
Responsible body Ministry of Health
Remarks/notes The National Composite Policy Index attempts to
assess both policy development and progress made
in policy implementation and, to the extent
possible, integrated many elements from the AIDS
Program Index effort
Indicator recommended by UNGASS
Nc4: Percentage of schools with teachers who have been trained in life-skills
based HIV/AIDS education and who taught it during the last academic year
Definition Percent of schools with teachers who have been trained in
life-skills based HIV education and who taught it during the
last academic year. Training refers to new training or
refresher training of individuals. This indicator assumes that
training is conducted to national or international standards,
when available. The training must have specific objectives, a
course outline or curriculum, and expected knowledge, skills
and / or competencies to be gained by participants. A life-
skills based approach to HIV/AIDS education helps young
people assess the individual, social, and environmental
factors that raise and lower the risk of HIV transmission
Calculation Numerator: Number of schools with staff trained in and
regularly teaching life-skills-based HIV education
Denominator: Total number of schools surveyed
Rationale and what is
measured
This indicator assesses progress towards implementation of
life-skills based HIV education in all schools
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Measurement tool School survey
Method of
measurement
Principles/heads of a nationally representative sample of
schools (both public and private) are briefed on the meaning
of life-skills based HIV education and then are asked the
following questions:
1. Does your school have at least one qualified teacher
who has received training in participatory life-skills
based HIV education in the last 5 years?
2. If the answer to question 1 is “yes”: Did this person
teach life-skills based HIV education on a regular
basis to each grade in your school throughout the
last academic year?
The teacher training must have included time dedicated to
mastering facilitation of participatory learning experiences
that aim to develop knowledge, positive attitudes, and skills
(e.g. interpersonal communication, negotiation, decision-
making, critical thinking and coping strategies) that assist
young people in maintaining safe lifestyles. Whenever
possible, the teacher training should have been performed in
accordance with the latest UNICEF guidelines, which can be
found at
http://www.unicef.org/lifeskills/index_documents.html.
For the purposes of calculating this indicator, at least 30
hour of tuition per year per grade of pupil is recommended
if life-skills-based HIV education is to qualify as standard
tuition.
Data collection
frequency
Biennial
Frequency of
reporting
Biennial
Responsible body Ministry of Education/Ministry of Health
Remarks/notes The indicator is a measure of coverage and not necessarily a
measure of the quality of education provided.
Indicator scores are required for all schools combined and
for primary and secondary schools separately each by
private/public status and by urban/rural setting. Church
schools should be treated as private schools for this purpose.
If school provides both primary and secondary education,
information should be collected and reported separately for
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both levels of education
Indicator
Recommended by
UNGASS
5.2.2 Partnerships / multi-sectoral response
Nc5: Number of line ministries with HIV work plans and budgets
Definition The number of Line Ministries that have a complete
annual HIV work plan and budget that describes the
activities to be undertaken in a specific year, the
budget for these activities, and the sources of
funding for these activities
Calculation Number of Line Ministries with a HIV/AIDS work
plan and budget allocated for the work plan
Rationale and what is
measured
This indicator assesses the commitment across
sectors to be actively involved in the national
response to HIV
Measurement tool Special survey of Line Ministries
Method of measurement A survey of Line Ministries is conducted to assess
the number of Line Ministries that have a HIV work
plan and budget, which is consistent with national
policy, and includes, at the minimum, the following
components:
Key components: annual work plan
Detailed list of activities for each defined objective
Timeframe for each activity
Definition of the person(s) or agency responsible for
implementation of each activity
Definition of the indicators to be used to assess
whether or not activities were successfully
implemented
Definition of the budget required for each activity,
whether or not activities were successfully
implemented
Description of the source of funding for each
activity
Key components: annual budget
There should be a table summarizing the budget
required for the annual plan of activities. This
should include the total budget requirements and a
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breakdown of the budget by line item
Data collection frequency Annual
Frequency of reporting Annual
Responsible body Line Ministries/Ministry of Health
Remarks/notes Assessment of the annual work plan and budget
alone cannot measure successful implementation or
whether the planned activities and budget will be
sufficient to achieve objectives
Indicator recommended by World Bank
5.3 Priority Area 2: Clinical and Diagnostic Management and Access to Care,
Treatment, and Support
5.3.1 Access to ART
Cts1: Percentage of women, men, and children with HIV infection receiving
ART who are eligible according to national guidelines
Definition Number of persons with HIV infection receiving
antiretroviral combination therapy, expressed as a
proportion of all persons with HIV infection who
are eligible for ART according to national guidelines
Calculation Numerator: All people with HIV infection receiving
ART at the start of the year, plus the number of
people who have commenced ART treatment in the
preceding 12 months minus the number of people
for whom treatment was terminated in the
preceding 12 months (including those who died or
were lost to follow-up)
Denominator: Number of people with known HIV
infection who are eligible for ART according to
national guidelines
The number of adults in need of ART is calculated
by adding the number of adults newly in need of
ART to the number who were on treatment in the
previous year and survived to the current year
Rationale and what is
measured
This indicator assesses progress towards providing
antiretroviral combination therapy to all eligible
people with HIV infection
Measurement tool Program reports and facility surveys
Method of measurement The denominator is generated by estimating the
number of people with HIV infection requiring
ART, most frequently on the basis of the latest
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sentinel surveillance data
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body NAPS/Ministry of Health
Remarks/notes The start and end dates of the period for which
ART is given should be stated. Overlaps between
reporting periods should be avoided as much as
possible.
The provision of ART in the private sector should
be included in the calculation of the indicator
whenever possible
Indicator recommended by UNGASS; GFATM
Cts2: Number and percent of regions with at least one service outlet
providing ART services following national standards
Definition Number and percent of regions with at least one
service outlet providing ART following national
standards. A service outlet refers to the lowest level
of service for which data exists, e.g., hospital, clinic,
or mobile unit
Calculation Numerator: Number of regions with at least one
service outlet providing ART following national
standards
Denominator: Total number of regions or regional
clusters
Rationale and what is
measured
Provides an estimate of the geographic coverage and
availability of ART services
Measurement tool Program reports and facility surveys
Method of measurement This indicator may include regions with NGOs
providing ART services. In order to measure this
indicator, reviews of records of regional health
authorities or departments, which may have a list of
service outlets, is recommended. Surveys of health
facilities are also recommended
Data collection frequency Annual
Frequency of reporting Annual
Responsible body NAPS/Ministry of Health
Remarks/notes This indicator is useful for tracking changes over
time as service provision is scaled up; however, once
coverage has reached a certain level, it is unlikely to
fall and this indicator will become redundant. This
indicator does not describe the geographic location
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or distribution of service outlets
Indicator recommended by UNAIDS; WHO
Cts3: Number of health workers trained on ART delivery according to
national guidelines
Definition Number of health workers newly trained or retrained
on ART delivery during the preceding 12 months.
Training refers to new training or refresher training
of individuals. This indicator assumes that training is
conducted to national or international standards,
when available. The training must have specific
objectives, a course outline or curriculum, and
expected knowledge, skills and / or competencies to
be gained by participants. This covers health workers
and others who have been trained to a level enabling
them to take up a direct function in support of the
scaling up of clinical or community-based ART
services. The training should include the provision
on clinical ART services, program management,
prevention services or monitoring.
It is assumed that such trainings occur through
specialized programs that health workers attend after
their regular education (in-service training). Only
health workers who have undergone such training
should be included.
Health workers include the following:
Physicians and health workers with physician
skills (e.g., medics)
Nurses and other health workers with nursing
skills (e.g., midwives, clinical officers)
Other health care workers and lays staff in
clinic settings
Laboratory technicians and staff
Pharmacy/dispensing staff
Community treatment supporters (e.g., peer
educators, outreach workers, volunteers,
informal caregivers)
Calculation Persons who have completed one or more trainings
with content related to the delivery of ART
Rationale and what is
measured
This indicator measures the availability of a trained
workforce for achieving national scale-up targets. It
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includes both clinical and non-clinical health workers
who contribute to the development and
implementation of ART services and provide critical
support services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
training (public, private, and NGOs) is
recommended. Surveys of health facilities providing
ART are also recommended
Data collection frequency Annual
Frequency of reporting Annual
Responsible body NAPS/Ministry of Health
Remarks/notes This indicator is most useful in the initial phases of a
countrywide response to HIV/AIDS, when the
cumulative number of trained health professionals is
expected to be continuously increasing until it
reaches a desired ceiling. At this point the
quantitative focus of the indicator on the number of
health workers trained may become redundant, and
measurement may shift so as to capture the quality of
training, refresher training and the
testing/supervision of health care practices
Indicator recommended by MOH
5.3.2 VCT
Cts4: Percentage of the general population aged 15-49 receiving HIV test
results in the past 12 months
Definition Number of persons aged 15-49 that were tested for
HIV in the past 12 months and received their test
results, expressed as a proportion of the total
population aged 15-49
Calculation Numerator: Number of people 15-49 years who
reported received their HIV test result in the past 12
months
Denominator: Total population 15-49 years surveyed
Rationale and what is
measured
This indicator gives an estimate of the coverage of
counseling and testing services and the percentage of
people who know their HIV status. Estimates of
coverage of counseling and testing services help to
determine whether those services are achieving their
threefold aims of providing an entry point for care
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and support, promoting safe behavior, and breaking
the cycle of silence and stigma
Measurement tool AIS
Method of measurement Respondents are asked whether they were tested in
the past 12 months, and if so, whether they received
their test results. This question is prefaced by the
statement saying, “I do not want to know the results
of the test,” so as to minimize stigma-based fear of
answering the question truthfully
Data collection frequency Baseline, then every 2-3 years
Frequency of reporting Every 2-3 years
Responsible body Regional Health Authority & Department/Ministry
of Health
Remarks/notes This indicator should be stratified by age, gender,
vulnerable group, and how the counseling and
testing services were provided. In general, three
service delivery methods should be considered:
stand-alone or free-standing VCT sites (includes
mobile testing); counseling and testing sites within
health facilities to which people are referred; or fully
integrated counseling and testing services in which a
provider can refer the person to a laboratory for a
test, but the provider carries out the counseling
Indicator recommended by MOH
Cts5: Number of individuals trained in the provision of VCT according to
national guidelines
Definition Number of individuals (by type) trained in the
provision of VCT services in accordance with
national guidelines during the last 12 months.
Training refers to new training or refresher training
of individuals. This indicator assumes that training
is conducted to national or international standards,
when available. The training must have specific
objectives, a course outline or curriculum, and
expected knowledge, skills and / or competencies to
be gained by participants
Calculation Persons who have completed at least one or more
trainings with content related to the provision of
VCT services
Rationale and what is
measured
This indicator provides an estimate of the
availability of VCT services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
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training (public, private, and NGOs) is
recommended. Surveys of health facilities providing
HPC are also recommended. If a training course is
conducted in several sessions or covers more than
one counseling and testing topic, for example
“specimen collection” and “post test counseling”,
individuals should only be counted once for that
training course
Data collection frequency Annual
Frequency of reporting Annual
Responsible body NAPS/Ministry of Health
Remarks/notes This indicator does not measure the quality of the
training, nor does it measure the outcomes of the
training in terms of the competencies of individuals
trained, nor their job performance.
Indicator recommended by MOH
5.3.3 Home and palliative care (HPC)
Cts6: Number of regions with service outlets that provide HPC
Definition Number of regions that have outlets that provide
HPC. A service outlet refers to the lowest level of
service for which data exists, e.g., hospital, clinic,
mobile unit, or CBO/FBO/NGO. HPC is the
provision of care, support, and symptom alleviation
to a person chronically or intermittently ill in the
home or in a clinical setting, when the interventions
provided by family members are complementary to
those of a client’s medical team
Calculation Regions or regional clusters with at least one or more
serviced outlets that provide HPC
Rationale and what is
measured
Provides an estimate of the geographic spread or
coverage of HPC services
Measurement tool Program reports and facility surveys
Method of measurement This indicator may include regions with service
outlets that are CBOs/FBOs/NGOs providing HPC.
In order to measure this indicator, reviews of records
of regional health authorities or departments, which
may have a list of service outlets, is recommended.
Surveys of health facilities are also recommended
Data collection frequency Annual
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
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Remarks/notes This indicator is useful for tracking changes over time
service provision scales up; however, once geographic
coverage is universal (based on the total number of
regions or blocks of regions) then this indicator
become redundant. This indicator does provide an
estimate of the distribution of service outlets
Indicator recommended by
Ct7: Number of service outlets that provide HPC
Definition Number of service outlets that provide HPC. A
service outlet refers to the lowest level of service for
which data exists, e.g., hospital, clinic, mobile unit, or
CBO/FBO/NGO. HPC is the provision of care,
support, and symptom alleviation to a person
chronically or intermittently ill in the home or in a
clinical setting, when the interventions provided by
family members are complementary to those of a
client’s medical team.
Calculation Service outlets that provide HPC
Rationale and what is
measured
Provides an estimate of the national availability of
HPC services
Measurement tool Program reports and facility surveys
Method of measurement This indicator may include CBOs/FBOs/NGOs
providing HPC. In order to measure this indicator,
reviews of records of regional health authorities or
departments, which may have a list of service outlets,
is recommended. Surveys of health facilities are also
recommended
Data collection frequency Annual
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes This indicator is useful for tracking changes over time
as service provision is scaled up; however, once
coverage has reached a certain level, it is unlikely to
fall and this indicator will become redundant. This
indicator does not describe the geographic location or
distribution of service outlets
Indicator recommended by
Cts8: Number of persons trained to provide HPC according to national
guidelines
Definition Number of persons that are trained to provide HPC
during the preceding 12 months. Training refers to
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new training or refresher training of individuals. This
indicator assumes that training is conducted to
national or international standards, when available.
The training must have specific objectives, a course
outline or curriculum, and expected knowledge, skills
and / or competencies to be gained by participants.
HPC is the provision of care, support, and symptom
alleviation to a person chronically or intermittently ill
in the home or in a clinical setting, when the
interventions provided by family members are
complementary to those of a client’s medical team
Calculation Persons who have completed at least one or more
trainings with content related to the delivery of HPC
Rationale and what is
measured
Provides an estimate of the availability of HPC
services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
training (public, private, and NGOs) is
recommended. Surveys of health facilities providing
HPC are also recommended
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes This indicator does not measure training quality or
outcome measures related to job performance
Indicator recommended by
Cts9: Number of persons who receive HPC following national standards
Definition Number of persons who receive HPC following
national standards. HPC is the provision of care,
support, and symptom alleviation to a person
chronically or intermittently ill in the home or in a
clinical setting, when the interventions provided by
family members are complementary to those of a
client’s medical team
Calculation This indicator consists of the number of people
receiving HPC at the start of the year plus the
number of people who have commenced HPC in the
past 12 months minus the number of people for
whom HPC was terminated in the past 12 months
(including those who died)
Rationale and what is
measured
Provides an estimate of the availability of HPC
services
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Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide HPC
(public, private, and NGOs) is recommended.
Surveys of HPC facilities are also recommended
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes
Indicator recommended by MOH
5.3.4 OI and STI
Cts10: Percentage of men and women with STI at health care facilities who
are appropriately diagnosed, treated, and counseled
Definition Percent of persons with STI who are provided
appropriate diagnosis, treatment, and counseling
Calculation Numerator: Number of STI patients for whom the
correct procedures were followed: a) history taking; b)
examination; c) diagnosis and treatment; and d)
effective counseling on partner notification, condom
use and HIV testing. This indicator assumes that
diagnosis, treatment and counseling are conducted to
national or international standards, when available
Denominator: Number of STI patients for whom
provider-client interactions were observed
Rationale and what is
measured
The availability and utilization of services to treat and
contain the spread of STI can reduce the rate of HIV
transmission within a population. One of the
cornerstones of STI control is comprehensive case
management of patients with symptomatic STI. This
composite indicator reflects the competence of health
service providers to appropriately provide these
services, and the quality of services provided
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide HPC
(public, private, and NGOs) is recommended.
Surveys of HPC facilities are also recommended
Data collection frequency Biennial
Frequency of reporting Annual
Responsible body Regional Health Authority &
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Department/NAPS/Ministry of Health
Remarks/notes Desegregation by gender and for patients under and
over 25 is recommended.
Indicator recommended by UNGASS
Cts11: Number of persons trained in the management of STI according to
national guidelines
Definition Number of persons that are trained to provide STI
management. Training refers to new training or
refresher training of individuals. This indicator
assumes that training is conducted to national or
international standards, when available. The training
must have specific objectives, a course outline or
curriculum, and expected knowledge, skills and / or
competencies to be gained by participants.
Management of STI includes history taking,
examination, diagnosis and treatment, and effective
counseling on partner notification, condom use and
HIV testing
Calculation Persons who have completed at least one or more
trainings with content related to the management of
STI
Rationale and what is
measured
Provides an estimate of the availability of STI services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide STI
services (public, private, and NGOs) is
recommended. Surveys of facilities that provide STI
services are also recommended
Data collection frequency Biennial
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes This indicator does not measure training quality or
outcome measures related to job performance
Indicator recommended by MOH
5.3.5 Tuberculosis
Cts12: Percentage of HIV positive registered TB patients given ART during
TB treatment
Definition Number of HIV-positive registered TB patients who
are started on ART or continue previously initiated
ART, during or at the end of TB treatment, expressed
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as a proportion of all HIV-positive registered TB
patients
Calculation Numerator: All HIV-positive TB patients receiving
ART at the start of the year plus the number of
people who have commenced ART in the past 12
months minus the number of people for whom ART
was terminated in the past 12 months (including
those who died)
Denominator: All HIV-positive TB patients registered
over the same given time period
Rationale and what is
measured
Provides a measure to commitment and capacity of
TB service to ensure that HIV-positive TB patients
are able to access ART
Measurement tool Program reports and facility surveys
Method of measurement Data collection methods depend on who provides
ART for TB patients. If a TB patient is referred to
HIV or other care services, then a system must be
established to ensure that the TB program is
informed of the outcome of the referral and this
information is captured in a modified TB register or
TB/HIV register. TB patients may be started on
ART at any time during their TB treatment; therefore,
the data collection method should be able to capture
ART initiation at any time during TB treatment
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes This indicator does not measure whether patients are
treated with an appropriate ART regimen, at what
point during TB treatment patients are started on
ART, whether they adhere to therapy, or the quality
of patient monitoring or follow-up
Indicator recommended by WHO
Cts13: Percentage of registered TB patients tested for HIV
Definition Number of registered TB patients who are tested for
HIV (after giving consent) expressed as a proportion
of the total number of registered TB cases
Calculation Numerator: All TB patients receiving TB treatment at
the start of the year plus the number of people who
have commenced TB treatment in the past 12 months
minus the number of people for whom TB treatment
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was terminated in the past 12 months (including
those who died)
Denominator: All TB patients registered over the same
time period
Rationale and what is
measured
Provides an assessment of the uptake of HIV testing
by TB patients
Measurement tool Program reports and facility surveys
Method of measurement National treatment protocols should suggest that all
TB patients should be offered an HIV test and all
HIV-positive patients should be screened for TB
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes This indicator does not measure whether patients are
treated with an appropriate ART regimen, at what
point during TB treatment patients are started on
ART, whether they adhere to therapy, or the quality
of patient monitoring or follow-up
Indicator recommended by WHO
5.3.6 Lab support
Cts 14: Percentage of patients on ARVs who receive regular CD4 monitoring
following national ARV treatment guidelines
Definition Number of HIV-positive patients who are started on
ARVs or continue previously initiated ARVs and who
receive regular CD4 monitoring, expressed as a
proportion of all HIV-positive patients who have
initiated ARVs
Calculation Numerator: All HIV-patients receiving both ARVs
and regular CD4 monitoring at the start of the year
plus the number of people who have commenced
ARVs and CD4 monitoring in the past 12 months
minus the number of people for whom ARV
treatment was terminated in the past 12 months
(including those who died). This indicator assumes
that diagnosis, treatment and counseling are
conducted to national or international standards,
when available
Denominator: All HIV-positive patients receiving
ARVs over the same time period
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Rationale and what is
measured
Provides an assessment of the number of HIV-
positive patients managed under comprehensive
national or international standards for ARVs and a
broad measure of the scale-up of ARV use according
to levels of testing priorities. WHO currently defines
four levels of testing priorities:
1) Absolute minimum tests before starting
antiretroviral combination therapy: HIV
antibody test and hemoglobin or hematocrit
level;
2) Basic tests: white blood cell count and
differential, serum alanine or aspartate
aminotranferase level, serum creatinine,
blood urea nitrogen, serum glucose and
pregnancy test;
3) Desirable tests: bilirubin, amylase, serum
lipids and CD4 count; and
4) Optional tests: viral load
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide CD4
services (public and private) is recommended.
Surveys of facilities providing CD4 services are also
recommended
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes This indicator does not measure whether patients are
treated with an appropriate ART regimen, whether
they adhere to therapy, or the quality of patient
monitoring or follow-up
Indicator recommended by MOH
Cts 15: Number of regional labs with capacity to perform CD4 tests following
national standards
Definition Number of laboratories with the capacity to perform
CD4 tests according to national or international
testing guidelines, if available
Calculation Public or private laboratory with the capacity to
perform CD4 testing (level 3 laboratory)
Rationale and what is
measured
Provides a broad measure of the scale-up of ARV use
and monitoring according to levels of testing
priorities. WHO currently defines four levels of
testing priorities:
1) Absolute minimum tests before starting
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antiretroviral combination therapy: HIV
antibody test and hemoglobin or hematocrit
level;
2) Basic tests: white blood cell count and
differential, serum alanine or aspartate
aminotranferase level, serum creatinine,
blood urea nitrogen, serum glucose and
pregnancy test;
3) Desirable tests: bilirubin, amylase, serum
lipids and CD4 count; and
4) Optional tests: viral load.
Laboratories are classified into three levels as follows:
Level 1: they meet the minimum testing
requirements for testing categories 1 and 2
(above);
Level 2: they meet the minimum testing
requirements for testing categories 1, 2, and
3; and;
Level 3: they meet the minimum
requirements of all four testing categories.
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide CD4
services (public and private) is recommended.
Surveys of laboratories providing CD4 services are
also recommended
Data collection frequency Annual
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes
Indicator recommended by MOH
Cts 16: Number of persons trained to conduct CD4 testing according to
national guidelines
Definition Number of persons that are trained to conduct CD4
testing in a laboratory setting. Training refers to new
training or refresher training of individuals. This
indicator assumes that training is conducted to
national or international standards, when available.
The training must have specific objectives, a course
outline or curriculum, and expected knowledge, skills
and / or competencies to be gained by participants.
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Calculation Persons who have completed at least one or more
trainings to conduct CD4 testing in a laboratory
setting
Rationale and what is
measured
Provides an estimate of the capacity to provide CD4
services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
training (public, private, and NGOs) is
recommended. Surveys of laboratories providing
CD4 services are also recommended
Data collection frequency Biennial
Frequency of reporting Annual
Responsible body Regional Health Authority &
Department/NAPS/Ministry of Health
Remarks/notes
Indicator recommended by MOH
5.4 Priority Area 3: Reducing risk and vulnerability to HIV infection
5.4.1 IEC/BCC
Pv1: Percentage of young men and women aged 15-24 who have had sex
before the age of 15
Definition The number of young men and women aged 15-24
who reported having penetrative sex before the age
of 15, expressed as a proportion of all youth
surveyed
Calculation Numerator: Number of young men and women aged
15-24 who have had penetrative sex before the age
of 15
Denominator: Total number of men and women aged
15-24 surveyed
Rationale and what is
measured
This indicator provides information on the
prevalence of early sexual initiation among young
people. Sex at young ages is thought to be more
risky than sex later in life. The female genital tract is
more susceptible to infection with HIV before it
has fully matured. Typically, young people have
partnerships that are more often of short duration
and perhaps less formal than those of older people.
Moreover, they are less likely to live with their
sexual partners, and this can often result in one of
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the partners having additional concurrent partners,
increasing the risk of infection. People who begin
having sex at young ages may spend a longer time in
such less stable sexual relationships than people
who delay their first sexual intercourse. Moreover,
they may be more likely than older people to be
bullied or exploited in sexual relationships.
Measurement tool BSS
Method of measurement This measure is constructed from BSS data on recall
and current status reported by young people.
Young people are asked whether or not they have
had penetrative sex, either vaginal or anal, and at
what age
Data collection frequency Every 4-5 years
Frequency of reporting Every 4-5 years
Responsible body Ministry of Health
Remarks/notes The advantage of using the reported age at sexual
initiation is that it makes the most use of data that
are already collected. Previously, sexual initiation
has been measured by calculating the median age at
first sex. Three different methods of calculating this
value were proposed, each of which had unique
limitations and produced different results. The
above calculation is simple and allows easy
comparison between times. The denominator is
easily defined because all members of the survey
sample contribute to this measure. For most people,
first sex is a significant event that they probably
remember with little difficulty. People may,
however, be unsure of their exact age. The
responses of young people of both sexes may be
influenced by views on young people’s sexuality in
the society in which they live. An analysis of the
reporting of age at first sex, however, has shown
that the occurrence, extent and direction of
reporting or recall bias are not predictable.
Indicator recommended by UNGASS
Pv2: Percentage of youths aged 15-24 reporting use of a condom during last
sexual intercourse with a non-regular partner
Definition Number of youths aged 15-24 years reporting
condom use with their last sexual encounter with a
non-regular partner (commercial or non-
commercial), expressed as a proportion of all youth
reporting sexual activity with a non-regular partner
(commercial or noncommercial) in the past 12
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months
Calculation Numerator: Number of youth who have reported
using a condom during their last sexual encounter
with a non-regular partner (commercial or
noncommercial) in the past 12 months
Denominator: Total number of youths who have had
sexual intercourse with non-regular partners in the
past 12 months
Rationale and what is
measured
Provides assessment of the progress towards
preventing early-age exposure to HIV through
unprotected sex with non-regular partners. This is
particularly important for youth because they have
low prior exposure to infection and (typically) they
have relatively high numbers of non-regular sexual
partners
Measurement tool BSS & AIS & MICS
Method of measurement This measure is constructed from BSS data on
current status reported by young people. Survey
respondents are asked whether they have
commenced sexual activity in the past 12 months.
Those who report sexual activity are then asked if
they have had sexual intercourse with a non-regular
partner (commercial and/or non-commercial) in the
past 12 months. If the answer is yes, then they are
asked if they had consistent (100%) condom use
with their non-regular partner over the past 12
months
Data collection frequency Every 4-5 years
Frequency of reporting Every 4-5 years
Responsible body Ministry of Health
Remarks/notes Indicator scores are required for all respondents
aged 15-24 years and for males and females,
separately, each by urban/rural residence. Percent of
young people who said they had started sex and the
percent of these who had had a non-regular partner
in the last 12 months should be stated
Indicator recommended by UNGASS; MDG
Pv3: Percentage of people aged 15-49 expressing accepting attitudes towards
persons living with HIV
Definition Number of people aged 15-49 years expressing
accepting attitudes toward persons living with HIV,
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expressed as a proportion of all people who have
ever heard of HIV
Calculation Numerator: Number of people who are able to
respond to six questions, which jointly measure
stigma and discrimination against people living with
HIV
Denominator: Total number of individuals who have
ever heard of HIV
Rationale and what is
measured
Provides assessment of the progress in decreasing
stigma and discrimination against people living with
HIV
Measurement tool BSS & AIS & MICS
Method of measurement This measure is constructed from BSS and AIS data.
In the BSS, the indictor is constructed by the
percentage of respondents able to provide the
following six answers, which jointly measure the
absence of stigmatizing and discriminating attitudes
against people living with HIV
1) Should people infected with HIV be
quarantined? (No);
2) Willingness to share a meal with an HIV
positive person (Yes);
3) Willingness to care for a male relative
infected with HIV (Yes);
4) Willingness to care for a female relative
infected with HIV (Yes);
5) Should an HIV infected colleague be
allowed to continue working? (Yes);
6) Willingness to buy food from a shopkeeper
or food seller whom one knew was HIV
positive (Yes); and
7) If a member of the family became ill with
HIV, would the respondent want it to
remain a secret? (No)
Data collection frequency Every 4-5 years
Frequency of reporting Every 4-5 years
Responsible body Ministry of Health
Remarks/notes
Indicator recommended by MOH
Pv4: Percentage of young people aged 15-24 who correctly identify ways of
preventing the sexual transmission of HIV and who reject major
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misconceptions about HIV transmission (male/female)
Definition Number of young people aged 15-24 years who
correctly identify ways of preventing the sexual
transmission of HIV and who reject major
misconceptions about HIV transmission, expressed
as a proportion of all people who have ever heard of
HIV
Calculation Numerator: Number of young men and women who
gave correct answers to all five questions relating to
transmission of HIV and misconceptions about
HIV.
Denominator: Total number of young men and
women surveyed
Rationale and what is
measured
Provides assessment of the progress toward the
universal knowledge of the essential facts about
HIV transmission
Measurement tool BSS & AIS & MICS
Method of measurement This measure is constructed from BSS and AIS data.
The indictor is constructed from responses to the
following set of prompted questions:
1) Can the risk of HIV transmission be
reduced by having sex with only one
faithful, uninfected partner?
2) Can the risk of HIV transmission be
reduced by using condoms?
3) Can a healthy-looking person have HIV?
4) Can a person get HIV from mosquito bites?
5) Can a person get HIV by sharing a meal
with someone who is infected?
Data collection frequency Every 4-5 years
Frequency of reporting Every 4-5 years
Responsible body Ministry of Health
Remarks/notes Indicator scores are required for all respondents
aged 15-24 years and for males and females,
separately, each by urban/rural residence. Scores for
the individual questions themselves as well as the
composite score
Indicator recommended by UNGASS; MDG
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Pv5: Number of condoms distributed by the public and private sector in the
past 12 months
Definition Number of male and femle condoms distributed
through regional and sub-regional sites in the past
12 months
Calculation Total number of condoms that have been
distributed by the public and private sector through
regional and sub-regional sites in the past three
months
Rationale and what is
measured
Provides an estimate of the availability of condoms
Measurement tool Program reports and facility surveys
Method of measurement Reports of the number of condom distributed by
the central medical supply center at the MOH and
private sector outlets
Data collection frequency Monthly
Frequency of reporting Quarterly
Responsible body NAPS/Ministry of Health
Remarks/notes
Indicator recommended by MOH
Pv6: Number of targeted prevention programs for Most at risk populations
(MARPS)
Definition Number of vulnerable groups (MARPS) that are
reached with targeted intervention programs aimed
at reducing HIV risk
Calculation Total number of targeted intervention programs
Rationale and what is
measured
This indicator gives and idea of the number of
groups that are reached with targeted intervention
programs and assess progress in implementing HIV
prevention programs for MARPS
Measurement tool Program reports
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
services to MARPS is recommended.
Data collection frequency Monthly
Frequency of reporting Quarterly
Responsible body NAPS/MOH
Remarks/notes
Indicator recommended by MOH
Pv7: Percentage of most-at-risk populations – sex workers, men who have sex
with men, mobile populations, and other vulnerable groups – who reported
using a condom during their last sexual encounter with a regular or non-
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regular partner
Definition Number of persons from most-at-risk populations
(MARPS) who reported condom use during their
last sexual encounter with their regular and non-
regular partner (commercial or noncommercial),
expressed as a proportion of all members of the
population reporting sexual activity with regular and
non-regular partner respectively in the past 12
months
Calculation Numerator: Number of members of most at-risk
populations who have reported using a condom
during their last sexual encounter with a regular of
non-regular partner (commercial or noncommercial)
in the past 12 months
Denominator: Total number of members of the most-
at-risk populations who had sexual intercourse with
regular or non-regular partners respectively in the
past 12 months
Rationale and what is
measured
Provides assessment of the progress towards
behavior change among members of most-at-risk
populations. This is particularly important for
countries with concentrated epidemics and measures
the success of targeted intervention programs.
Measurement tool BSS among MARPS
Method of measurement This measure is constructed from BSS data among
members of most-at-risk populations in Guyana. It
should be noted that even though sex workers and
men who have sex with men are mentioned above
other populations may also need to be included in
these surveys.
Data collection frequency Every 2-5 years
Frequency of reporting Every 2-5 years
Responsible body Ministry of Health
Remarks/notes Separate indicator scores are required for each
population surveyed.
Indicator recommended by UNGASS/MOH
5.4.2 PMTCT
Pv8: Number of service outlets that offer PMTCT services
Definition Number of service outlets that provide PMTCT
services. A service outlet refers to the lowest level
of service for which data exists, e.g., hospital, clinic,
or mobile unit. PMTCT services are defined as the
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minimum package of services for preventing HIV
transmission from mother-to-child, which includes
all four of the following:
1) Counseling and testing to prevent MTCT
2) ARV prophylaxis to prevent MTCT
3) Counseling and testing for safe infant
feeding practices
4) Family planning counseling or referral
Calculation Total number of service outlets that provide the
minimum package of PMTCT services
Rationale and what is
measured
Provides an estimate of the national availability of
PMTCT services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
records of regional health authorities or
departments, which may have a list of service
outlets, is recommended. Surveys of health facilities
are also recommended
Data collection frequency Monthly
Frequency of reporting Quarterly
Responsible body Regional Health Authority/NAPS/ MCH/MOH
Remarks/notes This indicator does not consider the quality of
service provision
Indicator recommended by MOH
Pv9: Number of pregnant women who received HIV counseling and testing
for PMTCT and received their test results
Definition The total number of pregnant women who received
HIV counseling and testing at a PMTCT service
outlet according to national standards, and received
their test results
Calculation Total number of pregnant women who receive HIV
counseling and testing at a PMTCT service outlet
according to national guidelines, and received their
test results
Rationale and what is
measured
Provides an estimate of the uptake of PMTCT
services
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
records of regional health authorities or
departments, which may have a list of service
outlets, is recommended. Surveys of health facilities
are also recommended
Data collection frequency Monthly
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Frequency of reporting Quarterly
Responsible body Regional Health Authority/NAPS/ MCH/MOH
Remarks/notes This indicator does not consider the quality of
service provision
Indicator recommended by MOH
Pv10: Percent of HIV-infected pregnant women who receive a complete
course of ARV prophylaxis to reduce MTCT in accordance with a nationally
approved treatment protocol
Definition The number of HIV-infected pregnant women
provided with complete course of antiretroviral
prophylaxis to reduce the risk of mother-to-child
transmission in the last 12 months, expressed as a
proportion of all HIV-infected pregnant women
giving birth in the past 12 months. ARV
prophylaxis may be a single dose nevirapine (SD
NVP) of short-course combination prophylaxis or
highly active anti-retroviral therapy (HAART)
Calculation Numerator: Number of HIV positive pregnant
women receiving a complete course of ARV
prophylaxis to reduce the likelihood of MTCT in the
last 12 months according to national standards
Denominator: Estimated number of HIV-infected
pregnant women giving birth in the last 12 months
Rationale and what is
measured
Assesses the progress in preventing mother-to-child
transmission of HIV
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
records of regional health authorities or
departments, which may have a list of service outlets
with program monitoring records, is recommended.
Surveys of health facilities are also recommended
Data collection frequency Annually
Frequency of reporting Annually
Responsible body Regional Health Authority/NAPS/ MCH/MOH
Remarks/notes This indicator does not consider the quality of
service provision
Indicator recommended by UNGASS
Pv11: Number of health workers trained in the provision of PMTCT
according to national guidelines
Definition Number of health workers trained in the provision
of PMTCT. Training refers to new training or
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retraining of individuals and assumes that training is
conducted according to national standards. A
training must have specific learning objectives, a
course outline or curriculum, and expected
knowledge, skills and/or competencies to be gained
by participants. A PMTCT training curriculum
should contain at least one of the PMTCT core
elements: PMTCT-related counseling and testing,
ARV prophylaxis, infant feeding counseling, or
family planning counseling or referral
Calculation Persons who have completed at least one or more
trainings with content related to the delivery of
PMTCT services
Rationale and what is
measured
Assesses the progress in preventing mother-to-child
transmission of HIV
Measurement tool Program reports and facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
training (public, private, and NGOs) is
recommended. Surveys of health facilities providing
HPC are also recommended
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority/NAPS/ MCH/MOH
Remarks/notes This indicator does not measure the quality of
training, nor does it measure the outcomes of the
training in term of the competencies of individuals
trained, nor their job performance
Indicator recommended by MOH
Pv12: Percentage of babies born to HIV-positive women who are tested
before age 18 months
Definition Number of babies born to HIV-positive women
who are tested before age 18 months, expressed as a
proportion of the number of babies born to HIV-
positive mothers
Calculation Numerator: Number of babies born to HIV-positive
mothers who are tested for HIV before age 18
months
Denominator: Total number of babies born to HIV
positive mothers
Rationale and what is
measured
Assesses the progress in preventing mother-to-child
transmission of HIV and progress in providing
appropriate care to babies born to HIV infected
women
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Measurement tool Program reports and facility surveys
Method of measurement Program reports
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority/NAPS/ MCH/MOH
Remarks/notes
Indicator recommended by MOH
5.4.3 Orphans and vulnerable children
Pv13 Percentage of OVC whose households received free, basic external
support in caring for the child
Definition The number of OVC who households receive free of
cost, basic external support in caring for the child,
expressed as a proportion of all OVC
Calculation Numerator: Number of orphaned and vulnerable
children who live in households and a ‘YES’ to at
least one of the following four questions by the head
of the household:
1) Has this household received medical
support, including medical care and/or
medical care supplies, within the last 12
months?
2) Has this household received school-related
assistance, including school fees, within the
last 12 months?
3) Has this household received
emotional/psychological support, including
counseling from a trained counselor and/or
emotional support/companionship, within
the last three months?
4) Has this household received other social
support, including socioeconomic support
(e.g., clothing, extra food, financial support,
shelter) and/or instrumental support (e.g.,
help with household work, training for
caregiver, childcare, legal services) within the
last three months?
Denominator: Total number of orphaned and
vulnerable children
Rationale and what is
measured
Provides assessment of the progress in providing
support to households that are caring for orphaned
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and vulnerable children
Measurement tool MICS
Method of measurement Household surveys in which heads of households are
asked four questions about the types and frequency
of support received (see above), and the primary
source of the help for each orphan and vulnerable
child
Data collection frequency Every 4-5 years
Frequency of reporting Every 4-5 years
Responsible body Ministry of Human Services and Social
Security/Ministry of Health
Remarks/notes External support is defined as free help coming from
a source other than friends, family or neighbors
unless they are working for a community-base group
or organization. This indicator does not measure the
needs of the household or the OVC
Indicator recommended by UNGASS
Pv14: Number of providers/caretakers trained in the provision of care for
OVC
Definition Providers and caretakers are anyone who ensures
care for OVC, including those who provide, make
referrals to, and/or oversee social services. This may
include parents, guardians, other caregivers, extended
family, neighbors, community leaders, police officers,
social workers, national, district, and/or local social
welfare ministry staff, as well as health care workers,
teachers, or community workers who receive training
on how to address the needs of OVC. Training refers
to new training or retraining of individuals and
assumes that training is conducted according to
national or international standards, if available. A
training must have specific learning objectives, a
course outline or curriculum, and expected
knowledge, skills and/or competencies to be gained
by participants
Calculation Providers or caretakers who have completed at least
one or more trainings with content related to the
delivery of care to OVC
Rationale and what is
measured
Assesses the progress in improving the lives of
children and families directly affected by AIDS-
related mortality and/or morbidity
Measurement tool Program reports and facility surveys
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Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
training (public, private, and NGOs) is
recommended
Data collection frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority/NAPS/MoH
Remarks/notes This indicator does not measure the quality of the
training, nor does it measure the outcomes of the
training in terms of the competencies of the
individuals trained, nor their performance
Indicator recommended by MOH
Blood Safety
Pv15: Percent of transfused blood units in the public and private sector in the
last 12 months that have been adequately screened for HIV according to
national guidelines
Definition This indicator gives and idea of the overall
percentage of blood units that have been screened
to sufficiently high standards that can be confidently
declared HIV free
Calculation Numerator: Number of blood units screened for HIV
in the last 12 months using national or international
standards
Denominator: Number of blood units transfused in
the last 12 months in the public and private sector
Rationale and what is
measured
This indicator assesses the degree to which blood is
screened and compliance with appropriate national
and international guidelines.
Measurement tool MEASURE EVALUATION blood safety protocol
Method of measurement Facility survey
Data collection frequency Biannual
Frequency of reporting Biannual
Responsible body MOH/NBTS
Remarks/notes This indicator measures compliance with blood
screening guidelines.
Indicator recommended by UNAIDS
5.5 Priority Area 4: Surveillance and research
Sr1: Percentage of service outlets with record-keeping systems to monitor
HIV prevention, care, treatment and support
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Definition Number of service outlets with record-keeping
systems for monitoring HIV/AIDS prevention, care,
treatment and support. A service outlet refers to the
lowest level of service for which data exists, e.g.,
hospital, clinic, or mobile unit.
Calculation Numerator: Number of service outlets maintaining
adequate records on the services provided
Denominator: Total number of service outlets surveyed
Rationale and what is
measured
This indictor is designed to measure the capacity of
health facilities to collect data on care and support
services and to compile these data
Measurement tool SPA
Method of measurement Health facility surveys that examine records on
HIV/AIDS care and support services and qualitative
interviews with people responsible for data collection
Data Collection Frequency Every 2-3 years
Frequency of reporting Every 2-3 years
Responsible body Regional Health Authority/ NAPS/MOH
Remarks/notes Patient record systems are diverse within facilities,
making comparisons across sites difficult. There is
also no international (or national) standard for data
reporting that can be used whether the record-
keeping is adequate
Indicator recommended by UNAIDS
Sr2: Number of persons trained in strategic information – monitoring and
evaluation and/or surveillance and/or HMIS
Definition Individuals may be newly trained or re-trained.
Training refers to new training or retraining of
individuals and assumes that training is conducted
according to national or international standards, if
available. A training must have specific learning
objectives, a course outline or curriculum, and
expected knowledge, skills and/or competencies to
be gained by participants
Calculation Persons who have completed at least one or more
trainings with content related to strategic information
(monitoring and evaluation, surveillance, or HMIS)
Rationale and what is
measured
This indictor is designed to measure progress towards
creating a cadre of professionals trained in the
collection, analysis, dissemination and use of strategic
information for HIV/AIDS programming
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Measurement tool Program reports or facility surveys
Method of measurement In order to measure this indicator, reviews of
program records of organizations that provide
training (public, private, and NGOs) is recommended
Data Collection Frequency Monthly
Frequency of reporting Annual
Responsible body Regional Health Authority/ MOH
Remarks/notes This indicator does not measure the quality of the
training, nor does it measure the outcomes of the
training in terms of the competencies of the
individuals trained, nor their job performance
Indicator recommended by MOH
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REFERENCES
Bureau of Statistics (2002). “Guyana Population and Housing Census 2002
Preliminary Report.” Government of Guyana.
CAREC (2004). “Status and Trend Analysis of the Caribbean HIV/AIDS Epidemic
1982-2002.” Available online at http://www.carec.org/orders/statustrends.html.
[Accessed on 29 September 2005].
CHRC (2004). “Assessment of the National HIV/AIDS Programme of Guyana.”
Prepared by Jennifer Pierre under the project “Strengthening the Institutional
Response to HIV/AIDS/STIs in the Caribbean Project.”
GFATM (2003). “Guyana’s National Initiative to Accelerate Access to Prevention,
Treatment, and Care, and Support for Persons Affected by HIV/AIDS.” Submitted
by Country Coordinating Committee, Guyana. Available online at
http://www.theglobalfund.org. [Accessed on 29 September 2005].
GFATM (2004). “Monitoring and Evaluation Toolkit. HIV/AIDS, Tuberculosis,
and Malaria.”
MOH (2002)a. “Status Report on HIV/AIDS in Guyana 1987-2001.” Government
of Guyana. Prepared by Dr. Navindra Persaud.
MOH (2002)b. “Guyana’s National Strategic Plan for HIV/AIDS 2002-
2006.”Government of Guyana.
MOH (2003). “National Health Plan 2003-2007. The Strategic Plan of the Ministry
of Health.” Government of Guyana.
Palmer C., et al. (2002). “HIV prevalence in a gold mining camp in the Amazon
region, Guyana.” Emerging Infectious Diseases. March. 8(3):330-1.
PEPFAR (2005). “The President’s Emergency Plan for AIDS Relief. Indicators,
Reporting Requirements, and Guidelines.” Revised for FY2006 reporting. [1 June
2005 Draft].
Persaud, N., et al. (1999). “Drug Use and Syphilis: Co-factors for HIV transmission
among commercial sex workers in Georgetown, Guyana.” West Indian Medical
Journal. June. 48(2):52-6.
WHO (2005). “A Guide to Indicators for Monitoring and Evaluating National
Antiretroviral Programmes.”
World Bank (2004). “Project Appraisal Document on a Proposed Grant in the
amount of SDR 6.7 million (US$10 Million Equivalent) to the Republic of Guyana
for a HIV/AIDS Prevention & Control Project.” Report No: 27394.
Guyana National HIV M&E Plan
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UNAIDS (2004). “Guyana Epidemiological Fact Sheet on HIV/AIDS and Sexually
Transmitted Infections.” Available online at http://www.unaids.org. [Accessed on
29 September 2005]
UNDP (2005). “Human Development Report 2005: International cooperation at a
crossroads: Aid, trade, and security in an unequal world.” Available online at
http://hdr.undp.org/reports/global/2005/. [Accessed on 7 October 2005]
United Nations General Assembly Special Session (UNGASS) on HIV/AIDS
(2006). “Guidelines for Construction of Core Indicators 2006 reporting.”
USAID Guyana (2003). “Guyana HIV/AIDS Strategic Plan 2004-2008.” Submitted
to the Bureau of Global Health USAID.
Guyana National HIV M&E Plan
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APPENDICES
Appendix 1. List of Contributors
Principal Leads
Dr. Shanti Singh, NAPS/MoH
Dr. Frank Anthony, HSDU/MoH
Technical Coordinator
Dr. Enias Baganizi, PAHO
Technical Committee
Dr. Navindra Persaud, GHARP
James Moore, CDC/Guyana
Anthony Willis, UNAIDS
Technical Advisors
Upama Khatri, MEASURE/JSI
Kathryn Boryc, USAID
Dr. Ruben Del Prado, UNAIDS
Merle Mendonca, GHRA
Appendix 2. GoG HIV/AIDS Program Logic Model
P a g e 1
G o v e r n m e n t o f G u y a n a H I V / A I D S P r o g r a m L o g i c M o d e l
P s y c h o s o c i a l a n d
E c o n o m i c S u p p o r t
A c t i v i t i e s
A R V T r e a t m e n t
S e r v i c e s
O r p h a n s &
V u l n e r a b l e C h i l d r e n
P a l l i a t i v e C a r e &
O p p o r t u n i s t i c
I n f e c t i o n s T r e a t m e n t
S e r v i c e s
( i n c l u d i n g T B )
S T I a n d H I V / A I D S
K n o w l e d g e &
A w a r e n e s s
H u m a n R e s o u r c e s
F i n a n c i a l R e s o u r c e s
I n s t i t u t i o n a l , P o l i t i c a l a n d
M a n a g e m e n t S u p p o r t
L a b o r a t o r y S e r v i c e s
S T I T r e a t m e n t
S e r v i c e s
C a p a c i t y B u i l d i n g
( e . g . , M O H , m a n a g e r s ,
h e a l t h p r o v i d e r s ,
N G O s , C B O s , l i n e
m i n i s t r i e s , e t c . )
I N P U T S P R O C E S S E S O U T C O M E S I M P A C T
P R E V E N T I O N T R E A T M E N T ,C A R E & S U P P O R T C R O S S – C U T T I N G
B A S E L I N E S T U D I E S , P R O G R E S S A N D P E R F O R M A N C E M O N I T O R I N G O U T C O M E S & I M P A C T E V A L U A T I O N
M a t e r i a l s & E q u i p m e n t
C o n d o m P r o m o t i o n
& D i s t r i b u t i o n o f
Q u a l i t y C o n d o m s
H I V C o u n s e l i n g &
T e s t i n g
P r e v e n t i o n o f
M o t h e r – t o – C h i l d
T r a n s m i s s i o n
S a f e B l o o d
U n i v e r s a l
P r e c a u t i o n s /
S a f e I n j e c t i o n s
S t r a t e g i c I n f o r m a t i o n
( e . g . , s u r v e i l l a n c e ,
M I S , r e s e a r c h ,
E l e c t r o n i c R e s o u r c e
C e n t e r a n d W e b s i t e )
S T I C a s e s
Q u a l i t y o f L i f e f o r
P L W H A
H I V I n f e c t i o n s
A v e r t e d
A I D S – R e l a t e d
M o r t a l i t y
Q u a l i t y o f H I V / A I D S
T r e a t m e n t , C a r e a n d
S u p p o r t S e r v i c e s
( e . g . a p p r o p r i a t e
d i a g n o s i s &
t r e a t m e n t , h o m e –
b a s e d c a r e )
H e a l t h P r o v i d e r a n d
P a t i e n t K n o w l e d g e
o f H I V / A I D S
P r e v e n t i o n , C a r e
a n d T r e a t m e n t
S t i g m a &
D i s c r i m i n a t i o n
A v a i l a b i l i t y o f H i g h
Q u a l i t y C o n d o m s
H I V / A I D S – R e l a t e d
M o r b i d i t y
H I V P r e v a l e n c e
Appendix 3. National Indictors for HIV/AIDS M&E System
Level and Area Indicators REF Data Source
Impact
Proportion of all deaths attributable to AIDS Imp1 Vital registration system and program reports
Percentage of adults and children with HIV alive and known to be
on treatment 12 months after initiation of ART Imp2
Vital registration system and program
reports
HIV prevalence among persons 15-24 Imp3 Sentinel surveillance at ANC sites
HIV prevalence among most-at-risk populations Imp4
BBSS and AIS with HIV testing and
sentinel surveillance at STI and TB
sites
Percent of infants born to HIV-infected mothers who are infected Imp5 Program reports and facility surveys
Ratio of current school attendance among orphans to that among
non-orphans aged 10-14 Imp6 AIS
Program Outputs
Priority 1: Strengthen National Capacity
Amount of national funds distributed by low- and middle-income
countries Nc1
National AIDS Spending Assessment
(NASA)
Implementation of the “Three Ones” Principle Nc2 Questionnaire
National composite policy index Nc3 NCPI questionnaire Policy Formation
Percent of schools with teachers who have been trained in life-skills
based HIV/AIDS education and who taught it during the last
academic year
Nc4 School survey
Partnerships/Multi-
sectoral Response
Number of line ministries with HIV work plans and budgets Nc5 Special survey of Line Ministries
Priority 2: Clinical and Diagnostic Management and Access to Care, Treatment, and Support
Percent of women, men, and children with HIV infection receiving
ART who are eligible according to national guidelines Cts1 Program reports and facility surveys
Number and percent of regions with at least one service outlet
providing ART services following national standards Cts2 Program reports and facility surveys
Access to ART
Number of health workers trained on ART delivery according to
national guidelines Cts3 Program reports and facility surveys
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Level and Area Indicators REF Data Source
Priority 2: Clinical and Diagnostic Management and Access to Care, Treatment, and Support (con’t)
Percent of the general population aged 15-49 receiving HIV test
results in the past 12 months Cts4 AIS
VCT Number of individuals trained in the provision of VCT according
to national guidelines Cts5
Program reports and facility
surveys
Number of regions with service outlets that provide HPC Cts6 Program reports and facility surveys
Number of service outlets that provide HPC Cts7 Program reports and facility surveys
Number of persons trained to provide HPC according to national
guidelines Cts8
Program reports and facility
surveys
Home and Palliative Care
Number of persons who receive HPC following national
guidelines Cts9
Program reports and facility
surveys
Percent of men and women with STIs at health care facilities who
are appropriately diagnosed, treated, and counseled Cts10
Program reports and facility
surveys OIs and STIs
Number of persons trained in the management of STIs according
to national guidelines Cts11
Program reports and facility
surveys
Percent of HIV-positive registered TB patients given ART during
TB treatment Cts12
Program reports and facility
surveys Tuberculosis
Percent of registered TB patients tested for HIV Cts13 Program reports and facility surveys
Percent of patients on ARVs who receive regular CD4 monitoring
following national ARV treatment guidelines Cts14
Program reports and facility
surveys
Number of regional labs with the capacity to perform CD4 tests
following national standards Cts15
Program reports and facility
surveys Lab Support
Number of persons trained to conduct CD4 testing according to
national guidelines Cts16
Program reports and facility
surveys
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Level and Area Indicators REF Data Source
Priority Area 3: Reducing Risk and Vulnerability to HIV infection
Percent of young men and women aged 15-24 who have had sex before age 15 Pv1 BSS
Percent of youth aged 15-24 reporting use of a condom during last sexual intercourse with a non-regular partner Pv2 BSS & AIS & MICS
Percent of people aged 15-49 expressing accepting attitudes toward
people with HIV/AIDS Pv3 BSS & AIS & MICS
Percent of people aged 15-24 who correctly identify ways of
preventing the sexual transmission of HIV and who reject major
misconceptions about HIV transmission
Pv4 BSS & AIS & MICS
Number of condoms (male and female) distributed in the past 12
months Pv5
Program reports and facility
surveys
Number of targeted prevention programmes for vulnerable groups Pv6 Program reports
IEC/BCC
Percentage of most-at-risk populations – sex workers, men who
have sex with men, mobile populations, and other vulnerable
groups – who reported using a condom during their last sexual
encounter with a regular or non-regular partner
Pv7 BSS
Number of service outlets that offer PMTCT services Pv8 Program reports and facility surveys
Number of pregnant women who receive HIV counseling and
testing for PMTCT and receive their test results Pv9
Program reports and facility
surveys
Percent of HIV-infected pregnant women who receive a complete
course of ARV prophylaxis as part of PMTCT Pv10
Program reports and facility
surveys
Number of health workers trained in the provision of PMTCT
according to national guidelines Pv11
Program reports and facility
surveys
PMTCT
Percent of babies born to HIV-positive women who are tested
before age 18 months Pv12
Program reports and facility
surveys
OVC Percent of OVC whose households receive free, basic external
support in caring for the child Pv13 MICS
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Number of providers trained in the provision of care for OVC Pv14 Program reports and facility surveys
Blood Safety
Percent of transfused blood units in the public and private sector
in the last 12 months that have been adequately screened for HIV
according to national guidelines
PV15 Facility surveys
Level and Area Indicators REF Data Source
Priority Area 4: Surveillance and Research
Percent of service outlets with record-keeping systems to monitor
HIV/AIDS care and treatment Sr1 SPA
Number of persons trained in strategic information (monitoring
and evaluation and/or surveillance and/or HMIS) Sr2
Program reports or facility
surveys
ACRONYMS
FOREWORD
Chapter 1. Introduction
1.1 HIV and AIDS in Guyana
1.2 The Presidential Commission on HIV/AIDS
A strong M&E system will ensure that: 1) relevant, timely, and accurate data are made available to program leaders and managers; 2) select quality data can be reported to national program leaders; and 3) the national program is able to meet donor and international reporting requirements under a unified global effort to combat the HIV pandemics.
1.4 Goals and Objectives of the National M&E Plan
1.5 Methodology of M&E Plan Development
- Chapter 2. Monitoring and Evaluation Concepts and Principles
2.1 Monitoring and Evaluation Definitions
2.2 Levels of Data in HIV and AIDS Monitoring and Evaluation
2.3 Principles of a Good Monitoring and Evaluation System
Chapter 3. National Level HIV and AIDS Indicators
3.1 Impact
3.3 Clinical and Diagnostic Management and Access to Care, Treatment, and Support
3.4 Reducing Risk and Vulnerability to HIV Infection
3.5 Surveillance and Research
- Chapter 4. National Monitoring and Evaluation Implementation Strategy
4.2 Data Sources
Population-based surveys, special studies, and operations research
Program monitoring and reporting
4.3 Institutional Roles and Responsibilities
4.4 Reporting Levels and Information Flows
4.5 Data Dissemination Plan
4.6 Resource Requirements
Chapter 5. National Indicator Reference Sheets
5.1 Impact indicators
5.2 Priority Area 1: Strengthening national capacity
5.3 Priority Area 2: Clinical and Diagnostic Management and Access to Care, Treatment, and Support
5.4 Priority Area 3: Reducing risk and vulnerability to HIV infection
5.5 Priority Area 4: Surveillance and research
REFERENCES
APPENDICES
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Government of Guyana National HIV/AIDS Programme
http://www.hiv.gov.gy
CONTENTS
PREFACE p
4
LIST OF ACRONYMS AND ABBREVIATIONS p
6
SECTION
1. INTRODUCTION p
9
1.1 Strategic Goal p9 | 1.2 The National Strategic Plan 2007-2011 p
10
SECTION 2. HIV/AIDS IN GUYANA p1
3
2.1 The Unfolding Story of HIV/AIDS of Guyana p17 | 2.2 The Impact of HIV/AIDS p31
| 2.3 Determinants and Dynamics of the Epidemic p33
SECTION 3. RESPONDING TO HIV/AIDS CHALLENGE IN GUYANA:
EXPERIENCES AND LESSONS LEARNT p3
5
3.1 Institutional Structure For The Response p35 | 3.2 Political Leadership, Development
Policies and Resources, Management Structure and Mulit-Sectorial p35 | 3.3 Financing th
e
Response to HIV/AIDS in Guyana p39 | 3.4 Building a comprehensive Prevention, Care and
Treatment programme p40 | 3.5 Challenges For The Future p41
SECTION 4. STRATEGIC FRAMEWORK p43
4.1 General Review of Previous Plans 1999-2001, 2002-2006 p43 | 4.2 The Strategic Planning
Process p43 | 4.3 Guiding Principles p44 | 4.4 Priority Objectives and Strategies p45
STRATEGIC PRIORITIES | Priority #1: Strengthening the National Capacity to
Implement a Coordinated, Multi-sectoral Response p4
8
| Priority #2: Clinical and Di
–
agnostic Management and Access to Care, Treatment and Support p51 | Priority #3:
Clinical and Diagnostic Management and Access to Care, Treatment and Support p57 |
Priority #4: Strategic Information p62
SECTION 5. MONITORING & EVALUATION p65
SECTION 6. NEXT STEPS – THE WAY FORWARD p
69
REFERENCES AND DOCUMENTS CONSULTED p69
ACKNOWLEDGEMENTS p71
4]
Guyana National HIV/AIDS Strategic Plan 2007-2011
PREFACE
HIV/AIDS is both a National and International crisis. Together with nuclear war, global warm-
ing, chronic and sustained armed conflicts in various parts of the world and inequitable inter-
national finance and trade policies, HIV/AIDS constitute one of the world’s most challenges.
HIV/AIDS today represents one of the greatest potential threat to achieving the Millennium
Development Goals (MDGs).
Guyana has boldly pursued polices and programs intended to reverse the impact that HIV/
AIDS has had on our country. In putting together a 2002-2006 National Strategy, we embarked
on an ambitious program at a time when all programs were being supported only by the Central
Government and at a time when few local or international NGOs were willing to be involved in
the Guyanese fight against
HIV/
AIDS.
Fortunately, soon after the introduction of the 2002-2006 National Strategy, Guyana became a
recipient of significant amount of funds from various sources – PEPFAR (the US Emergenc
y
Fund to fight against HIV/AIDS), CIDA (the Canadian Development Agency), the World
Bank, the Global Fund to Fight Against HIV/AIDS, TB and Malaria. Significant assistance
was derived, too, from traditional technical partners, which all increased their involvement in the
fight. These included PAHO, UNICEF, UNFPA and UNAIDS and CAREC and CDC.
The result was that Guyana has been able to make significant progress in the fight against HIV/
AIDS. The Guyana program includes all components in the fight against HIV/AIDS and the
new national strategy is designed so as to roll-out the various programs. Ultimately, the major
theme of the new strategy is UNIVERSAL ACCESS.
Most of the tools to fight against HIV/AIDS are known and are available for use. The limitation
is often access to these tools. National access is determined by several factors, including availabil-
ity of funds and human resource capacity and recognition that lifestyle is a major determinant of
the disease and consequently, major lifestyle changes are required.
But new tools are also becoming rapidly available and a country’s ability to quickly access these
new tools, including new drugs and vaccines is also important for a successful; fight against
HIV/AIDS. Our strategy must be designed to take immediate advantage of new tools and not
have to wait several years, long after the introduction of these prevention and treatment, care and
support tools in developed countries, to be able to access them in our country.
Guyana has made significant progress in our fight against HIV/AIDS. We have a chance to
successfully reduce the impact of HIV/AIDS in our country. We have a chance to be a model
for how to combat this scourge.
4]
Guyana National HIV/AIDS Strategic Plan 2007-2011
[5I commend the 2007-2011 National Strategy and urge every one to work diligently to imple-
ment the various programs. It is again an ambitious program and we faithfully implement the
various activities outlined in the strategy, we are bound to succeed.
Even as I express our profound gratitude to all those who have worked on this document, I urge
everyone that only a robust effort to provide universal access to all the prevention, treatment, care
and support programs quickly to people will suffice.
Thank you.
Dr. Leslie Ramsammy
Minister of Health, Guyana
6]
Guyana National HIV/AIDS Strategic Plan 2007-2011
LIST OF ACRONYMS AND ABBREVIATIONS
ABC Abstinence, Be Faithful, Correct, Consistent, Condom Use
AIDS Acquired Immunodeficiency Syndrome
AIS AIDS Indicator Study
ANC Ante-natal clinic
ART Anti-retroviral therapy
ARV Anti-retrovira
l
BCC Behaviour change communication
BSS Behavioural surveillance survey
CAREC Caribbean Epidemiology Centre
CARICOM Caribbean Community
CBO Community-Based organisation
CCM Country Coordinating Mechanism
CHART Caribbean Regional HIV/AIDS Training
CIA Central Intelligence Agency
CIDA Canadian International Development Agency
CIOG Central Islamic Organisation of Guyana
CMC Central Medical Centre
CSIH Canadian Society for International Health
CSW Commercial Sex Worker
s
CT Counselling and Testing
DDC Department of Disease Control
DHHS/CDC United States Centers for Disease Control and Prevention
DOD Department of Defence
DOTS Direct Observation Therapy Strategy
EP Emergency Plan
EU European Union
FBO Faith-based organisation
FTE Full Time Equivalen
t
G+ The Network of Guyanese Living with HIV and AIDS
GDF Guyana Defence Force
GDP Gross Domestic Product
GECOM Guyana Elections Commission
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GHARP Guyana HIV/AIDS Reduction and Prevention Programme
GOG Government of Guyana
GPC Guyana Pharmaceutical Corporation
GTUC Guyana Trades Union Congress
Guyana National HIV/AIDS Strategic Plan 2007-2011
[7
GTZ German Agency for Technical Cooperation
GUM Genito-urinary Medicine
HBC Home-based care
HDI Human Development Index
HFLE Health and Family Life Education
HIPC Heavily Indebted Poor Countries Initiative
HIS Health Information System
HIV Human Immunodeficiency Virus
HMIS Health Management Information Systems
HRM Human Resource Management
HSDU Health Sector Development Unit
ID Identification
IDB Inter-American Development Bank
IDEA Institute for Democracy and Electoral Assistance
IEC Information, Education and Communication
IHV Institute of Human Virology
ILO International Labour Organization
IMF International Monetary Fund
JHPIEGO Johns Hopkins Program for International Education in Gynaecology and Ob-
stetrics
LIDC Low Income Developing Country
LMIDC Low Middle-Income Developing Country
M&E Monitoring and Evaluation
MARPS Most at Risk Populatio
ns
MCH Maternal Child Health
MDR Multi Drug Resistance
MMU Materials Management Unit
MOH Ministry of Health
MSM Men who have sex with men
NAC National AIDS Committee
NAPS National AIDS Programme Secretariat
NBTS National Blood Transfusion Service
NDC Neighbourhood Democratic Council
NGO Non Governmental Organisation
NLID National Laboratory for Infectious Diseases
NTCC National Training Coordination Centre
8]
Guyana National HIV/AIDS Strategic Plan 2007-2011
OIS Opportunistic infections
OPEC Organisation of Petroleum Exporting Countri
es
OVC Orphans and vulnerable children
PAC Presidential AIDS Commission
PAHO Pan American Health Organization
PCVS Peace Corps Voluntee
rs
PEPFAR President’s Emergency Plan for AIDS Relief
PLWHA People living with HIV and AIDS
PMIS Patient Management Information System
PMTCT Prevention of Mother to Child Transmission
PNC-R People’s National Congress-Reform
RAC Regional AIDS Committee
RDC Regional Democratic Council
QI Quality improvement
S&D Stigma and discrimination
STI Sexually Transmitted Infection
SOP Standard Operating Procedures
TA Technical Assistance
TB Tuberculosis
TIMS Training Information Management System
TTIS Transfusion-transmitted infections
UK United Kingdom
UN United Nations
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Program
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
USDOL United States Department of Labour
USG United States Government
WHO World Health Organization
Guyana National HIV/AIDS Strategic Plan 2007-2011
[9
1INTRODUCTION
The Government of Guyana has declared HIV/AIDS a National Priority and has made thi
s
priority an important plank in its Poverty Reduction Strategy Program (PRSP). The Govern-
ment has committed itself to an accelerated, comprehensive, multi-sector, multi-level response
and has declared that only through a well – coordinated partnership with local and international
partners could Guyana respond effectively to the challenge of HIV/AIDS. The Government is
convinced that HIV/AIDS is a barrier to development.
The Plan that follows is based on a number of Government commitments and policy positions:
■ Universal access to HIV testing for all citizens: know you status campaig
n.
■ Universal access to PMTCT: ensure that all women of reproductive age and their families
have access to PMTCT through antenatal clinics (public and private).
■ Universal access to ARV-based treatment and CD4 based management to all PLWHA.
■ Link all relevant public health programmes to HIV services: just as all TB patients are tested
for HIV, similarly a VCT programme will be located within the Hanson, Malaria and other
relevant programmes.
■ Move to an “opting out” programme for HIV testing: starting with the PMTCT programme
an “opting out” procedure will be introduced and will be used in conjunction with VC
T
■ Promote legislation to prevent stigma and discrimination based on HIV status
■ Provide foster care as part of OVC.
■ Develop curricula for HIV/AIDS as examination subject in school.
1.1_STRATEGIC GOAL
The overall strategic goal of the 2007 -2011 NSP for HIV/AIDS remains the same as that of
the NSP 2002-2006:
“To reduce the social and economic impact of HIV and AIDS on individuals and
communities, and ultimately the development of the country”.
Overall Strategic Objective
The overall strategic objective is to reduce the spread of HIV and improve the quality of life
of PLWHAs.
Specific Objectives:
Some of the specific objectives are to:
SECTION
10]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ Empower citizens by providing universal access for HIV/AIDS care, support, education and
awareness program.
■ Promote behaviour changes that reduce risks among all people, especially vulnerable groups.
■ Enable each citizen to know his or her HIV status by providing easy accessible counselling
and testing and by promoting an “opt-out” strategy.
■ Provide easily accessible universal PMTCT services to all pregnant women and their fami-
lies.
■ Ensure safe blood supply.
■ Provide treatment, care and support for OVC.
■ Provide treatment, care and support for all PLWHA.
■ Create space for the involvement of all citizens and groups in the multi-sector fight against
HIV/AIDS, including space for the involvement of PLWHA.
■ Reduce stigma and discrimination through BCC program, supported by an adequate legal
framework.
■ Build capacity for the overall response.
■ Improve the information system and strengthen the surveillance program.
■ Strengthen the overall coordination of the HIV/AIDS response program.
1.2_THE NATIONAL STRATEGIC PLAN 2007-2011
Guyana is at a critical point in its HIV/AIDS response where its National Programme is faced
with new challenges. As a result the National Response has to be scaled-up to deliver more
programmes, services and activities that reach a wider cross section of people. Over the last two
years, through a combination of strong political leadership and the use of National HIV/AIDS
Strategic Plan 2002 -2006, the Government has been able to mobilize significant financial re-
sources to support the HIV/AIDS programme. It is therefore important that these new resourc-
es are used efficiently and effectively over the next four years if the country is to attain universal
access and achieve its long-term goal of reducing the social and economic impact of HIV/AIDS
on individuals and communities and ultimately the development of the country.
As we prepare to launch the new program, there is also the question of the adequacy of resources
to implement the strategy outlined. The plan being articulated in this document clearly dem-
onstrates that Guyana will need to use present resources productively and must also mobilize
more resource in order to fully implement the ambitious program planned for 2007-2011. The
exceptionality of the HIV/AIDS pandemic requires that the resources must be mobilized and
Guyana must not be forced to curtail its plan in order to fit available resources.
Cognisant of the problem of donor coordination, earlier this year at a Care and Treatment
Workshop in April 2005, the Minister of Health, Dr. Leslie Ramsammy, in his address said:
“The time had come to collectively review these various work plans, to identify the gaps, and
to decide on the allocation of responsibilities for implementing the new strategic plan which
was to be developed. It was hoped that a work plan for the next two years could be drafted
which would promote collaboration among the various agencies and avoid duplication.”1
This issue of harmonisation put forward by the Minister is important and timely. In February
2003, at a meeting in Rome, a Declaration on Harmonisation was signed by a number of donor
1 PAHO Workshop Report,
The Guyana HIV/AIDS
Care and Treatment
Plan, May 2005.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[11
agencies2. The agreement encourages donor agencies to improve coordination among them-
selves and with countries when responding to national priorities.
The National Strategic Plan 2007-2011 seeks to harmonise and align the resources and responses
of all its partners to ensure that they meet Guyana’s National Priorities. It is intended to strategi-
cally guide the future direction of Guyana’s National HIV/AIDS Response since it outlines the
basic approaches, principles, strategic priorities, objectives and strategic activities. The formula-
tion of the plan will also be aligned with one National Monitoring and Evaluation Plan.
The new Plan also seeks to build on the good work that was carried out during the development
of the 2002-2006 National HIV/AIDS Strategic Plan that was designed using a participative
process, involving the National AIDS Programme and the major partners within the public,
private and donor communities.
This 2007-2011 Plan aims to provide the following benefits:
■ A structured framework that will allow Government to continue to its leadership and to build
the capacity to manage and implement the programmes, interventions and activities of the
National response across the various sectors.
■ A structured framework that can be used to make optimal use of the financial and technical
resources.
■ An opportunity to strengthen the leadership and management initiatives that began with the
Presidential Commission on AIDS.
■ A structured framework that encourages harmonisation and alignment among partners in the
achievement of the National priorities of Guyana’s HIV/AIDS response.
■ An opportunity to coordinate and streamline the HIV/AIDS work plans of the various agen-
cies based on common arrangements, procedures and systems.
■ A chance to build capacity for a monitoring and evaluating system so that the GOG can
measure the impact of its multi-sectoral national HIV/AIDS response.
■ An effective vehicle for encourage the involvement and empowerment of all the stakeholders
and partners reaching all vulnerable populations.
A National Monitoring and Evaluation plan complements this framework so the information
can be used to measure progress and impact and to inform actions that will need to be taken to
strengthen the response during implementation.3
The National Strategic Plan 2007-2011 takes into consideration a number of declared public
policy statements by the Government. Those are detailed in Section: 4.
4
The plan also takes into consideration a number of national and regional development plans.
These include:
■ The National Development Strategy (NDS
)
■ The Poverty Reduction Strategy Program (PRSP)
■ The National Health Plan 2003-2007
■ The National AIDS Policy Document
■ Caribbean Charter on Health II (CCH II)
■ The CARIBBEAN Regional HIV/AIDS Strategic framework, and
2 The Rome Declaration on
Harmonization, High Level
Forum on Harmonization,
24-25 February ,2003, where
senior officials from more than
20 bilateral and multi-lateral
development organizations
and approximately 50
countries reaffirmed their
commitment to achieving the
Millennium Development
Goals and agreed to harmonize
their policies, procedures and
practices.
3 National M&E Plan outlines
the detailed indicators and
targets that will be used to
monitor and evaluate the
HIV/AIDS response.
12]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ PAHO/WHO Regional HIV/STI Plan
The Plan further takes cognizance of partnerships programs, such as:
■ The World Bank HIV/AIDS Reduction Program
■ The Global Fund HIV/AIDS Program
■ PEPFAR (GHARP)
■ CIDA’s HIV/AIDS/STI Program
The plan is also consistent with international declarations and commitments that Guyana is a
part of these include:
■ MDGs
■ UNGASS Declaration 2001
■ The 3 Ones
■ 3×5 Initiative
■ UNAIDS Declaration of universal access.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[13
SECTION
2 HIV/AIDS IN GUYANA
Guyana (215,000 square km), a developing country, located on the northeast coast of South
America, is bordered by the Atlantic Ocean, Suriname, Brazil and Venezuela. It is considered
part of the Caribbean and is a member of the Caribbean Community (CARICOM). However,
Guyana is today pursuing stronger political, economic and social engagements with its South
American sister countries, particularly, the neighbouring countries of Brazil, Suriname and Ven-
ezuela.
Political context: Guyana is a fledgling democracy, having reversed a period of non-democratic
rule between 1968 and 1992. The strengthening and expansion of democratic institutions, cou-
pled with recent constitutional and parliamentary reforms, have resulted in greater participation
of parliament and civic society in decision-making and fiduciary oversight.
This former British territory gained independence on 26th May 1966 and became a republic
in February 1970. An executive president is both the head of state and government. There are
several levels of elected government ranging from parliament and Regional Democratic Coun-
cils (RDCs) to Neighbourhood Democratic Councils (NDCs) and Community Development
Committees (CDCs). Members of parliament comprise members, representing national slates
and geographic regions, elected by a system of proportional representation. The local govern-
ment system consists of ten RDCs, seven mayoralties and sixty-five NDCs. There are also Am-
erindian village councils that operate under separate legislation. The RDCs are administratively
responsible for delivery of services – health, education, etc – to their populations.
A NDS was formulated in 2000 by a civic group, consisting of more than 150 professionals and
Private Sector Individuals, with financial support from the Government and with the Carter
Center of the USA playing a facilitating role. The NDS was formally adopted by Parliament
on December 15, 2005 and a mechanism was established for its updating and monitoring of its
implementa
tion.
Economic Context: Guyana is HIPC, with a per capita GDP of US$ 869 in 2004. From 1991-
97, GDP grew at an average of 7.3% per annum but, following internal political turmoil, unfa-
vourable weather conditions and external shocks, this growth trend has been difficult to sustain
in the period 1998-2004 (-1.8% to +3.0%). Guyana is today categorized as Low Middle-Income
Developing Country (LMIDC). It graduated from its position as a Low Income Developing
Country (LIDC), where it was for the whole of the 1970s, 1980s and most of the 1990s.
Debt Servicing: Between 1970 and 1992, Guyana accumulated one of the highest debt burdens
in the world as the debt rose from 30% to 470% of GDP. By 1992, 94% of its earnings had to go
towards servicing interests on its debt. Since then, through prudent fiscal management, grow-
ing economy and debt relief, Guyana has succeeded in significantly reducing this burden. As a
satisfactory-performing country, Guyana has benefited from significant debt-relief.
14]
Guyana National HIV/AIDS Strategic Plan 2007-2011
Social Context: A national population census was conducted in 2002.The census recorded a
multi-racial population of 751,223 (up from 723,673 from the 1991 Census). The sex distribu-
tion of the population shows that 50.1 % were males and 49.9% were females. Approximately
35.5% of the population was under 15 and 7% over 60 years old. The age group mostly af-
fected by HIV/AIDS (15-49) represents 51.3% of the population. Approximately 28.4% of the
population lives in urban areas and 71.6% live in rural areas. The coastal Regions 2 (49,253),3
(103,061),4 (310,320),5 (52,428) and 6 (123,695) account for 85.1% of the population. The
rural interior (Regions 1, 7, 8 and 9) is very sparsely populated with 9.4%. East Indians represent
approximately 43.5% of the population, African/Black 30.2% and the Amerindian population
9.2%. Mixed-heritage accounted for 16.7% of the population. Other ethnic groups in the coun-
try include 0.26% Portuguese (whites) and 0.2 Chinese. The Christian (various denominations)
population is 55.4%, the Hindus make up 28.4% and the Muslims make up 7.2%. Very small
groups include the Bahai and the Rastafarians. Adult literacy is estimated as 98%4. The gross
enrolment rate at the secondary level is 76% and at the primary level 99%. These represent
significant increases from a decade ago. There are also increasing numbers of students at the
University of Guyana and in various vocational institutions in the country.
Guyana is gradually recovering from debilitating poverty circumstances. The difficult economic
circumstances of the 1970s and 1980s culminated in poverty rates of between 65 and 86% for the
period 1988 and 1991. In 1993, after the restoration of democracy, absolute and critical poverty
fell to 43.2 and 27.2%respectively and this further improved in 1999, when approximately 36.3%
of the population lived in absolute poverty (US$ 510 per year or US$1.40 per day) and 19.1%
in critical poverty (US$ 364 per year or US$1 per day). Guyana was declared eligible for debt
relief under the HIPC in 1997 and is now part of the enhanced HIPC program. Guyana is in the
third year of its Poverty Reduction Strategy. Funds from debt relief are allocated to expenditures
in the social sectors (education, health, housing and water) and to poverty alleviation programs.
The PRSP budget is expected to increase allocation to health by about 30% of recurrent budget.
In 2005, Guyana ranked 107th on the Human Development Index 2005 Report. The Gender-
related Development Index (GDI) for Guyana is 79th in 2005. The GDP Index increased from
0.59 (2002) to 0.64 (2003) and 0.7 in 2005.
TABLE 1_KEY MORTALITY INDICATORS, ADJUSTED FOR UNDER-REPORTING5
INDICATOR REPORTED RATE PER
THOUSAND
ESTIMATED RATE
ADJUSTED
Stillbirth rate 17.1-18.2 19.5-34
Neonatal mortality rate 13.5-18.1 26-3
6
Infant mortality rate 18-54 30-54
Under five mortality rate 31.3 –72 40-72
Maternal mortality/100,000) 101-133 16
8
Crude death rate 5.4 7.5
4 Human development
Report 2005, UNDP.
5 National Health Plan
2003-2007.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[15
TABLE 2_MAJOR CAUSES OF DEATH BY AGE GROUP NATIONALLY
AGE GROUP LEADING CAUSES OF DEATH
Under 5 Perinatal, ARI1, ADD1, accidents/injuries, HIV/AIDS
5-15 Accidents/injuries, ARI1, ADD1, cancer, malnutrition/anaemia
15-44 HIV/AIDS, accidents/injuries, suicide, ARI2/ADD2
45-64 Heart disease3, cerebrovascular disease (stroke), diabetes, canc
er
TABLE 3_DISTRIBUTION OF HEALTH SERVICES BY REGIONS
NATIONAL
TOTALS
COASTAL REGIONS HINTERLAND REGIONS
3 4 5 6 10 TOTAL 1 2 7 8 9 TOTAL
Health Post 182 25 10 2 1 13 51 31 17 15 16 52 131
Health Centre 112 13 25 14 24 10 86 4 12 3 4 3 26
District Hospital 18 3 0 3 3 2 10 3 1 1 1 2 8
Regional Hospital 4 1 0 0 1 1 3 0 1 0 0 0 1
National Hospital 5 0 4 0 1 0 5 0 0 0 0 0 0
Totals 321 42 39 18 30 26 155 38 31 19 21 57 166
% total
population
100 13.3 81.0 7.1 19.7 5.4 86.5 2.5 6.0 2.0 0.8 2.1 13.4
Private Hospitals 5 – 5 – – – 5 – – – – – –
Private Doctors 115 5 80 5 20 4 114 0 0 0 0 1 1
Total Beds 2,187 183 951 37 554 146 1,871 85 107 56 28 40 316
Public Acute
Beds
1,631 183 615 37 334 146 1,315 85 107 56 28 40 316
16]
Guyana National HIV/AIDS Strategic Plan 2007-2011
TABLE 4_HEALTH NEEDS & PREDICTED CHANGES FOR THE GUYANESE POPULATION
CONDITION
E
S
T
I
M
A
T
E
D
N
U
M
B
E
R
S
P
R
E
D
I
C
T
E
D
T
O
C
H
A
N
G
E
A
G
E
S
A
F
F
E
C
T
E
D
D
IS
T
R
IB
U
T
IO
N
N
A
T
IO
N
A
L
P
R
O
G
R
A
M
P
R
IM
A
R
Y
C
A
R
E
IN
V
O
LV
E
D
INFECTIOUS
HIV/AIDS 25,000 Increase <5; 15-44 All Yes Yes
Malaria 30,000 Stable All Hinterland Yes Yes
TB 600 Increase All All Yes Yes
Syphilis/other STIs 15,000 Increase 15-64 All No Yes
Filariasis 20,000 Decrease 1-44 Urban Yes Yes
NUTRITION AND ANAEMIAS
Anaemia 320,000 Decrease All All
Planned Yes
Malnutrition 10,000 Decrease <5 All Planned Yes
Intestinal Worms 12,500 Stable All All No Yes
Vascular
Hypertension 65,000 Increase >45 All,
Higher
Afro
Guyanese
Planned Yes
Diabetes 40,000 Increase >45 All,
Higher
in East
Indians
Planned Yes
MISCELLANEOUS
Accidents and Injuries 17,000 Stable All All No Yes
Suicide 100 Stable All All, Higher
in East
Indians
Planned Yes
Risk factors
Smoking 130,000 Increase >15 All Planned Yes
Obesity 125,000 Increase All All Planned Yes
Diet All – All All Planned Yes
MATERNAL AND CHILD HEALTH
Antenatal and
Postnatal Care
Pregnant
women
– >12 All Yes Yes
EPI All infants – 0-2 All Yes Yes
Guyana National HIV/AIDS Strategic Plan 2007-2011
[17
Sector financing: health care services in the public sector are free. Total public sector expendi-
ture is estimated at US$ 33m or about $US48.5 per capita for 2003. It is believed that public
sector expenditure accounts for more than 80%, with out-of-pocket and insurance contributions
(private sector expenditure) accounting for less than 20% of the total health care cost in the
country (figure 2). In 2002, health expenditure amounted to 8.4% of total government expen-
diture (10.1% if debt payments are excluded) and trends for this are shown in table 7. While
it is obvious that the health sector requires a greater injection of financial resources, it must
also be obvious that the ability of government to do so in the foreseeable future is restricted.
Note that the government already commits more than 37% (table7) of its total expenditure on
the social services and that with debt servicing, more than 50% of public sector expenditure is
accounted for. In addition, the country’s revenues are usually significantly below budget projec-
tions (>-15%). The country receives significant technical cooperation support for the health
sector and in 1999, donors accounted for 5.22% of government health spending (compared with
11% in 1997). All the funds are grants. The principal sources of external financing in 1999 and
2000 were the Inter American Development Bank, UN agencies, PAHO, USAID and GTZ.
Guyana’s immunization program benefits significantly from GAVI.
TABLE 5_SECTOR EXPENDITURE 1992-2001
1991 1993 1994 1995 1996 1997 1998 1999 2000 2001
Per Capita GDP
($US)
350 531 612 680 766 808.3 777.5 770.3 773 737.9
Social Sector
Exp. as % of Total
Expenditure
8.9 20.4 25.6 22.2 29.7 28.7 29.6 31 32.5 35.2
Public expenditure
on health
($GY,000,000)
703 2,022 2,737 2,214 2,686 2,769 2,951 3,550 4,423 4,402
Public expenditure
on health as % of
total public
expenditure
3.6 7.9 9.0 6.3 6.8 7.6 6.8 7.6 7.4 6.9
Total per
capita health
expenditure in
US$
8 29.1 34 39 43.4 45.4 45.4 46 48 48
2.1 THE UNFOLDING STORY OF HIV/AIDS IN GUYANA
There appears to be a stabilization of the epidemic
The first documented case of HIV/AIDS in Guyana was in 1987. Since this documented first
case, UNAIDS estimated that Guyana has an adult prevalence of HIV infection of about 2.5%
(range 0.8% to 7%) at the end of 2004.
18]
Guyana National HIV/AIDS Strategic Plan 2007-2011
Surveillance studies among some vulnerable populations seem to suggest a stabilization of the
epidemic. The following Table supports this assertion:
TABLE 2.1.1: HIV PREVALENCE AMONGST VULNERABLE POPULATIONS
POPULATION GENDER YEAR PREVALENCE (%) REMARKS
Blood Donors All 2001
2004
1.0
0.8
Blood Bank survey
Pregnant Women Female 1993
1995
2000
2002
2003
2004
2004
2005
3.7
7.1
5.6
3.9
3.1
2.5
2.6
2.1
ANC Survey
PMTCT Sites
PMTCT Sites
PMTCT Sites
ANC Survey
PMTCT Report
STI Patients Male 1992
2002
2004
2005
13.2
15.1
19.8
17.3
Clinic Records
Clinic records
Clinic Records
Clinic Records
Female 1993
2002
2004
2005
6.
5
1
2.0
15.8
16.9
Clinic Records
Clinic Records
Clinic Records
Clinic Records
CSW Female 1992
1997
2004
25.0
45.0
26.6
CSW Survey
CSW Survey
BBSS, 2004
MSM Male 2004 21.25 BBSS, 2004
TB Patients All 1997
2003
2005
1
4.5
30.2
?
Clinic Records
Clinic Records
Clinic Records
Miners Males 2000
1999
2004
6.5
11.9
3.9
1 mine
1 mine
22 mines
Guyana has officially recorded 7,512 cases up to the end of 2004. The data in Table 2.2.2 be-
low provides further evidence that the epidemic has stabilized. With greater accessibility to
VCT and Treatment and Care Centers, more testing for HIV is being done by the public and
private sectors and NGOs. Under-reporting was a serious problem in the early years and while
significant under-reporting is still a problem, this issue is being gradually addressed. In spite of
increased testing, the number of new recorded cases has remained relatively stable between 2001
and 2005 as seen in Table 2.1.2 and Fig. 2.1.1
Guyana National HIV/AIDS Strategic Plan 2007-2011
[19
Fig. 2.1.1_HIV/AIDS in Guyana 1987-2004
Reported Cases & Incidence
TABLE 2.1.2: HIV AND AIDS CASES FROM 1987 – 2004 BY GENDER (2000-2004)
CLASSIFICATION 1987-
1999 2000 2001 2002 2003 2004
HIV Male 348 174 301 339 368
Female 300 226 268 368 408
Unknown 0 9 39 55 61
Total 648 409 608 762 837
AIDS Male 175 232 243 232 117
Female 132 185 146 163 204
Unknown 0 18 26 22 27
Total 307 435 415 417 348
HIV/AIDS Year Total 955 844 1023 1179 1185
Cumulative (All
cases from 1987)
2326 3281 4125 5148 6327 7512
Young people are disproportionately affected and there is an increasing feminization
of the epidemic
The data demonstrate that while the early epidemic affected more men than women, there is
an increasing feminization of the epidemic and more women are recorded with HIV today than
men, especially in the age groups of 15 and 24. More than 90% of the recorded cases occur
among the age groups of 15 to 49.
In
ci
de
nc
e/
10
0,
00
0
1
80
1
60
1
40
1
20
100
80
60
40
20
0
900
800
700
600
500
400
300
200
100
0
1
9
8
7
1
9
8
8
1
9
8
9
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
Year
C
as
es
HIV / AIDS /Rate
20]
Guyana National HIV/AIDS Strategic Plan 2007-2011
TABLE 2.1.3_DISTRIBUTION OF AIDS CASES BY GENDER AND AGE GROUPS
(1999-2004)
AGE
GROUP
1999 2000 2001 2002 2003 2004 TOTAL TOTAL
M F M F
M F M F M F
M F
M F
<1 3 0 2 2 7 3 0 0 0 0 0 0 12 5 17
1-4 10 1 6 5 9 4 9 5 7 5 1 4 42 24 66
5-14 1 2 3 0 6 4 5 5 2 5 5 5 22 21 43
15-19 4 7 3 4 1 9 4 3 0 2 4 2 16 27 43
20-24 19 14 16 16 20 28 9 16 13 13 9 14 86 101 187
25-29 30 53 35 23 32 24 43 30 28 21 20 17 188 168 356
30-34 51 20 25 30 48 28 48 27 54 37 42 19 268 161 429
35-39 32 14 30 24 33 14 37 26 38 28 40 17 210 123 333
40-44 20 9 26 9 19 20 24 11 25 19 26 9 140 77 217
45-49 20 8 11 6 15 15 15 8 20 11 15 7 96 55 151
50-54 6 3 3 7 5 7 14 2 16 7 11 3 55 29 84
55-59 3 2 3 4 4 3 4 3 2 0 5 2 21 14 35
60+_ 3 2 8 2 6 4 13 0 2 1 3 1 35 10 45
NS 2 2 4 0 27 22 18 10 23 14 25 17 99 65 164
204 137 175 132 232 185 243 146 232 163 204 117 1290 880 21
70
Treatment is Working
Guyana has moved from a centralized treatment program to providing treatment nation-
ally. Treatment with ARVs started in April 2002 at one treatment centre (the GUM Clinic).
Since then several new centres have been introduced in the public and private sector. At the
end of 2005, there were eight (8) public health centres offering treatment and care, including
the provision of ARVs and CD4 testing. These centres are located in Regions 2,3,4,6,7 and
10. In addition, treatment is being provided in Regions 1, 8 and 9 through visiting specialist
teams. The St. Joseph’s Mercy Hospital is a private hospital that also offers treatment and care
under the Ministry of Health’s program. These treatment and care programs are offered freely
to PLWHA. Private physicians and hospitals also provide treatment, but these private arrange-
ments have not yet become part of the national surveillance.
The numbers of person accessing the treatment program has accelerated since the begin-
ning of 2005. Fig. 2.1.2 shows the number of PLWHA who were initiated into the treatment
program by quarter in 2005. During the first quarter of 2005, the number of PLWHA that were
initiated into the treatment program was 13 per month. This increased to 23 per month in the
last quarter of 2005. At the end of 2005, there were 1202 on treatment in the national program,
exceeding the 3 by 5 target of 1,000 for the end of 2005.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[21
Fig. 2.1.2_Number of Persons Initiated on Treatment by Quarter in 2005
The immunological status of PLWHA and who are on treatment has significantly improved.
Immunological monitoring of PLWHA started in September 2004 with the introduction of
CD4 testing. This has been one of the factors that have led to the increased initiation of per-
sons on ARV treatment. Clinical decisions on when to start ARV treatment is now based on a
protocol that include the use of CD4. When the ARV treatment program started in 2002, the
decision was based on a sydromic model, without CD4. At the start of the program, a cut-off of
CD4 count of 200 was used. Since September 2005, the CD4 cut-off has been increased to 350.
Treatment with ARVs has resulted in significant clinical and immunological improvement for
PLWHA. For example, the average CD4 count for PLWHA at initiation for ARV treatment in
2005 was
113
. The CD4 count improved significantly by 3,6 and 9 months after treatment with
ARV started, as seen in Fig. 2.1.3
Fig. 2.1.3_CD4 Monitoring
39
43
50
80
70
60
50
40
30
20
10
0
1 2 3 4
N
um
be
r
of
p
at
ie
nt
s
Series1 / Linear (Series1)
Quarter
69
350
300
250
200
150
100
50
0
C
D
4
ce
lls
Date
Initaition 3 months 6 months 9 months
175
241
288
113
22]
Guyana National HIV/AIDS Strategic Plan 2007-2011
Viral Load Status of PLWHA has also shown indication that treatment is working: Viral load
testing was introduced through the Ministry’s program with St. Joseph’s Mercy Hospital. This
program is through the sponsorship of PEPFAR and is being implemented in collaboration with
CRS and the Baltimore-based Institute of Human Virology (IHV ). Preliminary analysis shows
that PLWHA and who are on HAART are generally doing well based on viral load testing. In
a survey of 114 PLWHA on HAART for up to six months, 26.3% had a viral load of under
400 and 68.6% had viral load of <1,000. When the 114 PLWHA were grouped into two groups
(those doing well and those not doing well, the viral load status was as follows:
Group Mean Viral Load Median Viral Load 75th Percentile VL
Clinical Failure 28,950 5,175 45,770
Doing Well 1,165 600 811
AIDS-Related Deaths have stabilized (Table 2.1.3 and Fig. 2.1.4). In the 1990s, there were in-
creasing numbers of persons whose deaths were directly attributed to HIV/AIDS. The number of
deaths per year has slowed down and appears to have been stabilized. This may be directly because
increasing numbers of persons are accessing treatment and care and survival time is increasing.
TABLE 2.1.3: MORTALITY RATE OF AIDS IN GUYANA (1999 – 2003)
1999 2000 2001 2002 2003
M F M F M F M F M F
AIDS Deaths 302 312 171 240 165 284 191 206 168
39.2 81.5 43.3 62.2 41.4 75.5 50.9 54.8 44.7
Crude Death
Rate
39.2 62 51.6 63.2 49.8
Fig. 2.1.4_Guyana HIV/AIDS Crude Death Rate 1999-2004
Year
100
80
60
40
20
0
1999 2000 2001 2002 2003 2004
R
at
e/
10
0,
00
0
Male /Female /All
Guyana National HIV/AIDS Strategic Plan 2007-2011
[23
Voluntary Counseling and Testing:
Lack of knowledge of VCT impedes the Government’s effort for Guyanese to know their sta-
tus. Thus, only 17% of MSM, 28% of CSW, 32% of GUYSUCO employees, 34% of uniform
services personnel, 55% of out of school youths and 66% of In-school youths knew of the avail-
ability of VCT (BSS 2004). By 1998, only 2 VCT sites were operating in Guyana by the Public
Sector (New Amsterdam in Region 6 and at the GUM clinic). By the end of 2005, VCT was
available in Regions 2, 3, 4, 5, 6, 7, 9 and 10. Besides the 56 PMTCT sites, which all offer VCT,
there are 28 fixed sites, including 10 sites operated by NGOs. Mobile teams also provide VCT
in un-served areas and a number of NGOs now also offer VCT in Regions 2, 3, 4, 6 and 10. One
private sector site, operated by St. Joseph’s Mercy Hospital, is also providing VCT. A rapid test
algorithm has been developed, field tested and validated and is in use at all VCT sites.
Reversing the Trend of HIV Infections among Pregnant Women
Limited studies and limited surveillance results are available for the period prior to 2001. Several
small surveillance studies among pregnant women done between 1993 and 2000 showed an
increasing HIV prevalence, reaching about 7% in 2000. The emergence of a PMTCT program
in 2001 have since provided a better picture of the HIV situation among pregnant women in
Guyana. An ANC surveillance Survey in 2004 confirmed the picture provided by an analysis of
PMTCT data from ANC Centers around the country.
The PMTCT program was initiated in 2001 at 11 pilot sites and has since grown to 56 sites in
8 of the 10 geographical regions of the country by the end of 2005. Since November 2001, more
than 21,000 women have been offered testing and more than 18,000 have accepted testing. In
2002, there was a 67% uptake and since then this has increased to 94.6% in 2005. During 2000,
almost 3,000 women accepted testing for HIV. This increased to 4,800 in 2004 and has exceeded
7,000 in 2005. With about 16,000 deliveries on an annual basis, this translates to almost 50% of
pregnant women having access to PMTCT in
Guyana.
Program Uptake_2002- Sept 2005
0
10
20
30
40
50
60
70
80
90
100
2002 2003 2004 2005
2002
2003
2004
2005
24]
Guyana National HIV/AIDS Strategic Plan 2007-2011
Sero-prevalence_2002 – September 2005
Behavioral and Attitudinal Characteristics of the population remain major challenges in
the prevention and management of HIV/AIDS in Guyana and it is imperative that programs
to effect behavior changes become an integral part of the response to HIV/AIDS. Guyana has
recently (2004/2005) completed both a BSS and an AIDS Indicator Survey (AIS). While these
surveillance tools have shown improvement in behavior and attitudes, the surveys also indicate
that the population is at significant risk because of certain behavior and attitudinal patterns.
There is still too wide a gap in comprehensive knowledge of the methods for prevention
of HIV among the population, especially among the young people. Table 2.1.4 demonstrates
that there are still between 14% and 38% of In-school and out-of-school youths who lack a
comprehensive knowledge of the methods of prevention for HIV. Male has less knowledge of
the prevention methods than female. More than 50% of the rural population, more than 30% of
CSW and MSM and 15% of the uniform services lack this knowledge.
TABLE 2.1.4_COMPREHENSIVE KNOWLEDGE OF THREE (3) METHODS OF
HIV PREVENTION – ABSTINENCE, FAITHFULNESS AND CONDOM USE
POPULATION
BSS AIS
In School Youths (% who knew all three methods) 62.0 75.9
Out of School Youths (% who knew all three methods) 71.1 85.6
Age Group 15 -24
In and Out-of School (% who knew all three methods)
Age group 15-19 (% who knew all three methods)
Age group 20-24 (% who knew all three methods)
M
59.5
6
7.8
F
63.7
74.0
M
47.3
42.
5
5
4.3
F
52.6
50.3
55.3
GUYSUCO Workers – (% who knew all three methods) 75.3 Not done
Female Sex Workers – (% who knew all three methods) 63.1
MSM – (% who knew all three methods) 67.1
Uniform Services – (% who knew all three methods) 84.0
Region 5 – (% who knew all three methods)
Region 6 – (% who knew all three methods)
M
22.1
F
49.1
43.2
0
1
2
3
4
5
6
7
8
1995 2000 2002 2003 2004 2005
Guyana National HIV/AIDS Strategic Plan 2007-2011
[25
Risky sexual practices constitute a major challenge in Guyana’s prevention efforts. The
sexual experience and sexual attitudes of young people and of some vulnerable groups, especially
in the debut age for sex, the involvement in pre-marital sex, number of sex partners, involve-
ment with CSWs and in the use of condoms, place the population at great risk for HIV. A good
example is to look at the uniform services personnel, a group considered to be an at-risk group.
Condom use by uniform personnel with non-regular partner is only 48% of the time. Table 2.1.5
shows that the sexual practices of the population place the population at great risk for HIV.
TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI
AWARENESS OF THE POPULATION
SEXUALLY ACTIVE
POPULATION BSS AIS
M F M F
In School Youths – Sexually Active
(%) [30.6]
Mean Age of First Sex (Years)
Mean age of first sex partner
% Sexually active who had sex in last
12 months
Mean number of non-commercial sex
partners last 12 months
Mean number of commercial sex part-
ners last 12 months
% Who have had sex with a CSW last
12 months
% Male who have had sex with another
male
% Aware where to obtain condoms
% Who used a condom at first sex
% Used condom with a non-commercial
partner last sex
% Used condom every time with non-
commercial partner
% Who has used condom with a CSW
at last sex
% Used condom every time with CSW
last 12 months
% Think condoms have holes and do
not work
% Awareness of STDs
% With abnormal discharge last 12
months
% Sexually active with genital ulcer last
12 months
43.5
1
4.2
14.8
59.9
2.5
0.89
29.6
1.9
89.6
51.0
75.7
57.4
55.0
57.1
40.1
72.8
4.5
7.4
22.3
15.0
19.9
68.1
1.2
0.34
18.7
–
64.2
64.1
69.3
47.5
50.0
14.3
45.5
74.9
9.7
8.5
18.0
17.8
6
1.3
–
0.8
0.8
–
91.4
–
–
–
84.6
84.6
–
–
–
–
18.4
18.4
56.1
–
–
–
–
80.3
–
–
–
–
–
–
–
–
–
Age Group 15-19 20—24 15-19 20-24
26]
Guyana National HIV/AIDS Strategic Plan 2007-2011
TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI
AWARENESS OF THE POPULATION
OUT-OF SCHOOL YOUTHS –
% Sexually Active [58.7 of total]
Mean Age (years) of First Sex [All
– 15.98]
Mean age (years) of first sex partner
[All- 18.6]
% Sexually active who had sex in last
12 months [72.8]
Mean number of non-commercial sex
partners last 12 months
Mean number of commercial sex part-
ners last 12 months
% Who have had sex with a CSW last
12 months [3.0]
% Male who have had sex with another
male [1.2]
% Aware where to obtain condoms
[81.4,M=90.5 F=72.8]
% Who used a condom at first sex
[60.7]
% Used condom with a non-commercial
partner last sex
% Used condom every time with non-
commercial partner
% Who has used condom with a CSW
at last sex
% Used condom every time with CSW
last 12 months
% Think condoms have holes and do
not work
% Awareness of STDs [90.1, M-90.2
F=90.1]
% With abnormal discharge last 12
months [2.4]
% Sexually active with genital ulcer last
12 months [1.1]
M
52.6
14.9
15.6
64.3
–
–
2.7
2.0
–
59.3
72.8
70.0
75.0
100
–
–
–
–
F
39.9
15.9
20.6
73.4
–
–
0.7
–
–
7
1.8
47.8
68.8
100
100
–
–
–
–
M
84.8
16.1
16.9
77.6
–
–
6.8
0.6
–
59.5
53.7
69.8
91.7
90.9
–
–
–
–
F
73.5
17.1
21.5
76.1
–
–
1.2
–
–
54.0
34.5
58.9
50.0
–
–
–
–
–
M
37.5
–
–
75.7
–
–
0.9
–
87.6
68.3
75.8
–
100.0
–
–
–
1.5
0.3
F
26.2
–
–
55.5
–
–
–
–
77.4
51.0
70.0
–
–
–
–
–
4.3
0.9
M
80.3
17.8
–
79.6
–
–
1.4
–
96.9
45.9
64.7
–
100.0
–
–
–
1.2
0.7
F
56.1
18.4
–
78.7
–
–
–
–
–
83.7
89.1
56.7
–
–
–
1.6
1.4
GUYSUCO EMPLOYEES M F
% Sexually active
Mean Age of First Sex (Years)
Mean age of first sex partner
% Sexually active who had sex in last
12 months
Mean number of non-commercial sex
partners last 12 months
Mean number of commercial sex part-
ners last 12 months
% Who have had sex with a CSW last
12 months
90.8
17.0
–
92.3
–
0.08
2.4
90.8
19.3
–
78.7
–
0
0
Continued from p25
Guyana National HIV/AIDS Strategic Plan 2007-2011
[27
TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI
AWARENESS OF THE POPULATION
GUYSUCO EMPLOYEES M F
% Male who have had sex with another
male
% Aware where to obtain condoms
% Who used a condom at first sex
% Used condom with a non-commercial
partner last sex
% Used condom every time with non-
commercial partner
% Who has used condom with a CSW
at last sex
% Used condom every time with CSW
last 12 months
% Think condoms have holes and do
not work
% Awareness of STDs
% With abnormal discharge last 12
months
% Sexually active with genital ulcer last
12 months
2.6
85.8
–
–
–
51.4
25.8
52.4
91.7
2.6
–
–
–
–
–
–
–
–
59.6
93.3
0.9
–
UNIFORM SERVICES: –
% SEXUALLY ACTIVE
MALE FEMALE
Mean Age of First Sex (Years)
Mean age of first sex partner
% Sexually active who had sex in last
12 months
Mean number of non-commercial sex
partners last 12 months
Mean number of commercial sex part-
ners last 12 months
% Who have had sex with a CSW last
12 months
% Male who have had sex with another
male
% Aware where to obtain condoms
% Who used a condom at first sex
% Used condom with a regular partner
last sex
% Used condom every time with a
regular partner
% Who has used condom with a CSW
at last sex
% Used condom every time with CSW
last 12 months
% Think condoms have holes and do
not work
97.6
16.6
92.0
0.56
0.04
1.7
97.3
19.4
10.7
100.0
87.5
48.5
97.5
17.7
84.7
0.58
0.03
–
91.6
13.3
7.8
–
–
47.7
Continued from p26
28]
Guyana National HIV/AIDS Strategic Plan 2007-2011
TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI
AWARENESS OF THE POPULATION
UNIFORM SERVICES: –
% SEXUALLY ACTIVE
MALE FEMALE
% Awareness of STDs
% With abnormal discharge last 12
months
% Sexually active with genital ulcer last
12 months
96.3
2.0
1.8
98.1
1.3
1.3
FEMALE COMMERCIAL SEX
WORKERS
MALE FEMALE
Mean Age of First Sex (Years)
Mean age of first sex partner
% Sexually active who had sex in last
12 months
Mean number of non-commercial sex
partners last 12 months
Mean number of commercial sex part-
ners last 12 months
% Who have had sex with a CSW last
12 months
% Male who have had sex with another
male
% Aware where to obtain condoms
% Who used a condom at first sex
% Used condom with a non-commercial
partner last sex
% Used condom every time with non-
commercial partner
% Who has used condom with a CSW
at last sex
% Used condom every time with CSW
last 12 months
% Think condoms have holes and do
not work
% Awareness of STDs
% With abnormal discharge last 12
months
% Sexually active with genital ulcer last
12 months mean age of FCSW
Mean Duration of sex work (years)
Median number of sex partners in the
past week
Use of condom with last paying partner
Use of condom with non paying partner
94.0
–
72.7
–
–
–
44.0
93.8
8.2
11.0
28.6
4.35
3.0
89.3
68.6
Continued from p27
Guyana National HIV/AIDS Strategic Plan 2007-2011
[29
TABLE 2.1.5_SEXUAL EXPERIENCE, CONDOM BEHAVIOR AND STI
AWARENESS OF THE POPULATION
MEN WHO HAVE SEX WITH MEN
(MSM):
M
Mean Age of First Sex (Years)
Mean age of first sex partner
% Sexually active who had sex in last
12 months
Mean number of non-commercial sex
partners last 12 months
Mean number of commercial sex part-
ners last 12 months
% Who have had sex with a CSW last
12 months
% Male who have had sex with another
male (anal)
% Aware where to obtain condoms
% Who used a condom at first sex
% Used condom with a non-commercial
partner last sex
% Used condom every time with non-
commercial partner
% Who has used condom with a CSW
at last sex
% Used condom every time with CSW
last 12 months
% Think condoms have holes and do
not work
% Awareness of STDs
% With abnormal discharge last 12
months
% Sexually active with genital ulcer last
12 months
–
–
2.18 (0-20)
4.20 (0-58)
–
92.4
97.0
–
80.7
50.5
83.8
66.2
50.8
94.9
17.8
–
Too few people know their HIV status and many people are unaware of the availability of
ARV treatment: There are too few people who have taken advantage of free VCT across the
country. Further, most people still are unaware that treatment is available. The result of this
contributes to the low level of the population that have tested for HIV (Table 2.1.6).
TABLE 2.1.6: TOO FEW PEOPLE KNOW THEIR HIV STATUS AND KNOW OF
TREATMENT AVAILABILITY
% WOMEN AND MEN WHO HAVE TESTED AND
RECEIVED RESULTS
BSS AIS
M F
Age Group 15-19: Ever tested and received results
Tested and received results in last 12 months
% Know of treatment availability (In-school youths)
% Know of treatment availability (Out-of-school youths)
17.6
41.6
12.9
5.4
4.2
14.6
9.0
Continued from p28
30]
Guyana National HIV/AIDS Strategic Plan 2007-2011
TABLE 2.1.6: TOO FEW PEOPLE KNOW THEIR HIV STATUS AND KNOW OF
TREATMENT AVAILABILITY
% WOMEN AND MEN WHO HAVE TESTED AND
RECEIVED RESULTS
BSS AIS
M F
Age Group 20-24: Ever tested and received results
Tested and received results in last 12 months
26.8
16.0
36.3
17.8
Age Group 25-29: Ever tested and received results
Tested and received results in last 12 months
25.6
16.5
36.9
14.9
Age Group 30-39: Ever tested and received results
Tested and received results in last 12 months
23.0
11.4
30.0
11.2
Age Group 40-49: Ever tested and received results
Tested and received results in last 12 months
19.9
7.0
19.4
6.9
Married: Ever tested and received results
Tested and received results in last 12 months
22.2
11.6
28.3
11.6
Formerly married: Ever tested and received results
Tested and received results in last 12 months
28.1
8.8
37.4
14.2
Never married: Ever tested and received results
Tested and received results in last 12 months
14.8
8.9
19.
5
9
.7
Urban: Ever tested and received results
Tested and received results in last 12 months
29.5
15.1
38.5
16.3
Rural: Ever tested and received results
Tested and received results in last 12 months
15.5
8.3
21.3
9.1
GUYSUCO: Ever tested and received results
Tested and received results in last 12 months
% Know of treatment availability
?
?
32.2
Uniform Services: Ever tested and received results
Tested and received results in last 12 months
% Know of treatment availability
48.2
48.2
63.3
CSW: Ever tested and received results
Tested and received results in last 12 months
% Know of treatment availability
85.2
64.3
70.8
MSM: Ever tested and received results
Tested and received results in last 12 months
% Know of treatment availability
43.8
87.6
66.5
Stigma and Discrimination are two factors that influence the spread of HIV in any country
and both stigma and discrimination are important factors in the Guyana HIV epidemic.
Table 2.1.7 shows that despite aggressive awareness and education programs in the last five years,
stigma and discrimination are still significant factors.
Continued from p29
Guyana National HIV/AIDS Strategic Plan 2007-2011
[31
TABLE 2.1.7: MEASURING PERCEPTIONS OF THE POPULATION
POPULATION BSS AIS
M F
Would buy food/goods from an infected shopkeeper
• % of In-School Youths
• % of Out-of-School Youths
• % of GUYSUCO Workers
• % of Uniform Services Personnel
• % MSM
• % of CSW
21.4
23.7
26.1
24.0
37.2
30.5
37.7
51.1
50.9
51.0
Perception of personal risk (none/low)
• % of In-School Youths
• % of Out-of-School Youths
• % of GUYSUCO Workers
• % of Uniform Services Personnel
• % MSM
• % of CSW
91.4
82.9
59.5
59.5
Persons with HIV should be quarantin
ed
• % of In-School Youths
• % of Out-of-School Youths
• % of GUYSUCO Workers
• % of Uniform Services Personnel
• % MSM
• % of CSW
28.8
50.3
76.
5
3
1.7
38.1
Practices in the health sector constitute potential risks: Blood safety, safe injection and waste
management practices are potential barriers in attempts to prevent the transmission of HIV/
AIDS. Although practices in Guyana tend to comply with safe practices, there are still areas for
strengthening. For example, a recent survey showed that:
■ Written procedures for PEP were found in only 14% of surveyed sites.
■ PEP prophylactic drugs were available in only 8 of the 39 surveyed sites
■ Needle stick injuries were reported by 21% of health care providers, but these were not re-
ported and documented
■ Only 16% of the surveyed sites had a formal ledger for the documentation of these injuries
■ Safety boxes are not routinely available
2.2_THE IMPACT OF HIV/AIDS
Socio-economic impact
The potential socio-economic impact of HIV/AIDS has already manifested itself in several
African countries where HIV prevalence rates are high. The potential that the socio-economic
impacts of HIV/AIDS seen in countries like Botswana, Swaziland, South Africa, Kenya etc. can
also be seen in Guyana is very real since Guyana is a country where:
■ HIV prevalence is already relatively high (2.5%)
■ Poverty rate of approximately 35% is significant
32]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ Migration restricts the pool of professional and skilled personnel eg A recent USAID study
estimated that 85% of qualified Guyanese migrate annually
■ High vacancy rate (greater than 40%) exists in the public sector
■ The economy is still largely dependent on labour-intensive industries such as agriculture, min-
ing and forestry which, as seen in African countries, are particularly vulnerable to prolong and
repeated periods of absenteeism due to chronic illness, disability and death due to HIV/AIDS.
In addition, the situation can be worsened as carers stay home to look after ill relatives suffer-
ing from HIV/AIDS.
The mortality pattern in Guyana clearly demonstrates that the burden is greatest in the 20-45
year age group. This is the economically active group in the country, which is expected to make
significant contributions to the state economy and support for the dependent population.
The BSS study clearly demonstrates that whilst knowledge is high amongst all professional
groups in the armed forces, teachers etc, little behaviour change has resulted. Whilst the preva-
lence of HIV/AIDS is not known in these groups, the lack of behaviour change and expressed
risky behaviour amongst these groups in an environment where the mortality is high in the
economically active age group clearly demonstrates the impact that HIV/AIDS can have in
Guyana.
The social burden from HIV/AIDS is already present. A study addressing the needs of orphans
and vulnerable children supported by UNICEF conducted in 2004 estimated that there are at
least 7,000 orphans and vulnerable children in Guyana. This number does not necessarily relate
only to children who are orphaned as a result of HIV/AIDS but due to other reasons. It will be
expected that if the epidemic is not controlled, the number will significantly increase as more
children become orphaned by HIV/AIDS or they become more vulnerable as parents who are
ill from HIV/AIDS become increasingly unable to support their children. The study clearly
demonstrates that of the children studied, many are in urgent need of social support as they
are looked after by relatives who are unable to provide the care which is needed to give these
children an opportunity in life. Establishment of mechanisms to address these issues pose a
significant burden on the social services support systems.
The costs of providing social safety nets to vulnerable groups, loss of economy and the costs of
provision of health services will be significant. Thus, unless the epidemic in Guyana is reversed,
morbidity and mortality associated with HIV/AIDS would significantly impact on:
■ The Economy: This scenario has not yet manifested itself in Guyana. But it has been seen in
several African countries and the potential of this scenario becoming manifested in Guyana
is very real. HIV/AIDS is the leading cause of death in working age people (15 to 44 years)
already in Guyana. Its effects are devastating, leading to increasing poverty, as breadwinners
die leaving their families struggling to make ends meet and many children parentless. The end
result is that the economy suffered from diminishing productivity.
■ National Demography: Countries with high HIV prevalence and deaths due to HIV/AIDS,
especially among young people are likely to suffer losses in life-expectancy which in turns
affects population growth. The overall structure (population pyramid), is shifted towards the
very young and the old. Such shifts have become dramatic in several African countries and has
already began to manifest it self in Guyana.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[33
■ Health: The National Health System, in countries with high HIV prevalence face signifi-
cant financial, infrastructure and human resource challenges in their HIV/AIDS responses.
Countries have been forced to shift resources to meet specific HIV/AIDS response needs.
This has manifested itself already and although Guyana has benefited from finical assistance
by partners, the human resources and infrastructural needs are becoming severe constraints as
both have began to be diverted away from other health problems to HIV/AIDS.
■ Orphans and vulnerable children: Already Guyana has seen an increase in the number of
children categorized as OVC because of the direct impact of HIV/AIDS.
The Government of Guyana has long recognized the potential negative impact of HIV/AIDS
and it is in this context that Guyana’s Poverty Reduction Strategy Paper (PRSP), endorsed by
the World Bank (WB) and the International Monetary Fund (IMF), identified HIV/AIDS as
a priority PRSP response.
2.3_DETERMINANTS AND DYNAMICS OF THE EPIDEMIC
Amongst the issues affecting the spread of HIV/AIDS in Guyana are stigma and discrimination,
poverty, risky behaviour, gender roles and relations, cultural and social norms and differences
among different generations. Stigma and discrimination play a significant role in driving the
epidemic underground in certain marginalised sub-groups such as MSMs, prison inmates and
CSWs. Many male-female relationships are still male dominated leaving women and girls in a
weaker position when it comes to determining their sexual relations, thus making them more vul-
nerable to HIV infection. In order to survive, poor and marginalised groups sometimes indulge in
risk-taking behaviours which also make them more susceptible to HIV infection. Amongst these
groups are the indigenous peoples who, while they live in largely isolated rural communities, are
amongst the poorest and do not easily access services. In addition, as the economy continues to
grow and work in the hinterland develops, travel and communication will create opportunities for
the spread of the epidemic if interventions and strategies are not put in place.
Determinants: The various significant determinants can be grouped as follows:
1. Behavioural
■ MULTIPLE SEX PARTNERS: The BSS (2004/2005) demonstrated clearly that the practice of
multiple sex partners in Guyana is significant and this clearly establishes a major risk for
HIV/AIDS.
■ INCONSISTENT USE OF CONDOMS: The 2004/2005 BSS showed that even though there is
high knowledge about the usefulness of condoms in reducing the risk for HIV/AIDS large
numbers of persons did not comply with advice to use condoms in risky situations.
■ SEX WITH CSWS: The 2004 surveillance among CSW demonstrated that the prevalence rate
for HIV among CSWs remain high (>25%). The BSS shows continued practice of sex with
CSWs and non-use of condoms.
■ SUBSTANCE ABUSE AND HIV (ALCOHOL AND GANJA): Thus far, this has not been a strong
determinant in Guyana. But there is growing risk in the Guyana context with excessive us of
alcohol and increasing concerns about substance abuse with ganja and cocaine.
6 World Bank HIV/AIDS
Prevention & Control Project
appraisal document for the
Republic of Guyana, March
2004.
34]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ LACK OF PERCEPTION OF PERSONAL RISK: The BSS and the AIS both showed that Guya-
nese young people still have a perception of low risk and thus places themselves in harms way.
■ INCONSISTENCY BETWEEN KNOWLEDGE AND BEHAVIOUR MODIFICATION CHANGE: The
BSS and the AIS show that while public awareness programs have led to relatively high knowl-
edge about HIV and its transmission, this knowledge has not resulted in behaviour change.
■ MYTHS ON TRANSMISSION: There is still significant level of misinformation pertaining to
HIV transmission. For example, almost 25% of respondents in the BSS believe that HIV
could be transmitted by mosquitoes.
■ DISCUSSION OF SEX IS STILL TABOO: There needs to be greater openness in discussing sub-
jects around sex. Much of the discussion about sex among young people occurs in ad hoc and
uninformed settings.
2. Economic
■ INADEQUATE ECONOMIC GROWTH: Guyana has a GDP of approximately $US900 per capita.
While this represents almost a tripling of the GDP since 1990, Guyana remains as one of the
poorest countries in the Americas.
■ UNEMPLOYMENT AND UNDEREMPLOYMENT: Employment opportunities are limited still,
even though significant improvements have been made in employment for young people.
■ RURAL/URBAN MIGRATION: Because of several factors, including access to higher education
and access to certain kinds of employment, there is a continued growth of migration from
rural to urban settings.
■ MOBILE POPULATION IN SEARCH OF ECONOMIC OPPORTUNITIES (MINERS, LOGGERS,
TRUCK DRIVERS ETC.): There has been impressive growth in the mining and forestry in-
dustries. This has resulted in increased movement of people to the hinterland and within the
hinterland.
■ INCREASE IN CROSS BORDER TRAVEL, AND INTERNATIONAL TRAVEL: Guyana tourism indus-
try has grown, but there has also been increased international travel into and out of Guyana. In
addition, movement across the borders with Brazil, Suriname and Venezuela has intensified.
3. Tourism
■ PROSTITUTION: With an increase of people from other countries supporting the service in-
dustries in Guyana, CSWs have found a large market for their services.
4. Social and cultural
■ DISCRIMINATION AND STIGMATIZATION: This is a major barrier in the universal access to
prevention, care and treatment
5. Gender
■ Inequalities in male/female relationship
■ Trans generational gaps (sugar daddy syndrome) older men younger women
■ Domestic violence
Guyana National HIV/AIDS Strategic Plan 2007-2011
[35
SECTION
3 RESPONDING TO HIV/AIDS
CHALLENGE IN GUYANA: EXPERIENCES
AND LESSONS LEARNT
3.1_INSTITUTIONAL STRUCTURES FOR THE RESPONSE
After the first case of HIV/AIDS was diagnosed in 1987, the GOG responded by establish-
ing, within the Ministry of Health a National AIDS Programme in 1989 that comprised of
the GUM Clinic, the National Laboratory for Infectious Disease (NLID), the National Blood
Transfusion Service (NBTS), and the National AIDS Programme Secretariat (NAPS). The
NLID was responsible for carrying out all HIV testing done in the public sector.
A National AIDS Committee (NAC) was also established to make recommendations and advise
the MOH on HIV/AIDS policy advocacy issues, with representatives from other ministries,
NBOs, PLWHA, FBOs, and the private sector. A national AIDS the Regional Advisory Com-
mittees (RAC), were also organised to carry out an HIV/AIDS advisory role at the Regional
Level.
3.2_POLITICAL LEADERSHIP, DEVELOPMENT POLICIES, RESOURCES, MAN-
AGEMENT STURCTURE AND MULTI SECTORIAL
National leadership
Political commitment and leadership in Guyana have grown over the years to the point where
Guyana is a good example of strong political leadership. Initially, the response was led by the
Ministry of Health which has provided and continues to provide invaluable technical advice and
leadership in the HIV/AIDS response. But now leadership can also be seen at the highest level
from the Office of the President through the establishment of the Presidential Commission on
HIV/AIDS.
The National AIDS Committee (NAC), a multi-sectoral body, advises the MOH on all aspects
of the response to HIV/AIDS. The United Nations Theme Group (UNTG) on HIV/AIDS
also provides advice to the PCHA in resource mobilisation, strengthening, institutional capacity,
promoting and applying national policy and coordinating donor support.
In 1998, after a review by the HIV/AIDS/STI surveillance system and the work of the Legal and
Ethical Committee of the National AIDS Programme, a National HIV Policy was developed
and approved by Cabinet and later adopted by Parliament as Government policy. This policy
was revised in 2003 to reflect changes to the NAPS and to allow for the delivery of free care and
36]
Guyana National HIV/AIDS Strategic Plan 2007-2011
treatment for people living with HIV/AIDS. During that year, Cabinet also approved the NSP
2002-2006 which focused on a more expanded response involving the ministries, NGOs, Faith
Based Organisations (FBOs), the private sector and funding agencies.
Management structure – the presidential commission on HIV/AIDS (PCHA)
In order to strengthen the implementation and coordination of the multi-sectorial response
on HIV/AIDS, the GOG established the PCHA in 2004 under the aegis of the Office of the
President. The commission is chaired by His Excellency, the president of Guyana The composi-
tion of the PCHA include key Ministries, the Attorney General, the chair of the United Nations
Theme group (UNTG) on HIV/AIDS, and the Head of the Presidential Secretariat.
The GOG response to HIV/AIDS is supported by the activities of numerous NGOs, CBOs,
FBOs, the private sector, and civic organizations. The primary responsibility of the PCHA is
to coordinate, oversee, and support the national response to HIV/AIDS. Key functions of the
PCHA include the following:
■ Supporting the implementation of the National Strategic Plan;
■ Mobilizing multi-sector support for the national response;
■ Coordinating, preparing and assisting in the implementation of the line ministries’ work pro-
gram;
■ Advising the Cabinet on HIV/AIDS policies and strategies;
■ Mobilizing resources (national and international) for HIV/AIDS programming;
■ Presenting annual and quarterly reports on the progress of the national response;
The PCHA is intended to meet on a quarterly, wherein each Ministry is required to present on
key HIV/AIDS-related activities. The PCHA is to issue a report to the public annually.
The Multi-Sector Approach
The Ministry of Health has a pivotal role to play in the comprehensive response to HIV/AIDS.
But the implementation of a multi-sector approach is critical in the fight against HIV/AIDS.
All Government Ministries and agencies must become involved, with each sector taking re-
sponsibility for some aspects of the response, using their own resources. But the response must
also involve sectors outside of Government, including businesses, civil society organizations
(including FBOs, CBOs and NGOs), communities, PLWHA, those affected by HIV/AIDS.
The HIV/AIDS National Strategy 2007-2011 seeks to tap the comparative advantages of each
partner so that Guyana can truly mount a comprehensive and effective response against HIV/
AIDS.
Guyana’s National Response has always embraced the multi-sector approach in the fight against
HIV/AIDS. However, the previous HIV/AIDS National Strategies have always been mainly
formulated as a National Health Response. The National HIV/AIDS Strategy 2007-2011 is
different from the previous strategies in that it is designed as a comprehensive multi-sector
response and is intended to guide all Government Ministries and Agencies, International Agen-
cies and partners and civil society in designing and implementing programs as part of the na-
tional response in the fight against HIV/AIDS.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[37
The Guyana Government joined other governments from around the world in 2001 in the Dec-
laration of Commitment at United Nations General Assembly Special Session on HIV/AIDS
and agreed “to ensure the development and implementation of a multi-sectoral national strategies
and financing plans for combating HIV/AIDs”.
The Commonwealth Ministers of Health at their meeting in New Zealand in 2001 and the
Commonwealth Heads of Government in the Coolum Declaration in 2002 further committed
to these principles. A Commonwealth Think Tank Meeting in London in 2001 defined a multi-
sector approach as follows:
A multi-sectoral response means involving all sectors of society – governments, business,
civil society organizations, communities and people living with HIV/AIDS, at all levels
– pan-Commonwealth, national and community – in addressing the causes and impact of
the HIV/AIDS pandemic. Such a response requires action to engender political will, leader-
ship and coordination, to develop and sustain new partnerships and ways of working, and
strengthen the capacity of all sectors to make an effective contribution.
Some Guiding Principles for the Multi-Sector Response:
■ A comprehensive and effective response demands leadership and coordination by the Govern-
ment of Guyana in fostering a supportive environment for a multi-sector response, providing
a framework for planning and implementing actions by all sectors.
■ The response must be linked to Guyana’s international commitments, such as the MDGs and
UNGASS 2001.
■ The response must take cognizance of the direct and indirect causes of the HIV/AIDS epi-
demic. The response must consider efforts at behaviour change, but must also address the
vulnerability factors such as fear, denial, stigma and discrimination, gender equality and power
differentials, poverty and livelihood insecurity, internal migration for employment purposes,
social-cultural norms, values and practices, and the national legislative and policy environ-
ment.
■ It is imperative that there be a linkage of HIV/AIDS response to Guyana’s PRSP.
■ People living with HIV/AIDS (PLWHA) are central to the overall response, they need to be
empowered to enable them to take effective action themselves and with others.
■ Society at large needs to be mobilized to break the silence about HIV/AIDS, reduce discrimi-
nation and stigma, protect human rights of PLWHA, provide effective programs to prevent,
treat, care for and mitigate the impact of HIV/AIDS, and mobilize and make available re-
sources for civil society organizations engaged in prevention and care.
■ Recognizes the special needs of adolescents and young people, especially girls.
■ Recognizes the special needs of OVC.
■ Recognizes the special needs of other vulnerable and disadvantaged groups, such as women,
those living in poverty, street children, the disabled, migrants, sex workers, prisoners, men who
have sex with men.
■ Ensures 100% access to PMTCT.
■ Ensures that the needs of those caring for PLWHA are taken into account.
■ Empower communities to take effective action themselves and in collaboration with others to
prevent HIV transmission and to improve the quality of life of PLWHA.
38]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ Facilitate partnerships among Government Ministries and agencies (local and national), in-
ternational partners, civil society, FBOs and the private sector.
■ Expand efforts and improve access to programs for prevention, treatment and care, including
provision of testing and drugs, not only for HIV/AIDS, but also for TB and STIs.
■ Mobilize and train members of the community, FBOs, CBOs, NGOs and the private sector
to provide complementary services to add to those provided by health care providers in coun-
seling and testing and in general awareness programs for HIV/AIDS, TB and STIs.
FRAMEWORK FOR GUYANA’S MULTI-SECTOR RESPONSE
GOVERNMENT INTERNATIONAL
PARTNERS
BUSINESS CIVIL SOCIETY
Actors • President
• Ministers
• MPs
• Other Political
Leaders
• Mayors and
Municipalities
• Local Govern-
ment Leaders
• Civil Servants
• UNDP
• UNAIDS
• PAHO/WHO
• UNICEF
• UNFPA
• UNDCP
• UNESCO
• ILO
• USAID
• CDC
• PEPFAR
• Global Fund
• World Bank
• CIDA
• EU
• Red Cross
• PANCAP
• Chief Executives
• Managing
Directors
• Boards of
Directors
• University of
Guyana
• PLWHA
• FBOs
• CBOs
• NGOs
• Trade Union
Leaders
• Professional
org
• Women and
Youth Leaders
• Vulnerable
groups
Sectors • Health
• Education
• Labor and
social security
• Finance
• Water and
Housing
• Local Govern-
ment
• Home Affairs
• Defense
• Youth, Sports
and Culture
• Agriculture
• Tourism
• Gender and
Children
• Health
• Education
• Donor/Financing
• Service
• GUYSUCO
• Rice
• Bauxite
• Mining
• Forestry
• Beverage
• Banking
• Insurance
• Construction
• Human
Resources
• Manufacturing
• Service Industry
• Retailing
• Charitable
Org.
• Professional
Bodies
• Religious Org.
• Cultural org
• Service
• Community
• Media
• Prominent
personalities
Resources • Political will
• Coordination
• Mandates
• Human
Resources
• Physical infra
• Technology
• Funds
• Clout
• Human Resources
• Physical infra
• Technology
• Funds
• Human
Resources
• Physical infra
• Technology
• Funds
• Human
resources,
families,
friends
• Moral suasion
• Volunteers
Guyana National HIV/AIDS Strategic Plan 2007-2011
[39
3.3_FINANCING THE RESPONSE TO HIV/AIDS IN GUYANA
Over the last two years Guyana has been successful in mobilising substantial external resources
to fund their 2002 – 2006 National
Strategic Plan.
However, even though the country has been
able to scale up the response certain gaps still remain in terms of human and technical capacity.
This will affect the ability to operationalized programme activities. A challenge that presents
itself is the number of donors who are now part of the response to HIV/AIDS and the co-ordi-
nation that that requires in order guaranteeing the optimum use of resources. It is crucial that the
country develops the capacity to harmonise and align its national strategic plan with the donors’
programme areas. Detailed annual operational plans translated from the NSP must be developed
to improve donor and partner alignment, coordination and harmonisation.
The international community that has placed the GOG in a powerful position to confront HIV
includes multilateral and bilateral organizations.
PARTNER MATRIX
DONOR/PARTNER MAJOR AREA OF ASSISTANCE ESTIMATED
FUNDING
UNAIDS Coordinate HIV/AIDS activities of the UN Theme
Group; strengthen capacity to UNGASS reporting
Ongoing
UNDP Limited activities; policy development Ongoing
UNICEF Strengthen coordination and M&E of PMTCT
services; support knowledge of women, children
and health care workers; support care treatment
and support for HIV positive children; youth friendly
health services
$1.5 (es
t)
(2006-10)
PAHO/WHO Chair UNAIDS Theme Group; technical assistance
for HIV/AIDS prevention, TB, and malaria control;
small grants scheme management; surveillance and
laboratory support
Ongoing
CIDA HIV/AIDS prevention; communicable disease con-
trol; public health management system; stigma and
discrimination; TB prevention and malaria
CN$5 mil
(2003-07)
EU Strengthen national capacity to respond to HIV/
AIDS
Limited
Work Bank Grant for HIV/AIDS program; support institutional
capacity strengthening; monitoring, evaluation and
research
US$10 mil
(2004-08)
UNFPA-OPEC Fund Caribbean-Central America project HIV prevention
among youth as a part of adolescent health program
US$450,000
(2004-08)
GFATM Multifaceted support for HIV/AIDS prevention,
treatment, care and support; training; HMIS; up-
grade laboratory capacity; strengthen surveillance
system; quality care for persons living with HIV/
AIDS; expand care and treatment; reduce stigma
and discrimination; condom social marketing
US$27.2 mil
(2004-08)
40]
Guyana National HIV/AIDS Strategic Plan 2007-2011
PARTNER MATRIX
DONOR/PARTNER MAJOR AREA OF ASSISTANCE ESTIMATED
FUNDING
IDB Regional Support for HIV/AIDS US$6.7 mil
(2004-08)
JICA Small Grant for HIV/AIDS
Limited
GATC HIV/AIDS project targeting commercial sex work-
ers, including condom social marketing campaign
Limited
The Emergency Plan
(US)
Coordinated, comprehensive HIV/AIDS support for
care and treatment, prevention, and laboratory sup-
port. Main partners are CDC and USAID.
US$34 mil
(2004-08)
3.4_BUILDING A COMPREHENSIVE PREVENTION, CARE AND TREATMENT
PROGRAMME
Guyana was one of the first developing countries to announce universal care and treatment for
people living with HIV/AIDS. The programme started in December 2001 with the MOH
providing drugs manufactured in Guyana. The programme aims to combine the synergies of
prevention, care, treatment and support on a continuum combining PMTCT, care and treat-
ment, a focus on orphans and vulnerable children, behaviour change communication and sup-
port counselling. Through the “Me to You: Reach One Save One Campaign” each Guyanese is
encouraged to get tested to know their status. Home-based and palliative care and the involve-
ment of NGOs, CBOs and FBOs to promote the reduction of stigma and discrimination in the
community are also part of the initiative.
In the mid-1990’s the MOH adopted the syndromic approach for the management of STIs.
Since then a number of interventions has occurred to strengthen the programme. The TB pro-
grammes have also been enhanced where all TB patients are now also offered HIV testing.
With continued political commitment and support GOG will strive to provide the following in
their care and treatment programme:
1_Increasing access to services to diagnose and manage STIs.
2_Strengthening services to diagnose and treat HIV/AIDS and related opportunistic and con-
current infection such as TB.
3_Increasing access to antiretroviral treatment and to other advanced HIV related treatments.
4_Providing a continuum of care from home to health facility, supported by a system of client
referral (e.g to nutritional support, psychosocial support and palliative care)7.
Summary of Achievements
■ The establishment of the PCHA demonstrates the Government’s strong political support and
leadership to HIV/AIDS.
■ A multi-sectoral response is being achieved but the coordinating structure needs strengthen-
ing in order to become operational.
7 WHO, Global Health-
Sector Strategy for
HIV/AIDS, Providing
a Framework for
Partnership and Action
2003-2007.
Continued from p39
Guyana National HIV/AIDS Strategic Plan 2007-2011
[41
■ External and internal resources have been mobilized to support the implementation of the
National HIV/AIDS response but the Presidential Commission and its Secretariat must en-
sure that the optimal use is made of these resources to avoid duplication.
■ The PMTCT Programme has been expanded to new Regions and the HIV prevalence rate
has declined from 7% prior to 2001 among the antenatal population to 2.4% in 2004.
■ The VCT services have been expanded into other Regions.
■ Expansion of care and treatment to seven government and two private site. HIV treatment is
available nationally and almost 1,000 persons are receiving ARV treatment.
■ The TB programme has been enhanced where by all TB patients are offered HIV testing and
all HIV clients are offered TB testing.
■ There has been greater involvement of NGOs, CBOs and FBOs over the last two years in the
delivery of HIV/AIDS prevention and care activities.
■ First Behavioural Surveillance Surveys and AIDS Indicator Survey have been completed.
3.5_CHALLENGES FOR THE FUTURE
■ Limited trained/qualified staff to fill the positions still poses a problem to providing and
implementing HIV/AIDS programmes and services. As Guyana’s economy faces more chal-
lenges many qualified professionals have migrated to seek employment and better wages. This
“brain drain” causes significant human resource constraints for the GOG and undermines
ability to provide quality health, education and social services and impedes government ad-
ministration and management. In some instances, some of the more qualified personnel have
been recruited by donors.
■ Insufficient training opportunities – no structured training, inadequate continuing education
(internal and external). Although training has been provided in the past from various sources,
there is a high turn over of trained personnel. Trained staff is always seek better opportunities
elsewhere, leaving a constant void in services.8
■ Donor environment is very complex, with many reporting procedures and requirements.-
Many of these agencies have different administrative requirements for the approval and the
monitoring and approval of funds. This also complicates the delivery of activities for persons
working in the field, in the clinics, RAC, NGOs, CBOs, and other sectors. They also conduct
multiple planning and assessment missions, in most cases calling on the same in-country staff
members for assistance in the process.
■ Work plans of the Donor agencies overlap in some places and this could lead to duplication of
efforts and an inefficient use of resources. If efforts are not made to harmonise and streamline
the workplans it could affect the rate at which the response can be scaled up, and HIV/AIDS
activities and services implemented.
■ Creating an environment free from stigma and discrimination
■ Weakening of other health sector responses
■ Psychosocial counselling requirements for PLWHA and those affected
■ Long term sustainability of the National HIV/AIDS Response Guyana has already integrated
HIV/AIDS in its PRSP as an element of sustainable development in the interest of scaling u
p
its response. Guyana has also taken the initiative to accelerate implementation by building a
comprehensive multi-sectoral programme that combines prevention, care and treatment. To
8 CHRC- Evaluation of
the National HIV/AIDS
Programme of Guyana.
42]
Guyana National HIV/AIDS Strategic Plan 2007-2011
sustain this approach, Guyana has adopted the UNAIDS sustainable strategies that emphasise
sufficient resources to finance the response and where these resources are used effectively to
reverse the spread and impact of AIDS9.
To remove the bottlenecks that can develop in scaling up the response the following areas must
be addressed: empowering inclusive national leadership and ownership; building human capacity
harmonising and aligning the workplans of the donor agencies; strengthening the multi-sectoral
response; and ensuring proper accountability and oversight.
9 UNAIDS, Resource
Needs for an Expanded
Response to AIDS in
Low and Middle Income
Countries, Discussion
Paper,‘ Making the
Money Work’ The Three
Ones in Action London,
United Kingdom, 9
March 2005.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[43
SECTION
4 STRATEGIC FRAMEWORK
4.1_GENERAL REVIEW OF PREVIOUS PLANS 1999-2001, 2002-2006
The CHRC assessment report stated10 that the successes of the implementation of the 1999-
2001 Medium Term Plan, as identified in its successor 2002-2006 Plan, include the following:
increased awareness of HIV/AIDS through information, education and communication (IEC);
increased availability of voluntary counselling and testing (VCT) services; provision of safe
blood through careful screening of donors; increased availability of condoms and condom social
marketing for high risk groups; provision of treatment for sexually transmitted infections (STIs)
through syndromic management; provision of treatment for opportunistic infections; limited
provision of antiretroviral (ARV ) therapy; greater involvement of NGOs and private enterprises;
and introduction of the prevention of mother to child transmission (PMTCT) programme.
The assessment went on to outline the following limitations: insufficient human, technical and
financial resources; inadequate emphasis on coordination and management of programme by
the NAPS which focused mainly on implementation; lack of involvement of other sectors—the
Ministry of Labour, and the Ministry of Education were the only other two entities from the
public sector with some involvement in the response; stigmatisation and discrimination of HIV
infected persons; and limited geographical reach.
4.2_THE STRATEGIC PLANNING PROCESS
This Plan is a product of two distinct steps that were inextricably linked but separated in execu-
tion.
The first step
In 2004, a number of participatory consultations involving a wide cross section of stakeholders
involving NGOs, CBOs, FBOs, representatives from other government and private sectors, oc-
curred during the development of certain key HIV/AIDS funding proposals. The information
gathered during the formulation of these proposals is still relevant and provides insight into the
achievements and challenges faced by the National AIDS Programme.
In 2005, the MOH in consultation with other partners, requested the Pan American Health
Organization (PAHO/WHO) to coordinate the Strategic Planning Process. They took the lead
in coordinating a series of small consultations on various components within the HIV/AIDS
Programme between April and August of 2005. These consultations were built on the earlier
consultations that occurred in 2004 and covered the following areas: care and treatment, home
based care (HBC), prevention of mother to child transmission (PMTCT), voluntary counselling
10 CHRC Assessment Report
of the National HIV/AIDS
Programme of Guyana, 2004,
prepared under “Strengthen-
ing the Intuitional
Response
to HIV/AIDS/STIs in the
Caribbean” Project managed
by the Caribbean Com-
munity and Common Market
(CARICOM) Funded by the
European Union (EU).
44]
Guyana National HIV/AIDS Strategic Plan 2007-2011
and testing (VCT), behaviour change communication, orphans and vulnerable children (OVC)
and laboratory diagnosis and blood safety. Key stakeholders from various sectors were invited to
participate in these consultations and asked to provide feedback on previous and current condi-
tions, conduct a SWOT analysis, a gap analysis, and outline some objectives and next steps.
The second step involved:
■ An in-depth review of the National HIV/AIDS Strategic Plan 2002-2006 that outlines the
overall strategic objective, the programme components and the activities
■ A review of national reports, the epidemiological data, the policies, programmes and inter-
ventions currently being implemented by the National AIDS Programme Secretariat and
Government Partners.
■ A review of the findings of the assessment of the National HIV/AIDS Programme of Guyana
that was conducted by the Caribbean Health Research Council (CHRC) in 2004. This review
was conducted by assessing data from written documentation, analysis of data from quantita-
tive indicators in key programme areas that were available at the time and interviews with
selected key informants who were knowledgeable with various components of the National
Response.
■ A review of international project agreements that outlined programme goals, objectives and
targets for the next four years to which the country had already made a commitment, such as,
the World Bank Project Appraisal Document 2004-2008, The Global Funds Project Docu-
ment-Guyana 2004-2008, and the President’s Emergency Plan for AIDS Relief 2004-2008
Strategy. The formulation of these documents involved a process of consultation with stake-
holders in Guyana during 2004.
■ A review of reports on selected programme areas such as AN ASSESSMENT: The Situation
of Children made Vulnerable or Orphaned in Guyana, Ministry of Labour, Human Services
and Social Security/ UNICEF, October 2004; The National Behaviour Change Communica-
tion Strategy of Guyana USAID/GHARP, 4th August, 2005;
■ A review of the reports from the consultations/workshops conducted in step 1;
■ Consultations with key individuals either by telephone or in person;
■ Presentation of the draft at a National Consensus meeting for comments and feedback;
The document is also developed in accordance with the principles outlined by WHO/UNAIDS
“3 by 5” Initiative and the “Three Ones” as guiding principles for improving the coordination of
the country’s response. This Plan falls under the First ‘One’ Principle: One agreed AIDS action
framework that provides the basis for coordinating the work of all partners.
4.3_GUIDING PRINCIPLES
The successful implementation on the plan is to be guided by a set of principles:
■ Ensuring strong political commitment at the highest level;
■ Continuing to strengthen and expand the coordinated and mulit-sectoral approach recognis-
ing HIV/AIDS as a development, society, education, security, economic, cultural issues, in
addition to being a health issue;
Guyana National HIV/AIDS Strategic Plan 2007-2011
[45
■ Mainstreaming HIV/AIDS into al government programmes to generate an effective re-
sponse;
■ Continuing to build the political support and commitment incorporating the line ministries,
NGOs, CBOs, FBOs and the private sector;
■ Empowering PLWHA to become involved in planning and implementing the response;
■ Creating an enabling environment for PLWHAs and other vulnerable groups, free from stig-
ma and discrimination;
■ Promoting respect for human rights and ensuring confidentiality at all levels;
■ Strengthening and accelerating efforts to prevent new infections, including all aspects of be-
haviour changes, safe sex and blood injections safety as well as vertical transmission;
■ Expanding efforts in prevention, care and support for orphans and vulnerable children;
■ Strengthening and expanding workplace, school and out-of-school education and common
social marketing programmes;
■ Expanding access to an availability of care and treatment services for all people living with
HIV/AIDS in Guyana.
4.4_PRIORITY OBJECTIVES AND STRATEGIES
The objectives and strategies of the NSP address the challenges faced by Guyana in controlling
the epidemic. They reflect Government’s policy, as previously stated and international commit-
ments such as the MDGs and the UNGASS Commitments.
As stated, the overall goal of the NSP 2007 -2011 is:
“To reduce the social and economic impact of HIV and AIDS on individuals and communi-
ties, and ultimately the development of the country”.
The strategic objective is to reduce the spread of HIV and increase the quality of life of persons
living with HIV/AIDS.
This will be achieved through four broad strategic priorities:
1_Strengthening the national capacity to implement and coordinate a multi-sectoral approach
to HIV/AIDS in Guyana.
2_Ensure all citizens, especially those most vulnerable, have access to information, preventative
services such as counselling and testing and live free of stigma and discrimination in order to
reduce transmission of HIV/AIDS.
3_Ensuring access to care and treatment for persons living with HIV/AIDS.
4_Strengthening of the surveillance system and monitoring and evaluation mechanisms to pro.
vide timely information for project management.
The specific objectives for each priority area are as follows:
1_Strengthening the national capacity to implement and coordinate a multi-sectroal ap-
proach to HIV/AIDS in Guyana
46]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ Strengthen institutional capacity to effectively coordinate the multi-sectoral response
through implementation of the Three Ones Principles (One Coordinating Body, One Na-
tional Strategy and One National Monitoring and Evaluation plan).
■ Strengthen human capacity to effectively coordinate and manage the mulit-sectoral re-
sponse.
■ Strengthen regional capacity to implement and manages HIV/AIDS interventions
2_Ensure all citizens, especially those most vulnerable, have access to information, preventa-
tive services such as counselling and testing and live free of stigma and discrimination in
order to reduce transmission of HIV.
■ Decrease misconceptions and discriminatory behaviours and increase knowledge and access
to prevention services.
■ Reduce sexual transmission of HIV infection with a focus on most at-risk populations and
their partners through delayed sexual debut, reduced partner change and number, increase
condom use.
■ Ensure universal access to prevention of mother-to-child-transmission services.
■ Reduce the risk for transmission in medical settings.
■ Reducing the socio-economic impact of HIV/AIDS on children and increase protection for
OVCs.
■ Ensure universal access to counselling and testing services.
3_Ensuring access to care and treatment for all persons living with HIV/AIDS.
■ Ensure universal access to quality diagnostic, care and treatment and support in an enabling
environment for all persons infected with HIV/AIDS, including access to ARVs and qual-
ity home based care services.
■ Expand comprehensive care for opportunistic infections, especially with greater links with
the TB control and monitoring.
■ Design and implement training programmes for HIV/AIDS treatment care and support for
services providers.
■ Ensure continued access to ARVs and other treatments supplied through improved pro-
curement and commodities management.
■ Established national public health reference laboratory.
4_Strengthening of the surveillance system and monitoring and evaluation mechanisms to
provide timely information for project management.
■ Strengthening of the HIV/AIDS surveillance system and the national health information
system.
■ Ensure one national system for monitoring and evaluating the response to HIV/AIDS.
■ Improve strategic information on HIV/AIDS by strengthening local capacity and identify-
ing priority studies and surveys.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[47
PRIORITY SPECIFIC OBJECTIVES
1_STRENGTHENING
THE NATIONAL
CAPACITY TO
IMPLEMENT A
COORDINATED,
MULTI-SECTORIAL
RESOURCE
1. Strengthen institutional capacity to effectively coordinate the
multi-sectoral response through implementation of the Three Ones
Principles
2. Strengthen human capacity to effectively coordinate and manage
the multi-sectoral response
3. Strengthen regional capacity to implement and manage HIV/AIDS
interventions
2_REDUCING RISK
VULNERABILITY TO
HIV INFECTION
1. Decrease misconceptions and discriminatory behaviors and
increase knowledge and access to prevention services
2. Reduce sexual transmission of HIV infection with a focus on most
at-risk populations and their partners through delayed sexual
debut, reduced partner change and number, increase condom use,
and promotion of treatment adherence
3. Reduce mother-to-child transmission of HIV infection
4. Ensure universal access to counseling and testing services
5. Reduce the risk for transmission in medical settings
6. Reducing the socio-economic impact of HIV/AIDS and increase
protection for OVCs
3_CLINICAL AND
DIAGNOSTIC
MANAGEMENT AND
ACCESS TO CARE,
TREATMENT AND
SUPPORT
1. Increase access to diagnostic management and comprehensive
treatment, care, and support in an enabling environment
2. Strengthen the service delivery system to provide uninterrupted
supply of medications and commodities (Comprehensive care
includes the scaled up coverage and access to care, provision of
antiretroviral drugs, needed psychosocial care for those infected
and affected, the option of home based care and treatment for OIs
including TB and STIs.)
4_STRATEGIC
INFORMATION
1. Increase local capacity to design and implement surveillance,
monitoring and evaluation, special studies, surveys and research
on HIV/AIDS according to national and international guidelines.
2. Strengthen capacity at the national and regional levels for
the collection and use of data for decision making, planning,
implementing, monitoring, and evaluating the local response to
HIV/AIDS
48]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
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Guyana National HIV/AIDS Strategic Plan 2007-2011
[49
P
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O
C
on
tin
ue
s
on
p
5
0
50]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
R
IO
R
IT
Y
#
1
_S
T
R
E
N
G
T
H
E
N
IN
G
T
H
E
N
A
T
IO
N
A
L
C
A
P
A
C
IT
Y
T
O
I
M
P
L
E
M
E
N
T
A
C
O
O
R
D
IN
A
T
E
D
, M
U
LT
I-
S
E
C
T
O
R
A
L
R
E
S
P
O
N
S
E
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
C
T
IV
IT
IE
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
1
.4
I
nc
re
as
e
th
e
in
vo
lv
em
en
t
of
c
iv
il
so
ci
et
y
or
g
an
is
at
io
ns
a
nd
t
he
p
riv
at
e
se
ct
or
in
t
he
s
ca
le
d
up
r
es
po
ns
e
N
um
be
r
of
N
G
O
s
tr
ai
ne
d
1
.
4
.5
B
ui
ld
c
ap
ac
iti
es
o
f
ne
w
ly
f
or
m
ed
N
G
O
s
to
d
ev
el
op
p
ro
po
sa
ls
a
nd
ac
ce
ss
f
un
di
ng
H
S
D
U
/U
N
A
ID
S
/U
N
D
P
/
P
E
P
FA
R
1
.5
A
dv
oc
at
e
fo
r
a
le
g
al
a
nd
p
ol
ic
y
en
vi
ro
nm
en
t
th
at
p
ro
te
ct
s
th
e
rig
ht
s
of
p
eo
pl
e
liv
in
g
w
ith
H
IV
/A
ID
S
a
nd
vu
ln
er
ab
le
g
ro
up
s
N
at
io
na
l C
om
po
si
te
P
ol
ic
y
In
de
x
N
a-
tio
na
l C
om
po
si
te
P
ol
ic
y
In
de
x
1
.5
.1
R
ev
is
e
ex
is
tin
g
le
g
al
f
ra
m
ew
or
k,
N
at
io
na
l H
IV
/A
ID
S
P
ol
ic
y
an
d
pr
ep
ar
e
ne
w
h
ea
lth
le
g
is
la
tio
n
to
co
m
ba
t
al
l a
sp
ec
ts
o
f
di
sc
rim
in
a-
tio
n
re
la
tiv
e
to
H
IV
/A
ID
S
M
O
H
/M
in
is
tr
y
of
L
eg
al
A
ff
ai
rs
,/
W
B
/
P
A
N
A
C
P
/U
N
A
ID
S
A
m
ou
nt
o
f
na
tio
na
l f
un
ds
s
pe
nt
o
n
H
IV
/A
ID
S
1
.5
.2
C
re
at
e
m
ec
ha
ni
sm
s
to
s
tim
ul
at
e
ad
vo
ca
cy
b
y
in
fo
rm
in
g
s
en
io
r
de
ci
si
on
m
ak
er
s
of
t
he
s
oc
ia
l a
nd
ec
on
o
m
ic
i
m
pa
ct
o
f
H
IV
/A
ID
S
o
n
N
at
io
na
l
D
ev
el
op
m
en
t
G
O
G
/W
B
1
.6
R
ev
ie
w
t
he
N
at
io
na
l
R
es
po
ns
e
to
H
IV
/A
ID
S
M
id
-t
er
m
r
ev
ie
w
r
ep
or
t
av
ai
la
bl
e
1
.6
.1
C
on
du
ct
m
id
t
er
m
r
ev
ie
w
o
f
th
e
N
at
io
na
l
S
tr
at
eg
ic
P
la
n
H
S
D
U
/U
N
D
P
/U
N
A
ID
S
/P
A
H
O
P
ar
t
ic
ip
at
or
y
re
vi
ew
a
va
ila
bl
e
1
.6
.2
C
on
du
ct
a
G
ov
er
nm
en
t-
le
d
pa
rt
ic
i-
pa
to
ry
r
ev
ie
w
o
f
th
e
N
at
io
na
l A
ID
S
R
es
po
ns
e
H
S
D
U
/N
A
P
S
/U
N
A
ID
S
a
nd
a
ll
pa
rt
ne
rs
C
on
tin
ue
d
fr
om
p
4
9
Guyana National HIV/AIDS Strategic Plan 2007-2011
[51
P
R
IO
R
IT
Y
#
2
_R
E
D
U
C
IN
G
R
IS
K
A
N
D
V
U
L
N
E
R
A
B
IL
IT
Y
T
O
H
IV
I
N
F
E
C
T
IO
N
:
S
tr
a
te
g
ic
O
b
je
ct
iv
e
s
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
2
.1
D
es
ig
n
an
d
im
pl
em
en
t
C
om
m
un
ic
at
io
n
P
ro
g
ra
m
m
e
on
H
IV
/A
ID
S
P
er
ce
nt
a
g
e
of
p
eo
pl
e
ag
ed
1
5
-4
9
y
ea
rs
ex
pr
es
si
ng
a
cc
ep
tin
g
a
tt
itu
de
s
to
w
ar
ds
pe
op
le
w
ith
H
IV
/A
ID
S
2
.1
.1
D
ev
el
op
a
nd
im
pl
em
en
t
N
at
io
na
l
be
ha
vi
ou
r
ch
an
g
e
st
ra
te
g
y
to
re
du
ce
s
tig
m
a
an
d
di
sc
rim
in
at
io
n
re
la
te
d
to
H
IV
/A
ID
S
G
O
G
/N
G
O
s/
G
FA
T
M
/
P
E
P
FA
R
/P
A
H
O
P
er
ce
nt
ag
e
of
p
eo
pl
e
ag
ed
1
5
-2
4
w
ho
co
rr
ec
tly
id
en
tif
y
w
ay
s
of
p
re
ve
nt
in
g
th
e
se
xu
al
t
ra
ns
m
is
si
on
o
f
H
IV
a
nd
w
ho
re
je
ct
t
w
o
m
aj
or
m
is
co
nc
ep
tio
ns
a
b
ou
t
H
IV
t
ra
ns
m
is
si
on
2
.1
.2
U
se
a
va
ila
bl
e
da
ta
t
o
de
ve
lo
p
m
as
s
m
ed
ia
c
am
pa
ig
n
to
e
ns
ur
e
th
at
a
ll
m
em
be
rs
o
f
so
ci
et
y
ha
ve
in
fo
rm
at
io
n
on
p
re
ve
nt
io
n,
c
ar
e
an
d
tr
ea
tm
en
t
se
rv
ic
es
G
O
G
/G
FA
T
M
/P
E
P
FA
R
/P
A
H
O
2
.1
.3
E
nc
ou
ra
g
e
th
e
pa
rt
ic
ip
at
io
n
of
N
G
O
s,
C
B
O
s
an
d
ot
he
r
pa
rt
ne
rs
in
t
he
d
ev
el
op
m
en
t
an
d
im
pl
em
en
ta
tio
n
of
t
he
b
eh
av
io
ur
ch
an
g
e
in
te
rv
en
tio
ns
G
O
G
/P
E
P
FA
R
/P
A
H
O
A
ve
ra
g
e
ag
e
at
fi
rs
t
se
x
(b
y
g
en
de
r)
2
.1
.4
C
on
du
ct
a
ss
es
sm
en
t
an
d
te
st
m
es
sa
g
es
t
ar
g
et
ed
t
ow
ar
ds
g
en
er
al
an
d
hi
g
h
r
is
k
po
pu
la
tio
ns
G
O
G
/P
E
P
FA
R
/N
G
O
/P
A
H
O
2
.1
.5
T
ra
in
s
ta
ff
t
o
co
nd
uc
t
he
al
th
pr
om
ot
io
n
ac
tiv
iti
es
G
O
G
/P
A
H
O
2
.2
D
ev
el
op
a
nd
im
pl
em
en
t
ta
rg
et
ed
be
ha
vi
ou
r
ch
an
g
e
in
te
rv
en
tio
ns
t
o
in
cr
ea
se
p
os
iti
ve
s
ex
ua
l p
ra
ct
ic
es
an
d
en
co
ur
ag
e
ea
rly
S
T
I/
H
IV
di
ag
no
si
s
an
d
tr
ea
tm
en
t
am
on
g
m
os
t
vu
ln
er
ab
le
g
ro
up
s
2
.2
.1
D
efi
ne
a
nd
p
rio
rit
is
e
po
pu
la
tio
ns
t
o
be
t
ar
g
et
ed
G
O
G
/M
O
H
/P
E
P
FA
R
/U
N
A
ID
S
/
U
N
F
P
A
/P
A
H
O
C
on
tin
ue
s
on
p
5
2
52]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
R
IO
R
IT
Y
#
2
_R
E
D
U
C
IN
G
R
IS
K
A
N
D
V
U
L
N
E
R
A
B
IL
IT
Y
T
O
H
IV
I
N
F
E
C
T
IO
N
:
S
tr
a
te
g
ic
O
b
je
ct
iv
e
s
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
P
er
ce
nt
ag
e
of
p
eo
pl
e
ag
ed
1
5
-4
9
ye
ar
s
re
po
rt
in
g
u
se
o
f
a
co
nd
om
d
ur
in
g
la
st
s
ex
ua
l i
nt
er
co
ur
se
w
ith
n
on
-r
e
g
ul
ar
pa
rt
ne
r
2
.2
.2
U
se
a
va
ila
bl
e
da
ta
t
o
de
ve
lo
p
ta
rg
et
ed
b
eh
av
io
ur
c
ha
ng
e
in
te
rv
en
tio
ns
f
or
s
el
ec
te
d
hi
g
h
ris
k
g
ro
up
s
M
O
H
/P
E
P
FA
R
/U
N
A
ID
S
/U
N
F
P
A
/
P
A
H
O
2
.2
.3
U
se
m
es
sa
g
es
d
es
ig
ne
d
to
in
cr
ea
se
th
e
us
e
of
V
C
T
s
er
vi
ce
s
an
d
ea
rly
tr
ea
tm
en
t-
se
ek
in
g
f
or
S
T
Is
a
nd
H
IV
/A
ID
S
M
O
H
/P
E
P
FA
R
/P
A
H
O
2
.2
.4
D
ev
el
op
“
fr
ie
nd
ly
”
se
rv
ic
es
f
or
y
ou
th
an
d
m
os
t
at
r
is
k
po
pu
la
tio
ns
M
O
H
/U
N
I
C
E
F
/U
N
F
P
A
/P
A
H
O
/
P
E
P
FA
R
2
.2
.5
D
ev
el
op
p
ee
r
ed
uc
at
io
n
pr
og
ra
m
m
es
f
or
h
ig
h
ris
k
yo
ut
h,
C
S
W
s
an
d
M
S
M
s
N
G
O
/P
E
P
FA
R
/U
N
F
P
A
/P
A
H
O
2
.2
.6
D
ev
el
op
m
as
s
an
d
sm
al
l m
ed
ia
in
te
rv
en
tio
ns
t
o
pr
om
ot
e
th
e
us
e
of
r
is
k-
re
du
ct
io
n
se
xu
al
h
ea
lth
pr
ac
tic
es
M
O
H
/L
in
e
M
in
is
tr
y/
P
E
P
FA
R
2
.3
Im
pl
em
en
t
pr
ev
en
tio
n
ed
uc
at
io
n
an
d
be
ha
vi
ou
r
ch
an
g
e
re
in
fo
rc
em
en
t
ac
tiv
iti
es
2
.3
.1
Im
pl
em
en
t
H
F
L
E
a
t
pr
im
ar
y
an
d
se
co
nd
ar
y
le
ve
ls
M
O
E
/U
N
IC
E
F
/P
A
H
O
2
.3
.2
D
ev
el
op
p
ee
r
ed
uc
at
io
n
pr
og
ra
m
m
es
f
or
y
ou
th
M
O
E
/N
G
O
/M
in
is
tr
y
of
C
ul
tu
re
/P
E
P
FA
R
C
on
tin
ue
d
fr
om
p
5
1
Guyana National HIV/AIDS Strategic Plan 2007-2011
[53
P
R
IO
R
IT
Y
#
2
_R
E
D
U
C
IN
G
R
IS
K
A
N
D
V
U
L
N
E
R
A
B
IL
IT
Y
T
O
H
IV
I
N
F
E
C
T
IO
N
:
S
tr
a
te
g
ic
O
b
je
ct
iv
e
s
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
2
.3
.3
C
on
tin
ue
t
o
im
pl
em
en
t
th
e
A
bs
tin
en
ce
a
nd
F
ai
th
fu
l p
ro
g
ra
m
s
M
O
H
/F
B
O
s/
P
E
P
FA
R
2
.3
.4
D
ev
el
op
a
nd
im
pl
em
en
t
se
ria
l
co
m
m
un
ic
at
io
n
pr
og
ra
m
s
re
in
fo
rc
ed
w
ith
c
om
m
un
ity
-l
ev
el
e
du
ca
tio
n.
M
O
H
/P
E
P
FA
R
/P
A
H
O
2
.4
E
xp
an
d
co
nd
om
s
oc
ia
l
m
ar
ke
tin
g
pr
og
ra
m
m
e
P
er
ce
nt
ag
e
of
p
eo
pl
e
ag
ed
1
5
-4
9
y
ea
rs
re
po
rt
in
g
u
se
o
f
a
co
nd
om
d
ur
in
g
t
he
la
st
s
ex
ua
l i
nt
er
co
ur
se
w
ith
a
n
on
–
re
g
ul
ar
p
ar
tn
er
2
.4
.1
R
ev
ie
w
a
nd
im
pl
em
en
t
st
ra
te
g
y
an
d
ex
pa
nd
p
ro
g
ra
m
M
O
H
/W
B
2
.4
.2
In
cr
ea
se
t
he
n
um
be
r
of
n
on
–
tr
ad
iti
on
al
o
ut
le
ts
t
ar
g
et
in
g
h
ig
h
ris
k
po
pu
la
tio
ns
M
O
H
/P
riv
at
e
S
ec
to
r/
P
E
P
FA
R
To
ta
l n
um
be
r
of
c
on
do
m
s
di
st
rib
ut
ed
in
pa
st
1
2
m
on
th
s
2
.4
.3
D
ev
el
op
m
on
ito
rin
g
a
nd
e
va
lu
at
io
n
pl
an
t
o
as
se
ss
im
pa
ct
o
f
th
e
in
te
rv
en
tio
ns
M
O
H
/W
B
2
.5
S
ca
le
u
p
th
e
P
M
TC
T
P
ro
g
ra
m
N
um
be
r
of
p
ub
lic
f
ac
ili
tie
s
th
at
o
ff
er
P
M
TC
T
s
er
vi
ce
s
2
.5
.1
S
tr
en
g
th
en
s
er
vi
ce
d
el
iv
er
y
ca
pa
ci
ty
of
P
M
TC
T
s
i
te
s
an
d
ex
pa
nd
g
eo
g
ra
ph
ic
c
ov
er
ag
e
at
p
rim
ar
y
ca
re
f
ac
ili
tie
s
M
O
H
/P
E
P
FA
R
/U
N
IC
E
F
/
U
N
F
P
A
N
um
be
r
of
p
re
g
na
nt
w
om
en
w
ho
re
ce
iv
e
H
IV
c
ou
ns
el
in
g
a
nd
t
es
tin
g
f
or
P
M
TC
T
2
.5
.2
S
tr
en
g
th
en
c
om
m
un
ity
m
ob
ili
za
tio
n
an
d
re
fe
rr
al
n
et
w
or
ks
t
o
in
cl
ud
e
P
M
TC
T
N
A
P
S
/U
N
IC
E
F
C
on
tin
ue
s
on
p
5
4
54]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
R
IO
R
IT
Y
#
2
_R
E
D
U
C
IN
G
R
IS
K
A
N
D
V
U
L
N
E
R
A
B
IL
IT
Y
T
O
H
IV
I
N
F
E
C
T
IO
N
:
S
tr
a
te
g
ic
O
b
je
ct
iv
e
s
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
N
um
be
r
of
h
ea
lth
c
ar
e
w
or
ke
rs
t
ra
in
ed
in
t
he
p
ro
vi
si
on
o
f
P
M
TC
T
2
.5
.3
D
ev
el
op
s
ta
nd
ar
di
se
d
sy
st
em
f
or
m
on
ito
rin
g
a
nd
t
ra
ck
in
g
N
A
P
S
/U
N
IC
E
F
P
er
ce
nt
o
f
ba
bi
es
b
or
n
to
H
I
V
p
os
iti
ve
w
om
en
w
ho
a
re
t
es
te
d
be
fo
re
a
g
e
1
8
m
on
th
s
2
.5
.4
In
cr
ea
si
ng
t
he
in
vo
lv
em
en
t
of
N
G
O
s
an
d
C
B
O
s
in
t
he
P
M
TC
T
r
es
po
ns
e
N
A
P
S
/U
N
IC
E
F
P
er
ce
nt
ag
e
of
w
om
en
w
ho
r
ec
ei
ve
a
co
m
pl
et
e
co
ur
se
o
f
A
R
V
p
ro
ph
yl
ax
is
a
s
pa
rt
o
f
P
M
TC
T
2
.5
.5
S
tr
en
g
th
en
in
g
P
M
TC
T
s
er
vi
ce
de
liv
er
y
at
la
b
or
a
nd
d
el
iv
er
y
w
ar
ds
N
A
P
S
/U
N
IC
E
F
2
.6
R
ed
uc
e
th
e
vu
ln
er
ab
ili
ty
o
f
O
V
C
t
o
H
IV
/A
ID
S
N
um
be
r
of
p
er
so
ns
t
ra
in
ed
in
c
ar
in
g
f
or
O
V
C
s
2
.6
.1
M
ob
ili
se
a
dd
iti
on
al
C
B
O
’s
N
G
O
’s
to
b
ec
om
e
in
vo
lv
ed
in
p
ro
vi
di
ng
su
pp
or
t
to
O
V
C
s
M
in
o
f
L
ab
ou
r/
U
N
IC
E
F
/P
E
P
FA
R
2
.6
.2
E
xp
ed
ite
a
nd
e
na
ct
t
he
le
g
is
la
tio
n
th
at
p
ro
te
ct
s
th
e
rig
ht
s
of
t
he
m
os
t
vu
ln
er
ab
le
c
hi
ld
re
n
an
d
ap
pr
ov
e
na
tio
na
l p
ol
ic
y
G
O
G
/U
N
IC
E
F
/M
in
o
f
L
ab
ou
r
P
er
ce
nt
o
f
O
V
C
s
en
ro
lle
d
in
sc
ho
ol
s
2
.6
.3
E
nc
ou
ra
g
e
th
e
pa
rt
ic
ip
at
io
n
of
k
ey
st
ak
eh
ol
de
rs
f
ro
m
a
ll
se
ct
or
s
to
en
su
re
t
he
p
ro
vi
si
on
o
f
es
se
nt
ia
l
se
rv
ic
es
, e
du
ca
tio
n,
h
ea
l
th
c
ar
e,
bi
rt
h
re
g
is
tr
at
io
n
et
c.
W
B
/U
N
IC
E
F
2
.6
.4
In
vo
lv
e
ch
ild
re
n
an
d
yo
ut
h
as
p
ar
tn
er
s
in
d
es
ig
ni
ng
a
nd
im
pl
em
en
tin
g
H
IV
/A
ID
S
in
te
rv
en
tio
ns
U
N
IC
E
F
C
on
tin
ue
d
fr
om
p
5
3
Guyana National HIV/AIDS Strategic Plan 2007-2011
[55
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R
IO
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IT
Y
#
2
_R
E
D
U
C
IN
G
R
IS
K
A
N
D
V
U
L
N
E
R
A
B
IL
IT
Y
T
O
H
IV
I
N
F
E
C
T
IO
N
:
S
tr
a
te
g
ic
O
b
je
ct
iv
e
s
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
P
er
ce
nt
o
f
O
V
C
w
ho
se
h
ou
se
ho
ld
re
ce
iv
ed
f
re
e
of
c
os
t
ex
te
rn
al
s
up
po
rt
in
ca
r
in
g
f
or
t
he
c
hi
ld
2
.6
.5
S
tr
en
g
th
en
t
he
c
ar
e
an
d
co
pi
ng
ca
pa
ci
tie
s
of
f
am
ili
es
a
nd
t
he
co
m
m
un
ity
N
A
P
S
/W
B
/U
N
IC
E
F
2
.7
E
xp
an
d
th
e
V
C
T
s
er
vi
ce
s
N
um
be
r
of
p
er
so
ns
r
ec
ei
vi
ng
t
es
t
re
su
lts
in
la
st
t
w
el
ve
m
on
th
s
be
tw
ee
n
ag
es
1
5
-4
9
2
.7
.1
D
es
ig
n
an
d
im
pl
em
en
t
op
er
at
io
na
l
st
ra
te
g
y
M
O
H
/P
E
P
FA
R
2
.7
.2
I
nc
re
as
e
av
ai
la
bi
lit
y
to
a
g
re
at
er
pr
op
or
tio
n
of
t
he
p
op
ul
at
io
n,
w
ith
a
sp
ec
ia
l
fo
cu
s
on
s
er
vi
ce
c
en
te
rs
de
liv
er
in
g
c
ar
e
to
h
ig
h
ris
k
g
ro
up
s
N
A
P
S
/N
G
O
/P
A
H
O
2
.7
.3
I
nc
re
as
e
se
rv
ic
e
up
ta
ke
t
hr
ou
g
h
co
m
m
un
ity
m
ob
ili
za
tio
n
N
A
P
S
/W
B
/N
G
O
2
.7
.4
Im
pr
ov
e
Q
C
a
nd
r
ef
er
ra
l s
ys
te
m
N
A
P
S
N
um
be
r
of
in
di
vi
du
al
s
tr
ai
ne
d
in
t
he
pr
ov
is
io
n
of
V
C
T
a
cc
or
di
ng
t
o
na
tio
na
l
g
ui
de
lin
es
2
.7
.5
C
on
tin
ua
lly
t
ra
in
a
nd
u
pd
at
e
sk
ill
s
fo
r
he
al
th
c
ar
e
pr
ov
id
er
s
an
d
la
b
or
at
or
ia
ns
a
cc
or
di
ng
t
o
N
at
io
na
l
G
ui
de
lin
es
N
A
P
S
/C
ID
A
/P
A
P
FA
R
/P
A
H
O
2
.8
R
ed
uc
e
th
e
vu
ln
er
ab
ili
ty
t
o
H
IV
/
A
ID
S
t
hr
ou
g
h
id
en
t
ifi
ca
tio
n
an
d
tr
ea
tm
en
t
of
S
T
I/
O
Is
P
er
ce
nt
o
f
m
en
a
nd
w
om
en
w
ith
S
T
Is
at
h
ea
lth
c
en
te
rs
w
ho
a
re
a
pp
ro
pr
ia
te
ly
di
ag
no
se
d,
t
re
at
ed
a
nd
c
ou
ns
el
ed
2
.8
.1
In
cr
ea
se
t
he
u
se
o
f
S
T
I/
O
I s
er
vi
ce
s
an
d
ea
rly
t
re
at
m
en
t-
se
ek
in
g
f
or
S
T
Is
a
nd
H
IV
/A
ID
S
M
O
H
/C
ID
A
/P
E
P
FA
R
/P
A
H
O
N
um
be
r
of
p
er
so
ns
t
ra
in
ed
in
m
an
ag
em
en
t
of
S
T
Is
a
cc
or
di
ng
t
o
N
at
io
na
l g
ui
de
lin
es
2
.8
.2
T
ra
in
h
ea
lth
c
ar
e
pr
ov
id
er
s
S
T
I/
O
I
m
an
ag
em
en
t
ac
co
rd
in
g
t
o
na
tio
na
l
g
ui
de
lin
es
N
A
P
S
/C
ID
A
C
on
tin
ue
s
on
p
5
6
56]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
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IO
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IT
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#
2
_R
E
D
U
C
IN
G
R
IS
K
A
N
D
V
U
L
N
E
R
A
B
IL
IT
Y
T
O
H
IV
I
N
F
E
C
T
IO
N
:
S
tr
a
te
g
ic
O
b
je
ct
iv
e
s
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
2
.9
E
ns
ur
e
sa
fe
b
lo
od
s
up
pl
y
P
er
ce
nt
o
f
tr
an
sf
us
ed
b
lo
od
u
ni
ts
in
th
e
la
st
t
w
el
ve
m
on
th
s
th
at
h
av
e
be
en
sc
re
en
ed
f
or
H
IV
a
cc
or
di
ng
t
o
na
tio
na
l
g
ui
de
lin
es
2
.9
.1
M
ai
nt
en
an
ce
o
f
sa
fe
b
lo
od
s
up
pl
y
M
O
H
/P
E
P
FA
R
/P
A
H
O
2
.1
0
Im
pl
em
en
t
pl
an
t
o
re
du
ce
h
ea
lth
w
or
ke
r
an
d
co
m
m
un
ity
r
is
k
of
H
IV
tr
an
sm
is
si
on
t
hr
ou
g
h
co
nt
am
in
at
ed
sh
ar
ps
N
um
be
r
of
p
er
so
ns
t
ra
in
ed
in
in
je
ct
io
n
sa
fe
ty
a
nd
w
as
te
m
an
ag
em
en
t
2
.1
0
.1
P
ro
vi
de
a
n
at
io
na
l p
ol
ic
y
to
ov
er
se
e
in
je
ct
io
n
sa
fe
ty
in
t
he
p
ub
l
ic
an
d
pr
iv
at
e
se
ct
or
M
O
H
/P
E
P
FA
R
N
um
be
r
of
c
ur
at
iv
e
in
je
ct
io
ns
P
er
p
er
so
n
2
.1
0
.2
B
ui
ld
c
om
pe
te
nc
y
of
h
ea
lth
w
or
ke
rs
t
o
pr
ov
id
e
in
je
ct
io
ns
a
nd
di
sp
os
e
of
s
ha
rp
s
ac
co
rd
in
g
t
o
st
an
da
rd
s
N
A
P
S
2
.1
0
.3
B
ui
ld
c
om
pe
te
nc
y
of
w
as
te
ha
nd
le
rs
t
o
di
sp
os
e
of
w
as
te
ac
co
rd
in
g
t
o
sa
fe
w
as
te
m
an
ag
em
en
t
st
an
da
rd
s
N
A
P
S
2
.1
0
.4
A
dv
oc
at
e
fo
r
ra
tio
na
l
u
se
o
f
in
je
ct
io
ns
N
A
P
S
2
.1
0
.5
R
ed
uc
e
de
m
an
d
fo
r
in
je
ct
io
ns
am
on
g
p
at
ie
nt
s
an
d
co
m
m
un
ity
m
em
be
rs
N
A
P
S
C
on
tin
ue
d
fr
om
p
5
5
Guyana National HIV/AIDS Strategic Plan 2007-2011
[57
P
R
IO
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IT
Y
#
3
_C
L
IN
IC
A
L
A
N
D
D
IA
G
N
O
S
T
IC
M
A
N
A
G
E
M
E
N
T
A
N
D
A
C
C
E
S
S
T
O
C
A
R
E
, T
R
E
A
T
M
E
N
T
A
N
D
S
U
P
P
O
R
T
B
R
O
A
D
S
T
R
A
T
E
G
I
C
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
3
.1
E
xp
an
d
ac
ce
ss
t
o
A
R
V
tr
ea
tm
en
t
to
s
ca
le
up
t
he
re
sp
on
se
P
er
ce
nt
o
f
pe
rs
on
s
w
ith
a
dv
an
ce
H
IV
in
fe
ct
io
n
re
ce
iv
in
g
A
R
T
3
.1
.1
S
tr
en
g
th
en
e
xi
st
in
g
t
re
at
m
en
t
si
te
s
an
d
ex
pa
nd
th
e
nu
m
be
r
of
t
re
at
m
en
t
M
O
H
/G
FA
T
M
/P
E
P
FA
R
/
P
A
H
O
N
um
be
r
of
r
eg
io
ns
w
ith
h
ea
lth
f
ac
ili
tie
s
th
at
h
av
e
th
e
ca
pa
ci
ty
t
o
pr
ov
id
e
H
IV
/
A
ID
S
c
ar
e,
t
re
at
m
en
t,
an
d
su
pp
or
t
3
.1
.2
S
ta
nd
ar
di
se
g
ui
de
lin
es
a
nd
p
ro
to
co
ls
f
or
c
ar
e
an
d
tr
ea
tm
en
t
M
O
H
/G
FA
T
M
/P
E
P
FA
R
/
P
A
H
O
N
um
be
r
of
h
ea
lth
c
ar
e
pr
ov
id
er
s
tr
ai
ne
d
to
d
el
iv
er
A
R
T
s
er
vi
ce
s
ac
co
rd
in
g
t
o
na
tio
na
l g
ui
de
lin
es
3
.1
.3
S
tr
en
g
th
en
t
ec
hn
ic
al
c
ap
ac
ity
o
f
he
al
th
c
ar
e
w
or
ke
rs
in
d
el
iv
er
in
g
c
o
m
pr
eh
en
si
ve
c
ar
e
to
P
LW
H
A
S
M
O
H
/G
FA
T
M
/P
E
P
FA
R
/P
A
H
O
N
um
be
r
of
p
er
so
ns
r
ec
ei
vi
ng
A
R
T
3
.1
.4
E
st
ab
lis
h
pu
bl
ic
-p
riv
at
e
pa
rt
ne
rs
hi
p
in
t
re
at
m
en
t
an
d
ca
r
e
M
O
H
/G
FA
T
M
/P
E
P
FA
R
/P
A
H
O
3
.1
.5
E
st
ab
l
is
h
ne
tw
or
k
of
P
LW
H
A
S
up
po
rt
g
ro
up
s
H
S
D
U
/P
E
P
FA
R
/U
N
A
ID
S
3
.1
.6
D
ev
el
op
N
at
io
na
l T
re
at
m
en
t
an
d
C
ar
e
co
m
m
un
ic
at
io
ns
s
tr
at
eg
y
M
O
H
/P
A
H
O
3
.1
.7
S
tr
en
g
th
en
h
um
an
c
ap
ac
ity
t
o
sc
al
e
up
t
he
c
ar
e
an
d
tr
ea
tm
en
t
re
sp
on
se
M
O
H
/P
A
H
O
/P
E
P
FA
R
3
.1
.8
D
ev
el
op
a
nd
im
pl
em
en
t
na
tio
na
l a
dh
er
en
ce
st
ra
te
g
y
M
O
H
/P
A
H
O
/P
E
P
FA
R
3
.2
C
re
at
e
C
en
tr
e
of
E
xc
el
le
nc
e
at
t
he
G
U
M
cl
in
ic
a
nd
G
P
H
C
3
.2
.1
U
pg
ra
de
t
he
f
ac
ili
ty
t
o
pr
ov
id
e
sp
ec
ia
liz
ed
c
ar
e
an
d
se
rv
e
as
a
r
ef
er
ra
l c
en
tr
e
M
O
H
/P
E
P
FA
R
3
.2
.2
D
es
ig
n
an
d
im
pl
em
en
t
C
on
tin
uo
us
Q
ua
lit
y
Im
pr
ov
em
en
t
(C
Q
I)
pr
og
ra
m
m
e
fo
r
th
e
C
en
tr
e
M
O
H
/
P
E
P
FA
R
C
on
tin
ue
s
on
p
5
8
58]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
R
IO
R
IT
Y
#
3
_C
L
IN
IC
A
L
A
N
D
D
IA
G
N
O
S
T
IC
M
A
N
A
G
E
M
E
N
T
A
N
D
A
C
C
E
S
S
T
O
C
A
R
E
, T
R
E
A
T
M
E
N
T
A
N
D
S
U
P
P
O
R
T
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
3
.2
.3
U
pg
ra
de
t
ec
hn
ic
al
c
ap
ac
ity
o
f
th
e
m
ul
tid
is
ci
pl
in
ar
y
te
am
t
o
pr
ov
id
e
sp
ec
ia
liz
ed
c
ar
e
in
H
IV
/A
ID
S
M
O
H
/
P
E
P
FA
R
3
.3
E
st
ab
lis
h
a
qu
al
ity
h
om
e
ba
se
d
an
d
pa
lli
at
iv
e
ca
re
pr
og
ra
m
m
e
pr
ov
id
in
g
su
pp
or
t
to
P
LW
H
A
a
nd
th
os
e
af
fe
ct
ed
b
y
H
IV
/
A
ID
S
N
um
be
r
of
r
eg
io
ns
w
ith
o
ut
le
ts
t
ha
t
pr
ov
id
e
H
P
C
3
.3
.1
D
ev
el
op
a
nd
im
pl
em
en
t
a
na
tio
na
l H
B
C
s
tr
at
eg
y
fo
r
P
W
L
H
A
a
nd
t
ho
se
a
ff
ec
te
d
by
H
IV
/A
ID
S
.
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
N
um
be
r
of
o
ut
le
ts
t
ha
t
pr
ov
id
e
H
P
C
3
.3
.2
S
tr
en
g
th
en
a
nd
e
xp
an
d
h
om
e-
ba
se
d
ca
re
se
rv
ic
es
f
or
P
LW
H
A
a
nd
t
ho
se
a
ff
ec
te
d
by
H
IV
/A
ID
S
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
3
.3
.3
E
st
ab
lis
h
ne
tw
or
k
of
h
om
e-
ba
se
d
ca
re
vo
lu
nt
ee
rs
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
3
.3
.4
E
st
ab
lis
h
pu
bl
ic
p
riv
at
e
pa
rt
ne
rs
hi
p
in
h
om
e
ba
se
c
ar
e
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
3
.3
.5
S
tr
en
g
th
en
t
he
t
ec
hn
ic
al
c
ap
ac
ity
o
f
H
B
C
w
or
ke
rs
in
p
ro
vi
di
ng
q
ua
lit
y
ca
re
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
3
.3
.6
E
st
ab
lis
h
N
at
io
na
l r
ef
er
ra
l s
ys
te
m
f
or
H
om
e
ba
se
c
ar
e
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
3
.3
.7
S
tr
en
g
th
en
t
he
c
ap
ac
ity
o
f
th
e
vo
lu
nt
ee
rs
in
pr
ov
id
in
g
H
B
C
s
er
vi
ce
s
M
O
H
/G
FA
T
M
/N
G
O
(G
+
)
3
.4
P
ro
vi
de
p
sy
ch
os
oc
ia
l c
ar
e
an
d
su
pp
or
t
to
P
LW
H
A
an
d
th
os
e
af
fe
ct
ed
3
.4
.1
In
cr
ea
se
t
he
n
um
be
r
of
s
oc
ia
l s
er
vi
ce
pr
og
ra
m
m
es
a
va
ila
bl
e
to
P
LW
H
A
a
nd
t
ho
se
af
fe
ct
ed
O
th
er
L
in
e
M
in
is
tr
ie
s
C
on
tin
ue
d
fr
om
p
5
7
Guyana National HIV/AIDS Strategic Plan 2007-2011
[59
P
R
IO
R
IT
Y
#
3
_C
L
IN
IC
A
L
A
N
D
D
IA
G
N
O
S
T
IC
M
A
N
A
G
E
M
E
N
T
A
N
D
A
C
C
E
S
S
T
O
C
A
R
E
, T
R
E
A
T
M
E
N
T
A
N
D
S
U
P
P
O
R
T
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
3
.3
.2
E
st
ab
lis
h
re
fe
rr
al
n
et
w
or
k
fo
r
ps
yc
ho
so
ci
al
su
pp
or
t
M
O
H
/P
E
P
FA
R
3
.4
.3
E
nc
ou
ra
g
e
pu
bl
ic
p
riv
at
e
pa
rt
ne
rs
hi
p
3
.5
D
es
ig
n
an
d
im
pl
em
en
t
in
st
itu
tio
n
tr
ai
ni
ng
pr
og
ra
m
m
es
f
or
H
IV
/
A
ID
S
t
re
at
m
en
t,
ca
re
a
nd
su
pp
or
t
3
.5
.1
D
ev
el
op
a
nd
im
pl
em
en
t
cu
rr
ic
ul
um
f
or
p
re
–
se
rv
ic
e
H
IV
t
ra
in
in
g
p
ro
g
ra
m
m
e
an
d
po
st
–
g
ra
du
at
e
tr
ai
ni
ng
p
ro
g
ra
m
m
es
a
t
ce
nt
ra
l a
nd
re
g
io
na
l l
ev
el
s
fo
r
th
e
m
ul
ti-
di
sc
ip
lin
ar
y
te
am
M
O
H
/P
E
P
FA
R
3
.5
.2
R
ev
ie
w
, r
ev
is
e
an
d
im
pl
em
en
t
cu
rr
ic
ul
um
o
f
g
ra
du
at
e
tr
ai
ni
ng
p
ro
g
ra
m
m
es
M
O
H
3
.6
E
xp
an
d
co
m
pr
eh
en
si
ve
ca
re
f
or
o
pp
or
tu
ni
st
ic
in
fe
ct
io
ns
3
.6
.1
S
tr
en
g
th
en
c
lin
ic
al
c
ar
e
fo
r
op
po
rt
un
is
tic
in
fe
ct
io
ns
a
t
pr
es
en
t
si
te
s
an
d
ex
pa
nd
t
o
ne
w
si
te
s
M
O
H
/G
FA
T
M
/P
A
H
O
3
.6
.2
R
ev
is
e/
re
vi
ew
p
ro
to
co
ls
f
or
o
pp
or
tu
ni
st
ic
in
fe
ct
io
ns
M
O
H
/G
FA
T
M
/P
A
H
O
3
.6
.3
D
ev
el
op
n
at
io
na
l c
om
m
un
ic
at
io
n
ca
m
pa
ig
n
fo
r
tr
ea
tm
en
t
an
d
ca
re
M
O
H
/G
FA
T
M
3
.7
S
tr
en
g
th
en
t
he
li
nk
be
tw
ee
n
th
e
T
B
a
nd
H
IV
/A
ID
S
/S
T
I
co
nt
ro
l
pr
og
ra
m
m
es
3
.7
.1
S
up
po
rt
in
cr
ea
se
d
sc
re
en
in
g
f
or
T
B
a
m
on
g
H
IV
po
si
tiv
e
pa
tie
nt
s
M
O
H
/G
FA
T
M
/P
A
H
O
C
on
tin
ue
s
on
p
6
0
60]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
R
IO
R
IT
Y
#
3
_C
L
IN
IC
A
L
A
N
D
D
IA
G
N
O
S
T
IC
M
A
N
A
G
E
M
E
N
T
A
N
D
A
C
C
E
S
S
T
O
C
A
R
E
, T
R
E
A
T
M
E
N
T
A
N
D
S
U
P
P
O
R
T
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
3
.7
.2
I
m
pr
ov
e
tr
ai
ni
ng
p
ro
g
ra
m
m
e
fo
r
st
af
f
M
O
H
/G
FA
T
M
/P
A
H
O
3
.7
.3
I
m
pr
ov
e
fa
ci
lit
ie
s
an
d
lo
g
is
tic
al
s
up
po
rt
M
O
H
/G
FA
T
M
3
.7
.4
S
up
po
rt
in
cr
ea
se
d
sc
re
en
in
g
f
or
H
IV
a
m
on
g
pa
tie
nt
s
w
ith
T
B
M
O
H
/G
FA
T
M
3
.8
I
m
pl
em
en
t
ac
tiv
iti
es
t
o
in
cr
ea
se
u
se
o
f
qu
al
ity
S
T
I/
H
IV
/A
ID
S
d
ia
g
no
st
ic
an
d
tr
ea
tm
en
t
se
rv
ic
es
P
er
ce
nt
o
f
pe
rs
on
s
w
ith
S
T
Is
w
ho
a
re
di
ag
no
se
d,
t
re
at
ed
, a
nd
c
ou
ns
el
ed
a
t
tr
ea
tm
en
t
si
te
s
ac
co
rd
in
g
t
o
na
tio
na
l
g
ui
de
lin
es
3
.8
.1
S
tr
en
g
th
en
S
T
I s
er
vi
ce
s
to
p
ro
vi
de
co
m
pr
eh
en
si
ve
c
ar
e
an
d
sy
nd
ro
m
ic
m
an
ag
em
en
t
fo
r
S
T
I
M
O
H
/H
S
D
U
/G
FA
T
M
N
um
be
r
of
p
er
so
ns
t
ra
in
ed
in
t
he
m
an
ag
em
en
t
of
S
T
Is
u
si
n
g
n
at
io
na
l
g
ui
de
lin
es
3
.8
.2
E
xp
an
d
th
e
po
ol
o
f
he
al
th
c
ar
e
w
or
ke
rs
t
ra
in
ed
in
s
yd
ro
m
ic
m
an
ag
em
en
t
M
O
H
/H
S
D
U
/G
FA
T
M
/P
E
P
FA
R
)
3
.8
.3
R
ev
ie
w
, u
pd
at
e
an
d
di
ss
em
in
at
e
g
ui
de
lin
es
,
pr
ot
oc
ol
s
an
d
tr
ai
ni
ng
, m
at
er
ia
l f
or
S
T
I
m
an
ag
em
en
t
in
b
ot
h
th
e
pu
bl
ic
a
nd
p
riv
at
e
se
ct
or
s
M
O
H
/H
S
D
U
/G
FA
T
M
/P
E
P
FA
R
3
.9
U
pg
ra
de
la
b
or
at
or
y
ca
pa
ci
ty
t
o
di
ag
no
se
a
nd
m
on
ito
r
H
IV
/A
ID
S
a
nd
as
so
ci
at
ed
o
pp
or
tu
ni
st
ic
in
fe
ct
io
ns
P
er
ce
nt
o
f
pa
tie
nt
s
on
A
R
V
s
w
ho
r
ec
ei
ve
C
D
4
t
es
tin
g
f
ol
lo
w
in
g
n
at
io
na
l A
R
V
tr
ea
tm
en
t
g
ui
de
lin
es
3
.9
.1
U
pg
ra
de
G
P
H
C
’s
f
ac
ili
ty
t
o
un
de
rt
ak
e
ad
di
tio
na
l
la
b
or
at
or
y
te
st
f
or
H
IV
, h
ae
m
at
ol
og
ic
al
, T
B
,
S
T
I,
B
io
ch
em
ic
al
, i
m
m
un
ol
og
ic
al
m
ar
ke
rs
a
nd
di
ag
no
si
s
of
o
pp
or
tu
ni
st
ic
in
fe
ct
io
ns
G
P
H
C
/W
B
/
P
E
P
FA
R
/P
A
H
O
N
um
be
r
of
p
er
so
ns
t
ra
in
ed
t
o
co
nd
uc
t
C
D
4
t
es
tin
g
3
.9
.2
S
tr
en
g
th
en
r
eg
io
na
l l
ab
s
to
c
on
du
ct
q
ua
lit
y
di
ag
no
si
s
of
H
IV
a
nd
o
pp
or
tu
ni
st
ic
in
fe
ct
io
ns
an
d
fo
r
tr
ea
tm
en
t
an
d
m
on
ito
rin
g
P
E
P
FA
R
/P
A
H
O
C
on
tin
ue
d
fr
om
p
5
9
Guyana National HIV/AIDS Strategic Plan 2007-2011
[61
P
R
IO
R
IT
Y
#
3
_C
L
IN
IC
A
L
A
N
D
D
IA
G
N
O
S
T
IC
M
A
N
A
G
E
M
E
N
T
A
N
D
A
C
C
E
S
S
T
O
C
A
R
E
, T
R
E
A
T
M
E
N
T
A
N
D
S
U
P
P
O
R
T
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
IN
D
IC
A
T
O
R
S
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
N
um
be
r
of
r
eg
io
na
l l
ab
s
w
ith
c
ap
ac
ity
t
o
do
C
D
4
3
.9
.3
F
in
al
is
e
an
d
im
pl
em
en
t
L
ab
S
tr
at
eg
ic
P
la
n
P
E
P
FA
R
/C
A
R
E
C
3
.9
.4
E
nh
an
ce
G
P
H
C
’s
c
ap
ac
ity
t
o
se
rv
e
as
a
Q
A
/
Q
C
/Q
I s
ite
f
or
t
es
ts
P
E
P
FA
R
3
.9
.5
T
ra
in
la
b
or
at
or
y
st
af
f
to
u
se
s
pe
ci
al
is
ed
m
et
ho
ds
fo
r
di
ag
no
si
s
an
d
m
on
ito
rin
g
o
f
H
IV
/A
ID
S
a
nd
re
la
te
d
is
su
es
a
t
th
e
po
st
g
ra
du
at
e
le
ve
l
M
O
H
/G
FA
T
M
3
.1
0
E
st
ab
lis
h
N
at
io
na
l
P
ub
lic
H
ea
lth
R
ef
er
en
ce
L
ab
or
at
or
y
3
.1
0
.1
C
on
st
ru
ct
n
at
io
na
l r
ef
er
en
ce
la
b
or
at
or
y
M
O
H
/
P
E
P
FA
R
S
tr
en
g
th
en
t
he
c
ap
ac
ity
o
f
th
e
qu
al
ity
a
ss
ur
–
an
ce
m
on
ito
rin
g
c
om
m
itt
ee
3
.1
0
.2
R
ev
ie
w
/u
pd
at
e
sy
st
em
s
fo
r
ce
rt
ifi
ca
t
io
n
3
.1
1
P
ro
cu
re
m
en
t
an
d
di
st
rib
ut
io
n
of
c
ar
e
an
d
tr
ea
tm
en
t
su
pp
lie
s
im
pr
ov
ed
(
co
m
m
od
iti
es
m
an
ag
em
en
t)
3
.1
1
.1
E
st
ab
lis
h
in
te
r-
ag
en
cy
c
ol
la
b
or
at
io
n
to
e
xp
e-
di
te
t
he
p
ro
ce
ss
o
f
pr
oc
ur
em
en
t
th
ro
ug
h
th
e
M
M
U
M
M
U
/G
F
/W
B
/P
E
P
FA
R
3
.1
1
.2
S
tr
en
g
th
en
t
he
m
an
ag
em
en
t
an
d
m
on
ito
rin
g
ca
pa
ci
ty
o
f
th
e
M
M
U
(
C
om
m
od
iti
es
M
an
ag
e-
m
en
t)
M
M
U
/G
F
/W
B
/P
E
P
FA
R
62]
Guyana National HIV/AIDS Strategic Plan 2007-2011
P
R
IO
R
IT
Y
#
4
_S
T
R
A
T
E
G
IC
I
N
F
O
R
M
A
T
IO
N
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
M
E
A
N
S
O
F
V
IR
IF
IC
A
T
IO
N
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
4
.1
S
tr
en
g
th
en
t
he
H
IV
/A
ID
S
su
rv
ei
lla
nc
e
sy
st
em
s
–
N
um
be
r
of
s
ur
ve
ill
an
ce
g
ui
de
lin
es
is
su
ed
–
N
um
be
r
of
s
ta
ff
t
ra
in
ed
in
su
rv
ei
lla
nc
e
–
N
um
be
r
of
r
eg
io
ns
w
ith
c
ap
ac
ity
t
o
co
nd
uc
t
su
rv
ei
lla
nc
e
–
N
um
be
r
of
r
ep
or
ts
d
is
se
m
in
at
ed
4
.1
.1
R
ev
ie
w
a
nd
u
pd
at
e
ex
is
tin
g
p
ro
to
co
ls
a
nd
g
ui
de
lin
es
f
or
H
IV
/A
ID
S
s
ur
ve
ill
an
ce
H
S
D
U
/M
O
H
/G
FA
T
M
/W
B
/P
A
H
O
4
.1
.2
E
m
pl
oy
a
nd
t
ra
in
s
ta
ff
a
t
na
tio
na
l a
nd
re
g
io
na
l l
ev
el
s
to
c
on
du
ct
H
IV
/A
ID
S
su
rv
ei
lla
nc
e
H
S
D
U
/M
O
H
/G
FA
T
M
/W
B
/P
A
H
O
4
.1
.3
R
eg
io
na
liz
e
th
e
H
IV
/A
ID
S
s
ur
ve
ill
an
ce
sy
st
em
H
S
D
U
/M
O
H
/G
FA
T
M
/W
B
/P
A
H
O
4
.1
.4
C
on
du
ct
r
eg
ul
ar
s
es
si
on
s
fo
r
th
e
re
vi
ew
of
s
ur
ve
ill
an
ce
a
nd
o
th
er
d
at
a
w
ith
k
ey
st
ak
eh
ol
de
rs
H
S
D
U
/M
O
H
/G
FA
T
M
/W
B
/P
A
H
O
4
.1
.5
P
re
pa
re
a
nd
d
is
se
m
in
at
e
re
g
ul
ar
r
ep
or
ts
o
f
th
e
re
su
lts
o
f
H
IV
/A
ID
S
s
ur
ve
ill
an
ce
H
S
D
U
/M
O
H
/G
FA
T
M
/W
B
/P
A
H
O
4
.2
D
ev
el
op
a
nd
im
pl
em
en
t
a
sy
st
em
f
or
m
on
ito
rin
g
a
nd
ev
al
ua
tin
g
t
he
r
es
po
ns
e
to
H
IV
/A
ID
S
–
N
at
io
na
l p
la
n
fo
r
M
&
E
–
#
o
f
st
af
f
em
pl
oy
ed
t
o
co
nd
uc
t
M
&
E
–
#
o
f
pe
rs
on
s
tr
ai
ne
d
in
M
&
E
–
N
at
io
na
l a
g
re
ed
u
po
n
da
ta
ba
se
4
.2
.1
D
ev
el
op
a
nd
d
is
se
m
in
at
e
a
na
tio
na
l M
&
E
P
la
n
M
O
H
/W
B
/G
A
F
TA
M
/P
A
H
O
/U
N
A
ID
S
4
.2
.2
Id
en
tif
y
at
t
he
n
at
io
na
l l
ev
el
a
u
ni
t
w
hi
ch
w
ill
b
e
re
sp
on
si
bl
e
fo
r
M
&
E
r
el
at
ed
t
o
H
IV
/A
ID
S
M
O
H
/W
B
/G
A
F
TA
M
/P
A
H
O
/U
N
A
ID
S
4
.2
.3
D
ev
el
op
a
nd
d
is
se
m
in
at
e
na
tio
na
l
g
ui
de
lin
es
o
n
sy
st
em
a
nd
t
oo
ls
f
or
t
he
m
on
ito
rin
g
t
he
r
es
po
ns
e
to
H
IV
/A
ID
S
M
O
H
/W
B
/G
A
F
TA
M
/P
A
H
O
/U
N
A
ID
S
Guyana National HIV/AIDS Strategic Plan 2007-2011
[63
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IT
Y
#
4
_S
T
R
A
T
E
G
IC
I
N
F
O
R
M
A
T
IO
N
B
R
O
A
D
S
T
R
A
T
E
G
IC
P
R
O
G
R
A
M
M
E
A
R
E
A
S
M
E
A
N
S
O
F
V
IR
IF
IC
A
T
IO
N
S
T
R
A
T
E
G
IC
A
R
E
A
S
L
E
A
D
A
G
E
N
C
Y
A
N
D
S
T
R
A
T
E
G
IC
P
A
R
T
N
E
R
(S
)
4
.2
.4
Id
en
tif
y
pr
io
rit
ie
s,
d
ev
el
op
a
nd
d
is
se
m
in
at
e
g
ui
de
lin
es
f
or
m
ea
su
rin
g
o
ut
co
m
es
a
nd
im
pa
ct
o
f
in
te
rv
en
tio
n
re
la
te
d
to
H
IV
/A
ID
S
M
O
H
/W
B
/G
A
F
TA
M
/P
A
H
O
/U
N
A
ID
S
4
.2
.5
E
m
pl
oy
a
nd
t
ra
in
s
ta
ff
a
t
th
e
na
tio
na
l a
nd
re
g
io
na
l l
ev
el
s
fo
r
m
on
ito
rin
g
a
nd
e
va
lu
at
io
n
M
O
H
/W
B
/G
A
F
TA
M
/P
A
H
O
/U
N
A
ID
S
4
.2
.6
Id
en
tif
y
an
d
es
ta
bl
is
h
a
na
tio
na
l s
ys
te
m
fo
r
th
e
st
or
ag
e
of
d
at
a
fo
r
m
on
ito
rin
g
an
d
ev
al
ua
tin
g
t
he
n
at
io
na
l r
es
po
ns
e
to
H
IV
/A
ID
S
M
O
H
/W
B
/G
A
F
TA
M
/P
A
H
O
/U
N
A
ID
S
4
.3
D
es
ig
n,
im
pl
em
en
t
an
d
di
ss
em
in
at
e
re
su
lts
o
f
sp
ec
ia
l
su
rv
ei
lla
nc
e
su
rv
ey
s
an
d
st
ud
ie
s
in
s
el
ec
te
d
g
ro
up
s
–
#
o
f
su
rv
ey
s
co
nd
uc
te
d
–
#
o
f
re
po
rt
s
di
ss
em
in
at
ed
–
#
o
f
pe
rs
on
s
tr
ai
ne
d
to
c
on
du
ct
sp
ec
ia
l s
ur
ve
ys
4
.3
.1
C
on
du
ct
H
IV
/A
ID
S
r
is
k
as
se
ss
m
en
t
su
rv
ey
s
to
c
ol
le
ct
in
fo
rm
at
io
n
on
a
tt
itu
de
s,
be
ha
vi
ou
rs
, s
ex
ua
l m
ix
in
g
p
at
te
rn
s,
he
al
th
f
ac
ili
tie
s
ut
ili
sa
tio
n,
a
nd
p
er
ce
iv
ed
in
te
rv
en
tio
n
ne
ed
s
am
on
g
d
efi
ne
d
ta
rg
et
g
ro
up
s
an
d
th
e
g
en
er
al
p
op
ul
at
io
n
M
O
H
/H
S
D
U
/P
E
P
FA
R
4
.3
.2
C
on
du
ct
b
eh
av
io
ur
al
s
ur
ve
ill
an
ce
s
ur
ve
ys
in
s
el
ec
te
d
g
ro
up
s
(in
a
nd
o
ut
-o
f
sc
ho
ol
yo
ut
hs
),
su
g
ar
w
or
ke
rs
; u
ni
fo
rm
ed
s
er
vi
ce
s
pe
rs
on
ne
l
M
O
H
/P
E
P
FA
R
4
.3
.3
C
on
du
ct
b
io
lo
g
ic
al
a
nd
b
eh
av
io
ur
al
su
rv
ei
lla
nc
e
su
rv
ey
s
am
on
g
M
S
M
a
nd
C
S
W
M
O
H
/P
E
P
FA
R
4
.3
.4
c
on
du
ct
a
nd
d
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64]
Guyana National HIV/AIDS Strategic Plan 2007-2011
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Guyana National HIV/AIDS Strategic Plan 2007-2011
[65
SECTION
5 MONITORING AND EVALUATION
To fully realize the strategic leadership of the GoG in reducing the spread of HIV/AIDS and in-
creasing the quality of life for PLWHA, a national monitoring and evaluation (M&E) plan has
been developed that will harmonise M&E efforts and ensure that the impact of the HIV/AIDS
epidemic and the effectiveness of the NSP are adequately monitored.* A set of core national
indicators that cut across all sectors and program areas has been established and will form the
basis of monitoring the national response to HIV/AIDS in Guyana.
The general purpose of the monitoring and evaluation plan is to:
■ Provide a framework that will be used to monitor and evaluate the coordinated national re-
sponse to HIV/AIDS;
■ Ensure consistent use of all indicators and appropriate linkages between all initiatives sup-
ported by the GoG, partners, and key stakeholders;
■ Ensure appropriate and sustainable linkages between data collection efforts by different stake-
holders.
The core indicators are summarized below in tabular form by program area. Consistent with
the NSP, the indicators have been grouped into the four key priority areas: Strengthen National
Capacity to Implement a Coordinated, Multi-Sectoral Response; Clinical and Diagnostic Man-
agement and Access to Care, Treatment, and Support; Reducing Risk and Vulnerability to HIV
Infection; and Surveillance and Research.
LEVEL & AREA INDICATORS REF DATA SOURCE
IMPACT
Proportion of all deaths at-
tributable to AIDS
Imp1 Vital registration system and
program reports
Percentage of adults and
children with HIV alive and
known to be on treatment
12 months after initiation
of ART
Imp2 Vital registration system and
program reports
HIV prevalence among
women aged 15-24
Imp3 Sentinel surveillance at ANC
sites
HIV prevalence among most-
at-risk populations
Imp4 BSS/AIS with HIV testing
and sentinel surveillance at
STI and TB sites
Percent of infants born to
HIV-infected mothers who
are infected
Imp5 Program reports and facility
surveys
* The national M&E plan
is published as a separate
document and is entitled the
“National Monitoring and
Evaluation Plan for the
Multi-Sectoral Response to
HIV/AIDS in the Co-opera-
tive Republic of Guyana.”
66]
Guyana National HIV/AIDS Strategic Plan 2007-2011
LEVEL & AREA INDICATORS REF DATA SOURCE
PROGRAM OUTPUTS
Priority 1: Strengthen National Capacity to Implement a Coordinated, Multi-Sectoral
Response
Policy Formation National composite policy
index
Nc1 NCPI questionnaire
Policy Formation Percent of schools with
teachers who have been
trained in life-skills based
HIV/AIDS education and
who taught it during the last
academic year
Nc2 School survey
Partnerships/Multi-
sectoral Response
Number of line ministries
with HIV work plans and
budgets
Nc3 Special survey of Line
Ministries
Priority 2: Clinical and Diagnostic Management and Access to Care, Treatment, and
Support
Access to ART Percent of persons with
advanced HIV infection
receiving ART
Cts1 Program reports and facility
surveys
Number and percent of
regions with at least one
service outlet providing ART
services following national
standards
Cts2 Program reports and facility
surveys
VCT Percent of the general
population aged 15-49
receiving HIV test results in
the past 12 months
Cts4 AIS
Number of individuals
trained in the provision of
VCT according to national
guidelines
Cts5 Program reports and facility
surveys
Home and Palliative
Care (HPC)
Number of regions with
service outlets that provide
HPC
Cts6 Program reports and facility
surveys
Number of service outlets
that provide HPC
Cts7 Program reports and facility
surveys
Number of persons trained
to provide HPC according to
national guidelines
Cts8 Program reports and facility
surveys
Number of persons who
receive HPC following
national guidelines
Cts9 Program reports and facility
surveys
OIs and STIs Percent of men and
women with STIs at health
care facilities who are
appropriately diagnosed,
treated, and counseled
Cts10 Program reports and facility
surveys
Guyana National HIV/AIDS Strategic Plan 2007-2011
[67
LEVEL & AREA INDICATORS REF DATA SOURCE
OIs and STIs Number of persons trained
in the management of
STIs according to national
guidelines
Cts11 Program reports and facility
surveys
Tuberculosis Percent of HIV-positive
registered TB patients given
ART during TB treatment
Cts12 Program reports and facility
surveys
Percent of registered TB
patients tested for HIV
Cts13 Program reports and facility
surveys
Lab Support Percent of patients on ARVs
who receive regular CD4
monitoring following national
ARV treatment guidelines
Cts14 Program reports and facility
surveys
Number of regional labs
with the capacity to perform
CD4 tests following national
standards
Cts15 Program reports and facility
surveys
Number of persons trained
to conduct CD4 testing
according to national
guidelines
Cts16 Program reports and facility
surveys
Priority Area 3: Reducing Risk and Vulnerability to HIV infection
IEC/BCC Percent of never-married
youth aged 15-24 who ever
had sex
Pv1 BSS & MICS
Percent of youth aged 15-24
reporting use of a condom
during last sexual intercourse
with a nonregular partner
Pv2 BSS & AIS & MICS
Percent of people aged
15-49 expressing accepting
attitudes toward people with
HIV/AIDS
Pv3 BSS & AIS & MICS
Percent of people aged
15-24 who correctly identify
ways of preventing the sexual
transmission of HIV and who
reject major misconceptions
about HIV transmission
Pv4 BSS & AIS & MICS
Number of condoms distrib-
uted in the past 12 months
Pv5 Program reports and facility
surveys
PMTCT Number of service outlets
that offer PMTCT services
Pv6 Program reports and facility
surveys
Number of pregnant women
who receive HIV counseling
and testing for PMTCT and
received their results
Pv7 Program reports and facility
surveys
68]
Guyana National HIV/AIDS Strategic Plan 2007-2011
LEVEL & AREA INDICATORS REF DATA SOURCE
PMTCT Percent of HIV-infected
pregnant women who receive
a complete course of ARV
prophylaxis as part of PMTCT
Pv8 Program reports and facility
surveys
Number of health workers
trained in the provision of
PMTCT according to national
guidelines
Pv9 Program reports and facility
surveys
Percent of babies born to
HIV-positive women who are
tested before age 18 months
Pv10 Program reports and facility
surveys
OVC Percent of OVC whose
households receive free, ba-
sic external support in caring
for the child
Pv11 MICS
Number of providers trained
in the provision of care for
OVC
Pv12 Program reports and facility
surveys
Ratio of current school at-
tendance among orphans
to that among non-orphans
aged 10-14
Pv13 AIS
Priority Area 4: Surveillance and Research
Percent of service outlets
with record-keeping systems
to monitor HIV/AIDS care
and treatment
Sr1 SPA
Number of persons trained in
strategic information (moni-
toring and evaluation and/or
surveillance and/or HMIS)
Sr2
Program reports and facility
surveys
Guyana National HIV/AIDS Strategic Plan 2007-2011
[69
SECTION
5 NEXT STEPS – THE WAY FORWARD
To make this plan a reality and move the process forward a detailed workplan with its attendant
budget needs to be developed in partnership with the representatives from the various minis-
tries, the donors and other stakeholders. This document is crucial since the National Strategic
Plan will be of limited use until the donors can align their financial resources with the strategic
priorities. Once this occurs, then implementation can begin and the beneficiaries will receive
the support needed for their programmes and intervention activities. For Guyana to achieve its
goal and to achieve the optimum use of resources in support of the programme, harmonisation
has to occur at the national level with respect to the coordination and alignment of activities.
Co-ordination among partners is also essential to ensure the smooth implementation of the
Strategic Plan.
70]
Guyana National HIV/AIDS Strategic Plan 2007-2011
REFERENCES AND DOCUMENTS
CONSULTED
■ PAHO Workshop Report, The Guyana HIV/AIDS Care and Treatment Plan, May 2005
■ President’s Emergency Plan for AIDS Relief, Guyana 2004-2005 Strategy
■ CHRC Assessment Report of the National HIV/AIDS Programme of Guyana, 2004
■ Guyana’s National HIV/AIDS Strategy Plan 2002-2006
■ Francois-Xavier Bagnoud Center – University of Medicine & Dentistry of New Jersey (FXB)
Guyana Quarterly Activity Report, April-June, 2005, 1st Quarter FY05
■ Facts Sheet on Care and Treatment, Guyana, updated April 2005
■ Project Grant Agreement between The Global Fund to Fight AIDS, Tuberculosis and Ma-
laria and the Ministry of Health, “National Initiative to Accelerate Access to Prevention,
Treatment, Care and Support for Persons Affected by HIV/AIDS” GYA-304-G01-H
■ PAHO/MOH Workshop Report , The Guyana HIV/AIDS Care and Treatment Plan, April
28-29, 2005
■ The National Behaviour Change Communication Strategy of Guyana (Draft) USAID/
GHARP, 4th August, 2005;
■ USAID/FHI Guyana HIV/AIDS Program implementing The President’s International
PMTCT Initiative (PPI) Final Report
■ Workshop Report, National HIV/AIDS- BCC Strategy for Guyana Georgetown, July 20-
22, 2005 Prepared by Sharda Ganga (Consultant to PAHO-Guyana office)
■ PAHO/MOH Workshop Report, Laboratory Support and Blood Safety, 2 – 3 August 2005
■ PAHO/MOH Workshop Report, Orphans and Vulnerable Children, 10 August 2005
■ World Bank Project Information Document (pid) Aappraisal Stage Report No.: AB458 Proj-
ect Name: HIV/AIDS Prevention & Control Project, Guyana, Prepared January 9, 2004
■ PAHO/MOH Workshop Report, Guyana HBC Strategic Planning, 28-29 July, 2005.
■ PAHO/MOH Workshop Report, The Guyana Voluntary Counselling and Testing Gap
Analysis, 29 – 30 June 2005
■ UN System Strategic Framework on HIV and AIDS 2006–2010, UNAIDS/PCB(17)/05.525
May 2005
■ The Guyana Poverty Reduction Strategy Paper, International Monetary Fund, August 2002
■ UNAIDS, Resource Needs for an Expanded Response to AIDS in Low and Middle Income
Countries, Discussion Paper,‘Making the Money Work’ The Three Ones in Action London,
United Kingdom, 9 March 2005
■ Ministry of Education, HIV/AIDS Sector Plan, June 5, 2005
■ Guidelines for Implementing a Multi-sectoral Approach to HIV/AIDS in Commonwealth
Countries, revised version, Commonwealth Secretariat, March 2003
■ Global Health-Sector Strategy for HIV/AIDS 2003-2007; Providing a Framework for Part-
nership and Action, Department of HIV/AIDS, WHO,2003
■ Human-capacity plan for scaling up HIV/AIDS treatment, Treat 3 million by 2005, WHO
2003;
■ Emergency scale-up of antiretroviral therapy in resource-limited setting: technical and opera-
tional recommendations to achieve 3 by 5, UNAIDS/WHO 2004.
Guyana National HIV/AIDS Strategic Plan 2007-2011
[71
The following persons participated in the development of the Guyana National Strategic Plan
2006-2010 from early on through the participation at the gap analysis workshops and by provid-
ing comments to the first draft of the Strategy.
■ Bernadette Abrams, Nurse, Hope for All
■ Clifford Accra, Administrator, Joshua Children Center
■ Audrey Adams, Director Health Visitor, Mayor Counsellor
■ Oswald Alleyne, M&E & Research Officer, GHARP
■ Nafeza Ally, Social Services Coordinator, Global Fund HIV/AIDS Prevention
■ Amanda Anderson, Counsellor/Tester, GPHC/VCT
■ Colleen Anderson, PMTCT/VCT Officer, GHARP
■ Dr. Frank Anthony, Executive Director, Health Sector Development Unit, MOH
■ Dr. Chuka Anude, Chief of Party, FXB/CDC
■ Dennis Arends, Programme Coordinator, UNICEF
■ Dr. Enias Baganizi, 3 by 5 Project Manager, PAHO/WHO
■ Trisha Bellamy, Medical Technologist, Woodlands Hospital
■ Basil Benn, Director, Linden Care Foundation
■ Lynette Berkeley, Laboratory Manager, CAREC
■ Kathryn Boryc, Youth Friendly Services Coordinator, Ministry of Health
■ Andrew Boyle, Director/Chairman, Eureka Laboratory/GAMLAP
■ Rita Brouet, Social Worker, Hope Foundation
■ Feyon Brumell, Social Worker, Lifeline Counselling Services
■ Chetram Budhu, Medical Doctor, Ministry of Health
■ Shondell Butters-Belfield, Project Coordinator, Hope For All
■ Mena Carto, Program Officer, Technical Services, CDC/FXB, Rapporteur for workshops
■ Shawndelle Charles-Gouveia, Project Coordinator, Comforting Hearts
■ Paulette Clarke, Deputy Chief Health Visitor, Mayor and City Council
■ Asiah Camacho, Social Worker/Counsellor, St. Joseph Mercy Hospital
■ Lucia Maria Costa Monteiro, Director, Adolescent Health, Ministry of Health
■ Emily Cumberbatch, Project Coordinator, CSIH
■ Allison Daniels, Senior Secretary, UNICEF
■ Dr. Dennison Davis, Director, Standards and Technical Services, Ministry of Health
■ Gloria De Caires, Chair, National Aids Committee
■ Michel De Groulard, Country Coordinator, UNAIDS
■ Dr. A. Devi, Medical Officer, St. Joseph’s Mercy Hospital
■ Bhoghkumarie Doodnauth, Medical Technologist, Mercy Hospital laboratory
■ Lilet Drepaul, Secretary/Treasurer, Canaan Children’s Home
■ Dr. Nybia Farinas, Scientific Laboratory Director, Central Medical Laboratory
■ Juliana Farley, Assistant Project Coordinator, Hope for All
■ Alex Foster, President, St. Francis Community Developers
LIST OF CONTRIBUTORS AND THEIR
AFFILIATIONS
72]
Guyana National HIV/AIDS Strategic Plan 2007-2011
■ Catherine Fraser, Counsellor/Tester, St. Francis Community Developers
■ Edris George, USAID
■ Dr. Karen Gordon Boyle, Community and Clinical Care Officer, GHARP
■ Patricia Gray, Chief Probation and Welfare Officer (Ag.), Ministry of Human Services
■ Mohammed Hamid, Technical Officer, UNICEF
■ Onix Hackett, Counselor/Tester, Lifeline Counseling Services
■ Keerti Hardowar, Executive Council Member, Volunteer Youth Corps
■ Lynette Hardy, Senior Laboratory Technical, FBX/CDC
■ Youlanda Hendricks, Medical Student, St. Joseph’s Mercy Hospital
■ Debra Henry, Senior Health Visitor, Ministry of Health
■ Nicolette Henry, PDO Blood Safety, CDC/GAP
■ Shellon Henry, Prevention and Care Associate, GHARP
■ Dexter Holder, Counselor/Tester, Linden Care Foundation
■ Nazim Hussain, Community Mobilization Coordinator, HSDU/World Bank/Global Fund
■ Yvette Irving, National Coordinator/Laboratory Director, Medical Laboratory Service,
Ministry of Health
■ Dr. Bizuayehu Jeffrey, Deputy Chief Medical Officer, Mayor and City Council
■ Dr. Curtis La Fleur, Technical Coordinator, CSIH
■ Grace Layne-Pitt, Project Assistant, Lifeline Counselling Services
■ Dr. Douglas Lyon, Chief of Party, CDC
■ Susanne Marquis-Hamel, Project Manager, CSIH
■ Dr. Clement McEwan, Medical Director, National Blood Transfusion Service
■ Edgar McNab, Laboratory Manager, CDC/FXB
■ Ivor Melville, Director, Hope Foundation
■ Camach Mohammed, Clinical Supervisor (Ag.), Guyana Responsible Parenthood Associa-
tion
■ Dr. Mallika Mootoo, Pediatrician, St. Joseph’s Mercy Hospital
■ Dr. Jomo Osborne, Technical Officer, GHARP
■ Ms. Bhagmattie Persaud, Administrative Assistant, PAHO/WHO
■ Dr. Navindra Persaud, M & E Director, GHARP
■ Nicholas Persaud, HIV/STI Counselor, Ministry of Health
■ Dr. Shamdeo Persaud, Director of Disease Control Department, MOH
■ Charlotte Picard, Administsrative Manager, Red Cross Children’s Convalescent Home
■ Julia Rehwinkel, Population Nutrition & Health Officer, USAID
■ Dr. Colin Anthony Roach, Project Development Officer, Quality Assurance, CDC
■ Oonah Wendel Roberts, Counselor/Tester, GHARP
■ Samantha Rodrigues, Public Relations/Monitoring Officer, Guyana Responsible Parenthood
Association
■ Angela Ross, Counselor/Tester, Lifeline
■ Deserne Sandy, Counselor, Roadside Baptist Skills Centre
■ Lall Bahadur Singh, Senior Drug Inspector, Food and Drugs
■ Dr. Narine Singh, Medical Superintendent, Region 2
■ Serena Singh, Laboratory Manager, Georgetown Medical Centre Inc.
■ Dr. Shanti Singh, Director, GUM Clinic
Guyana National HIV/AIDS Strategic Plan 2007-2011
[73
■ Derrick Springer, Orise Fellow, CDC
■ Jack Spencer, Management Consultant, CDC
■ Marlyn Subryan, VCT Coordinator, Hope Foundation
■ Paulette Sydney, Counselor/Tester, Linden Care Foundation
■ Nicola Taylor, Consultant, Trinidad & Tobago
■ Pamela Teichman, Regional Technical Advisor for LAC, USAID, Washington, DC
■ Lisa Thompson, OVC Officer, GHARP
■ Debra Vitalis, National PMTCT Coordinator, Ministry of Health
■ Keeran Williams, Linden Care
■ Thibaut Williams, Programme Manager, AIDS Relief/CRS
■ Alexis Wilson-Pearson, Senior Medical Technician, Central Medical Laboratory
■ Terry Witkus, Coordinator, Stemming the Tide Project, St. Joseph’s Mercy Hospital
■ Dr. Janice Woolford, Director, Maternal & Child Health Department, MOH
■ Sheila Yaw-Fraser, Program Director (Ag.), Guyana Responsible Parenthood Association
© Guyana Ministry of Health, 2006
This document was produced and printed with technical and financial support from PAHO/WHO.
The mention of specific companies or of certain manufacturers’ products does not imply that they
are endorsed or recommended by the Pan American Health Organization in preference to others
of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary
products are distinguished by initial capital letters.G
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MINISTRY OF HEALTH
Submitted to: Dr. Bheri Ramsaran, Minister of Health, Guyana
.
Submitted by: Dr. Shanti Singh, Programme Manger, NAPS/
MoH.
May 2012.
END OF TERM REVIEW
GUYANA NATIONAL
HIV/AIDS STRATEGY
2007-
201
1
Government of Guyana , National AIDS Programme Secretariat
G o v e r n m e n t o f G u y a n a
N a t i o n a l A I D S P r o g r a m m e S e c r e t a r i a t
Page 2
TABLE OF CONTENTS
List of Acronyms P4-8
Technical Review and Writing Team P9
Foreword P10
Acknowledgments P11
Executive Summary P12
Introduction P13
Objectives of the End of Term Review P13
Methodology P14
Outline of the Report P15
Section One:
VI: Status of the Epidemic P16
VI:1 Sex distribution of HIV and AIDS Cases P18
VI:2 Age Distribution P19
VI:3 Spatial Distribution of HIV and AIDS P21
VI:4 AIDS Related Mortality P21
Section Two:
VII: Priority Area 1: Strengthen the National Capacity to Implement a Coordinated National
Response P25
Section Three:
VIII: Priority Area 2: Reducing Risk and Vulnerability to HIV Infection P33
Section Four:
IX: Priority Area 3: Clinical and Diagnostic Management and Access to Care, Treatment an
d
Support P56
Section Five:
X: Priority Area 4: Strategic Information P74
Section Six:
XI: Summary of Findings by Programmatic Area P81-82
XII: Summary of Findings by Targets P82-83
Section Seven:
XII: Considerations for HIVISION 2020 P90-91
XIV: Conclusion P91
Appendix A: List of Contributors P92-93
Appendix B: Key Informant Interview Questionnaire P94-101
G o v e r n m e n t o f G u y a n a
N a t i o n a l A I D S P r o g r a m m e S e c r e t a r i a t
Page
3
TABLES AND FIGURES
Table 1: HIV prevalence among Key Populations in Guyana P17
Table 2: Trends in Reported Cases of HIV and AIDS by Sex, 2002-2011 P19
Table 3: Distribution of HIV cases by Age-group 2006-2011 P20
Table 4: Proportion of HIV cases by Region 2006-2011 P21
Table 5: Annual Number and Proportion of AIDS-Related Deaths P21
Table 6: Summary of Overall Progress 2007-2011 -Targets and Indicators P22-24
Table 7: Summary of Programmatic Achievements-Priority Area 1 P26-30
Table 8: Strengthening the national capacity to implement a coordinated multi-sectoral response P31-32
Table 9: Summary of Programmatic Achievements – Priority Area 2 P34-44
Table 10: Summary of Priority 2 Targets and Indicators 2007-2010 (Prevention PV) P45-55
Table 11: Summary of Programmatic Achievements – Priority Area 3 P57-67
Table 12: Summary of Priority 3 Targets and Indicators 2007-2011 (Care, Treatment and Support
CTS) P68-73
Table 13: Summary of Programmatic Achievements- Priority Area 4 P75-79
Table 14: Summary of Priority 4 Targets and Indicators 2007-2010 (Surveillance SR) P80
Table 15: Non Measurement of Cumulative Achievements P83-84
Table 16: measurements of Cumulative Achievements P85-89
Table 17: Summary of ratings of achievements by Priority Area P89
Figure 1: HIV Prevalence among various populations P16
Figure 2: Annual cases of HIV and AIDS, 2002-2011 P18
Figure 3: Proportion of HIV cases among Youth, 2006-2011 P20
G o v e r n m e n t o f G u y a n a
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4
LIST OF ACRONMYS
ADT Anti-Retroviral Dispensing Tool
AIDS Acquired Human Immune Deficiency Syndrom
e
ANC Antenatal Clinic
ARV Anti-Retroviral
BBSS Biological and Behavioural Surveillance Survey
BCC Behavior Change Communication
BRHA Berbice Regional Health Authority
BSS Behavioural Surveillance Survey
CAREC Caribbean Epidemiology Cente
r
CBO Community Based Organisation
CCM Country Coordinating Mechanism
CDC US Center for Disease Prevention and Control
CHW Community Health Worker
CME Continuing Medical Education
CML Central Medical Laboratory
CRIS Country Response Information System
CRS Catholic Relief Services
CSO Civil Society Organisation
CSS Client Satisfaction Survey
CSW Commercial Sex Worker
DNA De-oxyriboneucleic Acid
DPT Digital Proficiency Testing
EPP Estimation& Projection Package
ERC Electronic Resources Centre
ETR End of Term Review
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FBO Faith Based Organisation
FCSW Female Commercial Sex Worker
FSW Female Sex Worker
FXB Francois Xavier Bagnoud
GBCHA Guyana Business Coalition Association
GF Global Fund
GHARP Guyana HIV/ AIDS Reduction And Prevention Project
GOG Government of Guyana
GPHC Guyana Public Hospital Co-operation
GUYBOW Guyana Rainbow Foundation
GUYEXPO Guyana Exposition
GUYSUCO Guyana Sugar Cooperation
HAPSAT HIV/AIDS Programme Sustainability Analysis Tool
HBC Home Base Care
HCG HIV Clinician Group
HCW Health Care Worker
HFLE Health and Family Life Education
HIS Health Information System
HIV Human Immuno -Deficiency Virus
HMIS Health Management Information System
HPC Home and Palliative Care
HR Human Resource
HSDU Health Sector Development Unit
HTLV Human T-Lymphotropic Virus
ICT Information Communication and Technology
IEC Information, Education, Communication
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ILO International Labour Organisation
ITECH International Training and Education Center
JDG Joint Donor Group
L&D Leadership and Development
LHC Linden Hospital Complex
LSP Laboratory Strategic Plan
M&E Monitoring and Evaluation
MARP Most At-Risk
Population
MCH Maternal and Child Health
MCYS Ministry of Culture, Youth and Sport
MERG Monitoring and Evaluation Reference Group
MMU Materials Management Unit
MoE Ministry of Education
MOH Ministry of Health
MOLH&SS Ministry of Labour, Human Services & Social Society
MSH Management Science For Health
MSM Men Who Have Sex With Men
MTR Mid Term Review
NAC National AIDS Committee
NAPS
National AIDS Programme Secretariat
NASA National AIDS Spending Assessment
NCC Network for Community Commitment
NCTC National Care And Treatment Centre
NGO Non-Governmental Organisation
NHIVP National HIV Programme
NPHRL National Public Health Reference Laboratory
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NPOC National Procurement Oversight Committee
NSP National Strategic Plan
NTP National Tuberculosis Programme
NWT National Week of Testing
OI Opportunistic Infection
OVC Orphans and Vulnerable Children
PAHO Pan-American Health Organisation
PANCAP Pan Caribbean Partnership on HIV and AIDS
PCHA Presidential Commission on HIV and AIDS
PCR Polymerase Chain Reaction
PEPFAR US President’s Emergency Plan for AIDS Relief
PLHIV Persons Living With
HIV
PLWHAs People Living with HIV and AIDS
PMTCT Prevention of Mother to Child Transmission
PrEP Pre Exposure Prophylaxis
PSA Public Service Announcement
PUSH Positively United to Support Humanity
QA Quality Assurance
QC Quality Control
QI Quality Improvement
RAC Regional AIDS Committee
RDQA Routine Data Quality Assessment
RNCF Radio Needy Children Fund
SASOD The Society against Sexual Orientation and
Discrimination
SCMS Supply Chain Management System
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SOP Standard Operating Procedure
STI Sexual Transmitted Infection
TB Tuberculosis
TOR Terms of References
TST Tuberculin Skin Test
TWG Technical Working Group
UNAIDS Joint United Nations Programme on HIV and AIDS
UNFPA United Nations Population Fund
UNGASS United Nations General Assembly Special Session
UNICEF United Nations Children’s Fund
VCT Voluntary Counseling and Testing
WAD Women Across Differences
WB World Bank
WHO World Health Organisation
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TECHNICAL REVIEW AND WRITING TEAM
Dr. Shanti Singh- Programme Manager, MoH/NAPS- Principal Lead.
Miss Jennifer Ganesh- BCC Coordinator, MoH/NAPS
Mr. Nicholas Persaud- National Care and Treatment Programme, MoH/NAPS
Miss Shevonne Benn- National Home Base Care Coordinator, MoH/NAPS
Miss Nafeza Ally, Social Services Coordinator, MoH/NAPS
Miss Fiona Persaud, M&E Lead, MoH/NAPS
Miss Sophia Collier- Data Analyst, M&E, MoH/NAPS.
Dr. Bendita Lachmansingh – Epidemiologist, MoH/NAPS
Mr. Somdatt Ramessar- Food Bank Manager, MoH/NAPS
Miss Deborah Success- National VCT Coordinator, MoH/NAPS
Mr. Nazimul Hussain- Community Mobilisation Coordiantor, MoH/NAPS
Miss Elizabeth McAlmont – MARPS Coordinator, MoH/NAPS
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FOREWORD
The National HIV/AIDS response over the five years of 2007-2011 under the auspices of the National AIDS
Programme Secretariat received tremendous support from key stakeholders including the broader Ministry
of Health, other line ministries and government agencies, the private sector, the donor community and civil
society organizations. These years noted expansion in the strategic areas of programme implementation as
outlined in its NSP: Programme Coordination, Prevention, Care, Treatment and Support and Monitoring
and Evaluation. Surveillance data showed a continued reduction in the number of notified HIV cases
generally and with a stabilization and reduction in cases of pregnant women testing positive.
Coverage of the Prevention programme was expanded through the increased number of VCT and
PMTCT
sites linking to an increase in access with over 95 % coverage of test for pregnant women. Whilst 100
%
of
condoms distribution was not achieved, there has been an increase in the availability and access to
condoms in all administrative regions of Guyana. BCC initiatives addressed a wide variety of issues and
targeted the general as well as specific populations considered to be at a higher risk for HIV. Coverage for
the prevention efforts and access to services for some of the MARPS populations increased through the
significant inroads made by CSOs working with these groups. Key Coalitions such as the GBCHA and the
GFCHA were established.
Access to Care and Treatment increase covering all ten administrative regions of Guyana with significant
improvements in treatment outcomes. Larger proportions of persons eligible for, receive ARVS and survival
rates have increased. Legislation in support of OVCs was enacted and PLHIV benefitted from economic,
nutritional, and psycho social and other forms of support.
Of significant importance is the progress made in Monitoring and Evaluation. A fully staffed M&E Unit was
in place at the NAPS. The Unit was able to contribute towards effectively completing internal reports and
meeting external reporting requirements and participated in special surveys and research and in some case
led these studies. Biological and Behavioral surveillance Surveys were conducted among special
populations and Guyana‟s first Demographic Household Survey was done.
Although progress was achieved and Guyana was able to under this NSP 2007-2011 reverse and stabilize
the HIV epidemic, much still needs to be done. Focus as we move forward need to be placed on ensuring
that the gains made are sustained and importantly that the issues financial sustainability is addressed. At a
legislative and policy level, the issue of the HIV legislations needs to treated with priority. Programme areas
are now required to refocus their efforts from responding to an emergency to consolidating the gains made
and to ensure that value for money is guaranteed.
Dr. Shanti Singh
Programme Manager,
National AIDS Programme Secretariat
Ministry of Health
NAPS Mission Statement: To prevent the transmission and mitigate the impact of HIV/AIDS/STIs through a coordinated
national response that provides high quality services ensuring optimal health for all.
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ACKNOWLEDGEMENTS
The Ministry of Health, National AIDS Programme Secretariat expresses its profound gratitude to the
following individuals and organisations:
The Government of Guyana for its unwavering support and commitment to the HIV response.
The Honourable Minister, Dr. Bheri Ramsaran for his leadership and clear guidance to our work.
The Honourable Minister of Agriculture, Dr. Leslie Ramsammy ( former Minister of Health) for his
leadership, commitment and dedication to the HIV response not only over the last five year but throughout
his tenure as the Minister of Health
.
Mr. Hydar Ally, the former Permanent Secretary of the Ministry of Health.
Mr. Leslie Codogan, Permanent Secretary, Ministry of Health, and all other staff of MoH
All Clinical Staff and other field Staff.
Thanks to the staff of the National AIDS Programme for dedication and commitment to this response
not
merely as a job, but as real cause worth fighting for.
Very special thanks to all of our partners and donors who have contributed financially and technically and
who have placed their trust in us in knowing that Guyana can make a difference. Thanks to the US
Government and all of its partners (USAID, CDC, FXB, SCMS, ITECH and all others), The Global Fund, the
World Bank, the UN Family (UNAIDS, UNICEF, PAHO, UNDP, UNFPA, ILO and all others), to PANCAP,
the Clinton Foundation and all others who have made our successes possible.
Thanks to the Guyana Private Sector for working with us in ensuring that our workforce remains healthy.
Thanks to everyone who has contributed to the HIV response, our combined efforts have yielded results.
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1. EXECUTIVE SUMMARY
The End of Term Review of the 2007- 2011, National HIV/AIDS Strategic Plan confirms the significant
progress made in achieving universal access to HIV/AIDS prevention, treatment, care and support
programmes in Guyana.
The End of Term review process was commissioned by the Ministry of Health, National AIDS Programme
Secretariat with the main objective of reviewing programme progress according to the agreed priority areas
and activities, and indicators and targets.
It builds on the Mid Term Review recommendations to successfully reach agreed targets and serves part of
an important monitoring and evaluation framework to keep the HIV/AIDS response on track.
This End of Term Review document is therefore an indicative landmark to how far Guyana has come in
terms of the HIV response, where we are now and where we need to be going as it will serve to inform the
New National HIV/AIDS Strategy 2011-2020.
The Guyana programme includes all components in the fight against HIV/AIDS and is coordinated by the
National AIDS Programme Secretariat which is also responsible for rolling-out the various programmes.
The NHIVS review process was led by the NAPS and focused on the strategic activities for each indicator
under each of the broad strategic priority area as outlined in the NHIVS. The achievement for each of the
strategic activities was rated as one of the following: overachieved, fully achieved, partially achieved,
achieved or not achieved.
There are forty four (44) National M&E Indicators as per the National Monitoring and Evaluation Plan for the
Multi-Sectoral Response to HIV and AIDS in Guyana 2007-2011. These indicators were developed to
monitor and evaluate the HIV response in Guyana accordingly with each of the four (4) priority areas in the
Guyana National HIV/AIDS Strategic Plan 2007-2011.
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I. INTRODUCTION
The Guyana‟s response to HIV commenced once the first AIDS case was diagnosed in 1987. Since then
the Ministry with its stakeholder embarked on a multi-sectoral response to this serious public threat. The
National Strategic plan of 2007-2011 was the third strategic plan under the response. It was the first plan
that truly described a more comprehensive understanding of the local HIV epidemic and projected for a
intensive, multi-sectoral response.
The NSP 2007-2011 was implemented with a wide stakeholder involvement, with significant financial
contributions from the international donors. Guyana‟s programme has annual reported improvements.
With the conclusion of the NSP 2007-2011, it is critical understand the five years achievements, to highlight
the successes and to identify areas of gaps. Even more importantly the findings of ETR are important in
providing guidance in the development of the new NSP, HIVision2020.
II. OBJECTIVES OF THE END OF TERM REVIEW
The review will serve the following:
1. To understand the impact made during the five years period through an examination of the
epidemiological situation.
2. To provide an understanding of the level of achievement of the National Strategic Plan 20
07-2011
through the examination of its priority areas.
3. To understand the degree of achievement and the impact of the interventions through the
measurement of the indicators of the National Monitoring and Evaluation Plan.
4. To identify the areas of gaps in the implementation of the NSP.
5. To identify and document best practices under the NSP.
6. To identify challenges experienced in the implementation of the NSP.
7. To identify gaps under the priority areas that would inform the New NSP.
8. To solicit guidance and identify priorities areas for the development of the new National Strategic
Plan HIVision 2020.
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III. METHODOLOGY
To comprehensively evaluate the progress made, the review employed the following steps:
1. Review of key documents inclusive of the NAPS annual reports, the Universal Access and
UNGASS reports, PMTCT, Blood Banking, National TB and other relevant department annual
reports, report of the midterm review of the NSP and others.
2. Review of progress and achievements by the Ministry of Health. This was conducted this review in
the second and third quarters of 2011. A first draft of the report prepared.
3. Key informant interviews. This was conducted through the administration of a structured
questionnaire to a cross section of partners and stakeholders. A total of 30 persons were
interviewed. The results of the interviews were incorporated into the report.
4. Consultation with stakeholders in smaller targeted sessions as follows:
National Prevention Reference Group Meeting- 22nd February 2012.
NSP Steering Committee Meeting- 27th February 2012.
National Care and Treatment Technical Working Group Meeting- March 7th 2012
Monitoring and Evaluation Reference Group Meeting- 12th March 2012.
Focus Group sessions with PLHIVs (26th March 2012), FCSW (27th March 2012), MSM (27th
March 2012).
During these focus group sessions a total of 24 persons living with HIV, 26 men who have sex with men
and 19 female commercial sex workers participated. Feedback from these sessions was then incorporated
into the draft report. This generated a final draft.
5. Presentation of the findings at a National Stakeholders Consultation- April 12th 2012. Final draft
presented at the National Stakeholders Consultation and feedback incorporated to generate the
final report. A total of 44 persons attended the consultation and provided feedback.
6. Final report prepared and submitted to the Minister of Heath by April 30th 2012.
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IV. OUTLINE OF THE REPORT
The report would be structured in seven sections.
Section 1 of the report describes the Status of the Epidemic at the end of 2011. Epidemiological and
Surveillance data is presented for the five years period with trends described. Data presented are also
disaggregated by gender, agegroup and other variable to allow for a deeper understanding of the epidemic
and the results of the response.
Sections 2, 3, 4 and 5 of the report examine the status of progress made in the broad strategic
programme
areas and specifically the strategic activities under the relevant priority areas. Linked to the narrative report
are the results for all indicators in the National Monitoring and Evaluation Plan under the appropriate priority
areas of the NSP. The results for the indicators captures the entire period of the NSP.
Section 6 of the report summaries the findings according to the specific programmatic area and targets
Section 7 of the report highlights the priorities advanced for consideration in the development of the
HIVision2020.
Outline of Report
Section 1: Status of the Epidemic; Results of Key Impact Indicators
Achievements against programme areas
Section 2: Priority Area 1: Strengthening the National Capacity to Implement a Coordinated
Multi-Sectoral Response.
Section 3: Priority 2: Reducing Risk and Vulnerability to HIV Infection
Section 4: Priority 3: Clinical and Diagnostic Management and Access to Care, Treatment
and Support
Section 5: Priority 4: Strategic Information
Section 6: Summary of Findings (Programme Area and Targets)
Section 7: Priorities for HIVision 2020
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SECTION ONE: VI: STATUS OF THE EPIDEMIC
Adult HIV Prevalence has been on a steady decline over the past eight years. The most recent estimation
exercise conducted for 2011 revealed HIV prevalence among adults 15-49 of 1.1 percent (Spectrum/EPP
4.47). This represented a decrease from 2.4 percent in 2004 and 1.2 percent in 2009 (UNAIDS Estimates).
According to PMTCT programme data, HIV prevalence among pregnant women was maintained around 1
percent between 2009 and 2011. In 2010, 5.8 percent of babies born to HIV-positive mothers were
infected with HIV and 1.9 percent in 2011. HIV prevalence among blood donors was 0.2 percent in 2010
and 0.1 percent in 2011.
The 2009 Biologic Behavioral Surveillance Survey (BBSS) showed a sharp decrease (38%) in the HIV
prevalence among female sex workers (FSWs), from 26.6 percent (BBSS, 2005) to 16.6 percent (BBSS,
2009). In contrast only a slight decrease was observed among MSM, from 21.2 percent (BBSS, 2005) to
19.4 percent (BBSS, 2009). Figure 1 shows the most recent prevalence rates among key populations.
Figure 1: HIV Prevalence among various populations
23.4%
19.4%
16.6%
5.2%
3.9%
2.7%
1.1%
1.1%
0.1%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
TB Patien ts
MSM
FSW
Priso ners
Miners
Security Guards
Adult Prevalence
Pregnant Wo men
Blood Donors
HIV Prevalence
Year of prevalence: Blood donors, Pregnant women, Adult Prevalence, TB patients- 2011; FSW and MSM- 2009; Security
Guards and Prisoners- 2004; Miner- 2003
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A pattern of decreasing prevalence among key populations is illustrated in Table 1. The significant increase
in the proportion of voluntary blood donors and improved screening of potential donors have contributed to
the decreasing pattern observed among this group. The trend over the last eight years shows that the co-
infection prevalence among TB-HIV patients is decreasing.
Table 1: HIV Prevalence among Key Populations in Guyana
POPULATION SEX YEAR PREVALENCE REMARKS
Pregnant Women
Female 2004 2.3 ANC Survey
2006 1.6 ANC Survey
2003 3.1 PMTCT Programme Report
2004 2.5
2005 2.2
2006 1.6
2007 1.4
2008 1.2
2009 1.1
2010 0.9
2011 1.1
Blood Donors All 2004 0.7 Blood Bank Programme Reports
2005 0.9
2006 0.4
2007 0.3
2008 0.5
2009 0.2
2010 0.2
2011 0.1
Sex Workers Female 1997 45.0 Special Survey
2005 26.6
BBSS
2009 16.6 BBSS
MSM Male 2005 21.3 BBSS
2009 19.4 BBSS
TB Patients All 1997 14.5 Chest Clinic Records
2003 30.2
2004 11.2
2005 30.2
2006 33.2
2007 35.3
2008 22.0
2009 28.0
2010 26.0
2011 23.4
Miners Male 2000 6.5 Special Survey One mine study
2003 3.9 Special Survey 22 mines study
Security Guards All 2008 2.7 BBSS
Prisoners All 2008 5.24 BBSS
* 52%, 82% and 67% of TB patients were tested for HIV in 2004, 2005 and 2006 respectively
Source: National AIDS Programme Secretariat, 2011
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Since the first reported case of AIDS in 1987, there has been a progressive increase in the number of
reported cases over the years. A
cumulative
total of 9,473 cases of HIV and 1,899 cases of AIDS were
reported to the Ministry of Health for the period 2002-2011. The number of new AIDS cases has
progressively decreased since 2004. There were 972 cases of HIV and 62 cases of AIDS reported in 2011.
These are illustrated in Figure 2.
Figure 2: Annual Cases of HIV and AIDS, 2002-2011
VI.1 Sex Distribution of HIV and AIDS Cases
The male to female ratio for HIV cases has been fluctuating over the past four years. While HIV appears to
have initially been most prevalent among males, the infection has been transmitted to increasing numbers
of women. By 2003, the annual number of reported cases of HIV was higher among females and remained
so until 2008 when the male female ratio was 0.91. The situation was again reversed in 2010 and 2011
when more females were diagnosed with HIV, with a male to female ratio of 0.8 in both years. This trend is
illustrated in Table 2.
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Table 2: Trends in Reported Cases of HIV and AIDS by Sex, 2002 – 2011
CLASSIFICATION 2002 2003 2004 2005
2006 2007 2008 2009 2010 2011
HIV Male 301 339 368 325 591 422 446 600 449 432
Female 268 368 408 421 626 531 490 567 547 517
Unknown 39 55 61 36 41 40 23 9 43 23
Total 608 762 837 809 1,258 993 959 1176 1039 972
Sex Ratio 1.1 0.9 0.9 0.8 0.9 0.8 0.9 1.1 0.8 0.8
AIDS Male 243 232 117 58 99 80 14 21 86 41
Female 146 163 204 77 68 49 8 21 58 21
Unknown 26 22 27 7 5 1 2 1 2 0
Total 415 417 348 142 172 130 24 43 146 62
Sex Ratio 1.7 1.4 0.6 0.8 1.5 1.6 1.8 1.0 1.5 2.0
TOTAL
HIV
&AIDS
1,023 1,179 1,185 951 1,430 1,123 983 1,219 1,185 1,034
Source: Ministry of Health Statistics Unit and NAPS
VI.2. Age Distribution of HIV Cases
Whilst there are variations within the specific age groups, consistently more than three quarters of HIV
cases are reported in the combined age group of 20-49, which is considered the productive workforce.
Notable increases were observed among the age-groups 15-19 and 20-24 (in and out of school youth) in
2010 but there was a marked reduction in cases within these age groups in 2011. There was also an
increase in cases in the 30-34 in 2010 and 2011. The highest proportion of reported cases of HIV has been
occurring in the 30-34 age-group, as shown in Table 3.
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Table 3: Distribution of HIV Cases by Age-group 2006 – 2011
PROPORTION OF HIV CASES BY AGE GROUP 2006-2011
Age group in years 2006 2007 2008 2009 2010 2011
0-1 1.75 0.10 0.00 0.09 0.01 2.26
1-4 0.00 1.60 0.52 0.76 0.48 0.51
5 -14 1.66 2.50 1.56 1.19 0.87 0.93
15-19 3.60 3.80 2.91 6.04 6.83 4.01
20-24 12.00 10.70 11.47 11.56 17.52 13.68
25-29 17.00 16.30 17.30 13.69 12.80 13.27
30-34 19.60 19.60 18.03 17.35 18.58 18.10
35-39 15.34 15.70 16.37 16.83 13.67 15.23
40-44 11.00 11.40 11.05 12.15 11.93 11.52
45-49 7.00 6.00 7.30 8.93 6.54 8.54
50-54 4.50 3.70 5.01 4.08 4.04 5.66
55-59 2.25 2.70 2.19 2.55 2.60 4.12
60+ 1.03 2.60 3.44 2.12 2.02 2.16
Unknown 3.34 3.10 2.81 2.63 2.02 0.
00
Figure 3: Proportion of HIV Cases among Youth, 2006 – 2011
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VI.3. Spatial Distribution of HIV and AIDS
Region 4 continues to account for the largest proportion of notified HIV cases; reaching over 70% by 2011.
There have been fluctuations across the other regions over the past six years. However, the coastal
regions (2, 3, 5, 6 and part of 10) have stood out in terms of the proportion of reported HIV cases which
may be attributed mainly to the accessibility of the prevention programme in these regions as compared to
the hinterland regions which face challenges because of the difficult terrain associated with these
locations.The spatial distribution of HIV cases is illustrated in Table 4.
Table 4: Proportion of HIV Cases by Region 2006 – 2011
Region
Total
Population
% of
population
2006 2007 2008 2009 2010 2011
1 24,275 3.2 0.2 0.1 0.5 0.9 0.6 0.8
2 49,253 6.6 4.6 3.8 3.9 2.6 1.3 4.1
3 103,061 13.7 6.8 7.4 8.2 10.6 10.7 2.7
4 310,320 41.3 65.2 66.2 59.1 56.3 71.5 70.8
5 52,428 7.0 2.3 3.7 1.7 2.7 2.6 9.0
6 123,695 16.6 10.5 7.6 9.7 9.9 7.4 2.8
7 17,597 2.3 2.5 1.8 1.6 2.4 1.6 4.9
8 10,095 1.3 0.1 0.4 0.1 0.5 0.3 1.1
9 19,387 2.6 0.3 0.4 0.3 0.0 0.3 0.4
10 41,112 5.5 4.0 4.3 3.7 3.1 2.5 0.1
Unknown 0 0 3.7 4.2 11.1 10.8 1.3 3.3
Total 751,223 100.0 100.0 100.0 100.0 100.0 100.0 100
VI.4. AIDS-Related Mortality
The proportion of all deaths attributable to AIDS has declined from 9.5 percent in 2002 to 4.7 percent in
2008 and 4.2 percent in 2009. The actual number of AIDS-related deaths has also generally declined as
illustrated in Table 5. According to the Ministry of Health‟s 2008 Statistical Bulletin, AIDS-related deaths
have been among the top ten causes of deaths in Guyana, ranking at number 5 in 2006 and moving to
number 6 at the end of 2008.
Table 5: Annual Number and Proportion of AIDS-Related
Deaths
Year % of AIDS Related Deaths No. of AIDS Related
Deaths
Rate per 1,000 population
2002 9.5 475 0.6
2003 8.0 399 0.5
2004 7.1 356 0.5
2005 6.86 360 0.5
2006 5.9 298 0.4
2007 5.7 289 0.4
2008 4.7 237 0.3
2009 4.2 192 0.2
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Table 6: Summary of Overall Progress 2007-2011 – Targets and
Indicators
Summary of Overall Progress against key impact indicators and targets 2007-2011 (Impact IMP)
No. Indicators Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achiev
ement:
2007-
2011
Remarks
-2006 Target Results Target Results
Target Results Target Results Target Results
IMP1 Proportion
of all deaths
attributable
to AIDS
6.90% 6.40% 5.70% 6.20% 4.80% 6.00% 4.20% 5.80% N/A 5.60% NA 78.70%
Data for death is
not available for
2010 or 2011
from the Ministry
of Health,
Surveillance
Department.
IMP2 Percentage
of adults
and
children
with HIV
still alive 12
months
after the
initiation of
ARV
therapy
77.60% 78.50% 74.50% 79.50% NA 80.50% 72.20% 82.00% 80.70% 85% 80.40% 94.40%
IMP3 HIV
Prevalence
among
women
aged 15-24
1% <1% 1.3%
(177/
13605)
<1% 1.20%
(180/
15702)
<1%
1.10%
(130/
11776)
<1% 0.90%
(101/
11441)
<1% 0.9%
(116/1
3490)
1.06%
(704/
66014)
This figure is
based on
programme data
for all pregnant
women and is for
all women
accessing ANC
services. Data
not
disaggregated for
the 15-24 age
group.
IMP4 HIV Prevalence among most at risk populations
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Table 6: Summary of Overall Progress 2007-2011 – Targets and Indicators
Summary of Overall Progress against key impact indicators and targets 2007-2011 (Impact IMP)
No. Indicators Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achiev
ement:
2007-
2011
Remarks
-2006 Target Results Target Results Target Results Target Results Target Results
Prevalence
Among
MSM
21.25% – – – 19.40% 20% 19.40% 19% NA Rg4:
17.5%;
Nationa
l: 15%
NA 97%
Prevalence
among
CSW
26.60% – – 24% 15.00% 22.50% 16.60% 20% NA 18.70% NA 68.10%
Prevalence
among
mobile
populations
(miners)
3.90% – – – NA 3.20% NA – NA 3.00% NA Unable
to
calculat
e
Achieve
ment
Prevalence
among
male STI
patients
17.30% 17% NA 16.50% NA 16.00% 13.30% 15.00% 14.10% 15% 11.70% 85.00% All data
obtained
primarily from
NCTC
Prevalence
among
female STI
patients
16.90% 16.50% NA 16.00% NA 15.50% 10.90% 15.00% 13.00% 15.00% 9.00% 72.30% All data
obtained
primarily from
NCTC
Prevalence
among TB
patients
24% 25% 35.20% 25% 22.00% 22.50% 28.00% 20.00% 26.00% 18.70% 23.40% 121.70
%
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Table 6: Summary of Overall Progress 2007-2011 – Targets and Indicators
Summary of Overall Progress against key impact indicators and targets 2007-2011 (Impact IMP)
No. Indicators Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achiev
ement:
2007-
2011
Remarks
-2006 Target Results Target Results Target Results Target Results Target Results
IMP5 Percentage
of infants
born to HIV
infected
mothers
who are
infected
15% 14.00% 0% 13.00% 4.00% 3.50% 8.80% 3.00% 5.80% 2.70% 1.90% Unable
to
calculat
e
Achieve
ment
IMP6 Ratio of
current
school
attendance
among
orphans to
that among
non
orphans
age 10-14
– 1:01 NA 1:01 NA 1:01 – 1:01 – 1:01 NA Unable
to
calcula
te
Achiev
ement
Source of
Data:
MICS. Type of
Data: not
cumulative
MICS sample
size was too
small for this
indicator to
statistically cal.
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SECTION TWO:
VII.PRIORITY AREA 1: STRENGHTEN THE NATIONAL CAPACITY TO IMPLEMENT A COORINDATED
NATIONAL RESPONSE
Strategic Objectives:
1. Strengthen institutional capacity to effectively coordinate the multi-sectoral response through
implementation of the Three Ones Principles.
2. Strengthen human capacity to effectively coordinate and manage the multi-sectoral response.
3. Strengthen regional capacity to implement and manage HIV/AIDS interventions
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Table 7: Summary of programmatic achievements- Priority Area 1.
Broad Strategic
Programme Areas
Strategic Areas Activities/Achievements Additional Comments
1.1 PCHA, HSDU &
NAPS empowered to
coordinate Guyana’s
national
HIV/AIDS
multi-sectoral response
1.1.1 Strengthen the
leadership and programme
management capacity of the
PCHA, HSDU and NAPS
Training was conducted for MoH Staff on Project
Management with the University of Guyana, Staff were
trained in Public Health (Masters Degree with the London
School of Tropical Medicine and Hygiene). Training was
also conducted in leadership by GHARP using the MSH
module adapted for the Guyana context. Staff were also
trained with the Caribbean Health Leadership Institute on
Leadership in Public Health.
Linked to the capacity building, the programme generated
regular prescribed reports such as the Presidential
Commission Report on HIV and AIDS, the UNGASS,
Universal Access, Report on the Elimination Initiative and
other National and International Reports.
The strengthened leadership led to enhanced coordination with the
efficient functioning of existing mechanisms and with the establishment of
others. These include the Country Coordinating Mechanism, the NACC,
the GFCHA, GBCHA.
At a technical level several mechanisms established (National Care and
Treatment Working group, VCT Steering Committee, OVC Steering
Committee, HBC Steering Committee, The National Monitoring and
Evaluation Reference Working Group, the National Prevention Reference
group and others) also facilitated the coordination at the technical levels.
1.1.2 Define functions, roles,
responsibilities and reporting
relationships between
HSDU, NAPS, PCHA as
well as the Health Theme
Group/Partnership Forum
The organization of the multisectoral response was defined
with roles and responsibilities and reporting relationships
clearly determined.
The NAPS is seen as the lead coordinating agency for the response.
1.1.3 Review/update TORs,
and membership of the NAC
and RACs in light of the
scaled up response
The NAC continues to function with regular quarterly
meetings of its executive body. The RAC established at
regional levels throughout the country also functions and
are involved in advocacy , particularly on human rights
issues.
Many CSOs in country are working with HIV. Under the World Bank
project of the Ministry of Health, more than 40 NGOS were sub-recipients
and coordinating mechanism was established whereby these CSO
organisations met once per month. With the conclusion of the World Bank
project, this no longer takes place. Through the PEPFAR/GHARP a NCC
(Network for Community Commitment) was established with a steering
committee. The NCC met and continues to meet on a monthly basis. The
NCC has worked with stakeholders in ensuring CSO participation at
various for a such as the representation at one the Country Coordinating
Mechanism
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1.2 Integrate HIV/AIDS
into the programmes
and services offered by
other ministries
1.2.1 Provide technical
assistance in programme
management to the line
ministries to develop their
annual sectoral work plans
There are 16 line ministries with work plans and budgets
supported by the World Bank. All Line Ministries operated
with HIV Focal Points who were trained in programme
management, proposal development, workplanning,
monitoring and evaluation and in fiscal management. The
focal Points were responsible for the implementation of the
HIV workplans within each line Ministry. Coordination of
the work of the Line Ministries was achieved through
monthly meetings.
Major key Ministries were involved including the Ministry of Education,
Local Government, Home Affairs, Housing and Water, Labour, Human
Services and Social Security, Foreign Trade, Agriculture, Amerindian
Affairs, Culture, Youth and Sport, Public Service Ministry. Other key
parastatal agencies also implemented HIV work plans and included
GUYSUCO, Land and Surveys, Mayor and City Council, Guyana National
Newspapers Limited, Berbice Regional Health Authority and others.
1.2.2 Support the
implementation of the
HIV/AIDS Strategy for the
Amerindian population
The Ministry of Amerindian Affairs has been a key Ministry
in the implementation of a response to HIV among the
indigenous population and particularly in regions 1, 7, 8
and 9. Support was provided to the Ministry of Amerindian
Affairs in providing the evidence for programming, in the
implementation of programmes , particularly in regards to
prevention services ( outreaches, HIV testing) and through
the primary health care system in the provision of clinical
services for persons testing services.
The Ministry of Amerindian Affairs in ensuring a comprehensive
approach of its response, collaborates with key agencies such as the
National AIDS Programme Secretariat, the UN Agencies, CSO ( Youth
Challenge Guyana, The Guyana Red Cross, Remote Area Medical) and
other key Ministries ( Ministry of Local Government and Regional
Development, Ministry of Education and others).
1.3 Harmonize and
align resources to
ensure efficient use of
donor funding
1.3.1 Establish/strengthen
mechanism to streamline
the allocation of resources
from the donor agencies
A milestone of the Guyana HIV response has been the
implementation of the „three ones‟ principles by the
government and its partners leading to overall
coordination. Several high level mechanisms exist to
ensure that alignment occurs including the CCM and the
Policy Level Meeting between the Ministry of Health and
the PEPFAR programme. Additionally other joint donor
mechanisms such as the Health Thematic Group and the
Joint Donors Group Meeting were also instrumental in
coordination of financial resources.
Alignment was also facilitated through the costing of the National
Strategic Plan and the Operational Plan to the Monitoring and Evaluation
(M&E) Plan.
1.3.2 Monitor and evaluate
the utilization of resources
The Ministry of Health produces financial reports on a
regular basis to the Ministry of Finance. Regular financial
reports are also prepared for the Global Fund projects and
shared with the country coordinating mechanism and are
posted the global fund website-www.theglobalfund.org.
The Ministry conducted its second NASA, however that
report is still being prepared. An assessment on HIV
sustainability utilizing the HAPSAT tool was conducted and
provided important information for sustainability and
alignment.
Financial reports are not received from all agencies working in the HIV
response. However some submission of financial data was done for the
second NASA exercise ( report being prepared)
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1.3.3 Implement the
recommendations for Three
Ones implementation and of
the Global task Team on
Improving AIDS
Coordination among
Multilateral Institutions and
International donors
The „three ones‟ principles are being implemented by the
government and its partners. Several key international
agencies coordinate with the Government of Guyana in
ensuring that their agendas and priorities are aligned with
the NSP and the National Monitoring and Evaluation Plan.
The partners and donors involved include the PEPFAR programme, the
GF, the WB, the UN family and CSOs.
1.3.4 Effectively provide
surveillance, GOG and
donor programme planning,
and key activities using
Electronic Resource Centre
(ERC)
The Ministry of Health utilizes a database used for
capturing HIV surveillance data. This data is reported to
and posted on the CAREC website on a quarterly basis.
Additionally all programme areas utilize various methods in
ensuring that data is captured, reported and used for
planning. The HIV website was established in 2005
houses a wealth of information, toolkits and key
documents.
In addition to Surveillance data, technical Areas under the National
Programme also collect, analyze and use the data for programme
planning. These include the treatment, voluntary counseling and testing
and others.
1.4 Increase the
involvement of civil
society organizations
and the private sector in
the scaled up response
1.4.1 Provide technical
assistance with the
development of workplace
policies with a focus on
stigma and discrimination
HIV/AIDS Work Place Policy was developed patterned
after the ILO workplace Policy and being implemented.
There are 54 companies participating in HIV/AIDS
Workplace Education Programme which rejects stigma and
discrimination in the workplace. In addition the GBCHA
support the policy implementation in the private sector
workplace and 44 private companies have signed on to
workplace policies.
This work is done in close collaboration between the Ministry of Labour
and the ILO.
1.4.2 Provide technical
assistance with the
development of workplace
programme for prevention,
care and support
Technical assistance to the roll out of the Workplace
Programme has been provided through various partners
such as GHAPR I and GHARP II and through various
NGOS. The Guyana Business Coalition on HIV/AIDS
provides technical support to 44 companies which are
actively involved in prevention, care and support. There
are 54 companies participating in the HIV/AIDS workplace
policy developed jointly by Ministry of Labour and the
International Labour Organisation (ILO)
A spin off effect of the engagement of the private sector is their
involvement in contributing to the food bank initiative. A total of 26 private
sector companies at the end of 2010 covered approximately one quarter
of the needs of the food bank for 2010 in providing 4,715 hampers to
1,437 persons requiring support. For 2011, this trend continued with 4500
hampers distributed to 1087 patients with 30 private sector contributing
25.5% of the Food Bank needs.
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1.4.3 Provide training in
programme management for
these groups to strengthen
the capacity of their
organizations to respond
Repeated training was conducted in programme
management, proposal writing, monitoring, evaluation and
reporting and in fiscal management. Particular focus was
placed on newly established grass roots community based
organizations for capacity building, whilst ongoing
continued assistance was given to all other NGOs.
Capacity building in addition to the areas noted above also
was provided in leadership.
The number of CSOs working in HIV has increased over
the years and the scope of work has expanded to capture
almost all areas of HIV Prevention, Care and Support.
These NGOs are in all Administrative Regions of the
country covering HIV sensitization, education,
interpersonal communication, HIV testing and counseling,
care and support for PLHIVs and for OVCs .
A recent mapping exercise conducted by the NAPS, documented 73
NGOs, CBOs, FBOs working in the 10 administrative regions of Guyana.
1.4.4 Expand the number of
civil society organizations
involved in implementing
HIV/AIDS activities in the
regions
1.4.5 Build capacities of
newly formed NGOs to
develop proposals and
access funding
1.5 Advocate for a legal
and policy environment
that protects the rights
of people living with
HIV/AIDS and
vulnerable groups
1.5.1 Revise existing legal
framework, National
HIV/AIDS Policy and
prepare new health
legislation to combat all
aspects of discrimination
relative to HIV/AIDS
The National HIV policy was reviewed, revised and
disseminated.
A draft of HIV legislation is available for review and
finalization.
1.5.2 Create mechanisms to
stimulate advocacy by
informing senior decision
makers of the social and
economic impact of
HIV/AIDS on National
Development
There continues to be high political commitment to the HIV
response. This is demonstrated at events of the NWT and
WAD, where senior officials and decision makers are
integrally involved.
Mechanisms for stimulating advocacy include the
dissemination of information- PCHA, UNGASS process
and others.
1.6 Review the National
Response to the
HIV/AIDS
1.6.1 Conduct mid-term
review of the National
Strategic Plan
Stakeholder review conducted and included the National
and Regional Consultations of Health Care Workers,
Representatives of CSO, PLHIV, Faith based communities
and others. Report prepared and findings were used to
revisit targets for the follow up three years.
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1.6.2 Conduct a
Government-led
participatory review of the
National AIDS Response
Initial Review conducted by the MOH/ NAPS. Process
also included consultations with relevant TWGs, with
relevant communities (PLHIVs, MSM, CSW) and with the
wider stakeholder. The findings of the End of Term Review
would inform the development of Guyana‟s next Strategic
Plan.
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Priority Area 1: Strengthening the national capacity to implement a coordinated multi-sectoral response
Table 8: Summary of Priority 1 targets and indicators 2007-2011 (National Capacity NC)
INDICATORS Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achievement:2007-
2011
Remarks
-2006 Target Results Target Results Target Results Target Results Target Results
NC1 Amount of
National funds
allocated by
Government
for HIV
prevention and
care
USD
$503,805
NA
A second NASA was
conducted. Report is
being prepared.
NC2 Implementation
of the three
ones principles
Yes Yes Yes Guyana has fully
implemented the three
ones. A CHAT was
embarked on in
collaboration with
UNAIDS and the
report is to be
prepared.
NC3 National
Composite
Policy Index
Completed
This was prepared for
the last two UNGASS
reports and for the
country progress
report of 2010/11. See
UNGASS report
available on
www.hiv.gov.gy
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NC4 Percentage of
schools with
teachers who
have been
trained in life
skills based
HIV education
and who taught
it during the
last academic
year
– NA – 61.6% of
teachers
trained
in life
skills
– NA 70.00% 75.00% NA
In 2008, there was no
target set.
*results from the draft
Ministry of Education
Teachers survey
report. In 2010 a total
of 32 schools taught
HFLE.
NC5 Number of Line
Ministries with
HIV work plans
and budgets
7 11 11 14 16 16 17 18 16 20 NA 102.40% The decline in the
number of Line
Ministries in the last
year under review is
attributed to the
conclusion of the
World Bank support to
Line Ministries.
Arrangements are
being made for this
support to be
transitioned to under
the Global Fund Grant.
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SECTION THREE:
VIII: PRIORITY AREA 2- REDUCING RISK AND VULNERABILITY TO HIV INFECTION
Strategic Objectives:
1. Decrease misconceptions and discriminatory behaviors and increase knowledge and access to
prevention services
2. Reduce sexual transmission of HIV infection with a focus on most at-risk populations and their
partners through delayed sexual debut, reduced partner change and number, increase condom
use, and promotion of treatment adherence
3. Reduce mother-to-child transmission of HIV infection
4. Reduce the risk for transmission in medical settings
5. Reducing the socio-economic impact of HIV/AIDS and increase protection for OVCs
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Table 9: Summary of Programmatic achievements-Priority Area 2.
Broad Strategic
Programme Areas
Strategic Areas Activities/Achievements Additional Comments
2.1 Design and
implement
Communication
Programme on
HIV/AIDS
2.1.1 Develop and
implement National
behaviour change
strategy to reduce stigma
and discrimination
related to HIV/AIDS
BCC strategy was developed, printed, disseminated and used to guide implementation. One of the key components
of the BCC Strategy is the Creation of an Enabling Environment for persons living with and affected by HIV. The
effective implementation of this programme led to the involvement of NGO/FBO/CBO programs; reduction of stigma
and discrimination; policy-related advocacy; workplace/private sector programs; links to economic/social programs.
Another key element of the strategy was the identification of the MARPS groups and definition of key strategies to
work with the MARPS. CSOs were funded to implement these among the MSM and FCSW and this has resulted in
a reduction of the HIV prevalence among these groups as noted in the two rounds of the BBSS reports.
Between the period 2007-2010 a total of 775,599 IEC materials were distributed in the form of brochures, posters,
booklets etc. Messages of HIV prevention, stigma reduction, encouraging early HIV testing, Delaying onset of
intercourse; decreasing number of partners; increasing condom use; recognition of early symptoms of sexually
transmitted infections or HIV; How to access treatment for HIV; the importance of having a healthy lifestyle for HIV
positive individuals; the importance of adherence to antiretroviral drugs; decreasing the risk and vulnerability of
women to HIV; Increasing community involvement towards HIV prevention & reduction of stigma; decreasing
opportunistic infections in persons living with HIV; prevention of TB/HIV Co-infection. The BCC awareness
campaigns are part of an integrated, multilevel, interactive process with communities and involves community
based reinforcement activities.
2.1.2 Use available data
to develop mass media
campaign to ensure that
all members of society
have information on
prevention, care and
treatment services
Several mass media campaigns were developed targeting various issues for various populations. Campaigns
included Prevention of STIs, PMTCT, Prevention with Positives, Greater involvement of Men, Involvement of
Religious groups, Youth adults and Children, TB/HIV co-infection, Women‟s empowerment and condom
negotiation, Adherence to ARVS, HIV risk reduction among MARPS, Increase condom use, early HIV testing,
Reduction on stigma and discrimination, Community involvement on HIV and AIDS, Early OI diagnosis and others.
Each campaign comprised of several components- PSA, radio announcement, brochures, posters, billboards,
lighted signs and documentary. These campaigns were widely disseminated via TV and other fora. The BBSS of
2004 and 2008/9 were both consulted in the development of mass media campaigns on prevention, care and
treatment services targeted at the general population and specified MARPS populations.
2.1.3 Encourage the
participation of NGOs,
CBOs and other partners
in the development and
implementation of the
behaviour change
interventions
Several NGOs, CBOs, FBOs, Partners (GHARP) are consulted and participate in the development and production
of BCC materials.
All NGOs, CBOs, FBOs, Partners (GHARP) are fully involved in implementing BCC interventions. Full access to all
BCC materials (audio/visual) is employed.
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2.1.4 Conduct
assessment and test
messages targeted
towards general and high
risk populations
This has been conducted for all messages done. Testing of the messages constitute a key element of the
contractual arrangements with the agency.
2.1.5 Train staff to
conduct health promotion
activities
The Ministry of Health has established a health promotion Unit. This Unit oversees health promotion for the Ministry
of Health and also provides technical support to the HIV promotional activities. Staff of the Unit have been trained
and retrained in various aspects of Health promotion.
2.2 Develop and
implement targeted
behaviour change
interventions to
increase positive sexual
practices and
encourage early
STI/HIV diagnosis and
treatment among most
vulnerable groups
2.2.1 Define and
prioritize populations to
be targeted
The MARPS and vulnerable populations were defined. The BCC National Strategy prioritized the populations by:
Female commercial sex workers; Men who have sex with men; People living with HIV/AIDS and those affected by
HIV/AIDS; Orphans and other vulnerable children; STI patients/clients; Health care workers; Policy makers; Out-of-
school youth; Mobile populations; In-School youth.
Additional populations include the General Population; Interior populations including Amerindians and Prisoners.
Targeted Behaviours change interventions were designed and implemented for the MSM and CSW populations
using the Evidence Based Intervention approach of CDC ( Centers for Disease Control) of Popular Opinion Leader.
This programme has been implemented by CSO in seven regions at the end of 2010 ( Regions 2,3, 4, 6, 7,8 and
10)
The programme has shown
significant results in the
number of persons reached
(1,192FCSW and 1,154
MSM), however there
needs to be a greater
understanding of the size of
the population. In this
regard ongoing efforts have
been made with assistance
from the partners to
develop a size estimation.
2.2.2 Use available data
to develop targeted
behaviour change
interventions for selected
high risk groups
Utilized data from BBSS of 2004 and 2008/9 to tailor BCC campaigns for selected MARPS and general populations.
Focus groups are done with the target populations. In most cases the target populations led the development of the
interventions. In the keep the lights on project and the other interventions developed using the popular opinion
leader model, members of the population were hired as full time staff and trained to provide an enabling
environment for their peers (condoms availability etc) and for the transfer of knowledge.
2.2.3 Use messages
designed to increase the
use of VCT services and
early treatment-seeking
for STIs and HIV/AIDS
Several campaigns were developed on early testing and early treatment seeking behaviours. Campaigns included
PSA for TV and Radio, posters, brochures, billboards, and documentaries. Indirectly linked to these specific
campaigns were additional campaigns addressing stigma and discrimination, community involvement, and others.
The results are demonstrated with the increasing number of HIV testing being done over the years.
Audio/Visual and IEC materials utilized both at the general population level and interpersonal at community level.
Number of persons tested
2007- 67,681,
2008- 86,983,
2009- 105,030
2010-112,627.
2.2.4 Develop “friendly”
services for youth and
most at risk populations
There are a total of 19 Youth Friendly Services outlets located in 5 regions of Guyana (3, 4, 5, 6 and 10). These
provide friendly services for all youth and particularly youth at a higher risk for
HIV.
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2.2.5 Develop peer
education programmes
for high risk youth, CSWs
and MSM
Peer education programmes were developed for these groups of persons. A total of 919 youths were trained as
peer educator and have subsequently reached 26,229 persons through interpersonal communication through the
National AIDS programme. More than 150 young persons were also trained as peer educator through the
adolescent health unit.
In regards to in-school youth- several programmes were instituted. The HFLE was strengthened with teachers
trained and teaching the subject in school. The school health programme expanded over the years with a total of 75
school health clubs across all ten administrative regions. This has led to the development of a network of regional
representatives and health club member with teachers. Manuals for the school health club initiative has been
developed with a focus on sexual and reproductive health inclusive of HIV and targets both teachers and students.
Additionally youth friendly health services were offered to the in school youth as noted above.
As part of the popular opinion leader programme, CSWs and MSM were trained as peer educators. Manuals for
both CSW and MSM developed for training as peer educators.
Hence, several groups of Sex workers and MSM have been trained and are functioning as peer educators to
discuss prevention and safer sex strategies with their peers.
Direct intervention with Female sex workers and MSM are currently being targeted in regions 2, 3, 4, 6, 7, 8 and 10
and work is being done to improve their access to HIV and STI-related services at „friendly‟. However, several
organizations have established networks through which they reach MSM and Sex Workers in all regions of Guyana.
Yearly average shows close to a total of 1,400 MSM and 1,000 CSW being reached with HIV prevention activities.
IEC materials were designed and developed to target the MARPS such as trigger tapes, documentaries, teaching
aides such as cue cards.
20 MSMs in Region 4 were trained in VCT Testing and Counseling and now rotate on a no-pay shift with Artistes in
Direct Support and to other CSO.
In regards to prisoners, the Ministry of Home Affairs has taken the lead with a well define HIV work plan covering
HIV prevention and ensuring HIV testing services for new entrants to the prison system and care treatment and
support for PHIV in the system.
2.2.6 Develop mass and
small media interventions
to promote the use of
risk-reduction sexual
health practices
BCC campaigns have been developed and implemented. Mass media and small Media interventions on risk
reduction was developed addressing stigma and discrimination, abstinence, condom use and early HIV testing.
Posters, television and radio advertisements, television documentaries on HIV have been produced and a radio
serial drama is ongoing with accompanying community-based reinforcement activities.
Community based activities utilizing „Edutainment‟ has been employed with campaigns such as „PUT IT ON‟ for
condoms. A total of 15 road shows were held across the country.
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2.3 Implement
prevention education
and behaviour change
reinforcement activities
2.3.1 Implement HFLE at
primary and secondary
levels
Several stakeholders, including the Ministry of Education, GHARPII (in 130 schools), the MoH, and the Health and
Family Life Education (HFLE) program conduct HIV prevention for in-school youth. HFLE, a Caribbean Community
(CARICOM) multi-agency activity, trained 2,000 teachers from 180 schools nationwide between 2006 and 2009.
A survey conducted on 73 schools found 62 percent delivered HFLE to all grades in the 2009 academic year.
UNICEF and other organizations carry out smaller initiatives whereby youth are reached by teachers and frequently
by peer educators. In addition to the formal HFLE programme, In school youths are also reached through the
school health clubs, youth clubs, faith-based organizations, and sports clubs. Further edutainment such as music
events, sports events, and story writing competitions are other types of HIV/AIDS outreach conducted targeting this
population.
2.3.2 Develop peer
education programmes
for youth
Peer Education work continued under this NSP. For the period of 2007-2010, a total of 919 young persons were
trained as peer educators by the naps and an additional of more than 150 trained by the AHU. Several initiatives
engaged the persons trained including the “Me to You, Reach One, Save One” campaign where a total of 26,299
persons were reached through interpersonal communication. Persons trained as peer educators also provide
support to major public initiatives such as the National Week of HIV testing, World AIDS Day, GUYEXPO, MASH
and others.
A total of 919 youths were
trained as peer educators (
2007-250, 2008- 234, 2009-
145, 2010- 290)
2.3.3 Continue to
implement the
Abstinence and Faithful
programs
Abstinence and Be Faithful messages and education form part of Peer Education Programme and is included in all
campaign materials (targeted and general population). All school based programme include abstinence messages.
Community leaders, including FBO leaders, have been engaged to promote abstinence and faithfulness. The
Guyana Faith Coalition on HIV and AIDS is a lead agency in dealing with these.
2.3.4 Develop and
implement serial
communication programs
reinforced with
community-level
education.
BCC campaigns have been developed and implemented at population and community level.
Posters, television and radio advertisements, television documentaries on HIV have been produced and a radio
serial drama is ongoing with accompanying community-based reinforcement activities.
Community Opinion leaders were targeted and over the years a total of 382persons were trained. These leaders
then use their position of advantage to continue communication of HIV.
Merundoi, a radio serial has taken its reinforcement work to the communities using edutainment as the tool. The
Merundoi radio serial estimates that its Abstinence and Be faithful messages has reached more than half of the
population with almost 30% of those persons being weekly listeners with equal proportions of males and females.
A Tour of Guyana Cycle Race (The BIG Ride & Ride for LIFE) conducted annually to raise awareness about
HIV/AIDS and stigma and discrimination. During this time, cyclists were trained as peer educators and conduct
community level education at each point of the race.
Messages on abstinence, faithfulness, correct and consistent condom use, positive parent and child
communication, alcohol reduction and prevention, access to quality HIV and STIs services, and reduction of stigma
and discrimination information are reinforced at community level by the national programme, the regional health
services, adolescent health unit and departments of the Ministry and CSOs.
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2.4 Expand condom
social marketing
programme
2.4.1 Review and
implement strategy and
expand program
Condom distribution has increased over the year with an average of 3M condoms distributed annually via public
and private sector, NGO, female, Condom Vending Machines. Female Condoms were introduced during this period
on a larger scale and recorded a high acceptance particularly among the FCSW.
There has been an increase of Non -Traditional outlets (see below).
See condoms distributed in
the indicator table below.
2.4.2 Increase the
number of non-traditional
outlets targeting high risk
populations
The non -traditional outlets continued to function making condoms accessible to some of the hard to reach
populations and persons at increased risk. The number of non-traditional condom outlets increased from 931
outlets in 2007 to 1079 at the end of 2010.
The NAPS conducted several Stakeholder meetings with organizations working in the Hinterland Regions in efforts
to scale up condom distribution. An enhanced condom distribution Strategy was determined and is currently being
implemented.
Number of non traditional
condom outlets:
2007-931
2008-1042
2009-1071
2010-1079
2.4.3 Develop monitoring
and evaluation plan to
assess impact of the
interventions
The impact of the condom interventions are measured inherently in the BBSS for the target populations.
Comparison between the two rounds of BBS shows that condom use at last sex improved among all groups as
follows: CSW 46% (2004) vs 52.4% (2009), MSM 68.15% (2004) vs 79.9%(2009), military 19.8% (2004) vs 53.7%
(2009), police 16.3% (2004) vs 28.5%(2009), in school youth 72.2% (2004) vs 73.2% (2009), Out of school youth
51.6% (2004) vs 71.2% (2009). Routine programme data is also used to monitor the programme and provided
information that streamlined regional distribution. Mainly for community level interventions such as „PUT IT ON‟
campaign, an M&E component was developed and implemented to assess the effectiveness of the campaign.
2.5 Scale up the
PMTCT Program
2.5.1 Strengthen service
delivery capacity of
PMTCT sites and expand
geographic coverage at
primary care facilities
The PMTCT Programme has been integrated within the Maternal and Child Health Unit expanded its coverage over
the years, reaching a total of 165 sites at the end of 2010 in all ten administrative regions.
Guyana has achieved universal access to PMTCT with more than 85% of the mother receiving ARV for the PMTCT.
Guyana in 2008 DNA PCR testing for early infant diagnosis.
Number of PMTCT sites;
2007-110
2008- 134.
2009-157
2010-165
2011- 181
% mother receiving ARV :
2007-85.1%
2008-90.9%
2009-95.8%
2010-87.3%
2011-85.1%
2.5.2 Strengthen
community mobilization
and referral networks to
include PMTCT
HIV testing uptake remained high over this period with more than 90% of pregnant women testing and receiving an
HIV result. The PMTCT programme collaborated closely with the VCT programme and both VCT and PMCT
counseling and testing curricula were revised.
Significant public awareness was done through special campaigns on PMTCT that included PSA, radio
announcements, Brochures, posters and others.
In addition to women testing the PMTCT programme strongly advocated for both parents involvement and
embarked on a male partner involvement programme. At the end o f 2010, 5.5% of partners were tested through a
PMTCT setting.
Testing uptake
2007-97.6%
2008-95.5%
2009-89.8%
2010-93.7%
2011-94.8%
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2.5.3 Develop
standardized system for
monitoring and tracking
A curriculum was developed and used for training. SOP, Posters and other tools were developed to facilitate
training of the health care workers and to ensure a high quality of care. A total of 748 health care workers were
trained and retrained over the period from all ten administrative regions of Guyana.
The PMTCT system comprises three reporting forms: the Maternity Ward (L&D) Monthly Monitoring Report,
ANC/Postnatal Monthly Monitoring Report, and Laboratory forms. The M&E system is fully operational with reports
coming in to the surveillance and the PMTCT departments. The data collection tools were revised and the HIV
surveillance/notification form was also revised.
Health care workers
trained:
2007-300,
2008-218
2009-132
2010-98
2011-306
2.5.4 Increasing the
involvement of NGOs
and CBOs in the PMTCT
response
Guyana in 2008 introduced HIV DNA PCR testing for early infant diagnosis. The NPHRL developed the capacity for
in house testing. The algorithm for DNAPCR testing was developed and revised in the second revision of the
National guidelines for the management of adults and children infected with HIV.
A total of 15 heath care workers were trained on HIV DNA PCR blood Collection
The number of HIV exposed babies tested before the age of 18 months increased from 89 in 2009 to 159 in 2010
and to a further 213 at the end of 2011.
2.5.5 Strengthening
PMTCT service delivery
at labor and delivery
wards
Services continue to be delivered throughout the healthcare setting with a significant proportion of ANC/PMTCT.
Work continued and was intensified at all labour and delivery wards of the public hospitals and at several private
hospitals in ensuring that all protocols were adhered. Health care workers were trained and retrained, SOPS were
produced.
Curriculum developed was revised to ensure that management is aligned to current evidence.
.
Percentage of Babies
tested HIV positive
2007-6%
2008-3.8%
2009-8.9%
2010-6.0%
2011-1.95
The Ministry has embarked
on an elimination initiative
for the mother to child
transmission aligned to the
outcomes of the HLM in
June 2011 of Zero
transmission by 2015.
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2.6 Reduce the
vulnerability of OVC to
HIV/AIDS
2.6.1 Mobilize additional
CBO‟s NGO‟s to become
involved in providing
support to OVCs
OVC are being supported through the National Programme of the Ministry of Health, the Ministry of Human
Services, partners such as UNICEF and CSO supported primarily through the PEPFAR and World Bank
Programme. Support to OVC included support to package of minimum services for orphans and vulnerable
children. The Ministry of Health in supporting OVCs has refurbished 25 orphanages, has trained a total of 44
children in various skill building exercises.
In regards to CSOs funding was received to provide nutritional support through soup kitchens; uniform supplies;
learning aids and other school supplies. CSOs also provided critical support to children HIV infected in monitoring
Adherence on ARVs and in providing psychosocial support and home base care.
Persons trained in skills
building:
2007- 10 children in hair
dressing, dress making and
cake decorating
2008- 12 children trained in
hair dressing, dress making
and cake decorating.
2009- 15 children trained in
adolescent conflict
resolution
2010- 7 children trained in
quick meals preparations
2.6.2 Expedite and enact
the legislation that
protects the rights of the
most vulnerable children
and approve national
policy
There are 14 + legislation dealing with the Rights of the Child/Child Care Protection. During the review period of
2007-2011 the following legislations were enacted or amended:
1. Juvenile Offenders (Amendment) 2007, 2009, 2010
2. Protection of Children Act 2009
3. The Sexual Offences Act 2010
4. Status of Children Act 2009
5. Childcare & Protection Agency Act 2009
6. Adoption of Children Act 2009
7. The Labour Act 2008
MoLHS&SS and MoH in collaboration with partners developed and instituted Minimum Operation Standards for
institutional care and the formalization of foster care systems. The implementation of the minimum standards has
been ongoing with ongoing support to the children‟s homes across Guyana for in creating a comfortable and
enabling environment through infrastructure works, provision of amenities and supplies and others. Off the 29
registered children‟s home, a total of 25 benefitted from major infrastructure works. Further in supporting the
minimum standards of engaging the children in quality recreational activities, many outreaches were organized for
all children from the children homes in visiting the Guyana Museum, the National Zoological park. The children were
also engaged in activities such as kite flying, sports etc.
2.6.3 Encourage the
participation of key
stakeholders from all
sectors to ensure the
provision of essential
services, education,
health care, birth
registration etc.
Support to OVCs has been through the active involvement of all stakeholders. CSO organisations utilized their
funding as noted above. Several other key initiatives were taken on board. A special initiative was dedicated to
OVCs through the GT&T company in which the children of GPHC paediatric ward benefitted from the contribution of
5,000,000 G$.
Over the last two years, the collaboration as achieved with the Guyana Medical Watch, an overseas medical team
visiting Guyana during the summer holidays and providing medical services to several polulations. Over the last two
years collaboration with this organisation resulted in 357 children from the orphanages ( 171 in 2010 and 186 on
2011) benefitting from medical services including dental services such as cleaning and filling.
At end of 2010, registered in all 29 children‟s homes is a total of 1026 children of which 91.6% (940) attend school.
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The remaining 86 children not attending school falls into the categories of children who are too young to be in
attendance or who have already completed school.
The Radio Needy Children Fund (RNCF) has been a consistent partner in supporting the children of the
treatment
sites beginning from 2008 to current. The RNCF has sponsored the Christmas social for our infected children at the
NCTC site and has provided Christmas gifts for all of the HIV infected children as follows- 2008- 152, 2009- 279
and 2010-256.
2.6.4 Involve children
and youth as partners in
designing and
implementing HIV/AIDS
interventions
Children and Youths are consulted at various stages in the development of messages for interventions targeting
them. They are also involved in the implementation of some of these interventions such as the „PUT IT ON‟
campaign, „Me to You‟, Edutainment in the form of Drama in Schools among others
2.6.5 Strengthen the care
and coping capacities of
families and the
community
25 orphanages were provided with furnishings and equipment
1,328 households with OVCs received free, external basic support
2,322 PLWHAs received economic support through the voucher programme
917 orphans/vulnerable children received support
517 people were trained in case assessment, child abuse issues, psychosocial support techniques, effective
parenting skills and other areas of OVC care delivery
NAPS has an Amenities Programme to complement the school uniform voucher programme provided by the
MoLHS&SS.
2.7 Expand the VCT
services
2.7.1 Design and
implement operational
strategy
The National VCT programme is well defined and operates under the key strategic guidance of the NSP. The work
of the VCT programme is linked the strategies define in other related documents such as the BCC Strategy, the
VCT guidelines, the Participant and trainer‟s manual and others. Guyana during the period under review
scientifically tested the HIV testing algorithm and adapted it for Guyana‟s use. The algorithm utilizes parallel testing
with a tie breaker in the event of discordant results.
2.7.2 Increase availability
to a greater proportion of
the population, with a
special focus on service
centers delivering care to
high risk groups
With the introduction of VCT services in 1998, HIV testing became more accessible. The VCT programme is guided
in its work by the National Steering Committee comprising of technical persons involved in the VCT programme.
During the period of review the VCT programme expanded to ensure access to all administrative regions of
Guyana. The number of sites increased from 5 pilot sites in 1998 to 75 fixed VCT sites at the end of 2010 and the
number of testing accessed through the VCT programme doubled from 2007 to 2010.
In regards to the high risk groups- targeted testing was done in the MARPS population of FCSW and MSM and the
results are evident in the findings of the BBSS.
Number of sites:
2007-51
2008-62
2009-70
2010-75
Number of HIV tests done:
2007-48,573
2008-63,876
2009-85,554
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Access to testing measured by the % of persons ever having an HIV test in 2004 and 2008 shows an increase as
follows CSW- 54.2% (2004) vs 85.2% (2009), MSM-43.85%(2004) vs 87.6% (2009), Police 40.6% (2004) vs 97.6%
(2009), Military 55.8% 92004) vs 91.4% (2009) and out of school youth 17.6% vs 89.8%. All these persons having
an HIV test the return rate for results improved with more persons in the target population knowing their HIV status
as reported in the 2009 BBSS report: CSW- 93.6%, MSM-100%, Military-99.9%, Police-96.6%, In school youth-
93.5% and Out of school youth-96.9%.
In specifically addressing the issue of testing among the MARPS, the National Steering committee in reviewing the
recommendations for HIV testing focused on regular testing for this population. Further in targeting the population
CSOs working with CSO has resulted in member of the population trained and certified as tester counselor and
provided services to their population. In this regard a total of 20 MSM received training as VCT Tester/Counselors.
Linked to the access to services for all populations, but moreso the most at risk populations is the existence of
stigma and discrimination. This period has seen significant progress made in overcoming this as a barrier as health
care workers were trained to provide services to these populations in an unbiased manner. A policy on stigma and
discrimination was develop and facilities have signed on to the policy. Civil society organizations were funded to
work with the population on issues of self confidence, internal sigmatisation and other related issues impacting on
stigma and discrimination.
2010-93,532.
2011-106,491
In addition to VCT- HIV
testing services were
accessed through the
PMTCT and Blood banking
services with the
cumulative annual testing
as follows:
2007-67,681
2008-86,983
2009-105,030
2010-112,627
2011-127,910
2.7.3 Increase service
uptake through
community mobilization
HIV testing has increased over the years with testing become less stigmatized as evident in the increasing number
of persons testing on annual basis and the openness in which persons seek the services. Over the years of this
strategic plan community mobilization improved with more CSO bring on board testing programme and particularly
for the MARPS populations. Further the National week of HIV testing (NWT) has seen the unparalled mobilization of
all communities- the private sector, the media, the non health ministries, workplaces among others.
The results of testing during
the NWT over the years are
as follows:
2006-1,197,
2007-4,405,
2008-15,724,
2009-28,366
2010-35,771,
2011-45,198.
2.7.4 Improve QC and
referral system
Quality assurance for counseling has formed part of the routine monitoring of the VCT programme with regular
quarterly site visits and documentation of the findings. Quality assurance also included data verification and
validation. In advancing the process a model developed by the AIDS Institute of New York State Department of
Health called HIV QUAL international was adapted for the VCT programme ( VCTQUAL). This system is currently
being finalized and would be piloted in 2012.
Referral services from the VCT to care and treatment programme for persons tested has been strengthened during
this period with the pilot of the case navigator system. The results of the pilot demonstrated the effectiveness of this
approach and is under consideration for the expansion of a modified more cost effective version in the new planning
period.
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2.7.5 Continually train
and update skills for
health care providers and
laboratory staff according
to National
Guidelines
Curriculum for VCT – Counseling and Testing were developed. Facilitators‟ manuals and participants manuals
developed.
Monitoring and Evaluation System developed and fully functional.
Infrastructural refurbishment of Sites and the establishment of new sites.
All VCT sites adhere to National VCT Guidelines.
Testor Counsellors were trained and certified by the National AIDS Programme using a standardized curriculum.
Recertification of testor counselors occur on an annual basis. See indicator matrix below on the number of persons
trained and retrained.
Continue training to ensure
that there are skilled
healthcare providers.
2.8 Reduce the
vulnerability to
HIV/AIDS through
identification and
treatment of STI/OIs
2.8.1 Increase the use of
STI/OI services and early
treatment-seeking for
STIs and HIV/AIDS
The total number of sexually transmitted infections reported to the Ministry of Health Surveillance Unit increased
annually over the last five years. This increase was attributed mainly to the strengthening of the surveillance
system. In an effort to address the non HIV STIs in a more structured manner, a National Strategic Plan was
developed for the period of 2011-2020 and in under implementation.
Campaign to increase awareness and health seeking behavior for STI and OI developed and implemented.
STI campaign aimed at raising awareness of STIs, risky behavior, signs & symptoms and general STI diagnosis,
treatment and management was implemented at Mass Media, Community Level and Health care Service Provider
Level.
The development of relevant and appropriate messages targeting PLWHA that without treatment opportunistic
infections mainly TB shortens the life of persons infected.
2.8.2 Train health care
providers STI/OI
management according
to national
guidelines
STI guidelines were developed, printed and disseminated. The development of the guidelines was guided by a
sensitivity study and was an adapted version of the WHO guidelines using syndromic management.
429 persons trained in management of STIs according to national guidelines
Refurbishment were done to clinical sites
IEC materials were developed such as STI quick reference, brochures and others
2.9 Ensure safe blood
supply
2.9.1 Maintenance of
safe blood supply
All blood continues to be screened for infectious markers inclusive of HIV, syphilis, Hepatitis B and C, HTLV and
others.
The National Blood Transfusion Service (NBTS) adheres to the National External Quality Assessment Scheme for
blood transfusion laboratory practice.
The NBTS performs confirmatory tests for HIV and syphilis for all clinic facilities.
There has been an annual increase in the number of units of blood collected and the proportion of those being
voluntary donation. Over the reporting years an average of 7,500 units of blood is collected annually with close to
75% being through voluntary blood donations.
Total number of Units of
blood collected:
2008-7500
2009-7700
2012-7595
2011-7930
Percentage voluntary
donation-
2008-55%
2009-68%
2010-79%
2011-89%
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2.10 Implement plan to
reduce health worker
and community risk of
HIV transmission
through contaminated
sharps
2.10.1 Provide a national
policy to oversee
injection safety in the
public and private sector
A National policy for injection safety was developed and adhered to all health facilities. Additionally, protocols for
the rational use of injectables were developed based on the findings of a comprehensive assessment.
National coverage of medical facilities with safe injection practices has been achieved
Safe injection training has been integrated into the training programmes of various Schools of Nursing, VCT,
PMTCT and HPC. Key personnel, including waste handlers, Prescribers, pharmacists and physicians have been
trained in the standards and correct practices for injection safety and waste management.
Retractable syringes were introduced in several high risk settings to further minimize the risk of transmission of
blood borne diseases.
2.10.2 Build competency
of health workers to
provide injections and
dispose of sharps
according to standards
Health care workers and workers involved in the disposal of medical waste were trained in the appropriate disposal
of waste.
Worker safety was enhanced by providing personal protective gear and pre-exposure vaccination.
A new hydroclave system has been procured and set up at the GPHC to ensure the safe disposal of biomedical
waste at the Georgetown Hospital and its environs.
2.10.3 Build competency
of waste handlers to
dispose of waste
according to safe waste
management standards
Training was conducted to increase knowledge of disposal of sharps according to the safe waste management
standards.
A needle remover and sharps barrel was introduced to minimize the amount of infectious waste.
All clinical sites are furnished with biohazards containers and needle removers.
2.10.4 Advocate for
rational use of injections
Training in injection safety covers administering injections according to standards, ensuring proper disposal,
continuous supply, and proper care for sharps injuries as well as rational use of injections.
2.10.5 Reduce demand
for injections among
patients and community
members
The training of Community Health Workers involves them educating/encouraging community members/patients to
use oral medication and to have injections only when necessary. The use of injection safety posters was used to
reinforce messages and demonstrations were done in front of patients in the form of cutting the needle and
disposing same in the safety box.
An example of community success of this programme and the understanding of injection safety by community
members was the building of a „burn box‟ funded by community members to safely dispose of injections.
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target
Result
s
Target Results Target Results Target Results
PV
1
Percent of
young men
and
women
aged 15-
24 who
have had
sex before
the age of
15
44.00% – NA 41.00% NA – 21.40% – – 191.60% Source of
Data:
BBSS
2008/2009.
BBSS is
conducted
every 4-5
years: New
target for
2013 is
20% for
OSY
PV
2
Percent of
youths
aged 15-
24
reporting
use of a
61.6
Females
– NA 67% NA – 81% – – 120.90% Source of
Data:
BBSS
2008/2009.
Type of
Indicator:
not
cumulative
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results
Target Result
s
Target Results Target Results Target Results
condom
during last
sexual
intercourse
with a non-
regular
partner
67.6%
Males
81% is for
non-
transaction
al sex
partner.
The BBSS
asked for
paying and
non-paying
partners
and not
non-
regular.
New target
for 2013 is
75% for
OSY
PV
3
Percent of
persons
aged 15-
49
expressing
accepting
attitudes
towards
people
with
HIV/AIDS
19.4%
Females1
9.5%
Males
– – 40% NA – 20.1%:
Females
23.9%:
Males
– – 55%
Source of
Data; DHS
Report.
DHS is
conducted
every 5
years
hence the
New target
for 2013 is
75% for
OSY
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
4
Percent of
young
people
aged 15-
24 who
correctly
identify
ways of
preventing
the sexual
transmissi
on of HIV
and who
reject
major
misconcep
tions about
HIV
transmissi
on
35% – – 63% NA 51.10% – – 81.10%
Source of
Data: DHS
2009
DHS is
conducted
every 5
years
New target
for 2013 is
70% for
OSY
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
5
Number of
condoms
distributed
by the
public and
private
sector in
the past 12
months
(,000s)
2,261 3,000 2,715 3,300 2,350 3,630 2,573 3,993 4,881 4,392.30 2701.02 83.1% Source of
Data:
NAPS
Programm
e records,
MMU
programm
e records
and private
sector
records.
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
6
Number of
targeted
prevention
programs
for most at
risk
population
s (MARPS)
– 3
(CSW,
MSM,
Youth,
PE)
3 4 3 5 4 5 4 5 8 160%
Target
programs
exist for
MSM,
CSW, In-
school
youths,
Out of
school
youth,
Military,
Police,
Miners,
and
Prisoners
Source of
Data:
MARPS
Programm
e Records.
Cumulative
PV
7
Percentage of most at risk populations (sex workers, men who have sex with men, mobile populations, and other vulnerable groups) who reported using a
condom during their last sexual encounter with a regular or non-regular partner
% CSW
reporting
use of
89.3%
client
46.0%
– – 83% 94.20% – – – – 113.50% BBSS is
conducted
every 4-5
years
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
condom at
last
intercourse
non-
paying
partner
Source of
Data:
BBSS
2008/2009
Report and
Secondary
Analysis
on the
dataset.
% MSM
reporting
use of a
condom at
last
intercourse
68.1%
regular
partner
83.8%
commerci
al partner
– NA – 72% 79.9%
regular
partner
84.2%
commer
cial
partner
– – – – 87.70%
BBSS is
conducted
every 4-5
years
Source of
Data:
BBSS
2008/2009
Report and
Secondary
Analysis
on the
dataset.
% Miners
reporting
use of a
condom at
last
intercourse
NA – NA – NA – NA 89% NA 95% NA
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
8
Number of
service
outlets that
offer
PMTCT
services
94 110 110 130 135 150 157 175 165 190 181 95.30% Source of
Data:
PMTCT
Programm
e
Report/rec
ords. Type
of
Indicator:
cumulative
PV
9
Number of
pregnant
women
who
receive
HIV
counseling
and testing
for PMTCT
and
receive
their
results
11,731 12,035 12,004 12,325 14,337 12,615 10,046 12,905 10,794 94.80%
Source of
Data:
PMTCT
Programm
e
Report/rec
ords. Type
of
Indicator:
not
cumulative
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
% of
pregnant
women
who were
tested for
HIV and
received
test results
and were
counseled
85%
(12,900
/15,180
)
93.7%
(11,635/
12,415)
90%
(13,000/
14,444)
94.8%
(13490/1
4234)
107.80%
Indicator
was
modified to
read as a
percentage
at last
target
setting
Exercise
PV
10
Percentag
e of HIV
infected
pregnant
women
who
receive a
complete
course of
ARV
prophylaxi
s as part of
PMTCT
63% 80% NA 82% 95.80
%
85% 91.00% 95% 82.70% 98% 64.80% 94.20% Source of
Data:
PMTCT
Programm
e
Report/rec
ords. Type
of
Indicator:
not
cumulative
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
11
Number of
Health
Care
workers
trained in
the
provision
of PMTCT
according
to National
guidelines
197 150 300 130 218 110 132 150 98 130 306 157.50% Source of
Data:
PMTCT
Programm
e
Report/rec
ords. Type
of
Indicator:
not
cumulative
PV
12
Percentag
e of babies
born to
HIV
positive
women
who are
tested
before the
age of 18
months
74 tested
at 18
mths
0% 116
Actual
Numbe
r
provide
d
90% 89 90% 234
Actual
Number
provide
d
95% 97.40% 98.00% 80.70% 86.20%
Actual
Numbers
used
where
Denominat
or not
available.
Source of
Data:
PMTCT
Programm
e
Report/rec
ords. Type
of
Indicator:
not
cumulative
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
13
Percentag
e of OVC
whose
household
s received
free basic
external
support in
caring for
the child
NA – NA 60% NA 70% NA 45% 1,328 45% 373
Denominat
or not
known, so
percent
cannot be
calculated.
Source of
Data: OVC
Programm
e
Report/Rec
ords. Type
of
Indicator:
not
cumulative
PV
14
Number of
providers/c
are takers
trained in
the
provision
of OVC
253 200 182 200 205 200 124 200 173 200 127 81.10% Source of
Data: OVC
Programm
e
Report/Rec
ords. Type
of
Indicator:
Not
Cumulative
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Priority Area 2: Reducing Risk and vulnerability to HIV Infection
Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)
INDICATO
RS
Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achieveme
nt:2007-
2011
Remarks
2006 Target Results Target Result
s
Target Results Target Results Target Results
PV
15
Percent of
transfused
blood units
in the
public and
private
sector in
the last 12
months
that have
been
adequately
screened
for HIV
according
to national
guidelines
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Source of
Data:
Blood
Bank
Programm
e
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SECTION FOUR:
IX: PRIORITY AREA 3: CLINICAL AND DIAGNOSITIC MANAGEMENT AND ACCESS TO CARE
TREATMENT AND SUPPORT.
Strategic Objectives
1. Increase access to diagnostic management and comprehensive treatment, care, and support in
an enabling environment
2. Strengthen the service delivery system to provide uninterrupted supply of medications and
commodities
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Table 11: Summary of Programmatic Achievements- Priority Area 3
Broad Strategic
Programme Areas
Strategic Areas Activities/Achievements Additional Comments
3.1 Expand access to
ARV treatment to scale
up the response
3.1.1 Strengthen existing
treatment sites and expand the
number of treatment
The number of ART treatment sites over the years has increase to ensure coverage in all ten
administrative regions of Guyana with the hinterland regions served by a mobile unit.
All treatment sites were strengthened to ensure a multidisciplinary approach to the
management of persons living with HIV and AIDS. Physical infrastructure were enhanced,
equipment were provided (BP apparatus, X-ray view boxes, stethoscope etc) , health care
workers were trained and retrained. Details provided in the section below.
The epidemiological profile of the national HIV care and treatment programme as at the end of
December 2011, revealed that there are 4612 persons actively enrolled in the national
HIV/AIDS care and treatment programme, of which 3432 persons are actively receiving
antiretroviral therapy, 201 are children (females 97, males 104) which represents
approximately 78 percent of the estimated number of PLHIV in Guyana. . Females accounted
for 57% of all persons actively enrolled in the national programme, while the distribution on Pre
ART and ART is 60% and 55.3% respectively .There are 1180 persons In Care (Non Art) of
which 41 are children (females 23, males 18), while the distribution of adults In Care are 453
males and 686 females.
The national cohort report for the period January-December 2010-2011 reveal 534 persons
were initiated on ART in 2010 with males accounting for 51.5% of the entire population. There
twelve months survivability outcomes reveals that 80.4% are still alive and on treatment,
females 0-14, 85.7% and 15 + females 83.8% while 15 + males 76.9% and 0-14, 80% .The
overall mortality is 8.7% while lost to follow (LTF) account for 9.6%.
70% of adult‟s are receiving a standard first line regime of Truvada/ Efavirenz while 24.1%
receives Truvada/ Nevirapine. 33.3% of pediatrics in the national programmme receives the
combination of Dimune+Nivirapine while 19.8% are on Dimune + Evavirenz. 9.6% of the total
adult‟s patient populations are on second line regime compared to 10% of all children. The
National Care and Treatment Centre and Saint Joseph Mercy Hospital accounts for 56.7% of
all patients enrolled in the national programmme. Region # 4 accounts for 78.4% of all persons
on ART.
3.1.2 Standardize guidelines and
protocols for care and treatment
National HIV guidelines for the management of HIV infected adults and children and for the
management of Opportunistic Infections developed in 2004 were revised in 2006 and 2010.
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Many supporting tools were developed in aiding clinicians and the clinical team and included
standard operating procedures, quick references etc. A patient monitoring system developed
using the generic PAHO system is fully implemented and integrated within all sites.
To monitor prescribing practices and adherence to guidelines, the ADT-Anti retroviral
Dispensing Too was introdcuedl: This system is a Microsoft Access based computer software
package that is used for the monitoring of pharmaceuticals. This programme is installed at
thirteen of the sixteen treatment sites. It provides the utility for tracking and monitoring of drugs
consumption, identifying defaulters, provides data for quantification and subsequent ordering of
drugs.
3.1.3 Strengthen technical
capacity of health care workers
in delivering comprehensive
care to PLWHAS
A multi-disciplinary team is in place with a holistic approach towards care. The team consists of
HIV Clinicians, Nurse, Home Based Care (HBC) Nurse, Pharmacist, Data Entry Clerk, Social
Workers and Out Reach Workers in addition to other supportive and administrative staff.
Significant number of health care workers were trained and retrained on the HIV guidelines.
Additionally specialized training modules were developed for targeting physicians.
A more specialized Clinical mentoring programme for physicians was developed using a 11
module curriculum. With this programme 13 physicians were trained and certified.
A specialized programme was also developed for medexes. Several medexes were from the
hinterland regions of 1,7, 8 and 9 as the programme begins to transition its HIV mobile
treatment services to the regional health services.
There has been training done through various agencies e.g. FXB, I-Tech along with the CMP
for physicians trained through FXB. This also includes training done through the HBC
programme for which training targets have been surpassed.
Number of health care
workers trained and
retrained: Total 1237
2007- 200
2008-325
2009-207
2010-396
2011-109
3.1.4 Establish public-private
partnership in treatment and
care
The public-private partnership has been established. This is noted with the establishment of
ST. Joseph Mercy Hospital and Davis Memorial Hospital services as treatment sites. In
addition, the management of patient at the Bartica Hospital
With a focus towards the sustainability the private sector engagement has been critical in the
provision of nutritional support to persons living with HIV. The Private Sector support to the
Food Bank accounted at the end of 2011 for 25.5% of the needs and is described in more
details under priority area one dealing with public- private partnership.
The private hospitals
involved in treatment is
fully integrated with the
overall Ministry‟s response
particularly in regards to
prescribing practices
according to guidelines,
the quality of care for
patients and in the
monitoring and reporting.
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3.1.5 Establish network of
PLWHA Support groups
The PLWHA Support groups have been established for 11 care and treatment sites in 6
regions of Guyana. All coastal regions except regions 1, 7, 8 and 9.
The network of support groups were established to enhance the well being and coping
mechanisms of members of the various groups. Members are offered psychosocial and
economic support.
Skills based training programmes to support income generation as well as knowledge sharing
and increased HIV awareness and education are provided.
National programme now
promoting the self-
sustainability of these
support group programs.
3.1.6 Develop National
Treatment and Care
communications strategy
Although the formal document has not yet been developed, these areas have been covered in
other documents such as the BCC strategy, the Home base care strategy, the stigma and
discrimination policy and others.
In the implementation of the BCC strategy, issues affecting , PLHIV who were identified as a
priority group, were addressed through several mass media and other forms of
communication. PSA announcements were designed, developed and disseminated to address
adherence, early treatment, disclosure and others. Other communication channels used
included posters, brochures, patient education sessions.
.
3.1.7 Strengthen human
capacity to scale up the care
and treatment response
The human capacity has been strengthened at various levels: In service training at the medical
school, nursing school, medexes programme, pharmacy programme, CHW programme and
others. Capacity has been strengthened through a number of training within the inservice
arena. Highlights of these are captured in other sections of the report. A specialized Clinical
mentorship programme was introduced with clinicians engaged in a comprehensive training at
an inservice level. Medexes were trained to ensure the continuity and sustainability of the ART
programme in the hinterland regions of 1,7,8 and 9.
The Guyana-Cuba partnership has produce medical doctors for the health sector; they were
exposed to extensive HIV/AIDS clinical didactic and practical session and has subsequently
assume post at care and treatment centers, thus enhancing our local capacity to manage
HIV/AIDS.
Continuous training of members of the multi-disciplinary team has been ongoing with technical
support from agencies such as FXB.
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3.1.8 Develop and implement
national adherence strategy
Although there is no formal national adherence strategy, this aspect of the programme has
been addressed in a number of ways. In the implementation of the BCC strategy, several
specific campaigns were developed on adherence and included PSAs, posters, brochures .
Additionally, general patient education sessions almost always dealt with this. Special sessions
on adherence are part of the package that social workers are mandated to cover with all
patients and group counseling on adherence has been introduced as a novel approach in
some clinics.
A manual in adherence that proposes individual case management was developed and would
be introduced under the next strategic plan.
3.2 Create Centre of
Excellence at the GUM
clinic and GPHC
3.2.1 Upgrade the facility to
provide specialized care and
serve as a referral centre
The NCTC as the centre of excellence has the capacity to provide specialized care and
treatment services, as well as providing training for HCWs. The NCTC has be strengthened to
serve in that capacity through training of key clinical staff and supporting staff. The
Multidisciplinary team of the Center is now well established and fully staffed to provide optimal
care. The Center provides technical support to other clinical sites across the country in the
review of cases, the mentoring of physicians and in the determination of movement of patients
from first to second line therapy.
3.2.2 Design and implement
Continuous Quality Improvement
(CQI)Programme for the Centre
HEALTHQUAL Guyana Project was established in collaboration with the New York State. A
system developed is now fully integrated and has completed the second wave of data
collection; data would be analyzed to guide quality improvement activities. The first data
extraction and audit was at 22 pilot sites regionally. The Project will facilitate the development
of sustainable quality improvement activities through capacity building and capability for quality
improvement. Quality Improvement Committees are established at clinical sites. These
committees review and analyse their site specific data and design and develop quality
improvement
projects.
The National Patient Monitoring System is implemented at all care and treatment sites
regionally. It is seen as an important part of high quality patient care.
The period under review saw the first Client Satisfaction Survey (CSS) being conducted at HIV
and TB sites throughout the country. The CSS saw high levels of satisfaction reported for the
health facility, health staff and health services.
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3.2.3 Upgrade technical capacity
of the multidisciplinary team to
provide specialized care in
HIV/AIDS
Training was conducted for all category of health care workers. Persons were trained and
retrained on the HIV guidelines and management of patients, on the management of
opportunistic infections, paediatric management. Training was also done through continuing
medical, nursing and pharmacy education.
Specialised training was conducted for clinicians and medexes. A core group of persons were
trained as trainer of trainers in conducting nutritional assessment.
Training for supportive functions was also were conducted on counseling, adherence, and
others.
3.3 Establish a quality
home based and
palliative care
programme providing
support to PLWHA and
those affected by
HIV/AIDS
3.3.1 Develop and implement a
national HBC strategy for
PWLHA and those affected by
HIV/AIDS.
HBC Strategy has been developed and implemented with the major objectives of empowering
individuals, families and communities. It addressed the reduction of stigma and discrimination,
the streamlining of the client referral system, the facilitation of quality community care and
mobilization of the resources necessary for the sustainability of the service.
The strategy was fully implemented.
3.3.2 Strengthen and expand
home-based care services for
PLWHA and those affected by
HIV/AIDS
HBC programs have been expanded and are presently available at the main care and
treatment sites covering 7 administrative regions with 22 service outlets.
A hospice for step down care was established and provides this service.
Specialised home base care nurses serve the programme. These nurses were trained in home
base care and as facilitators/trainer of trainers in HBC. All Home Base Care Volunteers were
trained and retrained over the period.
Members of the general public who expressed an interest in home base care and families of
persons living with HIV were also trained.
All volunteers and HBC workers are optimally furnished with supplies and consumables
needed to effectively provide the services.
3.3.3 Establish network of Home
Based Care Volunteers
A network of volunteers is established. This network remains robust through the facilitation of
lessons sharing sessions and case presentations. A network of HBC nurses is also established
comprising of the nurses at the clinical sites and at the NGOS. This network has facilitated
easy and coordinated referral and management of cases. The robustness of the network is
demonstrated at regular quarterly feedback meetings where referrals and cross referrals and
other programmatic and clinical management issues are discussed.
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3.3.4 Establish public private
partnership in Home Base Care
The establishment of the Hospice/Step down care has been a model private public partnership
under home base care . This imitative was started by CRS with the MoH providing support to
capacity building and other areas of support. Collaboration on HBC was significant with other
agencies such as GHARP I and GHARPII and the 9 NGOs providing HBC services.
3.3.5 Strengthen the technical
capacity of HBC workers in
providing quality care
All HBC workers including HBC nurses and volunteers were trained and retrained using a
standardized curriculum.
3.3.6 Establish National referral
system for Home Base Care
A national referral system has been established clearly linking the services and referrals for
patients between the clinical sites and the NGO providing HBC services. As part of the referral
and monitoring system, standardized referral and additional related forms are utilized.
3.3.7 Strengthen the capacity of
the volunteers in providing HBC
services
Linked to previous notes in immediate section above, volunteers are trained and retrained
using standardized curriculum. Additional training indirectly related to HIV home base care
issues were also added to the training the volunteers received. These included mental health,
substance use, chronic diseases and others. Other avenues for capacity building were also
used such as case discussions.
3.4 Provide
psychosocial care and
support to PLWHA and
those affected
3.4.1 Increase the number of
social service programmes
available to PLWHA and those
affected
A wide range of services were provided to PLHIV. Programmes implemented during the period
included the voucher programme where eligible persons were provided with economic support.
As of December 2010, 49% of persons on treatment (1500/ 3037) were benefiting from this
program.
PLHIVs received psychosocial support through the routine services of the treatment. More
specialized support is provided through the network of support groups established at 11 care
and treatment sites in 6 Geographic Regions.
Nutritional support programmes also were implemented mainly through the food bank initiative
and through CSOs. The details of support from the food bank are noted in sections above.
Several capacity building sessions were conducted in strengthening nutritional support to
PLHIV. Health care workers with a focus on senior nurses, medexes and social workers were
trained as trainer of trainers in conducting nutritional assessment and follow up for PLHIVs.
Prevention with Positive programme was initiated , with a manual and training curriculum
develop.
Significant support was provided to the children‟s institutions for children infected and affected
through the school amenities programmes. All children of school going ages and children
infected attending treatment sites have received this support.
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The PLWHA Support groups have been established for 11 care and treatment sites in 6
regions of Guyana. A specialized support group was established to address issues affecting
adolescent living with HIV. The members of the support groups benefitted from facilitated
technical discussion and from a variety of skills building training. Training ranged from basic
literacy to computer studies, from carpentry to masonry and others.
A special initiative launched with the MoH, WB, Ministry of Housing , Food for the Poor and
Habitat for Humanity resulted in a number of PLHIVs accessing house lots and home provided
to PLHIVS.
PLHIV‟s eligible for also received economic support in the forms of a monthly voucher value at
the current public assistance value.
3.3.2 Establish referral network
for psychosocial support
Referral network has been established and is an effective and efficient two-way process of
linking a client from one health care service to another. It is not only functional for psychosocial
support but is functional in other care aspects and is essential to ensure continuity of care.
3.4.3 Encourage public private
partnership
Private public partnership has been developed and continues to be strengthened over the
period. See details in related section above.
3.5 Design and
implement institution
training programmes for
HIV/AIDS treatment,
care and support
3.5.1 Develop and implement
curriculum for pre-service HIV
training programme and post-
graduate training programmes at
central and regional levels for
the multi-disciplinary team
Work commenced through ITECH collaborating with University of Guyana and the Ministry of
Health, Health Sciences Unit in reviewing the existing curricula. Further work was done in
updating the HIV materials in these curricula. Specialised training using these curricula were
conducted for pharmacist, medexes, physicians and other categories of health care workers.
3.5.2 Review, revise and
implement curriculum of
graduate training programmes
3.6 Expand
comprehensive care for
opportunistic infections
3.6.1 Strengthen clinical care for
opportunistic infections at
present sites and expand to new
sites
The management of opportunistic infections has been standardized and is in place at all HIV
sites. Physicians and other members of the clinical team have been trained in the,
management of IS based on standardized guidelines. Special emphasis was placed on the
management of TB/HIV co-infection, see related section below. Tools were developed and
disseminated at sites – brochures, documentary and other IEC materials. The laboratory
diagnosis for opportunistic infections was enhanced and the NPHRL now has diagnostic
capabilities for toxoplasmosis, Hepatitis B and C, tuberculosis and others.
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3.6.2 Revise/review protocols for
opportunistic infections
The protocols for opportunistic infections were developed as part of the National Guidelines for
the management of adults and children infected with HIV. These protocols developed in 2006
were revised in 2008 and 2010 and were distributed to all physicians and members of the
clinical team. Additionally, aids were developed and distributed to facilitate easy use of the
protocols.
3.6.3 Develop national
communication campaign for
treatment and care
Several national Communication campaigns were developed on the following issues linked to
care and treatment:
1. Adherence
2. Home Base Care
3. Opportunistic Infections.
4. Disclosure.
5. Tuberculosis.
6. Sexually Transmitted Infections.
7. Others
3.7 Strengthen the link
between the TB and
HIV/AIDS/STI control
programmes
3.7.1 Support increased
screening for TB among HIV
positive patients
Screening for TB among HIV positive patients was done using the WHO symptom screen and
the TST at base line and annually.
Health care workers at HIV sites were trained in the administration and read off of TST and are
currently conducting the screening at HIV sites.
The National TB Programme also continues to screen all persons for TB including HIV
persons.
3.7.2. Improve training
programme for staff
There has been significant training of staff during the period. In service training curriculum
were developed for TB/HIV and for Sexually transmitted infections (Please see related sections
above on STIIs).
All levels of healthcare workers were trained including physicians, social workers, nurses,
pharmacist, outreach workers, Dots Workers.
3.7.3 Improve facilities and
logistical support
Facilities, particularly clinics have been improved to enhance infection control. Refurbishments
and reconstruction were configured to facilitate optimal air flow and other needed dimensions
for infection control.
The reconfiguration of these facilities also ensure other functions were incorporated including
enhanced privacy, patient flow, laboratory and pharmacy efficiency and others.
A draft infection control policy was developed and is in the process of being finalized.
Additionally, a National Infection Control Committee is being formed with hospital specific
infection control boards.
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3.7.4 Support increased
screening for HIV among
patients with TB
All TB patients are required to be screened for HIV. The National TB programme has
incorporated this guideline into its day to day functions with VCT sites established at Chest
Clinics or at a minimum within close capacity. This has led 93% screened at the end of 2011
and represented an consistent increase over the five years period.
3.8 Implement activities
to increase use of
quality STI/HIV/AIDS
diagnostic and
treatment services
3.8.1 Strengthen STI services to
provide comprehensive care and
syndromic management for STI
STI services continued mainly as syndromic management. Over the years however several
hundred of health care workers were trained and retrained using as standardized developed
STI in service curriculum.
Clinical sites provided syndromic management and some sites linked to HIV management
provided etiologic diagnosis based on smear results from the site. The vast majority of patients
were managed based on syndrome and parnter notification and contact tracing were done.
Guidelines were developed and disseminated for use. A number of supporting tools such as a
quick reference, posters, brochures, PSA (TV and Radio) and other IEC materials were
developed and disseminated.
3.8.2 Expand the pool of health
care workers trained in
syndromic management
There has been technical capacity building of health care workers on syndromic management
using a training curriculum. ( see notes above)
3.8.3 Review, update and
disseminate guidelines,
protocols and training, material
for STI management in both the
public and private sectors
Guidelines were developed, adapted from WHO guidelines for syndromic management and
considered the findings of the STI study. The guidelines were used to train physicians and
other members of the clinical team. Supporting materials were also developed and distributed
including quick reference, posters, brochures, PSA (TV and Radio) and others.
These were made available to both public and private sectors.
3.9 Upgrade laboratory
capacity to diagnose
and monitor HIV/AIDS
and associated
opportunistic infections
3.9.1 Upgrade GPHC‟s facility to
undertake additional laboratory
test for HIV, haematological, TB,
STI, Biochemical, immunological
markers and diagnosis of
opportunistic infections
Georgetown Public Hospital (GPHC) , Central Medical Laboratory (CML) was strengthened
through procurement of key laboratory equipment. Additionally in support of the functions
reagents and consumables were acquired on a regular basis.
Laboratory staff was received appropriate technical capacity building.
3.9.2 Strengthen regional labs to
conduct quality diagnosis of HIV
and opportunistic infections and
for treatment and monitoring
There is some regional capacity to conduct quality HIV testing but this is not available in all
regions. Quality assessment of testing primarily done through the NPRHL.
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3.9.3 Finalize and implement
Lab Strategic Plan
A Laboratory Strategic Plan ( SPL) has been drafted and finalized for the period of 2011-
2014.
3.9.4 Enhance GPHC‟s capacity
to serve as a QA/QC/QI site for
tests
Capacity was strengthened at the GPHC CML. This function was however quickly transitioned
over to the NPHRL established in 2008.
3.9.5 Train laboratory staff to
use specialized methods for
diagnosis and monitoring of
HIV/AIDS and related issues at
the post graduate level
Technical capacity was built with laboratory staff in very specialized fields including TB
diagnosis (culture) , toxoplasmosis diagnosis and others.
3.10 Establish National
Public Health
Reference Laboratory
3.10.1 Construct national
reference laboratory
The NPRHL was constructed and commenced functioning in the second quarter of 2008.
Since its opening, the NPHRL has expanded its diagnostic and monitoring scope.
Strengthen the capacity of the
quality assurance monitoring
committee
Quality Assurance (QA) is led by a specialized department within the NPHRL. The dry tube
specimen model recommended by CDC was adapted for the local context and is currently in
use for QA of HIV testing. The NPHRL conducts internal QA through a quality management
implementation system which entails regular audits and controls. External QA is also
conducted with an International laboratory using the Digital Proficiency test (DPT)
3.10.2 Review/update systems
for certification
The NPRHL has achieved local accreditation through the Bureau of Statistics Guyana and has
maintained this. The NPHRL has commenced preparation for the International accreditation.
3.11 Procurement and
distribution of care and
treatment supplies
improved (commodities
management)
3.11.1 Establish inter-agency
collaboration to expedite the
process of procurement through
the MMU
A National Procurement Oversight Committee (NPOC) was established and functions at the
level of the Ministry of Health with the Minister of Health as the Chair of the Committee. The
NPOC served as a coordinating mechanism for dealing with all technical procurement issues
such as quantification and forecasting. The NPOC also addressed policy and other issues.
A Joint Donors Group (JDG) comprising of all partners involved in the procurement for the HIV
programme was established and met on a biannual basis. The JDG involved the Global Fund,
The US Government (PEPFAR And USAID), the IDM, WB , EU and the MoH. The group
addressed coordination of procurement among all donors.
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3.11.2 Strengthen the
management and monitoring
capacity of the MMU
(Commodities Management)
Significant capacity building of the staff of the Materials management Unit (MMU) was
achieved. Senior staff received specialized training on procurement and on warehouse
management. Additionally there has been ongoing capacity building through mentoring by
technical officers of the Supply Chain Management Systems ( SCMS) office. Capacity was
also built in inventory systems, in forecasting and quantification.
A logistic management system developed and introduced is being strengthened and would
allow for accurate reporting and requisitioning of supplies from the primary health care setting
to the Central MMU level.
At HIV treatment and care sites, the ARV dispensing tool was introduced and strengthened
allowing sites to closely monitor the stock levels and therefore make timely requisition avoiding
situations of stock outs.
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Priority Area 3: Clinical and Diagnostic Management and Access to Care, Treatment and Support
Table 12. Summary of Priority 3 targets and indicators 2007-2011 (Care, Treatment and Support CTS)
INDICATO
RS
Baseli
ne
2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. %
Achievement:20
07-2011
Remarks
-2006 Target Result
s
Targe
t
Result
s
Targe
t
Result
s
Target Result
s
Target Result
s
CTS1 Percentage
of women,
men and
children
with HIV
infection
receiving
ART who
are eligible
according
to National
Guidelines
1,569 70.00
%
60.60
%
80.00
%
72.70
%
85.00
%
83.50
%
90.00% 71.80% 90.00% 77.20
%
88.30% Source of Data:
Treatment &
Care
Programme
reports.
Denominator is
based on
UNAIDS
estimates
CTS2 Number
and
Percentage
of Regions
with at least
one outlet
providing
ART
services
following
National
Standards
10
(100%)
10
(100%)
10
(100%
)
10
(100
%)
10
(100%
)
10
(100
%)
10
(100%
)
10 (100%) 10
(100%)
10 (100%) 10
(100%
)
100% Achieved
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CTS3 Number of
Health
Care
Workers
trained on
ART
delivery
according
to National
Guidelines
189 150 200 165 325 180 207 195 396 210 109 137%
CTS4 Percentage
of general
population
aged 15-49
receiving
HIV test
results in
the past 12
months
11.3%
Female
s;
10.3%
Males
12% 12.60
%
13.80
%
9.00% – 24.8%
(DHS
surve
y)
– – 85.1% DHS is
conducted every
5 years
CTS5 Number of
individual
trained in
the
provision of
VCT
according
to national
Guidelines
71 95 96 111 125 117 137 420 330 440 333 96.30% This includes
newly trained
Counselor/Test
ers (287) and
those who
underwent
Refreshers’
training (43).
Source of Data:
VCT
Programme
Report/Record
s. Type of
Indicator:
cumulative
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*Includes
Refreshe
rs‟
Training
CTS6 Number of
Regions
with
Service
Outlets that
provide
HPC
6 7 6 8 6 9 7 10 7 10 7 75.70% Source: HBC
Programme
Reports
CTS7 Number of
Service
Outlets that
provide
HPC
18 19 19 20 20 21 21 22 22 23 21 98.30% Source: HBC
Programme
Reports
CTS8 Number of
persons
trained to
provide
HPC
according
to National
Guidelines
66 50 310 100 210 100 140 120 182 145 112 239.80% Source: HBC
Programme
Reports
CTS9 Number of
adults and
children
receiving
HPC
following
National
Standards
1,026 1,050 1,160 1,100 1,276 1,150 826 918 1,189 Source: HBC
Programme
Reports.
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CTS
9 (a)
Number of
adults and
children
receiving
HIV related
care and
support
according
to National
Standards
4,055 5,600 4,213 7,200 4,612
<18yrs:2,1
00
<18yrs:2,7
00
Programme
Data is
disaggregated
as <15 years
and 15+ years,
hence the
disaggregation
required is not
available
CTS1
0
Percentage
of men and
women with
STI at
health care
facilities
who are
appropriatel
y
diagnosed,
treated and
counseled
– 853.00
%
NA 85.00
%
NA 55.00
%
100% 65.00% 100% 75.00% 100% 156% Source: STI
Programme
reports
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CTS1
1
Number of
Persons
trained in
the
manageme
nt of STI
according
to National
Guidelines
82 200 84 200 NA 200 145 160 210 200 217 88.60% Source of Data:
STI Programme
Report/records.
Type of
Indicators: not
cumulative
CTS1
2
Percentage
of eligible
HIV
positive
registered
TB patients
given ART
during TB
treatment
(modified)
– – 97.00
%
90.00
%
92.00
%
90.00
%
93.00
%
95.00% 91.00% 95.00% 88.00
%
98.5% Source of Data:
TB Programme
Records. Type
of Indicator:
not cumulative.
For the period
Jan-
March2011:74
persons were
trained; April-
September
2011: 123
persons were
trained.
CTS1
3
Percentage
of
registered
TB patients
tested for
HIV
81.90% 83.00
%
80% 100% 83% 100% 89% 90% 90.00% 90.00% 92% 94.1% Source of Data:
TB Programme
Records. Type
of Indicator:
not cumulative
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CTS1
4
Percentage
of patients
on ARVs
who
receive
regular Cd4
monitoring
following
ARV
national
treatment
guidelines
NA 80% NA 90% 82.90
%
90.00
%
– 92.00% 78% 92.00% NA 88.40% Result from the
HEALTH QUAL
report for the
period 1st July
2009 – Dec 31st
2009 for 15
care and
treatment sites.
Based on a
sample size of
1,198 persons.
CTS1
5
Number of
Regional
Labs with
capacity to
perform
CD4 tests
following
National
Standards
3 3 3 4 2 4 – 5 3 5 3 67.50% Source of Data:
NPHRL
Programme
Records. Type
of Indicator:
cumulative.
CTS1
6
Number of
Persons
trained to
conduct
CD4 testing
according
to National
Guidelines
NA 5 2 7 1 9 NA 14 11 15 1 34.90% Source of Data:
NPHRL
Programme
Records. Type
of Indicator:
not cumulative.
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SECTION FIVE:
X: PRIORITY AREA 4- STRATEGIC INFORMATION
Strategic Objectives
1. Increase local capacity to design and implement surveillance, monitoring and evaluation, special
studies, surveys and research on HIV/AIDS according to national and international guidelines.
2. Strengthen capacity at the national and regional levels for the collection and use of data for
decision making, planning, implementing, monitoring, and evaluating the local response to
HIV/AIDS
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Table 13: Summary of Programmatic Achievements-Priority Area 4.
Broad Strategic
Programme Areas
Strategic Areas Activities/Achievements
Additional
Comments
4.1 Strengthen the
HIV/AIDS surveillance
systems
4.1.1 Review and update existing
protocols and guidelines for HIV/AIDS
surveillance
The existing HIV case-base surveillance form has been reviewed and updated to meet the new WHO
clinical staging criteria. The reviewed system is being piloted and would be fully integrated under the
new NSP. An electronic database has been developed to capture this information and would be
implemented in collecting and analyzing the surveillance data.
Health care workers were trained on the revised HIV surveillance forms as well as epidemiology
nurses of the surveillance department.
4.1.2 Employ and train staff at
national and regional levels to
conduct HIV/AIDS surveillance
Health care workers were trained on the revised HIV surveillance forms as well as epidemiology
nurses of the surveillance department.
75 MOH staff from various regions trained in basic M&E; including NAPS staff.
M&E head of unit trained in Routine Data Quality Assessment (RDQA) and conducted a mini training
with some coordinators.
Staff of the Ministry of Health and the NAPS were trained in the use of SPSS, basic Epi Info and
advanced Epi-Info and on basic and advance research skills.
12 social workers in the OVC programme were trained in data quality management.
4.1.3 Regionalize the HIV/AIDS
surveillance system
There have been some advances made in regionalizing the HIV surveillance, however this was limited
to only Regions 3 and 6. Working in ongoing to ensure that this continues.
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4.1.4 Conduct regular sessions for
the review of surveillance and other
data with key stakeholders
Regular sessions of HIV surveillance data to review findings are held with stakeholders. Within the
MoH /NAPS sessions are held with technical staff as well as with all TWG. Of special importance are
the meetings of the MERG.
Other specials sessions are also held and includes the dissemination of the reports on universal
access, UNGASS elimination initiative reports and others. These sessions usually involves a wider
stakeholder.
The NAPS Annual reports and the MoH surveillance report are widely disseminated and can be found
on the MoH and HIV websites.
All other HIV related data gathered and reported on is usually disseminated through the channels
listed above, for example the Client Satisfaction Survey, the HIV Sustainability Assessment.
4.1.5 Prepare and disseminate
regular reports of results of HIV/AIDS
surveillance
Please see section above 4.1.4
4.2 Develop and
implement a system for
monitoring and
evaluating the response
to HIV/AIDS
4.2.1 Develop and disseminate a
national M&E Plan
A National Monitoring and Evaluation Plan was developed to measure progress under this Strategic
Plan of 2007-2011. The M&E plan was further strengthened with the development of an costed
operational plan. These documents were disseminated through the mechanisms as listed in the two
sections above and have been used consistently to ensure compliance to the 3X1s specifically to the
one monitoring and evaluation framework.
4.2.2 Identify at the national level a
unit which will be responsible for M&E
related to HIV/AIDS
An M&E unit for the HIV response was defined in the operations manual. The M&E Unit was
subsequently fully staffed with M&E Lead, Data Analyst, Researcher and Data Entry Clerk. This team
has been instrumental in moving the M&E agenda forward with advancements made in almost every
area- data verification, data quality, timeliness of reporting, accuracy of reporting, data analysis to list
a few.
4.2.3 Develop and disseminate
national guidelines on system and
tools for monitoring the response to
HIV/AIDS
The operations manual to the National M&E Plan was developed and disseminated. This manual
included guidelines and tools for monitoring the HIV response. All sub programmes have defined their
monitoring tools such as the PMS for care and treatment and VCT monitoring tools
At a Central, the Country Reponses Information System (CRIS) is being adapted for use. Member of
the M&E team and technical officers engaged in M&E were trained in CRIS.
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4.2.4 Identify priorities, develop and
disseminate guidelines for measuring
outcomes and impact of intervention
related to HIV/AIDS
The measurement of impact and outcomes are built into the National M&E plan and the operational
plan to the M&E plan. These measurements are taken periodically as defined within the M&E plan,
with the vast majority being reported from special studies. The National programme has conducted
the following special studies :
1. BBSS- CSW and MSM (2004)
2. BBSS-FCSW and MSM ( 2009)
3. BSS( military, police, GUYSUCO workers, in school youth (ISY) and Out school youth
(OSY))-2004
4. BSS( military, police, in school youth (ISY) and Out school youth (OSY))-2009
5. ANC survey (2004 and 2006)
6. BBSS- security Guards- 2008
7. BBSS prisoners- 2008
8. DHS- 2009/10
9. Client satisfaction survey -2010.
Impact was also measured particularly for the care and treatment programme utilizing the developed
patient monitoring system.
4.2.5 Employ and train staff at the
national and regional levels for
monitoring and evaluation
Staff employed in the various sub programmes were trained in Monitoring and evaluation specific to
there are of work. Regular refreshers training also include aspects of monitoring and evaluation.
4.2.6 Identify and establish a national
system for the storage of data for
monitoring and evaluating the
national
response to HIV/AIDS
The National Programme through the M&E Unit has adapted CRIS as the tool for data storage at the
National Level. M&E staff and technical coordinators were trained in the use of CRIS and the system
is currently being implemented. Additional sub programme also store data in specialized databases
such as the Channel for condoms, Fox Pro for VCT.
4.3 Design, implement
and disseminate results
of special surveillance
surveys and studies in
selected groups
4.3.1 Conduct HIV/AIDS risk
assessment surveys to collect
information on attitudes, behaviours
and sexual mixing patterns, health
facilities utilization, and perceived
intervention needs among defined
target groups and the general
population
See 4.2.4.
Additionally several assessments were conducted- an assessment on the uptake of PMTCT services
on the labour and deliver wards, TB/HIV services.
4.3.2 Conduct behavioural
surveillance surveys in selected
groups (in and out of school youth,
sugar workers, sugar workers
personnel)
See 4.2.4 and 4.3.1
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4.3.3 Conduct biological behavioural
surveillance among MSM and CSW
See 4.2.4 and 4.3.1
4.3.4 Conduct and disseminate
results of needs assessment-
PLWHAs and orphans
The Client Satisfaction survey was done in 2010 and issues affecting PLHIVs were addressed.. The
needs of PLWHAs including HIV infected children are routinely monitored through the care and
treatment programme and through the support groups established at 11 treatment sites. The needs of
orphans are also routinely monitored through the programmes established by the Ministry of Human
Services and social security and through the monitoring of the minimum package of services for
children‟s institutions.
The DHS and the MICS conducted by the Ministry in collaboration with USAID /PEPFAR and UNICEF
respectively provided additional information on OVC.
4.3.5 Assess capacity of health
facilities in both the public and private
sector to provide services related to
HIV/AIDS
Capacity of healthcare facilities are assessed prior to the introduction of the HIV services and on ay
yearly basis using standarised tools.
4.4 Strengthen local
capacity to undertake
research related to
HIV/AIDS
4.4.1 Establish a multi-disciplinary
HIV/AIDS Research Unit
The M&E unit within the NAPS, in collaboration with the MERG, the surveillance department and M&E
department of the National Tuberculosis Programme (NTP) has built capacity to conduct research. A
research agenda has been developed and several studies conducted over the period. The
establishment of the M&E unit serves as the research unit since the full complement of staff has the
requisite skills to conduct research. The BBSS, HIV Client Satisfaction Survey, Adherence, Drug
Resistance Survey conducted.
4.4.2 Establish and support an
HIV/AIDS Research Agenda
A HIV/AIDS research agenda was developed and supported. A number of special studies and as
indicated above 4.2.1 and 4.3.1.
4.4.3 Develop a cadre of persons with
appropriate skills to undertake
research related to HIV/AIDS
A core group of persons from the Ministry of Health were trained on research methodologies through
several mechanisms- through masters in public heath programme, thorough basic and advanced
research skills training by the CHRC and other specialized short courses such as the sampling
methodology course by the University of San Francisco.
On site mentoring of the M&E Staff of the National AIDS Programme Secretariat, the National TB
programme, the Surveillance department and clinical staff were mentored over a one year period by a
resident advisor from MEASURE EVALUATION.
. The IRB was established and meets once monthly to review and approve proposals. Members of the
IRB were trained and retrained in order to best serve in their capacity.
The University of Guyana through the School of Medicine, the Social Worker programme, the
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pharmacist programme has trained their students in the conduct of research. Many operations
research were conducted on HIV by the students.
4.4.4 Conduct operations and cost-
effectiveness research relevant to
HIV/AIDS and disseminate findings
Operations research were conducted in a number of areas particularly in collaboration with the
University of Guyana. Major of areas of focus included adherence among persons on ARVS and
TB/HIV co-infection and access to services.
4.5 Strengthen the
Health Information
System
4.5.1 Develop and disseminate
national guidelines on system and
tools for a national HMIS
There is a national MIS Strategy and also an accompanying ICT Policies and Procedures document
that has been developed to guide the implementation of ICT/HIS at the national and regional levels
within the public health sector.
4.5.2 Hire and train staff at the
national and regional levels for the
operation and maintenance of the
network
The National MIS Unit is fully functional with technical as well as support staff. This is currently
ongoing and there are staff identified at the national level (MOH) and at some regional level to
implement and support information networks established within these levels. With this HR support
several advances were made in HIV including the modification and deployment of a CHANNEL
database for condoms, a FoxPRO database for VCT, a SQL database for care and treatment, CRIS
for the National M&E system. Support from the MIS unit was also critical in special assignments such
as the HEALTHQUAL data collection and analysis, the HIVDR Survey and in all special studies.
In addition to technical issues, the MIS Unit provided invaluable support to the maintenance of the
technological infrastructure of the HIV programme.
4.5.3 Establish and interconnect
networks at the national and regional
levels
There are networks established at the national level (MoH) and at the regional levels being BRHA6,
GPHC and LHC which are being interconnected back to the national level to facilitate data/information
exchange across these sites.
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Priority Area 4: Strategic Information
Table 14: Summary of Priority 4 targets and indicators 2007-2010 (Surveillance SR)
INDICATORS Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % of
Achievement
:2007-2011
Remarks
-2006 Target Results Target Results Target Results Target Results Target Results
SR
1
Percentage of
service outlets
with record
keeping
systems to
monitor HIV
and AIDS care
and treatment
– 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
SR
1
Number of
persons
trained in
strategic
information
monitoring and
evaluation
and/or
surveillance
and/or HMIS
162 75 – 75 114 75 0 75 86 75 66 70.90% 27 persons
trained in
Surveillance, 39
in M& E where
20 were trained
in SPSS and 19
in CRIS.
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SECTION SIX:
XI: SUMMARY OF FINDINDS BY PROGRAMME AREA
The National Strategic Plan has achieved the majority of what was intended. Full accomplishments were seen for
the majority of strategic areas under the broad programme areas. Some areas were fully achieved were identified as
priority in moving into the HIVision2020 and are highlighted in the related section below. The following summarises
the key achievements:
1. Priority Area A: The roles of the coordinating mechanisms were strengthened with the National Programme
building capacity in leadership and Public Health among key cadres. The multi-sectoral response was rolled
out to key line Ministries affecting specific constituents and to an increasing number of civil society and
community based organisations reaching the most at risk populations. The Programme fully adhered to the
three one principles and to all of its international, regional and national reporting commitments, including a
wide stakeholder consultative midterm and end of term review processes.
With the multi-sectoral response the Ministry of Amerindian Affairs was a key Ministry engaged. The findings
particularly from the focus groups sessions and key informant interviews suggest that the access to
prevention, care and treatment services was limited for the indigenous populations and the mobile
communities of Regions 1, 7, 8 and 9. On the legal front, the national HIV policy was revised and a draft HIV
legislation was prepare and being reviewed. Whilst coordination has been achieved, the programme has
been unable to conduct regular AIDS spending assessments.
2. Priority Area 2: Significant work was done in reducing risk among the general populations and with a focus
on the most at risk populations. In comprehensively capturing the IEC done among these population groups,
the BCC strategy developed was fully implemented with the exception of the population of the mini bus
drivers. The BCC prevention efforts were widely implemented among the in school youth and the out of
school youth and the results of the comparative BSS indicate the effectiveness of these intervention.
Several hundreds of young persons and community opinion leaders were trained as peer educators. The
HFLE has commenced and is being led by the Ministry of Education thus approaching HIV prevention from
a structured and wider base stand point of sexual and reproductive health. The PMTCT Programme
continued its strengthening over this five years period making the services accessible within all 10
administrative regions. The Voluntary Counselling and Testing programme expanded with a focus on more
outreaches and with special initiatives such as the National Week of HIV testing. The Blood Bank continued
its monitoring of donor supply to persons requiring same, though high quality screening of all blood and
blood products. The Health care facilities ensured that all infection control practices in place, including safe
injection practices and linked to this the rational use of injectables. A policy addressing stigma and
discrimination in the health care setting was developed and rolled out to treatment sites. OVC issues were
addressed through the enactment of several legislations dealing with the rights of the child and child
protection. Minimum standards defined for Children‟s Homes were supported. Several critical coalitions
were established targeting key populations. The Guyana Business Coalition on HIV and AIDS targeting the
private sector has engaged the private businesses across the country. The Guyana Faith Coalition on HIV
and AIDS also established during this period has been integral in HIV prevention among the Hindus,
Muslims, Christians, Baha‟is and Rastafarians. Civil Society Organisations were critical in ensuring that
services were delivered to the communities and particularly to the most at risk populations in preventing
HIV.
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3. Priority Area 3: HIV management including the provision of ARVS was significantly strengthened over the
period. Treatment sites were established in all ten administrative regions of the country (Mobile services to
the hinterland regions of 1, 7, 8 and 9). The multidisciplinary management of persons living with HIV was
well defined in the National Care and Treatment Guidelines which were revised and updated on two
occasions to incorporate new scientific evidence. Health care workers were trained and retrained on the use
of the guidelines and specialized Clinical Mentoring Programmes were rolled out. The IMAI was
implemented at the level of the Primary Health care setting. All persons accessing treatment and care are
provided appropriate laboratory, counseling and treatment services. New services were incorporated such
as the screening for cervical cancer using the VIA Methodology. The Laboratory services has been
strengthened with the establishment of National Public Health Reference Laboratory providing important
testing such as Viral Load, CD4 , DNA PCR , TB Culture and all other supporting and monitoring tests.
The NTP was significantly strengthened enhancing TB/HIV care and co-management
Several Communication Campaigns were developed, and disseminated in support of HIV positive persons
and in the reduction of stigma and discrimination.
The Quality of services was monitored through the introduction of HEALTH Guyana with quality
improvement projects implemented at clinical sites. The CSS was conducted with follow up improvement
projects.
Psycho social support was provided to all patients in addressing their issues and the support group network
also facilitated a support system for PLHIV. Prevention with Positives was introduced. Economic support
was provided through the voucher programme and nutritional support through the Food bank and other
related initiatives. Housing initiative provided house lots and houses for a number of persons and the safe
water programme ensure access to Pur and Chlorosol.
The HBC programme established provides formal services in 7 of the 10 administrative regions.
4. Priority Area 4: The availability and use of strategic information improved. The capacity of the MoH in
dealing with Strategic Information was enhanced through specialized training of key staff and through
mentorships arrangements. The research agenda developed by the MoH/NAPS was followed with the
completion of major special studies. The surveillance system for HIV has been revised. M&E capacity was
developed and a fully functional M&E Unit for HIV established.
XII. SUMMARY OF FINDINGS BY TARGETS
The National Monitoring and Evaluation describes a total of forty four (44) indicators with the vast majority
measuring progress under priority areas 2 and 3, risk reduction and care, treatment and support
respectively. The measurement of progress under this framework was possible, as at the inception national
targets were set against the proposed strategic areas of the NSP. These targets were based on a wide
stakeholder consultative process .The Mid Term Review (MTR) of the NSP demonstrated the
overachievements of the programme relative to the set targets. A key recommendation of the MTR was the
revision of the targets to ensure that they were more realistic considering the results at that point.
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The second target setting process was also conducted in a consultative manner and with wide stakeholder
participation. During this process, not only targets were revised, but also some indicators were split to
facilitate more detailed and meaningful disaggregated reporting. This resulted in an increase in the number
of indicators to fifty two (52).
The ETR therefore evaluated the 52 indicators from the second target setting process. Of the 52 indicators
10 were not measured for various reasons. See table 15 below.
Table 15: Non measurement of cumulative achievements
Name of Indicator
Reasons for not Measuring Cumulative 5 years
achievement
IMP1. Proportion of all Deaths Attributable
to AIDS
This information is not available from for the years 2012 and
2011 at the time of the ETR
IMP 3: HIV Prevalence among Women
aged 15-24 years of age
The target set for this specific indicator was not absolute
numerical value but instead a less than value. Whilst this
noted the target set was less than 1%, the cumulative
achievement over the years is reported at 1.06%
IMP5. Percentage of Infants born to HIV
Infected mothers who are infected.
Although the indicator was reported on for every year, the
cumulative achievement was not calculated. The earlier
years of the 5 years plan- data on the numerator and
denominator was not available.
IMP 6. Ratio of current school attendance
among orphans to that among non orphans
age 10-14 years
Whilst this indicator was initially placed in the M&E plan,
newer and subsequent guidance provided by the UN
System, indicated that this indicator was not relevant for
Guyana. The reason noted for this, is that with HIV
prevalence as with Guyana, this is not required and would
not be statistically significant if calculated. The MICS
conducted between the MoH and UNICEF collected some
related information, however the sample size was too small
for statistical significance.
NC 1: Amount of National Funds allocated
to Government of Guyana for HIV
prevention and care
This was done through a NASA in the earlier years and a
follow up done in 2010/2011. Report on the second NASA
not available at the time of review.
NC4: Percentage of schools with teachers
who have been trained in life skills based
HIV education and who taught it during the
last academic year
This is an indicator linked to school health survey. The report
of the 2012 survey did not capture this information as per
definition.
PV 2: Percentage of Youths Aged 15-24
reporting the use of condoms during their
The BBSS reported on paying and non paying partners and
not on non regular partners. However 81% was reported for
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last sexual intercourse with a non regular
partner ( males)
non transactional sex partners.
PV 7: Percentage of Most at Risk
Populations (Miners) who reported
condom use during their last sexual
encounter with a regular or a non regular
partner.
No study was conducted among the miners during this
period.
PV 13: Percentage of OVCs whose
households received free basic external
support in caring for the child.
Whilst absolute numbers were reported for this indicator, the
denominator is unknown as a result of the issues highlighted
and linked to indicator IMP 6 above.
PV 9: Number of Adults and Children
Receiving HPC following National
Standards
This indicator was changed and redefined at the Mid Term
Review. The revised indicator was “Number of adults and
children receiving HIV related care and support according to
national Standards”. Whilst this is a related indicator, it is
much bigger than the first indicator. For these reasons, the
five years cumulative achievements were not possible to
measure.
This specific indicator was counted as two indicators in the
context of the overall 25 Indicators.
For the 42 indicators cumulative achievement was measured in the following way:
– For indicators with absolute numeric targets, the total 5 years achievements were measured against the
total five years targets.
– For percentages indicators, the 5 years cumulative results ( Numerator) was used against the cumulative 5
years targets ( denominator) to calculate the percentage 5 years cumulative achievement.
– To rate the degree of success a scale was used as follows- 80%-100%-Excellent , 70-79%- Good, 50-
69% -Fair and <50% -Poor.
Based on the findings of the findings the vast majority of the targets set for indicators were achieved with almost 81%
reporting excellent achievement and 90.4% reporting a combine excellent and good rating. The indicator relating to
the number of persons to be trained in CD4 testing was reported at below 50%, this was the only indicator rated as
poor. Please see table 16 below with the rating for each indicator and table 17 with rating per priority area.
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Table 16: Measurement of Cumulative Achievements
Indicator
Cummulative Five
Years Achievements
(%)
Rating
IMP1 : Proportion of all deaths attributable to AIDS
Not measured See notes in table above
IMP 2: Percentage of all adults and Children with HIV still alive 12 months after the initiation of ARVS
therapy
94.40% Excellent
IMP 3: HIV Prevalence among women aged 15-24 Not measured See notes in table above.
IMP 4: HIV Prevalence among MARPS
Prevalence Among MSM 97% Excellent
Prevalence among CSW 68.10% Fair
Prevalence among mobile populations ( miners) Not measured See notes in table above.
Prevalence among male STI patients 85% Excellent
Prevalence among STI female patients 72.3% Good
Prevalence among TB patients 121.70% Excellent
IMP5: Percentage of infants born to HIV infected mothers who are HIV infected Not measured See notes in table above
IMP 6: Ratio of current school attendance among orphans to that among non orphans age 10-14 Not measured See notes in table above
NC 1. Amount of National Funds allocated by Government for HIV Prevention and Care Not measured See notes in table above.
NC 2: Implementation of the three ones principles 100% Excellent
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NC3: National Composite Policy Index
100% Excellent
NC4: Percentage of schools with teachers who have been trained in life skills based HIV education and
who taught it during the last academic year
Not measured See notes in table above
NC 5: Number of Line Ministries with HIV workplans and budgets 102.40% Excellent
PV1: Percentage of young men and women aged 15-24 who have had sex before the age of 15 191.6% Excellent
PV2: Percent of youth aged 15-24 reporting the use of condoms during the last sexual intercourse with a non regular partner
PVC 2: Percent of youth aged 15-24 reporting the use of condoms during the last sexual intercourse
with a non regular partner ( FEMALES)
120.90% Excellent
PVC 2: Percent of youth aged 15-24 reporting the use of condoms during the last sexual intercourse
with a non regular partner ( MALES)
Not measured See notes in table above
PV3: Percent of persons aged 15-49 expressing accepting attitudes towards people with HIV and AIDS 55% Fair
PV4: Percent of young people aged 15-24 who correctly identify ways of preventing the sexual
transmission of HIV and who reject major misconceptions about HIV transmission
81.1% Excellent
PV5: Number of condoms distributed by the public and private sector in the past 12 months 83.1% Excellent
PV6: Number of targeted prevention programmes for Most at Risk Populations 160% Excellent
PV7:Percentage of MARP ( sex workers, MSM, Mobile Populations and other vulnerable groups) who reported using a condoms during their last encounter with a
regular or a non regular partner
Percentage of MARP who reported using a condoms during their last encounter with a regular or a non
regular partner ( CSW)
113.5% Excellent
Percentage of MARP who reported using a condoms during their last encounter with a regular or a non
regular partner ( MSM)
87.7% Excellent
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Percentage of MARP who reported using a condoms during their last encounter with a regular or a non
regular partner ( Miners)
Not measured See notes in table above
PV8: Number of Service Outlets that offer PMTCT services 95.3% Excellent
PV9: Number of Pregnant Women who receive HIV counseling and testing for PMTCT ad receive their
results
94.8% Excellent
PV9 (a): Percentage of pregnant women who were tested for HIV and received their results and were
counselled
107.80% Excellent
PV10: Percent of HIV Infected pregnant women who receive a complete course of ARV prophylaxis as
part of PMTCT
94.2% Excellent
PV11: Number of Health care workers trained in the provision of PMTCT according to National
Guidelines
157.50% Excellent
PV12: Percentage of babies born to HIV positive women who are tested before the age of 18 months 86.2% Excellent
PV13: Percentage of OVC whose household received free basic external support in caring for the child Not measured See notes in table above
PV 14: Number of providers /care takers trained in the provision of OVC 81.1% Excellent
PV15:Percentage of Transfused Blood Units in the Public and Private Sector in the last 12 months that
have been adequately screened for HIV according to national guidelines
100% Excellent
CTS1: Percentage of women, men and children with HIV infection receiving ART who are eligible
according to National Guidelines
88.3% Excellent
CTS 2: Number and Percentage of regions with at least one outlet providing ART services following
National Standards
100% Excellent
CTS3: Number of Health care workers trained in ART Delivery according to National Guidelines 137% Excellent
CTS4: Percentage of the general population aged 15-49 receiving an HIV test result in the past 12 85.1% Excellent
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months
CTS5: Number of Individuals trained in the provision of VCT according to National Guidelines 96.3% Excellent
CTS 6: Number of Regions with Service Outlets that provide HPC 75.5% Good
CTS7: Number of Service Outlets that provide HPC 98.3% Excellent
CTS8:Numberof persons trained to provide HPC according to Natioanl Guidelines 239.8% Excellent
CTS 9:Number of adults and children receiving HPC following National Standards Not measured See notes in table above
CTS 9: Number of adults and children receiving HIV related care and support according to National
Guidelines
Not measured See notes in table above
CTS10: Percentage of men and women with STI at healthcare facilities who are appropriately
diagnosed, treated and counselled.
156% Excellent
CTS11: Number of persons trained in the management of STI according to national guidelines 88.6% Excellent
CTS12: Percentage of eligible HIV positive registered TB patients given ART during TB treatment 98.5% Excellent
CTS13: Percentage of registered TB patients tested for HIV 94.1% Excellent
CTS14: Percentage of patients on ARVS who receive CD4 monitoring following National treatment
guidelines
88.4% Excellent
CTS15: Number of Regional Laboratories with capacity to perform CD4 tests following National
Standards
67.5% Fair
CTS16:Number of persons trained to conduct CD4test according to national guidelines 34.9% Poor.
SR1: Number of persons trained in strategic information, monitoring and evaluation and/or surveillance
and /or HMIS
70.9% Good
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SR2:Percentage of service outlets with record keeping systems to monitor HIV and AIDS care and
treatment
100% Excellent
Table 17: Summary of ratings of achievements by priority areas.
Indicator Type Total #of Indicators
in M&E Plan
Total # indicators including
sub indicators ( after MTR)
Total
Indicators
measured
Excellent Good Fair Poor
Impact 6 11 7 4 2 1 0
NC 5 5 3 3 0 0 0
PV 15 18 16 15 0 1 0
CTS 16 16 14 11 1 1 1
SI 2 2 2 1 1 0 0
TOTAL 44 52 42
(80.7%)
34
(80.9%)
4
( 9.5%)
3
(7.1%)
1
( 2.3%)
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SECTION SEVEN:
XIII. CONSIDERATIONS FOR HIVISON2020
The discussions during the midterm review provided recommendations for consideration in the development of the
new National HIV strategic Plan (HIVision2020). The following are highlighted:
1. With the evolving nature of the global economic and political architecture, greater focus must be placed on
the understanding of the financial requirement s of the National Response, thus the need for better
coordination among all donors and for regular AIDS spending assessments. Linked to this is the need for
programmes to be results based and that value for money is demonstrated.
2. Nationally, with the changing dynamics and HIV now a Chronic Disease coupled with Treatment as
Prevention, mush of the response must continue within the Health Sector. A Review of the Current
Coordinating Mechanism is recommended to consider these and other changes.
3. Guyana‟s response has shown success in many areas. The relatively lower rates of reduction seen in the
FCSW and MSM populations and the continuing HIV infection rates requires a re-prioritising and refocusing
HIV prevention to address the MAPRS through evidence based interventions.
4. Addressing risk factors for unsafe behaviours- gender base violence, alcohol use, bully in school, socio
economic factors such as unemployment, poor education status and single parenting and single head
households.
5. Efforts on Stigma and Discrimination must be strengthened including finalization and the passing of the HIV
legislation.
6. The evidence that treatment prevents is now widely available and therefore prevention in the New NSP
should be through the lenses of a robust treatment programme.
7. With the environment of reduced external support to programmes, sustainability of all services must be
addressed with particular reference to sustainability of ARVS.
8. Addressing HIV as a chronic disease and all associated co morbidities.- mental health issues, Diabetes,
Hypertension, Cardio Vascular and other diseases.
9. With the development of resistance to second line therapy, considerations for third line therapy should be
made.
10. Continued monitoring for HIV drug Resistance
11. The treatment programme has made significant strides in the PMS and collection and analysis of data.
There is the urgent need for an Electronic Medical Records System.
12. Increase private public partnerships to enhance care and support services.
13. Integrate HIV services into the Primary Health care setting.
14. Continued capacity building for M&E, surveillance, research.
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15. Continue with the surveillance surveys; however focus must also be on operations research particularly in
the treatment programme and with TB/HIV co-infection.
XIV. CONCLUSION
The five years under review saw significant achievements in the areas of policy, prevention, treatment,
support, monitoring and evaluation, capacity building for human resources, private sector involvement,
multi stakeholder involvement and many others. The resulting programmatic achievements measured by
the targets for the indicator set for the five year period confirms that that the National Programme
accomplished what was set out to be done.
.
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APPENDIX A : LIST OF CONTRIBUTORS
1. Dr. Shanti Singh- Programme Manager, NAPS/MoH
2. Dr. Abdel Abdalla- Coordinator of the Roving Hinterland Medical Team, NAPS/MoH
3. Ms. Nafeeza Ally- Social Services Coordinator , NAPS/MoH.
4. Ms. Shevonne Benn- Home & Palliative Care Coordinator, NAPS/MoH.
5. Ms. Sophie Collier –Data Analyst, M&E Unit, NAPS/MoH
6. Ms. Lynette Fiedtkou-Baird- Researcher /Writer, NAPS/MoH
7. Ms. Jennifer Ganesh- Prevention Coordinator, NAPS/MoH
8. Mr. Nazimul Hussain- Community Mobilisation Coordinator, NAPS/MoH
9. Dr. Bendita Lachmansingh- Epidemiologist, M&E, NAPS/MoH
10. Mr. Trevor McIntosh- VCT Regional Supervisor and Quality Assurance Manager(frm), NAPS/MoH
11. Mr. Delon Braithwaite- VCT Regional Supervisor and Quality Assurance Officer, NAPS/MoH
12. Ms. Fiona Persaud – M&E Coordinator, M&E Unit, NAPS/MoH
13. Ms. Sophia Collier, Data Analyst, M&E Unit, NAPS/MoH.
14. Mr. Nicholas Persaud- Treatment and Care Coordinator, NAPS/MoH
15. Dr. Shauna Scotland- STI Coordinator, NAPS/MoH.
16. Ms. Deborah Success- VCT Coordinator, NAPS/MoH.
17. Mr. Somdatt Ramessar- Food Bank Manager, NAPS/MoH.
18. Ms Aneela Persaud, Support Group Coordinator, NAPS/MoH.
19. Mr. Joe Hamilton, Parliamentary Secretary, Ministry of Health.
20. Dr. Leslie Ramsammy- Minister of Health, Guyana (Former).
21. Ms. Cilandell Glen, Youth Friendly Health Services Coordinator, Adolescent Health Department,
MoH.
22. Ms, Jessica Small, VCT/SRH Coordinator, Adolescent Health Department, MOH.
23. Mr. Arjune Deally- Statistician, MoH
24. Ms. Preeta Saywack, Surveillance Officer, MoH
25. Mr. Ishwardatt Singh- MIS Director, MoH.
26. Dr. Ravindra Swammy, STI coordinator, NAPS/MoH
27. Ms. Elizabeth McAlmont- MARPS Focal Point, NAPS/MoH.
28. Dr. Ravi Homenauth, NAPS/MoH
29. Dr. Colin Roach, Director, NPHRL/ MoH.
30. Mr. Roland Birkett, MIS Director, HSDU/MoH
31. Ms. Sarah Insanally, Director, Planning Unit, MoH.
32. Dr. Vishwa Mahadeo, Chief Executive Office, Berbice Regional Health Authority.
33. Ms. Cristel Teixeria, NCTC/MoH
34. Ms. Diana Dhanraj, NTP/MoH
35. Ms. Angelina Karim, PMTCT/MoH
36. Mr. Collin Haynes, Strategic Information Advisor, Davis Memorial Hospital.
37. Mr. Donald Cole, Strategic information Advisor, PUSH project, CDC.
38. Ms. Rushell Perry, Social Services Officer, Red Cross , Guyana.
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39. Mr. Dereck Springer-PANCAP
40. Ms. Ann Greene- Ministry of Human Services
41. Mr. Trevor Thomas- Permanent Secretary, Ministry of Human services and Social Security
42. Ms. Janelle Sweatnam- HIV/AIDS coordinator, Ministry of Education.
43. Mr. Renato Gonzales- Advisor, Ministry of Amerindian Affairs.
44. Ms. Claudia Scott-Senior Personnel Officer, Ministry of Home Affairs.
45. Mr. Patrick Mentore, Line Ministries Coordinator, HSDU, Ministry of Health
46. Mr. Cleazel Gray, VCT Coordinator, Youth Challenge Guyana.
47. Ms. Desiree Edghill, Executive Director, Artiste in Direct support.
48. Ms. Merica George, Prevention Coordinator, Artiste in Direct Support.
49. Ms. Coleen McEwan, Executive Director, GUYBOW.
50. Ms. Namela Baynes –Rowe, Co-chairperson, SASOD.
51. Dr. Beverly Barnett, PWR, PAHO, Guyana.
52. Dr. Rosalinda Hernandez, HIV/STI Advisor, PAHO, Guyana.
53. Dr. Ruben del Prado, Country Representative, UNAIDS, Guyana.
54. Ms. Otilia St. Charles, M&E, Resident Advisor, UNAIDS, Guyana.
55. Dr. Barbara Allen, Chief of party, CDC, Guyana.
56. Ms. Licelot Mercer, Fellow, CDC, Guyana.
57. Nicolette Henry, Programme Officer, CDC, Guyana.
58. Mr. Oswald Alleyene, Strategic Information Officer, USAID, Guyana.
59. Ms. Beverley Gomes-Lovell- Programme manager, Guyana Defence Force.
60. Dr. Owoeye Olufemi, Chief of Party GHARP II.
61. Ms. Megan Kearns, Technical Director, GHARP II.
62. Dr. Karen Boyle, Prevention Director, GHARP II.
63. Ms. Vashti Hinds, Care and Support Officer, GHARPII.
64. Ms. Shaundell Shipley, MARPS, Coordinator, GHARP II.
65. Mr. Sean Wilson, Project Coordinator, ILO
66. Dr. San San Min, Lead Resident Advisor, SCMS.
67. Ms. Cheryl Morgan, Programme Manager, Catholic Relief Services.
68. Ms Patrice LaFleur, Country Representative, UNFPA, Guyana.
69. Mr. Jason Shepherd, HIV/AIDS Officer, UNFPA, Guyana.
70. Miss Jewel Crosse, Youth and Adolescent Development Officer, UNICEF, Guyana.
71. Mr. Michael Khan, Chief executive Officer, GPHC.
72. Ms. Paula Sampson, Senior Programme Officer, Guyana Responsible Parenthood Association.
73. Members of the PLHIV Community – 24 persons
74. Members of the MSM Community- 26 persons
75. Members of the FCSW Community-19 persons.
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APPENDIX B- KEY INFORMANT INTERVEIW QUESTIONNAIRE
Guyana National Strategic Plan 2012-2020 Questionnaire
Date:_____/____/______ Name:_______________________________
Organization: _________________________________ Designation: ___________________________
The Ministry of Health through the National AIDS Programme Secretariat, is conducting an assessment
on the implementation of it National HIV/AIDS Strategy 2007-2011. This plan would be cessated as of
December 2011. As part of the process of planning for the development of HIVision 20/20 you have
been identified as a key resource person within the multisectoral response to HIV. We therefore would
like to solicit your opinion of implementation of the 2007-2012 strategy and your view on direction of
the HIVISION 20/20. I wish to thank you for this interview and assure you that your contributions are
valuable to the process.
1. Have you heard of the National HIV/AIDS Strategy 2007-2011?
A. Yes B. No If so, are you familiar with the contents of the strategy? A. Yes B. No
……………………………………………………………………………………………………………………………………………………………….
2. As you know the Guyana National HIV/AIDS Strategy 2007-2011 address four (4) priority areas;
Strengthening the national capacity to implement a coordinated, multi-sectorial resource,
reducing risk vulnerability to HIV infection, clinical and diagnostic management and access to
care, treatment and support and strategic information.
Do you felt that the plan adequately achieve what it intended? ( if yes, ask what areas, if no ask
what areas )
A. Yes
B. No. If No, which area there should more attention be placed and Why?
Priority Area Discussion (if No) – Why do you believe
that this was not achieved? What were
the challenges
Discussion (if Yes) – What do you believe
were the successes? What would you
attribute this success to?
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1.0 Multi Sectoral Coordination
YES NO REMARKS
1.1 PCHA, HSDU& NAPS empowered
to coordinate Guyana’s National
HIV/AHIDS multi sectoral response
1.2 Integrate HIV/AIDS into the
programmes and services offered by
other Ministries
1.3 Harmonize and align resources to
ensure efficient use of donor
funding.
1.4 Increase the involvement of civil
society organizations and the Private
Sector in the scaled up response
1.5 Advocate for a legal and policy
environment that protects the rights
of people living with HIV/AIDS and
vulnerable groups.
1.6 Review the National Response to
HIV/AIDS
2.0 RISK REDUCTION
2.1 Design and implement
Communication Programme on
HIV/AIDS
2.2 Develop and implement targeted
behavior change interventions to
increase positive sexual practices
and encourage early STI/HIV
diagnosis and treatment among
vulnerable groups.
2.3 Implement prevention education
and behavior change reinforcement
activities.
2.4 Expand condom social marketing
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programme
2.5 Scale up the PMTCT Programme.
2.6 Reduce the vulnerability of the
OVC to HIV/AIDS
2.7 Expand VCT services
2.8 Reduce the vulnerability to
HIV/AIDS through identification and
treatment and treatment of STI/OIs.
2.9 Ensure safe Blood supply
2.10 Implement plan to reduce
health worker and community risk to
HIV transmission through
contaminated sharps.
3.0 CARE, TREATMENT & SUPPORT
3.1 Expand access to ARV treatment
to scale up the response.
3.2 Create Centre of Excellence at
the GUM clinic and GPHC
3.3 Establish a quality home based
and palliative care programme
providing support to PLHIV and
those affected by HIV/AIDS
3.4 Provide psychosocial care and
support to PLHIV and those affected.
3.5 Design and implement institution
training programmes for HIV/AIDS
treatment, care and support.
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3.6 Expand comprehensive care for
opportunistic infections
3.7 Strengthen the link between the
TB and HIV/AIDS/STI control
programmes.
3.8 Implement activities to increase
use of quality STI/HIV/AIDS
diagnostic and treatment services.
3.9 Upgrade laboratory capacity to
diagnose and monitor HIV/AIDS and
associated opportunistic infections.
3.10 Establish National Public Health
Reference Laboratory
3.11 Procurement and distribution of
care and treatment supplies
improved (commodities
management)
4.0 Strategic Information
4.1 Strengthen the HIV/AIDS
surveillance systems
4.2 Develop and implement a system
for monitoring and evaluating the
response to HIV/AIDS
4.3 Design, implement and
disseminate results of special
surveillance surveys and studies in
selected groups.
4.4 Strengthen local capacity to
undertake research related to
HIV/AIDS.
4.5 Strengthen the Health
Information system
G o v e r n m e n t o f G u y a n a
N a t i o n a l A I D S P r o g r a m m e S e c r e t a r i a t
Page 98
3. Can you identify gaps or challenges of the NSP 2007-2011 as it relates to areas that are
mentioned? Do you think that there were missing elements to the last NSP under these priority
areas /
1.0 Multi Sectoral
Coordination
YES NO REMARKS
1.1 PCHA, HSDU& NAPS empowered
to coordinate Guyana’s National
HIV/AHIDS multi sectoral response
1.2 Integrate HIV/AIDS into the
programmes and services offered by
other Ministries
1.3 Harmonize and align resources to
ensure efficient use of donor
funding.
1.4 Increase the involvement of civil
society organizations and the Private
Sector in the scaled up response
1.5 Advocate for a legal and policy
environment that protects the rights
of people living with HIV/AIDS and
vulnerable groups.
1.6 Review the National Response to
HIV/AIDS
2.0 RISK REDUCTION
2.1 Design and implement
communication programme on
HIV/AIDS
2.2 Develop and implement targeted
behavior change interventions to
increase positive sexual practices
and encourage early STI/HIV
diagnosis and treatment among
G o v e r n m e n t o f G u y a n a
N a t i o n a l A I D S P r o g r a m m e S e c r e t a r i a t
Page 99
vulnerable groups.
2.3 Implement prevention education
and behavior change reinforcement
activities.
2.4 Expand condom social marketing
programme
2.5 Scale up the PMTCT Programme.
2.6 Reduce the vulnerability of the
OVC to HIV/AIDS
2.7 Expand VCT services
2.8 Reduce the vulnerability to
HIV/AIDS through identification and
treatment and treatment of STI/OIs.
2.9 Ensure safe Blood supply
2.10 Implement plan to reduce
health worker and community risk to
HIV transmission through
contaminated sharps.
3.0 CARE, TREATMENT & SUPPORT
3.1 Expand access to ARV treatment
to scale up the response.
3.2 Create Centre of Excellence at
the GUM clinic and GPHC
3.3 Establish a quality home based
and palliative care programme
providing support to PLHIV and
those affected by HIV/AIDS
G o v e r n m e n t o f G u y a n a
N a t i o n a l A I D S P r o g r a m m e S e c r e t a r i a t
Page 100
3.4 Provide psychosocial care and
support to PLHIV and those affected.
3.5 Design and implement institution
training programmes for HIV/AIDS
treatment, care and support.
3.6 Expand comprehensive care for
opportunistic infections
3.7 Strengthen the link between the
TB and HIV/AIDS/STI control
programmes.
3.8 Implement activities to increase
use of quality STI/HIV/AIDS
diagnostic and treatment services.
3.9 Upgrade laboratory capacity to
diagnose and monitor HIV/AIDS and
associated opportunistic infections.
3.10 Establish National Public Health
Reference Laboratory
3.11 Procurement and distribution of
care and treatment supplies
improved (commodities
management)
4.0 Strategic Information
4.1 Strengthen the HIV/AIDS
surveillance systems
4.2 Develop and implement a system
for monitoring and evaluating the
response to HIV/AIDS
4.3 Design, implement and
disseminate results of special
surveillance surveys and studies in
selected groups.
4.4 Strengthen local capacity to
G o v e r n m e n t o f G u y a n a
N a t i o n a l A I D S P r o g r a m m e S e c r e t a r i a t
Page 101
undertake research related to
HIV/AIDS.
4.5 Strengthen the Health
Information system
4. Having looked at the last NSP and now moving forward what would you suggest are key areas
for inclusion in the next National Strategic Plan bearing in mind that this plan is for the period
2012-2020. Is there any other area that you would like to identified that should be re included
in HIVision 20/20
5. Is there another new priority area that you would like to indentify for the new strategic plan?
Kindly provide details ?
6. Any additional comments or ideas that you would like to mentioned?
END OF QUESTIONNAIRE
2015
Reporting Period: January ‐ December 2014
GUYANA AIDS RESPONSE
PROGRESS REPORT
Republic of Guyana
GUYANA AIDS RESPONSE PROGRESS REPORT
Republic of Guyana
Reporting period: January – December 2014
Presidential Commission on HIV and AIDS
Government of Guyana Global AIDS Response Progress Report, 2015
1
FOREWORD
Guyana AIDS Response Progress Report 2014 provides us once more with another
opportunity to assess the progress made towards achieving the bold targets set in June 2011
Political Declaration on HIV and AIDS and its Millennium Development Goal Six (MDG 6)
of halting the spread and beginning the reversal of HIV and AIDS. Importantly it allows us
to critically access and understand the challenges and the gaps in the response and to
develop strategies for responding. This is a critical year not only for the AIDS progress
report and MDG 6, but for taking stock of all the MDGs. Parallel to this report therefore
the Government of Guyana with its stakeholders have been critically examining the MDGs,
reviewing the degree of achievement, highlighting success stories, understanding the
challenges and more importantly developing the roadmap for the future, as we enter into the
post 2015 era of Sustainable Development Goals (SDGs).
The body of this report provides a preponderance of evidence that point to the further
stabilizing of the HIV epidemic. There has been an annual reduction in the number of HIV
cases reported since 2009, a reduction in AIDS cases, and the number of AIDS-related
deaths.
Guided by HIVision 2020, Guyana continues to deliver a comprehensive multi-sectoral
response with involvement of a variety of partners and stakeholders. Civil Society
Organisations have been instrumental in ensuring that prevention services reach the key
populations. The community of people living with HIV and AIDS has maintained its focus
on advocacy and on providing psychosocial support and empowerment for their
constituency. The Private Sector has extrapolated best practices of the private public
partnership in the HIV response to broader health issues whilst continuing to support the
response. The donor community has maintained its support for Guyana and has worked
assiduously in ensuring that there is smooth transitioning of their support to Government, a
key ingredient to sustainability. Our technical partners – local, regional and global, continue
to provide important technical guidance to the programme.
HIV prevention programmes continue with National Coverage and with greater emphasis
on reaching the key populations at higher risk. In fact 2014 has been an exceptional year in
working with and reaching the key populations. With continued support from our partners,
the national programme has reached greater numbers of men who have sex with men,
female commercial sex workers, transgender persons, miners and loggers. The investment
over the years in prioritizing the key populations has yielded good results as evident in the
reduced HIV prevalence among these populations in the findings of the Biological and
Behavioural Surveillance (BBSS) findings released in November 2014.
Other prevention programmes continue to show good progress with greater than 95%
uptake of HIV testing among the antenatal populations, sustained HIV testing for the
general population, 100% screening of blood and blood products, continued training and
sensitization of the young persons, persons in the workforce and the general population.
Condom programming and cervical cancer screening continued in 2014, building on the
gains in previous years.
Government of Guyana Global AIDS Response Progress Report, 2015
2
Guyana’s HIV treatment programme continues to deliver the highest quality of care to
persons living with HIV with the great majority of those persons (85.2%) on antiretroviral
therapy, achieving universal coverage for ART. There continues to be favorable treatment
outcomes with increasing survivability and reduced AIDS related deaths.
TB/HIV co-infection, still a public health problem has seen significant progress with
continued high uptake of HIV testing of greater than 91% among the TB patients and a
reducing co-infection rate from 31% in 2012 to 22% at the end of 2014. There is increasing
coverage of TB/HIV co-infected patients on antiretroviral therapy.
Laboratory support to the programme continued with the strengthening of TB diagnosis
among HIV patients through the introduction of state of the art technology of Gene Xpert.
Critically, the programme is now equipped to better understand the burden of multidrug
resistant tuberculosis among TB patients as well as TB/HIV co-infected patients.
There continues to be concerted efforts in strengthening the HIV surveillance system with a
revision of the system in 2014, thus enabling the reporting of HIV, advanced HIV, and
AIDS cases. Planning has started with partners in the development of an Electronic Medical
Record System and a Health Information System.
Notwithstanding our achievements, 2014 recorded its own challenges – particularly those of
transitioning which affected the work force and implicitly health service delivery. Other
challenges are noted in the report to which the Ministry will work with all stakeholders in
addressing as we move forward. Despite these, it is imperative that we continue to deliver
evidence-informed strategies and activities to achieve prevention, particularly among the
most vulnerable – youth, sex workers, men who have sex with men, drug users and persons
with disabilities. We will work assiduously in reducing the vulnerabilities for HIV as we
comprehensively address the social determinants of health and tackle the difficult and
challenging issues such as gender based violence.
In the face of the reducing donor funded resources for the national HIV response, we will
focus our efforts at ensuring that our programmes are transitioned to full local ownership
while maintaining a comprehensive evidence-based scope and scale. The Government of
Guyana commits to ensuring that no baby is born HIV positive, that every Guyanese knows
their HIV status, having available and accessible HIV prevention methods, and that every
person infected with HIV will continue to receive the highest quality of care and treatment. I
am confident that this approach, implemented through the strategies of HIVision 2020 and
in collaboration with all partners and stakeholders, will accelerate the path of reversal of the
HIV epidemic and guarantee us an AIDS free Guyana. The Government of Guyana stands
committed.
I wish to thank all partners, donors, civil society organizations, people living with HIV and
AIDS, members of the key populations, health care workers, policy makers and everyone
who has contributed to the HIV response.
Dr. George A. Norton MD, Ophthalmologist, MP.
Minister of Public Health
Government of Guyana Global AIDS Response Progress Report, 2015
3
TABLE OF CONTENTS
ACRONYMS………………………………………………………………………………………………………………………..7
1. STATUS AT A GLANCE………………………………………………………………………………9
Inclusiveness of Stakeholders in the Report Preparation……………………………………………..9
Status of the Epidemic……………………………………………………………………………………………………..9
Policy Response……………………………………………………………………………………………………………9
Programmatic Response……………………………………………………………………………………………….11
II. OVERVIEW OF THE EPIDEMIC…………………………………………………………….19
TRENDS IN THE EPIDEMIC…………………………………………………………………………………..21
Distribution of HIV and AIDS Cases According to Sex……………………………………………….21
Distribution of HIV Cases According to Age Groups………………………………………………….22
Geographic Distribution of HIV and AIDS………………………………………………………………….24
AIDS-Related Mortality……………………………………………………………………………………………….24
III. NATIONAL RESPONSE TO THE AIDS EPIDEMIC……………………………….26
POLITICAL COMMITMENT…………………………………………………………………………………26
Institutional Roles and Responsibilities……………………………………………………………………….27
Multi-Sectoral Coordination……………………………………………………………………………………….28
PREVENTION………………………………………………………………………………………………………..33
Behavior Change Communication (BCC)……………………………………………………………….33
Information, Education and Communication (IEC)………………………………………………..35
Condom Distribution…………………………………………………………………………………………………35
Prevention of Mother-to-Child Transmission (PMTCT)…………………………………………….37
Voluntary Counseling and Testing (VCT) for HIV………………………………………………….41
Blood Safety Programme……………………………………………………………………………………………..45
Post Exposure Prophylaxis (PEP)……………………………………………………………………………..46
Prevention and Control of Other Sexually Transmitted Infections (STIs)…………………..48
Community Mobilization…………………………………………………………………………………………….51
Interventions with Key Populations at Higher Risk……………………………………………………53
Prevention Among Youth………………………………………………………………………………………64
Prevention of Gender Based Violence……………………………………………………………………..66
Government of Guyana Global AIDS Response Progress Report, 2015
4
Other Key Initiatives Implemented Under the National Prevention Programme……….67
TREATMENT AND CARE………………………………………………………………………………………71
The HIV Treatment and Care Programme………………………………………………………………71
Monitoring Quality Treatment and Care………………………………………………………………….79
Home Based Care……………………………………………………………………………………………………81
MITIGATION……………………………………………………………………………………………………………83
Support to Orphans and Vulnerable Children (OVC)……………………………………………..83
Psychosocial Support for Persons Living with HIV………………………………………………..84
Nutritional Support for Persons living with HIV/AIDS………………………………………..86
IV. BEST PRACTICES…………………………………………………………………………………..90
1. HIV CITIES Project……………………………………………………………………………………………….90
2. The Private Sector as a Major Partner in Providing Nutritional Support………………..93
3. The Guyana Defence Force Actively Promotes HIV Prevention………….………94
4. BBSS 2014 Completed Through Strong Multisectoral Collaboration………….……96
V. MAJOR CHALLENGES AND REMEDIAL ACTIONS………………………………..98
VI. SUPPORT FROM COUNTRY’S DEVELOPMENT PARTNERS……………….102
VII. MONITORING AND EVALUATION ENVIRONMENT………………………..103
ANNEXES…………………………………………………………………………………………………..107
ANNEX 1: Training Activities Conducted During the Reporting Period………………….107
ANNEX 2: Core Indicators for Global AIDS Response Progress Reporting……………113
ANNEX 3: Core Indicators for Universal Access Reporting……………………………………..120
ANNEX 4: Consultation/Preparation Process for the National Report……………………134
ANNEX 5: Contributors to the Reporting Process…………………………………………………….135
Government of Guyana Global AIDS Response Progress Report, 2015
5
LIST OF TABLES
Table 1: Overview of Indicator Data…………………………………………………………………………………..15
Table 2: Trends in Reported Cases of HIV and AIDS According to Sex, 2002–2014…………21
Table 3: Distribution of Reported HIV Cases by Age-groups 2010 – 2014…………………………23
Table 4: Proportion of Reported HIV Cases by Region 2006 – 2014………………………………….24
Table 5: Annual Number and Proportion of AIDS-Related Deaths……………………………………24
Table 6: HIV Prevalence among Key Populations in Guyana……………………………………………..25
Table 7: Mass Media Campaigns Held During the Period 2005-2014………………………………….36
Table 8: Distribution of Lubricants by Region During 2014……………………………….37
Table 9: Major trends in the PMTCT Programme 2006-2014……………………………………………..40
Table 10: Annual Testing by Gender: 2010 – 2014…………………………………………42
Table 11: HIV Testing by Regions: 2010-2014……………………………………………..43
Table 12: HIV Testing by Age Groups: 2014………………………………………………43
Table 13: HIV Testing in Various Settings for the Period 2005-2014…………………………………45
Table 14: STI by Type 2009 – 2014…………………………………………………………………………………….49
Table 15: Number of Peer Educators Trained by Region…………………………………52
Table 16: Organizations that Provided Services to Key Populations During 2012–2014…….60
Table 17: Persons on ART for the Period 2003-2014………………………………………73
Table 18: Remedial Actions in Response to Challenges……………………………………99
Table 19: HIV Estimates: Guyana 2014………………………………………………….105
Table 20: Key Coverage Indicators: Guyana 2014………………………..………………105
LIST OF FIGURES
Figure 1: Annual Cases of HIV and AIDS 2001-2014…………………………………………………………20
Figure 2: Trends in the number of annual cases of HIV and AIDS: 2001-2014………..…..20
Figure 3: Trends in Reported Cases of HIV According to Sex 2001–2014…………………21
Figure 4: Trends in Reported Cases of AIDS by Sex 2001–2014…………………..………22
Figure 5: HIV cases According to age groups: 2008-2014………………………….……..22
Figure 6: Proportion of HIV Cases Among Youth, 2008–2014…………………………………………..23
Figure 7: Guyana Multi-sectoral Response Mechanism for HIV and AIDS………………………..27
Figure 8: Condom Distribution Through NAPS During 2010-2014……………………………………38
Figure 9: Condom Distribution in Guyana during 2014………………………………………………………38
Figure 10: Trend in VCT Uptake from 2010-2014…………………………………………………………….38
Figure 11: Prevalence of HIV in ANC Population: 2010-2014…………………………….39
Figure 12: Number of Tests done According to Gender: 2010–2014………………………42
Figure 13: Number of Tests done Among Key Populations in 2014………………………44
Figure 14: Proportion of Infectious Markers, 2009-2014…………………………………………………….46
Figure 15: Number of Reported PEP Cases 2010–2014……………………………………………………..47
Figure 16: Needle Stick Injuries vs Sexual Assault in PEP Cases…………………………..48
Figure 17: Number of Reported STI Cases 2007 – 2014……………………………………………………..48
Figure 18: Distribution of STI Cases According to Sex 2010 – 2014…………………………………..49
Figure 19: Number of Peer Educators Trained 2009 – 2014……………………………………………….52
Figure 20: FSWs and MSM Reached with Prevention Programmes During 2009-2014……61
Figure 21: Regional Distribution of Condoms/Lubricants Among Key Populations………59
Government of Guyana Global AIDS Response Progress Report, 2015
6
Figure 22: TB/HIV Co-Infection Rate in Prison During the Period 2007–2014…………………64
Figure 23: Persons in Care and Treatment Disaggregated by Gender, 2010-2014………….72
Figure 24: Persons in Care (non ART) and Treatment (ART), 2009-2014………………….72
Figure 25: Trends in Outcomes for Patients not Included in the Survivability Measure.…..74
Figure 26: Deaths by Gender and Time Cohorts……………………………………….…75
Figure 27: Stop Rates by Gender and Time Cohorts…………………………….…….…..75
Figure 28: Average CD4 at Initiation…………………………………………………..…..78
Figure 29: HIV/TB Co-infection Among New TB Patients: 2005–2014………………..…79
Figure 30: Patient Enrollment at NGOs and Government Treatment Sites 2010 – 2014.…82
Figure 31: Patient Enrollment by Regions During 2010-2014…………………………….83
Figure 32: Membership of the Support Groups – 2010 – 2014…………………………….85
Figure 33: Hamper Distribution: 2007–2014………………………………………………87
Figure 34: Gender Disaggregation of Beneficiaries 2007–2014……………………………88
Figure 35: Beneficiaries in Treatment and Care: 2007–2014…………………………….…89
Figure 36: Private Sector Sponsorship of Hampers:2007–2014……………………….…..89
LIST OF BOXES
Box 1: DNA PCR Testing………………………………………………………………………………………………….39
Box 2: Capacity Development Within the PMTCT Programme During 2014…………….41
Box 3: Persons Tested During Couples Testing…………………………………………………………………45
Box 4: Needle Stick Injuries Versus Sexual Assault Cases 2014……………………………46
Box 5: Needle Stick Injuries Versus Sexual Assault: 2010-2914……………………..…….47
Box 6: VIA Services Provided 2012-2014………………………………………………………………………….50
Box 7: MSM Population Reached 2009–2014…………………………………………………………………….57
Box 8: FSW Population Reached 2009–2014……………………………………………………………………..58
Box 9: Twelve Month Survivability Among the National Cohort………………………………………73
Box 10: VCT Among the Military: 2006-2014……………………………………………..95
Government of Guyana Global AIDS Response Progress Report, 2015
7
ACRONYMS
AIDS Acquired Immune Deficiency
Syndrome
ABC Abstain, Be faithful, Condomize
ANC Antenatal Clinic
APC Advancing Partners and
Communities
ART Antiretroviral Therapy
ARV Antiretroviral
BCC Behavior Change Communication
BMS Breast Milk Substitute
BBSS Biological and Behavioral
Surveillance Survey
CARICOM Caribbean Community
CBOs Community-based Organizations
CCM Country Coordinating Mechanism
CCPA Child Care Protection Agency
CDC US Center for Disease Control and
Prevention
CSO Civil Society Organization
CSS Client Satisfaction Survey
CSW Commercial Sex Worker
DHS Demographic Health Survey
DOTS Direct Observed Therapy
DNA Deoxyribonucleic Acid
EMR Electronic Medical Record
FBO Faith-based Organization
FCSW Female Commercial Sex Worker
FSW Female Sex Worker
GARPR Global AIDS Response Progress
Report
GBCHA Guyana Business Coalition on
HIV/AIDS
GBoS Guyana Bureau of Standards
GBV Gender Based Violence
GDF Guyana Defence Force
GDP Gross Domestic Product
GDS Genital Discharge Syndrome
GFATM Global Fund to Fight AIDS,
Tuberculosis and Malaria
GFCHA Guyana National Faith Coalition
on HIV and AIDS
GIZ Deutsche Gesellschaft fur
Internationale Zusammenarbeit
GoG Government of Guyana
GRPA Guyana Responsible Parenthood
Association
GSWC Guyana Sex Worker Coalition
GUD Genital Ulcer Disease
GUM Genito-Urinary Medicine
GINA Guyana Information Agency
HAART Highly Active Antiretroviral Therapy
HBC Home-Based Care
HDI Human Development Index
HFLE Health and Family Life Education
HIV Human Immuno-deficiency Virus
HIV DR HIV Drug Resistance
HPV Human Papilloma Virus
HSDU Health Sector Development Unit
HTC HIV Testing and Counseling
HTLV Human T-Lymphotropic Virus
HVOP HIV Other Prevention
IEC Information, Education,
Communication
ILO International Labor Organization
IPT Isoniazid Preventive Therapy
IYCF Infant and Young Child Feeding
Practices
JFA Justice for All
LEEP Electrosurgical Excision Procedure
LGBT Lesbian, Gay, Bisexual and
Transgender
LTFU Loss to Follow Up
MARPs Most At-Risk Populations
MERG Monitoring and Evaluation
Reference Group
M&E Monitoring and Evaluation
MIS Management Information Systems
MMU Materials Management Unit
MoLHS&SS Ministry of Labor, Human Services
and Social Security
MoH Ministry of Health
MOU Memorandum of Understanding
MSM Men Who Have Sex with Men
MSW Male Sex Worker
MTCT Mother-to-Child-Transmission
MYCS Ministry of Youth Culture and
Sports
NAC National AIDS Committee
NAP National AIDS Programme
NAPS National AIDS Programme
Secretariat
NASA National AIDS Spending
Assessment
NBTS National Blood Transfusion Service
Government of Guyana Global AIDS Response Progress Report, 2015
8
NCTC National Care and Treatment Centre
NGOs Non Governmental Organizations
NLID National Laboratory for Infectious
Disease
NPHRL National Public Health Reference
Laboratory
NTP National Tuberculosis Programme
OIs Opportunistic Infections
OVC Orphans and Vulnerable Children
PAHO-WHO Pan American Health Organization-
World Health Organization
PANCAP Pan Caribbean Partnership against
HIV/AIDS
PCHA Presidential Commission on HIV
and AIDS
PCR Polymerase Chain Reaction
PEP Post Exposure Prophylaxis
PEPFAR President Emergency Plan for AIDS
Relief
PHDP Positive Health, Dignity and
Prevention
PITC Provider-Initiated Testing and
Counseling
PLACE Priorities for Local AIDS Control
Efforts
PLHIV Persons Living with HIV
PMS Patient Monitoring System
PMTCT Prevention of Mother-to-Child-
Transmission
PUID Personal Unique Identifier
RACs Regional AIDS Committees
RCC Rolling Continuation Channel
SASOD Society against Sexual Orientation
Discrimination
SCMS Supply Chain Management Systems
SPSS Statistical Package for Social Sciences
SRH Sexual and Reproductive Health
STIs Sexually Transmitted Infections
SVA Single Visit Approach
SW Sex Workers
TB Tuberculosis
TWG Technical Working Group
UBL United Brick Layers
UNAIDS Joint United Nations Programme on
HIV and AIDS
UNDP United Nations Development
Programme
UNESCO United Nations Education Scientific
and Cultural Organization
UNFPA United Nations Population Fund
UNICEF United Nations Children Fund
USAID United States Agency for
International Development
VCT Voluntary Counseling and Testing
VIA Visual Inspection with Acetic Acid
WAD World AIDS Day
YES Youth Educators Safe Guarding over
Workforce
I. STATUS AT A GLANCE
Inclusiveness of Stakeholders in the Report Preparation
The preparation of the Guyana AIDS Response Progress Report (GARPR) for the 2014
reporting period was led by a broad-based country team comprising key stakeholders
involved in the national response to HIV (see Annex 5) along with the Monitoring and
Evaluation Reference Group (MERG). The country team held ongoing meetings to discuss
the indicators that Guyana would report on, the report preparation process, and also to
provide feedback on the various sections of the GARPR as they were being drafted.
The inputs of other key stakeholders including bilateral and donor partners, technical
agencies, Civil Society Organisations, and non-health Line Ministries, were also solicited
during the desk review process in the GARPR preparation. Upon request, these agencies
submitted their individual progress reports for incorporation into the overall GARPR.
During this period, there was ongoing verification of the data provided and continuous
communication with partners who remained engaged throughout the review process. Prior
to the finalization of the GARPR, a broad-based consensus meeting was held with key
stakeholders (see Annex 5) to present a summary of the draft that was circulated prior to the
meeting and to obtain the feedback of partners. This feedback, along with additional
feedback received after the meeting, were taken into consideration in finalizing the GARPR
for submission to the Joint United Nations Programme on HIV and AIDS (UNAIDS).
Parallel to the process of developing this narrative report, the National AIDS Programme
Secretariat (NAPS) worked with relevant stakeholders in addressing the data requirements
for the report, and submitted this data online using the UNAIDS reporting format. This
also included an ARV Use Report Form from WHO as well as an updating of policy issues.
Further, a country team comprising representatives from NAPS, PMTCT (MoH),
Surveillance Unit (MoH), UNAIDS and CDC, developed the HIV country estimates.
Status of the Epidemic
Based on the UNAIDS 2013 estimation exercise, Guyana’s adult HIV prevalence is 1.4%.
There has been a steady reduction in the prevalence of HIV among the general population
from 2004, when it was 2.4 percent.
At the end of 2014, a total of 751 cases of HIV were diagnosed compared with 758 cases
reported in 2013. This continues to represent a significant reduction when compared to the
1,176 HIV cases reported in 2009.
While the trend since 2010 has shown a greater number of reported HIV cases among
females compared to males, the male female ratio once again increased in 2013 to 1.01,
continuing into 2014 with a male female ratio of 1.09 (MoH Surveillance data). In terms of
notified AIDS cases, the male female ratio continues to show a higher proportion among
males with a ratio of 1.4 in 2014 as occurred in 2013.
Government of Guyana Global AIDS Response Progress Report, 2015
1
0
The highest number of reported cases of HIV in 2014 occurred in the 25-49 age-group
accounting for 61.7% (463/751) of all cases compared with 67.7% in 2013. It is important
to note that the number of HIV cases under 1 year old has remained below 5 since 2008.
Children aged 0-4 accounted for 1.2% of the reported HIV cases in 2014 compared to 0.7%
in 2013. Persons 50 years and above accounted for 17.9% of all cases of HIV in 2014
compared to 14.1% in 2013 (MoH Surveillance Unit).
Region 4 continued to have the highest proportion, of all HIV cases in 2014 with 72.8% of
all cases compared with 75.4% in 2013 (MoH Surveillance Unit). The relatively higher
notification of cases in Region 4 can be attributed to the larger population size and the
higher concentration of HIV services, including counseling and testing.
The proportion of all deaths attributable to AIDS has been declining steadily from 9.5% in
2002 to 4.8% in 2012 (preliminary data from MoH Statistics Unit).
HIV prevalence among pregnant women was 1.9% (293/15,494) in 2014 which was the
same prevalence in 2013 (PMTCT programme reports). In 2014, 2.6% (5/193) of babies
born to HIV-positive mothers were infected with HIV compared to 2.1% (4/191) in 2013
(PMTCT programme reports). HIV prevalence among blood donors was 0.96% of all blood
screened compared with 0.3 % in 2013 (Blood Bank Programme data).
The Biological and Behavioral Surveillance Survey (BBSS) 2014 showed a sharp decrease in
the HIV prevalence among female sex workers (FSWs), from 26.6 percent (BBSS, 2005) to
5.5% (BBSS, 2014). There was also a marked decrease in prevalence among MSM from 21.2
percent (BBSS, 2005) to 4.9% (BBSS, 2014) and among miners from 6.5% in 2000 to 1%
(BBSS 2014). Several populations were surveyed for the first time with HIV prevalence
reported as follows: Loggers 1.3%; male sex workers (MSWs) 5.1% and; transgenders 8.4%
(BBSS 2014).
Data for the period 2005 – 2014 indicate that the rate of TB/HIV co-infection fluctuated
between 36 % in 2005 to 22% in 2014.
Policy Response
A major achievement during 2014 was the tabling in Parliament in January 2014 of the HIV
and AIDS Regulations, made under the Occupational Safety and Health Act 1997. These
Regulations seek to enforce the National Workplace HIV and AIDS Policy and includes the
right of persons living with HIV (PLHIV) to secure employment and be provided with the
same health and other benefits accorded to other employees. The Regulations were a
product of ongoing collaboration during the previous reporting period, between the Ministry
of Labour, MoH, the Attorney General’s Chambers, the International Labour Organization
(ILO) and other key stakeholders.
During 2013, a Sexual and Reproductive Health (SRH) Policy was drafted with inputs from a
broad-based technical committee chaired by the Chief Medical Officer and supported by
legal personnel. The policy seeks to provide a cohesive response to address universal access
to Sexual and Reproductive Health for all and to link reproductive rights and SRH to
Government of Guyana Global AIDS Response Progress Report, 2015
11
physical and mental health, gender, adolescents and youth. During 2014, the draft submitted
by the legal personnel was reviewed by the members of the committee and is currently being
updated to include pertinent statistical background data in relation to youth, obtained from
the Ministry of Health. Once finalized, this document will be presented to Cabinet for
approval. An SRH Strategy was also drafted in alignment with the SRH Policy, Health
Vision 2020 and HIVision 2020 and is currently being finalized.
A National Youth Policy was drafted as a result of extensive consultations held with key
stakeholder groups. This Policy seeks to protect the rights of adolescents and youth,
including those living with HIV. The draft Policy was reviewed during 2014 and additional
work is to be undertaken to facilitate its finalization.
During the reporting period, the Ministry of Labour, Human Services and Social Security
(MoLHS&SS) in collaboration with various stakeholder groups, including practising lawyers,
developed the Domestic Violence Regulations. These Regulations, which were tabled in
Parliament during February 2015, will further operationalize the Domestic Violence Act of
Guyana. The Domestic Violence Act was passed in December 1996 to give legal protection
to persons who suffer abuse or are at risk of suffering domestic abuse.
Programmatic Response
HIVision 2020, Guyana’s National HIV Strategic Plan (2013 – 2020) is underpinned by the
principles of Human Rights, Gender Equality, Inclusiveness, Accountability, Value for
Money and Sustainability. It encompasses the vision of Zero New HIV Infections, Zero
Discrimination and Zero AIDS-Related Deaths. The vision of HIVision 2020 is “To
eliminate HIV in Guyana” and its goal is “To reduce the social and economic impact of HIV
and AIDS on individuals and communities and ultimately the development of the country.”
HIVision 2020 focuses on five priority areas: Coordination; Prevention; Treatment, Care and
Support and; Integration and: Strategic Information. The programmatic response of the
Government of Guyana during the reporting period, has thus been grounded in these
overarching principles throughout the national HIV response.
The period under review was characterized by increased coverage of HIV-related services in
the areas of prevention, treatment, care and support. Special emphasis was placed on key
populations at higher risk in light of the increased vulnerability of these groups with regard
to the transmission of HIV. Emphasis was also placed on strengthening monitoring,
evaluation and surveillance systems and the increased use of strategic information to inform
programming and quality improvements.
During the reporting period, more than 5,218 health care workers and other individuals
received training in a wide range of subject areas (see Annex 1) including: leadership and
coordination; adolescent health; sexual and reproductive health; gender-based violence; HIV
sensitization; stigma and discrimination; workplace wellness; key affected populations;
prevention of mother to child transmission of HIV (PMTCT)); voluntary counseling and
testing (VCT); sexually transmitted infections (STIs); peer education; post exposure
prophylaxis (PEP); TB; clinical management of HIV; migrant services; DNA/PCR testing;
Government of Guyana Global AIDS Response Progress Report, 2015
12
orphans and vulnerable children (OVC) care and support; vaginal inspection with acetic acid
(VIA); home-based care and; data management.
The HIV programme continued to been benefit from financial resources primarily from
PEPFAR (President Emergency Fund for AIDS Relief) and the Global Fund against HIV,
TB and Malaria (GFATM). In 2014 the Country Coordination Mechanism (CCM) received
TRP approval for its reprogramming request for the HIV Rolling Continuation Channel
(RCC) application, extending the grant through December 2017. There continued to be
significant technical support from technical agencies and partners including UNAIDS, Pan
American Health Organization/World Health Organization (PAHO/WHO), United
Nations Children Fund (UNICEF) and other United Nations (UN) agencies.
Prevention
The Prevention of Mother to Child Transmission (PMTCT) programme is now poised to
report on the elimination of mother to child transmission of HIV in alignment with the
MDG goals. A proactive case management system ensures that HIV infected pregnant
women and HIV exposed infants are followed through pregnancy and 18 months
postpartum in order to provide the appropriate care, treatment and support. The PMTCT
programme was expanded in 2014 to increase coverage through 188 PMTCT sites, with the
addition of a hinterland health centre to the 187 sites that existed in 2013. The uptake of
voluntary counseling and testing (VCT) by pregnant women attending these sites was 94.4%
in 2014 compared with 97.2% in 2013.
During 2014, VCT continued to be provided country-wide through 62 fixed sites and several
mobile units conducting outreaches particularly in the hinterland communities and key
affected populations. Heightened VCT efforts have seen a steady increase in the number of
persons seeking testing with a total of 54,815 tests done during 2014 which was a 10.1%
increase when compared with 2013.
Special emphasis was placed on reaching key populations at higher risk during the reporting
period with these populations accounting for 13.9% of the total number of persons tested
during 2014. Initiatives directed at increasing male testing such as Valentine’s Day couples
testing, have seen significant increases in the number of persons being tested during the
period. This one-day initiative in 2014 achieved 6% of the overall total number of persons
tested during the year.
Information, Education and Communication along with Behaviour Change Communication,
continued to be a prominent part of the national strategy to reach the masses with
HIV/AIDS prevention messages. The national response included a number of mass media
advertisements on television and radio during major events that had large audiences
countrywide. Special attention was paid to key populations at higher risk with efforts that
included a targeted campaign. Other campaigns focused on male involvement in their
health, cervical cancer, and home based care. Prevention efforts sought to maximize the use
of annual commemorative days such as World AIDS Day, Zero Discrimination Day,
International Women’s Day and also national events such as GUYEXPO (Guyana’s premier
exhibition) and Mashramani (local carnival) which provided unique opportunities to increase
HIV awareness among the general public and promote healthy lifestyles.
Government of Guyana Global AIDS Response Progress Report, 2015
13
During 2014, a total of 2,648,976 condoms, including male and female condoms, were
distributed through the national programme free of cost. This was in addition to 614,898
pieces provided through the private sector.
There was special focus on key populations at higher risk during the reporting period with
the 2014 BBSS showing an HIV prevalence of 4.9% in MSM, 5.1% in MSWs, 5.5% in FSWs,
8.4% in transgenders, 1% in miners and 1.3% in loggers. A total of 2,629 MSM were
reached with an appropriate package of HIV prevention services in 2014 which was a 382%
increase when compared to 2013. Similarly there was a 150% increase in FSWs (3,327)
reached with HIV prevention programmes, when compared with 2013. Heightened efforts
to target key populations also resulted in a total of 1,895 miners and loggers being reached
with HIV prevention programmes while outreach programmes continued in the prisons.
During 2014, a wide range of public and private sector organizations continued to benefit
from workplace education programmes with 30 Training and Educational Awareness and
HIV sensitization sessions held by the Ministry of Labour with Employers, Trade Unions
and informal sectors. In addition, The Guyana Business Coalition on HIV and AIDS
(GBCHA) with its membership of over 47 companies, continued to support the HIV
workplace programme through HIV sensitization sessions integrated gender based violence
awareness along with other aspects of health and wellness. Activities also included peer
education training, health fairs, VCT, and the distribution of HIV information brochures
and condoms at workplaces.
During 2014, the Blood Bank collected 10,016 units of blood (Blood Bank Reports). All
units were screened for infectious markers and the proportion of units that tested positive
for HIV was 0.96% compared with 0.3% in 2013.
The VIA screening programme continued at health care facilities, including all HIV
treatment sites. VIA was done through onsite administration using a Single Visit Approach
(SVA). During the period, 3,678 persons received VIA including 505 HIV positive clients.
Of the 3,678 persons screened, 392 received a positive VIA of which 375 accepted follow up
treatment.
The curriculum for the health and family life education (HFLE) pilot programme underwent
a review during the reporting period. This pilot programme was expanded to all secondary
schools during 2014 as a timetabled subject, thereby providing all students with life skills
education.
The Youth Friendly Health Services Initiative continued in Primary Health Care facilities for
the purpose of providing sexual reproductive health services to adolescents. This service also
included the establishment of special antenatal clinics for pregnant teenagers.
A total of 5,127 STI cases were reported in 2014 representing a significant decrease (24%)
from the 6,777 cases reported in 2013 (MoH Surveillance Unit). The majority of STI cases
reported were among females (82%) while male cases remained under-reported. Genital
discharge syndrome (GDS) remained the most frequently reported syndrome (95% of STIs
in 2014) while 42% of the STI cases reported at the main sentinel site were within the 15-24
Government of Guyana Global AIDS Response Progress Report, 2015
14
age group. There were 105 cases of HIV co-infection with other STIs. During 2014, 117
health care workers of different categories and 28 Ministry of Education officials were
trained in STI Syndromic Management.
During 2014, 17 public health facilities and 2 private hospitals provided post exposure
prophylaxis (PEP). There was timely provision of PEP to 69 reported cases and a total of
82 health care workers of different categories from regions 2, 5, 9 and 10 received training in
how to avoid occupational exposure to HIV and also in the delivery of PEP.
Treatment
During 2014, treatment and care services were delivered through 22 treatment sites.
A total of 5,041 HIV patients (55.8% females and 44.2% males) were listed on the register in
the care and treatment programme at the end of 2014 with 4,295 (85.2% of the patients)
receiving antiretroviral therapy (ART). 11.6% of those on ART were on second line therapy.
There were 602 new enrollments during the year, including 17 children. Survivability within
the 2013-2014 national cohort was reported at 81.2% over a 12-month period while
survivability for 24, 36 and 60 months was reported at 75%, 72.4% and 63% respectively.
Monitoring visits to treatment sites continued and clinical mentoring sessions, chart reviews
and capacity building of healthcare workers through clinical management trainings, were
conducted in the ongoing efforts to improve the quality of care provided.
The diagnostic capacity of the treatment and care programme continued to be supported by
the National Public Health Reference Laboratory (NPHRL) which provides CD4, viral load
and DNA PCR testing. CD4 testing was also provided by the laboratories of 5 government
hospitals in Regions 2, 3, 6, 7 and 10. Three of these hospitals are regional hospitals.
Care and support
The provision of care and support to persons living with and affected by HIV continued
with a total of 716 new persons enrolled into the Home Based Care (HBC) programme in
2014 (NAPS programme reports). The psychological, social and nutritional needs of persons
living with HIV (PLHIV) were addressed through monthly support group (20 groups)
activities and the distribution of 3,689 nutritional food hampers through the Food Bank to
937 eligible PLHIV. Public Assistance for eligible PLHIV was also provided through the
Ministry of Human Services & Social Security.
Monitoring and Evaluation
Throughout the reporting period, Monitoring and Evaluation (M & E) of the national
response continued with oversight provided by the MERG. During 2014 a major activity
was the Biological & Behavioral Surveillance Survey (BBSS) Round 3 among key affected
populations. Estimates for MSM and FSWs were developed using the BBSS data and
National HIV estimates for 2014 were also developed using Spectrum and EPP. In addition,
data for the 2013 Client Satisfaction Survey was analyzed, a Global Fund M&E plan was
developed, finalized and approved and a National HIV Monitoring and Evaluation plan was
drafted. Tools to adequately report on prevention initiatives among the key populations were
revised which very importantly, included the VCT recording and reporting system among
others. Throughout the period, M & E personnel received ongoing training to adequately
equip them in performing their functions.
Government of Guyana Global AIDS Response Progress Report, 2015
15
The Surveillance Unit of the MoH led the initiative of revising and updating HIV
surveillance. Started in 2013, this initiative concluded in 2014 with a revised case based
surveillance system developed, supported by an HIV case-based surveillance manual.
Table 1: Overview of Indicator Data
Targets Indicator Data
origin
Period Value Remarks
Target 1: Reduce
sexual transmission
of HIV by 50 percent
by 2015
General Population
1.1 Percentage of young
women and men aged 15‐24
who correctly identify ways of
preventing the sexual
transmission of HIV and who
reject major misconception
about HIV transmission
DHS 2009 51.10% No new survey
1.2 Percentage of young
women and men aged 15‐24
who have had sexual
intercourse before the age of
1
5
DHS 2009 13.60% No new survey
1.3 Percentage of adults aged
15‐49 who have had sexual
intercourse with more than
one partner in the last 12
months
DHS 2009 4.90% No new survey
1.4 Percentage of adults aged
15‐49 who have had more than
one sexual partner in the past
12 months who report the use
of a condom during their last
intercourse
DHS 2009 ‐ No new survey
Note: There were fewer than
25 unweighted cases for
females 15‐19 and 20‐24, 25
‐
29, 30‐39, 40‐49, and have
been suppressed in DHS report.
All Females DHS 2009 ‐
All Males DHS 2009 65.50%
1.5 Percentage of women and
men aged 15‐49 who received
an HIV test in the past 12
months and know their results
DHS 2009 24.80% No new survey
1.6 Percentage of young
people aged 15‐24 who are
living with HIV
ANC
Programm
e data
2014
1.9%
Data reported is from the total
pregnant woman population
and is not only reflective of
women 15‐24. Additionally, the
reported data reflects women
who were newly tested HIV
positive during the reporting
period as well as women with
known HIV positive status who
Note: Data not disaggregated
by sex
Government of Guyana Global AIDS Response Progress Report, 2015
16
Targets Indicator Data Period Value Remarks
accessed ANC services.
Sex Workers 1.7 Percentage of sex workers
reached with HIV prevention
programmes
BBSS 2014 48.2% Data reflects male, female and
Transgender Sex Workers
1.8 Percentage of sex workers
reporting the use of a condom
with their most recent client
BBSS 2014 75.7%
1.9 Percentage of sex workers
who have received an HIV test
in the past 12 months and
know their results
BBSS 2014 47.6%
1.10 Percentage of sex workers
who are living with HIV
BBSS 2014 6.1%
Men who have sex
with men
1.11 Percentage of men who
have sex with men reached
with HIV prevention
programmes
BBSS 2014 37.5% Data includes Transgender
1.12 Percentage of men
reporting the use of a condom
the last time they had anal sex
with a male partner
BBSS 2014 64.4%
1.13 Percentage of men who
have sex with men that have
received an HIV test in the past
12 months and know their
results
BBSS 2014 37.8%
1.14 Percentage of men who
have sex with men who are
living with HIV
BBSS 2009 4.9%
Target 2: Reduced
transmission of HIV
among people who
inject drugs by 5
0
percent by 2015
2.1 Number of syringes
distributed per person who
injects drugs per year by
needle and syringes
programmes
‐ ‐
Target 2 is Not applicable to
Guyana
2.2 Percentage of people who
inject drugs who reported the
use of a condom at last sexual
intercourse
‐ ‐
2.3 Percentage of people who
inject drugs who reported
using sterile injecting
‐ ‐
Government of Guyana Global AIDS Response Progress Report, 2015
17
Targets Indicator Data Period Value Remarks
equipment the last time they
injected
2.4 Percentage of people who
inject drugs that received an
HIV test in the past 12 months
and know their results
‐ ‐
2.5 Percentage of people who
inject drugs who are living with
HIV
‐ ‐
Target 3: Eliminate
mother‐to‐child
transmission of HIV
by 2015 and
substantially reduce
AIDS‐related
maternal deaths
3.1 Percentage of HIV‐positive
pregnant women who received
antiretrovirals to reduce the
risk of mother‐to‐child
transmission
ANC
Programm
e Report
2014
188
Numerator is inputted and
reflects data from the National
Care and treatment programme
and the PMTCT programme.
183 women received ARVs and 5
women single dose nevirapine.
Denominator is derived from
Spectrum file and will be
finalized in May 2015
3.1a Percentage of women
living with HIV who are
provided with antiretroviral
medicines for themselves or
their infants during
breastfeeding period
PMTCT
Programm
e Report
&
Spectrum
2014 NA 2 babies were being exclusively
breastfed at admission during
2014. The denominator is
derived from Spectrum file and
will be finalized in May 2015
3.2 Percentage of infants born
to HIV‐positive women
receiving a virological test for
HIV within 2 months of birth
NPHRL &
PMTCT
data
2014 59.5% 115 samples were processed
within 2 months; 159 between 2
to 12 months and 16 samples
beyond 12 months.
3.3 Mother‐to‐child
transmission of HIV modeled
Modeled
using
Spectrum
2014 Not
Available
This indicator will be updated
from the finalized Estimates File
in May 2015.
Denominator:
193
HIV positive
pregnant women who delivered
in 2014
Target 4: Have 15
million people living
with HIV on
antiretroviral
treatment by 2015
4.1 Percentage of eligible
adults and children currently
receiving antiretroviral therapy
NAPS
Programm
e Reports
2014 4295 4295 persons were receiving
treatment at the end of 2014.
Denominator will be available in
May 2015 from finalized
Spectrum file.
Modeled
using
Spectrum
4.2 Percentage of adults and
children with HIV known to be
on treatment 12 months after
initiation of antiretroviral
therapy
Patient
Monitorin
g System
(NAPS
2014 81.2%
Government of Guyana Global AIDS Response Progress Report, 2015
18
Targets Indicator Data Period Value Remarks
Target 5. Reduce
tuberculosis deaths
in people living with
HIV by 50 percent by
2015
5.1 Percentage of estimated
HIV‐positive incident TB cases
that received treatment for
both TB and HIV
Chest
Clinic
Programm
e Reports
2014 103 Numerator reflects number of
co‐infected patients at TB sites
who received ART (both new
and retreatment cases).
Denominator will be available
from WHO later in 2015.
Programme coverage reflects
69.6% (103/148)
Target 6: Reach a
significant level of
annual global
expenditure (US22‐
24 billion) in low and
middle‐income
countries
6.1 Domestic and international
AIDS spending by categories
and financing sources
‐ NASA report is appended to the
online submission of the GARPR.
Target 7: Critical
Enablers and
Synergies with
Development
Sectors
7.1 National Commitments and
Policy Instruments (prevention,
treatment, care and support,
human rights, civil society
involvement, gender,
workplace programmes, stigma
and discrimination and
monitoring and evaluation)
Key
informant
interviews
The NCPI was not required for
the 2015 GARPR report
7.2 Proportion of ever‐married
or partnered women aged 15‐
49 who experienced physical
violence from a male intimate
partner in the past 12 months
Data not available. The DHS
2009 asked about women’s
attitude towards wife beating:
16.3% of women 15‐49 agree
with at least one specified
reason.
7.3 Current school attendance
among orphans and non‐
orphans aged 10‐14
‐ Indicator relevant but data not
available
7.4 Proportion of the poorest
households who received
external economic support in
the last 3 months
‐ Indicator relevant but data not
available
Target 8: Eliminating
Stigma &
Discrimination
8.1 Percentage of women and
men aged 15–49 who report
discriminatory
DHS 2009 women 20.10%
attitudes towards people living
with HIV
men 23.90%
II. OVERVIEW OF THE AIDS EPIDEMIC
Guyana has a population of approximately 747,884 (2012 population census) with a
landmass of 215,000 km2 extending along the north-eastern coast of South America. It is
the only English-speaking country in South America and is bordered by Suriname, Brazil and
Venezuela. Guyana is divided into ten administrative regions and according to the 2012
census of the Guyana Bureau of Statistics (GboS), most of the population (89.1%) is
concentrated in the coastal areas (Regions 3, 4, 5 and 6).
The 2012 census also showed that the ratio of men to women was 49.8% to 50.2%. The 25-
54 age group comprised the highest proportion (37.2%) of the population followed by the
0-14 age group (29%). Per capita gross domestic product (GDP) was US$8,500 in 2014
(2013 est.). Guyana is classified as a medium developing country on the Human
Development Index (HDI) scale and is ranked at 121 of 187 countries in the 2014 HDI
Report.
The first case of AIDS was reported in 1987 followed by a progressive increase in the
number of reported cases. The epidemic in Guyana is considered generalized as an HIV
prevalence of greater than 1.0% has been consistently found among the general population.
Since the introduction of VCT in 1998, there has been a fluctuating trend in the number of
HIV cases diagnosed with a peak of more than 1,200 infections being diagnosed in 2006.
From 2009 through 2013, there has been a continuing reduction in new cases both for HIV
as well as AIDS. In 2014, the Surveillance system was revised to report on advanced HIV
Government of Guyana Global AIDS Response Progress Report, 2015
20
cases (persons with CD4 = 200-350). In this regard, a total of 53 cases were reported.
During 2014, 751 HIV cases were reported compared with 758 in 2013. The number of new
AIDS cases increased to 105 compared with 88 cases in 2013.
Figures 1 and 2 show the trends in the number of annual cases of HIV and AIDS reported
during the period 2001 – 2014.
Figure 1: Annual Cases of HIV and AIDS, 2001-2014
0
200
400
600
800
1000
1200
1400
1600
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
2
0
1
1
2
0
1
2
2
0
1
3
2
0
1
4
AIDS
Advanced
HIV
HIV
Source: Ministry of Health Surveillance Unit and NAPS
Figure 2: Trends in the number of annual cases of HIV and AIDS: 2001-2014
0
200
400
600
800
1000
1200
1400
2001 2002 2003 2004 2005 2006 2007 2008 2009
2010 2011 2012 2013
2014
HIV AIDS
Source: Ministry of Health Surveillance Unit and
NAPS
Government of Guyana Global AIDS Response Progress Report, 2015
21
TRENDS IN THE EPIDEMIC
Distribution of HIV and AIDS Cases According to Sex
The male to female ratio for HIV cases has fluctuated over the past 4 years. While HIV was
initially more prevalent among males, by 2003 the annual number of reported cases of HIV
was higher among females and remained so until 2009 when the male female ratio was 1.1.
The situation was again reversed from 2010 to 2012 when more females were diagnosed
with HIV, with a male to female ratio of 0.9 in 2012. In 2013, the male to female ratio once
again showed a higher number of males infected with a ratio of 1.01 and this continued into
2014 with a male to female ratio of 1.09 (MoH Surveillance Unit). These trends are
illustrated in Figure 3 and Table 2 below.
Figure 3: Trends in Reported Cases of HIV According to Sex 2001 – 2014
0
200
400
600
800
1000
1200
1400
2001 2002 2003 2004 2005 2006 2007 2008
2009 2010 2011 2012 2013 2014
HIV Unknown HIV Female HIV Male
Source: Ministry of Health Surveillance Unit and NAPS
Table 2: Trends in Reported Cases of HIV and AIDS According to Sex 2002 – 2014
CLASSIFICATION 2002 2003 2004 2005 2006 2007 2008 2009
2010 2011 2012 2013 2014
HIV Male 301 339 368 325 591 422 446 600 449 432 393 378 39
1
Female 268 368 408 421 626 531 490 567 547 517 424 374 358
Unknown 39 55 61 36 41 40 23 9 43 23 3 6 2
Total 608 762 837 809 1,258 993 959 1176 1039 972 820 758 751
Sex Ratio 1.1 0.9 0.9 0.8 0.9 0.8 0.9 1.1 0.8 0.8 0.9 1.01 1.09
AIDS Male 243 232 117 58 99 80 14 21 86 41 61 51 61
Female 146 163 204 77 68 49 8 21 58 21 42 37 44
Unknown 26 22 27 7 5 1 2 1 2 0 2 0 0
Total 415 417 348 142 172 130 24 43 146 62 105 88 105
Sex Ratio 1.7 1.4 0.6 0.8 1.5 1.6 1.8 1.0 1.5 2.0 1.5 1.4 1.4
TOTAL
HIV &
AIDS
1,023 1,179 1,185 951 1,430 1,123 983 1,219 1,185 1,034 925 846 856
Source: Ministry of Health Surveillance Unit and NAPS
Government of Guyana Global AIDS Response Progress Report, 2015
22
With regard to the number of AIDS cases, the male to female ratio was consistently higher
during the period 2002 to 2014 with the exception of 2004 and 2005. These trends are
illustrated in table 2 above and Figure 4 below.
Figure 4: Trends in Reported Cases of AIDS by Sex 2001 – 2014
0
50
100
150
200
250
300
350
400
450
500
2001 2002 2003 2004 2005 2006
2007 2008 2009 2010 2011 2012 2013 2014
AIDS Unknown
AIDS Female
AIDS Male
Source: Ministry of Health Surveillance Unit and NAPS
Distribution of HIV Cases According to Age Groups
The HIV epidemic continues to affect the productive sector of Guyanese society. At the
end of 2014, a total of 463 cases were reported within the combined age group of 25-49
which accounted for 61.7% of all HIV cases reported during the year. In comparison,
during 2013, 513 cases were reported within this age group accounting for 67.7 % of all
cases. Figure 5 and table 3 show the distribution of HIV cases among the various age
groups during the period 2008 – 2014.
Figure 5: HIV cases According to age groups: 2008-2014
Government of Guyana Global AIDS Response Progress Report, 2015
23
Source: Ministry of Health Surveillance Unit and NAPS
Table 3: Distribution of reported HIV Cases by Age Groups, 2010 – 2014
Age
Group
2010
2011
2012
2013 *2014
Under 1 1 4 3 1 0
1‐4 5 5 10 4 9
5‐14 9 9 11 6 2
15‐19 71 39 48 21 26
20‐24 182 133 98 83 89
25‐29 133 129 125 103 115
30‐34 193 176 139 110 118
35‐39 142 148 141 127 94
40‐44 124 112 91 104 71
45‐49 68 83 55 69 65
50‐54 42 55 41 45 57
55+ 48 61 43 62 77
Unknown 21 18 15 23 28
Total 1,039 972 820 758 751
Source: Ministry of Health Surveillance Unit and NAPS
Figure 6 below shows the HIV prevalence among the 15-19 and 20-24 age groups during the
period 2008-2014. During the period this prevalence fluctuated between 2.9% and 3.5% in
the former age group and 11.5% and 11.9% in the latter age group.
Figure 6: Proportion of reported HIV Cases Among Youth 2008–2014
Source: Ministry of Health Surveillance Unit and NAPS
Government of Guyana Global AIDS Response Progress Report, 2015
24
Geographic Distribution of HIV and AIDS
Region 4, with 41.3% of the general population (2002 Population Census), continues to be
disproportionately affected accounting for 72.8% in 2014 compared with 75.4% in 2013.
The geographic distribution of HIV cases is illustrated in Table 4.
Table 4: Proportion of reported HIV Cases by Region 2006 – 2014
Region
*
Total
Population
% of
population
2006 2007 2008 2009 2010 2011 2012 2013 2014
1 24,275 3.2 0.2 0.1 0.5 0.9 0.6 0.8 1.5 0.83 1.6
2 49,253 6.6 4.6 3.8 3.9 2.6 1.3 4.1 2.2 2.25 5.9
3 103,061 13.7 6.8 7.4 8.2 10.6 10.7 2.7 15.9 9.57 7.3
4 310,320 41.3 65.2 66.2 59.1 56.3 71.5 70.8 63.3 75.4 72.8
5 52,428 7.0 2.3 3.7 1.7 2.7 2.6 9.0 2.7 1.42 1.9
6 123,695 16.6 10.5 7.6 9.7 9.9 7.4 2.8 6.0 6.74 8.1
7 17,597 2.3 2.5 1.8 1.6 2.4 1.6 4.9 1.2 0.71 0.7
8 10,095 1.3 0.1 0.4 0.1 0.5 0.3 1.1 0.4 0.47 0.1
9 19,387 2.6 0.3 0.4 0.3 0.0 0.3 0.4 0.4 0.35 0.1
10 41,112 5.5 4.0 4.3 3.7 3.1 2.5 0.1 2.1 1.65 0.3
Unknown 0 0 3.7 4.2 11.1 10.8 1.3 3.3 4.5 0.59 1.2
Total 751,223 100 100 100 100 100 100 100 100 100 100
Source: Ministry of Health Surveillance Unit
* 2002 Population Census
AIDS-Related Mortality
The proportion of all deaths attributable to AIDS has declined steadily from 9.5 % in 2002
to 4.8% percent in 2012 (preliminary data) as shown in table 5.
Table 5: Annual Number and Proportion of AIDS-Related Deaths
Year Total Number
of Deaths
No. of AIDS
Related
Deaths
% of AIDS
Related Deaths
Rate per 1,000
population
2002 5003 475 9.5 0.6
2003 4986 399 8.0 0.5
2004 5141 356 7.1 0.5
2005 5258 360 6.9 0.5
2006 5031 298 5.9 0.4
2007 5066 289 5.7 0.4
2008 5003 237 4.7 0.3
2009 4562 192 4.2 0.2
2010 5433 194 3.6 0.2
2011 5402 230 4.3 0.3
*2012 4670 226 4.8 0.3
*2012 data is preliminary
Source: Ministry of Health Statistics Unit
Government of Guyana Global AIDS Response Progress Report, 2015
25
Table 6 illustrates the pattern of decreasing prevalence among key populations.
Table 6: HIV Prevalence among Key Populations in Guyana
POPULATION SEX YEAR PREVALENCE REMARKS
Pregnant Women
Female 2004 2.3 ANC Survey
2006 1.55 ANC Survey
2003 0.7 (3.1) PMTCT Programme
Reports show
prevalence of just
over 1% since 2005.
As seen in brackets,
the percentage of
new cases that are
HIV positive have
consistently been
around 1%
2004 0.9 (2.5)
2005 1.6 (2.2)
2006 1.5 (1.6)
2007 1.3 (1.4)
2008 1.1 (1.2)
2009 1.3 (1.1)
2010 1.2 (1.0)
2011 1.6 (0.9)
2012 1.7 (0.7)
2013 1.9 (0.8)
2014 1.9 (0.8)
Blood Donors All 2004 0.7 Blood Bank
Programme Reports 2005 0.9
2006 0.42
2007 0.29
2008 0.46
2009 0.16
2010 0.20
2011 0.1
2012 0.3
2013 0.34
2014 0.96
Sex Workers
Female 1997 45.0 Special Survey
2005 26.6 BBSS
2008/2009 16.6 BBSS
2014 5.5 BBSS
Male 2014 5.1 BBSS
MSM Male 2005 21.25 BBSS
2008/2009 19.4 BBSS
2014 4.9 BBSS
Transgender 2014 8.4 BBSS
TB Patients All 1997 14.5 Chest Clinic Records
2003 30.2
2004 11.2 (52% tested)
2005 30.24 (82% tested)
2006 33.2(67% tested)
Government of Guyana Global AIDS Response Progress Report, 2015
26
POPULATION SEX YEAR PREVALENCE REMARKS
2007 35.32
2008 22.0
2009 28.0
2010 26.0
2011 23.4
2012 31
2013 25
2014
22
Miners Male 2000 6.5 Special Survey
One mine study
2003 3.9 Special Survey
22 mines study
2014 1.0 BBSS
Loggers Male 2014 1.3 BBSS
Security Guards All 2008/2009 2.7 BBSS
Prisoners All 2008/2009 5.24 BBSS
Source: National AIDS Programme Secretariat, 2014
III. NATIONAL RESPONSE TO THE AIDS EPIDEMIC
POLITICAL COMMITMENT
Following the first diagnosed case of AIDS in Guyana in 1987, the Government of Guyana
was quick in responding, fully cognizant of the devastating effects of HIV.
In 1989, the Government of Guyana established the National AIDS Programme (NAP)
under MoH which resulted in the development of the Genito-Urinary Medicine (GUM)
Clinic, the National Laboratory for Infectious Diseases (NLID) and the National Blood
Transfusion Service (NBTS). In 1992, the National AIDS Programme Secretariat (NAPS)
was established and charged with the role of coordinating the national response to the AIDS
epidemic. The National AIDS Committee (NAC) was also established in 1992 with
responsibility for developing and promoting HIV and AIDS policy and advocacy issues,
advising the Minister of Health and assessing the work of the National AIDS Programme
Secretariat. The NAC also encourages the formulation of Regional AIDS Committees
(RACs) and networking amongst NGOs involved in the HIV response. The government’s
response is complemented by the activities of various civil society organizations, whose
approach focus primarily on prevention and psychosocial support.
The government also developed a number of strategic plans for the health sector over the
years and in 2013, HIVision 2020 and Health Vision 2020 were launched for the period
2013-2020. Health Vision 2020 was designed to be in concert with the various strategic
plans for the different components of the health care programme, including HIV and
sexually transmitted infections. For the latter, a National Sexually Transmitted Infections
Strategy and a Monitoring and Evaluation Plan 2011-2020 were developed.
Government of Guyana Global AIDS Response Progress Report, 2015
27
In light of the reducing donor funded resources to support the national HIV response, the
Government of Guyana continues to transition ownership to the Government. During
2014, there was significant transitioning of donor-funded staff to government-supported.
Other areas of transitioning included the absorption of 25% of PEPFAR-supported ARVs
and the commencement of transitioning of the Global Fund-supported ARVS in 2015. All
laboratory supplies in support of the HIV treatment programme along with testing of CD4,
Viral Load, and DNA PCR have been fully transitioned.
Institutional Roles and Responsibilities
Political commitment was further demonstrated over the years by the establishment of the
Presidential Commission on HIV and AIDS (PCHA) in 2005 under the aegis of the Office
of the President to strengthen the coordination of the various components of the National
Strategic Plan across all sectors. The Commission is chaired by the President of Guyana and
coordinates the HIV response nationally. This institutional structure permits the wide
participation of all public and private sector actors, civil society, and the international donor
community (Country Harmonization and Alignment Tool Report, 2010). Figure 7 illustrates
the Guyana multi-sectoral response mechanism for HIV and AIDS.
Figure 7: Guyana Multi-sectoral Response Mechanism for HIV and AIDS
NAPS, operating from within the MoH, is the technical unit within the Department of
Communicable Diseases with responsibility for coordination, implementation and
monitoring and evaluation of the national response. NAPS provides support to the PCHA
on technical issues and works closely in providing technical directional guidance to donors
and to Line Ministries and Civil Society organizations implementing HIV programmes.
Project
Implementation
Unit (PIU)
Ministry of
Health (MOH)
NAPS
MoF
Donors
Presidential Commission on
HIV/AIDS (PCHA)
Cabinet
UN HIV/AIDS Theme
Group
National AIDS
Committee (NAC)
Technical
Support Unit
Line Ministries
NGOs and Civil
Society
Population
Private Sector
MOH – Central Level
Departments/Units
Regional Health
Authorities
Implementing agencies
Implementing agencies
Consultants, Service
Providers.
Suppliers,
Contractors
Government of Guyana Global AIDS Response Progress Report, 2015
28
The Health Sector Development Unit (HSDU) has responsibility for coordinating donor
funded projects for the Ministry of Health which includes HIV funded projects.
The Country Coordinating Mechanism (CCM) is a multi-sectoral body charged with the
responsibility for providing oversight to the Government of Guyana Global Fund to Fight
AIDS, Tuberculosis and Malaria (GFATM) grants. The CCM has representation from
government, civil society including NGOs, faith-based organizations, private sector, donor
agencies, academia, key populations at higher risk, and PLHIV.
The NAC is an independent advocacy body for civil society and the private sector. In
principle, the body is responsible for providing the Minister of Health with
recommendations and advising on HIV and AIDS policies, educational, training and public
information activities, in addition to measures for improving programmes and the
effectiveness of the national response.
Multi-Sectoral Coordination
The National HIV Strategic Plan 2013 – 2020 identified priority areas with key strategic
objectives necessary for the achievement of the Millennium Development Goals (MDGs)
2015, as well as the long term goal of the plan. To support effective implementation of
HIVision 2020, the monitoring and evaluation framework was drafted and will be finalized
in 2015. Significant changes were made relative to the previous National M&E plan and
these included the addition of indicators on the HIV cascade, the continuum of care, and
targets on the 90-90-90 projections post 2015. A detailed costed 3-year operational plan will
be developed as well as an estimated cost for the overall plan.
Through coordination led by the Ministry of Finance, the NAPS provided a status update to
the MDG goal 6 and all HIV related targets.
In 2013, The National Programme coordinated with the Country Coordinating Mechanism
and partners in the successful submission of a phase 2 Global Fund Rolling Continuation
Channel (RCC) application for HIV. In 2014, the CCM was invited to submit a
reprogramming request for an extension of the HIV grant through December 2017. This
was successfully submitted with the initial TRP approval. Final board approval is anticipated
in early 2015. As in the case of the Phase 2 RCC application, the reprogramming
considered the Epi profile of the disease and this was approved with a 50% focus on key
populations at higher risk. In 2014, sub recipient agreements were signed with three major
implementers providing national roll out of programmes targeting the key populations. Sub
Sub recipient agreements were signed with CSOs for direct service delivery and accounts for
the significant increase in coverage of services to the key populations.
Donor Coordination
The Paris Declaration 2005 which is further reinforced by the Accra Agenda for Action,
lays out a practical, action-oriented roadmap to improve the quality of aid and its impact on
development (www.oecd.org/dac). The Paris Declaration outlines the following five
fundamental principles for making aid more effective:
Government of Guyana Global AIDS Response Progress Report, 2015
29
Ownership: Developing countries set their own strategies for poverty reduction,
improve their institutions and tackle corruption.
Alignment: Donor countries align behind these objectives and use local systems.
Harmonisation: Donor countries coordinate, simplify procedures and share
information to avoid duplication.
Results: Developing countries and donors shift focus to development results and
results get measured.
Mutual accountability: Donors and partners are accountable for development results.
In keeping with these principles, as part of the national response to HIV, the Guyana
government maintains ongoing communication and collaboration with its donor partners to
ensure that the aid provided achieves its full impact.
Throughout the reporting period, UN agencies and US government partners/PEPFAR
agencies were represented on various Steering Committees for the development of HIVision
2020. They were represented on the Country Coordinating Mechanism for Global Fund,
and were also members of several high level sub committees and ad hoc committees. These
include the Monitoring and Evaluation Reference Group (MERG) which aims at
streamlining monitoring and evaluation efforts among the various partners with regard to
HIV, the Prevention Technical Working Group, Care and Treatment Technical Working
Group, and the VCT Steering Committee among others.
Additional coordination with US government partners included:
Annual GOG/PEPFAR portfolio review successes, identify gaps and develop activities
for the coming fiscal year’s country operational plan
Joint planning of the country operational plan
Coordination with the UN included participation in the monthly UN Joint Meetings which
addressed issues related to the UN Joint Plan for HIV. At this meeting, each UN agency is
represented by a focal point. The UN was actively involved in technical working groups and
steering committees at NAPS on PMTCT, ART, STI, and M&E among others.
The Country Coordinating Mechanism (CCM) established to oversee global fund grants, also
serves as an important mechanism for coordination. The CCM convened on a quarterly
basis, brings together a wide range of stakeholders including representatives from the UN
System and from the PEPFAR programme.
Aligned to the governance recommendations of the Global Fund, the restructuring of the
Guyana CCM commenced and this included a revision of its membership to include a
greater representation of the key populations including MSM and FCSW. This process is
expected to conclude in 2015.
Through the CCM, Guyana was invited to submit concept notes for the National Malaria
and TB programmes. The concept note for TB which is due in the first half of 2015, will
address a significant scale up of the TB/HIV response.
Government of Guyana Global AIDS Response Progress Report, 2015
30
Coordination with People Living with HIV
Aligned to the guiding principle of HIVision2020, “HIV programming will adhere to the
principle of the Greater Involvement of People Living with HIV”. The reporting period
saw continued leadership and involvement of this population in the HIV response. The
PLHIV community is represented on the country CCM for Global Fund and they also serve
on several special sub-committees and ad hoc committees, including the oversight and
proposal writing committees.
PLHIVs are represented at several national level technical and coordinating committees. The
National Steering Committee for support to PLHIV comprises leaders of support groups
and the members of this Committee meet quarterly to discuss with the National Programme,
issues affecting PLHIV. The PLHIV population is also represented on the technical working
group for client satisfaction surveys. During 2014, the Network of Guyanese living with and
affected by HIV (GPlus) received funding from the US PEPFAR programme as well as a
sub sub recipient under the Global Fund HIV grant for programme implementation among
its constituency. In collaboration with NAPS, GPlus provided support to the Positive Health
Dignity and Prevention (PHDP) Programme through interactions with PLHIV in their
support groups.
The PLHIV community provided inputs into HIV programme implementation through
several mechanisms. Support groups whilst primarily seeking to address social issues
through counseling and education, also serve as a forum for information gathering from the
beneficiaries regarding the quality of services and other service delivery issues. Through
direct involvement in implementation within the National Programme, PLHIVs employed
within the programme, continue to work to bridge the gap between testing and treatment
and to impact treatment outcomes through reduced defaulter rates.
Coordination with Line Ministries
Line Ministries continued to be engaged in the national response during the reporting
period. These Ministries serve on the CCM for Global Fund and also on several high level
sub committees and ad hoc committees, including the governance and oversight sub
committees. Line Ministries and their technical arms also serve on the steering committee to
define and roll out implementation strategies. For example, the Guyana Forestry
Commission and the Guyana Geology and Mines Commission linked to the Ministry of
Natural Resources, serve on the technical working group for miners and loggers.
Key Line Ministries are required to mainstream the implementation of HIV-related activities
as part of their ministry’s work programme. In this regard, some Line Ministries have
specific focal points for example, the Ministry of Local Government and the Ministry of
Education.
Workplace programme activities focused on achieving prevention of HIV and STIs through
training, education and behavior change communication, condom distribution, and
dissemination of information. Linkages were also provided to treatment and care for
PLHIV and their families. There was special emphasis during the reporting period on
creating awareness within public and private sector entities with regard to gender based
violence and its impact on HIV. Promotion of the ministries’ workplace policy on HIV was
ongoing throughout the period (see section on workplace programme).
Government of Guyana Global AIDS Response Progress Report, 2015
31
During the period, key line ministries utilized their core functions for achieving
complementarity in the HIV response. Such involvement included the Ministry of
Education’s continued implementation of the HFLE programme, and the Ministry of Home
Affairs’ collaboration in the testing of prison inmates and their referral to care and treatment
services. Of special note is the Ministry of Culture, Youth and Sports continued use of
sports as a vehicle for healthy living and in particular, its collaboration with the Ministry of
Health, the private sector and civil society organisations (CSOs) in hosting the “Ride for
Life” focused on HIV prevention. This initiative which started out with full funding from
the Ministry of Health, has now been fully transitioned to the MCYS. The MCYS also
integrated within its summer camps, modules on HIV prevention.
The Ministry of Human Services continues to provide public assistance to PLHIV and is
also very proactive in providing support for victims of gender based violence, in addition to
providing public education on gender based violence. The Ministry of Housing and Water
continues to collaborate with the Ministry of Health in facilitating the allocation of house
lots to PLHIV and it has also integrated HIV education and VCT into its one-stop shop
initiative in its house lot allocation process. The Central Employment and Recruitment
Agency facilitates the employment of PLHIV through collaboration with the National
Programme and the Ministry of Labour Occupational Health and Safety remains vigilant in
the implementation of the HIV workplace programme. During the annual World AIDS Day
commemoration, all Line Ministries are involved in the national HIV testing initiative.
Coordination with the Private Sector
The Private Sector provides leadership at the level of the CCM through its representation on
the Guyana Business Coalition on HIV and AIDS (GBCHA).
Throughout the reporting period there was support from the private sector in various forms.
There was a steady increase in private sector sponsorship for the food bank during the
period 2009 – 2014. Through the food bank, hampers were provided to PLHIV and
HIV/TB co-infected patients. In addition, the private sector contributed towards the
provision of hot meals and nutritious drinks for the latter patients. As part of the national
level prevention efforts, a number of mass media advertisements in the form of public
service announcements were aired on the private television and radio through concessionary
arrangements granted by the private media. The media was also engaged in the annual
World AIDS Day sensitization.
During the reporting period, the private sector continued to support the national Valentine’s
Day Couples Testing by sponsoring incentives. The Supermarket Initiative which aims at
promoting awareness of HIV and AIDS and general health and wellness, continued through
collaboration with the 19 participating supermarkets whose focal points were proactive in
following up on the provision of training for their staff on HIV and general health-related
matters. These supermarket staff were also involved in the distribution of information,
education and communication (IEC) health materials and free condoms to their clientele.
The workplace programme continued with the active engagement of the private sector in
implementing comprehensive health and wellness programmes which addressed issues
beyond HIV, to include gender based violence. The Guyana Business Coalition on HIV and
Government of Guyana Global AIDS Response Progress Report, 2015
32
AIDS (GBCHA) through its membership of 47 companies, continued to be a key agency in
supporting the HIV workplace programme in keeping with Guyana’s National HIV Policy.
Through the GBCHA’s efforts, both staff and clients of the member companies were
offered VCT on an ongoing basis.
Coordination with Civil Society Organizations (CSOs)
Civil Society Organizations (CSOs) continued to provide leadership at the highest level in
the national response to HIV, serving as key members on the Steering Committee for Key
Populations at Higher Risk. The CSO constituent is represented and serves as the Vice
Chair on the CCM. Additionally, the CSO representative also serves on several high level
select ad hoc and sub committees of the CCM including the Governance and Oversight Sub
Committees.
At the coordination level, CSOs contribute through established technical working groups
(TWGs) such as the TWG on migrants and mobile populations, the steering committee for
the key population’s response and the steering committee on home based care. Ad hoc
committees also received CSOs’ leadership e.g. the Technical Working Group for the
Biological and Behavioural Surveillance Surveys.
During the reporting period, through donor support, CSOs continued to contribute to the
national HIV response in providing HIV prevention and support services. CSOs operated
in collaboration with government, other local partners and the international community in
providing services to PLHIV. With decreasing donor funding within recent years, CSOs
have been placing more emphasis on sustainability through partnerships with the business
community and creative resource mobilization ventures.
During 2014, 8 NGOs funded through the PEPFAR-funded Advancing Partners and
Communities (APC) project were actively involved in the delivery of HIV services within the
community in collaboration with MoH/NAPS. These CSOs especially targeted key
populations in providing peer education and support, distribution of condoms, lubricants
and education and communication (IEC) materials, HIV Testing and Counselling (HTC) and
referrals for other prevention services. These CSOs, targeted bars, brothels, mining and
logging camps and adjacent communities frequented by these migrant workers. CSOs also
provided GBV education and shared coping strategies with FSWs, MSM, their respective
clients and partners, and the broader community.
The involvement of these CSOs in Positive Health, Dignity and Prevention (PHDP) among
persons living with HIV (PLHIV) focused on reduction of high-risk behaviors for HIV
transmission and reinfection, and the empowerment and development of leadership among
PLHIV for modelling good HIV-prevention behaviours among their peers. In addition, the
CSOs involved PLHIV in small group activities which focused on skills building, the
benefits of disclosure, and gender equality.
CSOs also provided care and support services for adult PLHIV and children
infected/affected by HIV across the various administrative Regions of Guyana.
Community-based care to clients, case navigation to care and support across various service
agencies, nutritional supports, adherence and viral load monitoring and retention in care and
treatment programs were integral components of care and support. CSOs also assisted in
Government of Guyana Global AIDS Response Progress Report, 2015
33
building linkages to skills training, child protective services and other youth-centred
resources through the distribution of comprehensive service directories.
Through the active involvement of CSOs in a field survey during 2014, a cross section of
perceptions about stigma and discrimination was revealed in addition to the degree of
violence experienced by PLHIV, MSM, FSWs and women in general. The findings of
this survey indicated that while stigma and discrimination towards PLHIV has decreased
during the past decade due to increased knowledge of HIV, it is still significant in
relation to MSM and FSWs. This stigma also results in violence against these groups
and impedes access to HIV services.
The Guyana Responsible Parenthood Association (GRPA) whose focus is on providing
sexual and reproductive health services, works in close collaboration with the MoH/NAPS
in providing these services. During 2014, collaboration included joint outreaches with MoH,
provision of VCT, STI and VIA services. In the latter regard, GRPA was able to benefit
from VIA refresher training provided through MoH in beefing up their VIA services.
The Guyana Faith Coalition on HIV and AIDS continued to coordinate the response among
the faith community, with a focus on the strength of the family as the core unit of society.
3.2 PREVENTION
The Guyana National Reference Group for HIV Prevention is led and coordinated by
NAPS to support national level prevention efforts and to ensure adherence to the National
HIV Prevention Policy. Meetings held during the reporting period focused on the status of
national prevention efforts. To further boost the national prevention programme, the
Prevention Coordinator’s skills were strengthened through participation in a course on
“Strengthening Prevention in HIV and Public Health Programmes” aimed at equipping
participants with increased knowledge and skills in leading HIV prevention programmes as
part of the national HIV response.
During 2014, Information, Education and Communication along with Behaviour Change
Communication, continued to be a prominent part of the national strategy to reach the
masses with HIV/AIDS prevention messages.
Behavior Change Communication (BCC)
During 2014 the national programme continued to work on the development and
production of Behaviour Change Communication campaigns, and existing campaigns were
disseminated. These campaigns which focused on behavior change to reduce risks to HIV,
addressed a variety of issues. A campaign encouraging greater health seeking behaviours
among men was conducted with a focus on the importance of knowing one’s HIV status,
blood sugar, and cholesterol levels, etc. while promoting healthy living practices. A
campaign focusing on prevention of cervical cancer and promotion of screening using VIA
(Vaginal Inspection by Acetic acid) among women and girls, was also rolled out.
Government of Guyana Global AIDS Response Progress Report, 2015
34
In prioritizing access to HIV testing and risk reduction among the key populations, a
campaign focusing on HIV testing and condom use among MSM and FSWs was developed
and rolled out. The design and development of the campaign had the integral involvement
of this target audience. A campaign promoting home based care (HBC) targeting caregivers
for the elderly and bed-ridden persons was also conducted using a documentary and
brochure. These materials educated the public on how to effectively provide HBC and also
included the experiences of caregivers. Table 7 provides a list of the mass media campaigns
that were launched during the period 2005 – 2014.
Table 7: Mass Media Campaigns Held During the Period 2005-2014
Period Campaign
2005-2006 1. Reduce Stigma and Discrimination
2. Increase Community Involvement in HIV/AIDS Prevention,
Treatment and Care
3. Encourage Early HIV Testing
4. Increase Condom Social Marketing
2007-2009 5. Reduce Stigma and Discrimination
6. Increase Community Involvement in HIV/AIDS Prevention,
Treatment and Care
7. Reduce HIV Transmission among High Risk Groups
8. Encourage Early HIV Testing
9. Increase Condom Social Marketing
10. Promote Early Diagnosis and Treatment of Opportunistic Infections
11. Promote Women Empowerment and Increase skills in Condom
Negotiation
12. Promote Adherence Among HIV Positive Persons on Anti-retroviral
Therapy
2010-2013 13. Prevention of TB/HIV Co-infection Among Persons Living with HIV
14. Prevent Sexually Transmitted Infections
15. Prevention of Mother to Child Transmission of HIV
2014 16. Male Involvement in Their Own Health
17. Protection Against and Screening for Cervical Cancer
18. HIV Testing and Condom Use Among Key Populations
19. Promotion of Home Based Care
During 2014, at the treatment site level, nursing supervisors and social workers were guided
in the integration of standard operating procedures for assessing their caseload to determine
which clients are at increased risk of HIV transmission. These clients were provided with
Positive Health, Dignity and Prevention (PHDP) services for sexual and reproductive
health care, disclosure to partner and family, assessment of partner’s status, treatment
adherence, substance abuse management, HIV-risk reduction and broader health
maintenance. In addition, with NGO support, PHDP enrolees were involved in small group
activities which highlighted harmful gender norms, promoted gender equality, and
discouraged gender-based violence as cross cutting supporting activities. Achievements for
PHDP shows a total of 424 PLHIV being provided with at least six service sessions based
on their needs identified at intake.
Government of Guyana Global AIDS Response Progress Report, 2015
35
Within the Guyana Defence Force, during the period 2006-2014, 5,098 members of the
Force (officers, ranks and recruits) completed a standardized HIV prevention intervention
which included education on HIV/STI transmission, prevention and care and correct and
consistent use of male and female condoms. This included the distribution of condoms at
various military bases within the country.
Information, Education and Communication
During 2014, IEC materials targeting various population groups were developed, reproduced
and distributed as part of the prevention programme. These included
brochures/posters/stickers on: safe sex; condom promotion; women empowerment; STIs;
PMTCT and; stigma and discrimination. During 2014 several advertisements were also
placed in magazines to reach various target audiences.
Annual Commemorative Activities Aimed at Prevention
During the reporting period, several national commemorative activities continued and these
included World AIDS Day (WAD) observances, Mashramani (National Carnival)
celebrations, GUYEXPO and International Women’s Day and for the first time, the globally
observed Zero Discrimination Day. These national events served as a good media for
providing HIV education, sensitization, and HIV services including testing, screening for
STIs and referral to treatment services. There was also painting of a Youth Pledge to build
HIV/AIDS awareness among youths.
World AIDS Day 2014 commemoration included: broadcasting of brief messages from
senior in-country officials focusing on the WAD theme; an annual walk attended by more
than 200 persons; a film festival attended by more than 1000 schoolchildren; painting of a
mural on “An AIDS Free Generation”; showing of a play “Your Top My Bottom” which
focused on bisexuality, unfaithfulness and HIV risk; an AIDS-awareness walk-a-thon; a rally
targeting members of the community; a Red Ribbon Day and; HIV testing for key
populations in an outlying area.
Condom Distribution
Over the years, consistent condom use has been promoted by the national programme as a
key behavioural and biological prevention strategy, and significant efforts were made to
increase the awareness, availability and use of condoms to prevent the transmission of
HIV/AIDS and STIs.
During 2014, free condoms continued to be distributed to the general public, among the
Armed Forces, civil society organizations, stakeholder agencies, health facilities and
government ministries in the effort to reach all ten (10) Administrative Regions. The
national programme was also supported by the private sector through the procurement and
sale of condoms at a reduced cost. During 2014, a total of 2,648,976 pieces of condoms,
were distributed through the national programme free of cost. This amount represented
81% of the condoms made available to the public, while the private sector contributed 19 %
(614,898) of the total amount of condoms distributed nationally.
Government of Guyana Global AIDS Response Progress Report, 2015
36
As seen in Figure 8 below which shows the trend in condom distribution through the
national programme from 2010-2015, the number of condoms distributed during 2014 saw
an approximately 50% reduction when compared to 2013. This was however due to more
targeted efforts directed towards key affected populations in making condoms and lubricants
available to them through the Prevention Package of Services as reported in the section of
this report which addresses interventions targeting these populations.
Figure 8: Condom Distribution Through NAPS During 2010 – 2014
Source: NAPS Programme Reports
Figure 9 below, shows the proportions of the contributions made by the respective partners
involved in condom distribution during 2014.
Figure 9: Condom Distribution in Guyana During 2014
Government of Guyana Global AIDS Response Progress Report, 2015
37
During 2014, 75934 packets of lubricants were distributed. This was done mainly through
CSOs that provide services for MSM. Table x below shows the distribution of lubricants by
Regions.
Table 8: Distribution of Lubricants by Region During 2014
Region 1
st
Qtr. 2
nd
Qtr. 3
rd
Qtr. 4
th
Qtr. Total %
1 0 6 0 4,200 4,206 5.5
2 60 0 0 2,400 2,460 3.2
3 0 0 0 25 25 0.0
4 144 56 37 52,179 52,416 69.0
5 0 0 0 2,400 2,400 3.2
6 0 0 0 7,250 7,250 9.5
7 0 36 0 2,600 2,636 3.5
8 5 0 0 2,700 2,705 3.6
9 0 0 0 1,800 1,800 2.4
10 36 0 0 0 36 0.0
Total 245 98 37 75,554 75,934 100
Prevention of Mother-to-Child Transmission (PMTCT)
The National PMTCT Programme continues to receive strategic directions from a
multisectoral National PMTCT Oversight committee led by the Minister of Health. During
2014, meetings of this committee in addition to PMTCT feedback meetings were held with
key stakeholders to review the coordination, successes and challenges of the PMTCT
programme. The programme is poised to report on the elimination of mother to child
transmission of HIV in alignment with the MDG goals. During 2014, a regional meeting
was held in Guyana to review plans to move the Caribbean region (including Guyana)
towards the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis
in the Americas. Resulting from this forum, a national evaluation committee was established
to prepare Guyana’s application for Elimination status.
In intensifying all efforts to achieve elimination status by 2015, the PMTCT programme
introduced a proactive case tracking management system which seeks to ensure that each
HIV infected pregnant women is followed throughout pregnancy, delivery and the post
partum period, and is provided with the appropriate care, treatment and support. This
system also provides for each exposed infant to be managed up to 18 months, including the
mandatory DNA PCR testing as per national guidelines. At the end of 2014, 150 pregnant
women were enrolled and receiving support, care and treatment while 87 infants were being
tracked.
During 2014, the number of primary sites providing PMTCT services, including antenatal
clinics, delivery wards and private hospitals, increased to 188 compared to 187 in 2013. The
Lethem Health Centre in the hinterland Region was upgraded to meet National PMTCT
Guidelines and standards, with emphasis on creating a safe space for privacy and
confidentiality during counselling, including pre- and post-test HIV counselling.
Government of Guyana Global AIDS Response Progress Report, 2015
38
The proportion of pregnant women who accessed PMTCT services in 2014 was 94.4%
(14,623/15,494) compared to 88.7% in 2013. HIV prevalence among women attending
antenatal clinics remained at 1.9% (293/15,494) in 2014 as in 2013. It should be noted that
in previous years a low HIV prevalence was recorded among the antenatal population as this
indicator was calculated based on women who were newly tested positive in the reporting
year. From 2012, the programme reported on HIV prevalence using a combination of all
newly tested HIV positive and women with known HIV positive status (who were
previously tested HIV positive and accessed ANC during the reporting period.)
During 2014, there was the continued thrust of provider initiated testing and counseling
(PITC). Uptake of VCT services among pregnant women however was 94.4% in 2014
compared with 97.2% in 2013 due to a stock out of test kits at selected Regional sites during
2014. The reduced number of tester counselors within the programme as a result of the
transitioning process from donor-funded to government, also contributed to the reduced
PMTCT coverage Figure 10 below shows the trend in VCT uptake by antenatal women
during the period 2010 – 2014.
Figure 10: Trend in VCT Uptake from 2010 – 2014
Source: PMTCT Programme Reports
The prevalence of HIV among the antenatal population remained at 1.9% (293/15,494) at
the end of 2014. Figure 11 below shows the prevalence of HIV in the antenatal population
during the period 2010–2014.
Government of Guyana Global AIDS Response Progress Report, 2015
39
Figure 11: Prevalence of HIV in ANC Population: 2010-2014
The proportion of HIV-positive pregnant women who received ART to prevent mother-to-
child transmission was 97% (187/193) (PMTCT & ART Programme data).
Babies born to HIV positive mothers continued to be provided with early HIV diagnosis
through DNA PCR testing at the Guyana National Public Health Reference Laboratory. In
2014, 2.6% (5/193) of the babies born to HIV-positive mothers were infected with HIV
compared to 2.1% in 2013 (4/191). Exposed infants are currently being tracked at the care
and treatment sites through use of the Exposed Infants Register, in addition to the case
tracking system. Box 1 shows the trend in DNA PCR testing during the period 2010 – 2014.
Box 1: DNA PCR Testing
2010 2011
2012 2013 2014
DBS specimens received 211 229 281 274 284
Samples rejected 27 16 18 23 4
Samples processed 184 213 263 251 280
Number of positive
samples
11 5 3 4 5
% positive 6% 2.3
%
1.7% 2.1% 1.7%
Babies tested before 2
months
87 102 75 62 115
Government of Guyana Global AIDS Response Progress Report, 2015
40
The number of babies tested before 2 months was impacted by challenges experienced by
the laboratory due to equipment down-time and a shortage of staff and supplies.
Table 9 below shows major trends in the PMTCT programme during the period 2006 –
2014.
Table 9: Major Trends in the PMTCT Programme, 2006-2014
Source: PMTCT database 2006-2014
* This figure is higher than the number of **“Exposed live infants born to HIV positive mothers” during
2014 due to the rollover of a number of pregnant women into 2015.
Male partner involvement
Male partner involvement is measured at the national level through male partner testing
which constitutes part of the PMTCT programme’s couples counseling and testing initiative
and promotion of family planning services at all PMTCT sites. 9.2% male partners of
pregnant women (1,424 of 15,494) were tested through ANC settings in 2014. Of those
males, 17 (1.2%) were found to be HIV-positive. During 2013, the same proportion of male
partners were tested (9.2%) of which 0.7% were HIV positive.
In the ongoing attempt to prevent Mother to Child Transmission (MTCT), the provision of
infant feeding counseling and breast milk substitute (BMS) continued with exposed infants
being provided with these substitutes up to the age of 18 months. During 2014, 3,769 tins
of full cream milk and 7,559 tins of infant formula were distributed among health facilities
country-wide.
During 2014, a National Assessment and Accreditation was conducted for Baby Friendly
Hospitals in the effort to promote breastfeeding and address Infant and Young Child
Feeding Practices (IYCF) for the well child and children born to HIV Positive mothers. Six
out of twelve hospitals met the Global Criteria of the BFHIs and all hospitals met the
criteria for Steps 6, 7, and 9 International Code of the Marketing of Breast milk Substitutes
and HIV Infant Feeding. The national PMTCT programme was found to be active and
functional in all the hospitals, including the provision of on-site VCT services. The majority
CATEGORY
2006 2007 2008 2009 2010 2011 2012 2013 2014
No. of sites with
PMTCT
92 117 143 157 165 181 183 187
188
ANC mothers
tested for HIV
13,041 13,151 12,528 11,766 11,441 12,635 12,697 13,413 12,592
Uptake of VCT
among pregnant
women (%)
94.6 97.6 98.5 89.8 93.7 94.8 93.3 97.2 94.4
*No. of HIV
positive mothers
215 176 177 180 164 233 241
279
293
Prevalence of HIV
(%)
1.5 1.3 1.1 1.3 1.2 1.6 1.7 1.9 1.9
**Exposed live
infants born to HIV
positive mothers
126 217 227 169 161 189 177 192 190
Government of Guyana Global AIDS Response Progress Report, 2015
41
of pregnant women interviewed were aware of the importance of HIV testing. The survey
also found that midwives were trained in how to counsel HIV positive women about their
infant feeding options and they also assisted in ensuring that women accessed support
services. It was recommended that the Labour and Delivery protocols should be updated to
address the Mother Friendly Care Practices and that there should be a review of current
National HIV Infant Feeding Guidelines based on the 2010 WHO/UNICEF/UNAIDS
guidelines.
Box 2 below shows capacity development activities within the PMTCT programme during
2014.
Box 2: Capacity development within the PMTCT programme during 2014
1. Drafting of Standard Operating Procedures (SOPs) for Case Tracking Managing System
(CTMS) with regard to Paediatric Care of HIV Exposed Infants.
2. Capacity development of 89 primary health care staff (Regions 3,4,5,6,10) in utilizing the
CTMS Tools.
3. Participation of 18 health professionals from public and private health care facilities in a
trainer-of-trainers workshop on CTMS.
4. Participation of 15 health care professionals, including Regional health centre supervisors
in an Integrated Paediatric Care workshop in preparation for piloting at 10 selected sites.
5. Drafting of an Integrated PMTCT Curriculum and review of this curriculum by 15
health care professionals at a workshop to determine its applicability and efficacy in
integrating it into the training curriculum for pre-service nurses and Medex
6. Review of Safe Motherhood and STI training programme by a group of 33 health care
workers of different categories, including training facilitators
7. Training in Dried Blood Sampling for 22 health care workers of different categories
taken from hinterland Regions 7 and 8.
A research into the cause for repeat pregnancies among women (both HIV positive and
negative) was also conducted, with 287 persons being interviewed including clients and
health care workers. The results of this research are currently being analyzed
Challenges encountered during the year included the shortage of laboratory reagents to do
DNA/PCR testing as part of Early Infant Diagnosis. Increasing male partner involvement
also continued to be a challenge despite continued efforts in this area.
Voluntary Counseling and Testing (VCT) for HIV
The National Voluntary Counseling and Testing Programme continued to receive strategic
guidance from the National Steering Committee which convenes quarterly to deliberate on
technical and coordination issues. The VCT steering committee met regularly and invested
significant time in considering the shift in the HIV testing algorithm from parallel testing to
serial testing. This technical discussion will conclude in 2015.
During the period 2006-2013, the VCT programme expanded from 38 fixed sites and 2
mobile units to 62 fixed sites spread across the 10 regions with several mobile units targeting
Government of Guyana Global AIDS Response Progress Report, 2015
42
the key populations and the hinterland communities. During 2014, VCT continued to be
provided country-wide through these sites.
During 2014, a total of HIV 54,815 tests (24,627 among males and 30,189 among females)
were done showing an increase when compared with the 2013 total of 49,674 tests. Females
continued to access VCT services more than males, accounting for 55.1% of testing in 2014
which was lower than the 2013 figure of 59.6%. Among all testing in 2014, 1,034 tests
(1.9%) were found to be HIV positive in comparison to 983 (2%) in 2013. Testing among
Females comprised 46.6% (442/1,034) of the positives compared to 51.5% in 2013.
In relation to the general population based on the 2002 census, females account for a slightly
higher proportion of the population (50.3%) with a male to female ratio of 0.98. Based on
the last 5 year trends the male to female ratio for testing has been consistently lower than
that of the population, however 2014 testing showed improvement compared to the
previous years and significant improvement compared to 2013 (0.68 vs 0.8). Figure 12 and
table 10 below shows HIV testing according to gender during the period 2010 – 2014.
Figure 12: Number of Tests done According to Gender: 2010–2014
0
10000
20000
30000
40000
50000
60000
70000
2010 2011 2012 2013 2014
N
u
m
b
e
r
o
f
te
st
s
Year
Annual testing by gender: 2010 ‐ 2014
Ma
Fe
Table 10: Annual testing by Gender 2010-2014
Gender Population > 15
years
(2002 census)
2010 2011 2012 2013 2014
Number of Tests Done
Males 240,405
40,107 45,954 26,329 20,062 24,627
Females 243,671
53,425 61,562
37,136 29,612
30,189
Male to
Female Ratio
0.98 0.75 0.75 0.71 0.68 0.8
Total Tests 484,076 93,532
107,516 63,465 49,674
54,815
Government of Guyana Global AIDS Response Progress Report, 2015
43
Region 4 with 42% of the populations accounts for 63% of all testing in 2014, a trend which
was maintained over the years. There has been a gradual decline in the proportion of testing
occurring in Region 6 which has 15% of the population. Testing in this region was reported
at 11.9% in 2014 compared with 19.2% on 2010. Region 3 with 14% of the population, has
consistently had low levels of testing coverage accounting for 6.7% of the tests in 2014.
This represents a reduction when compared to 2012 and 2013. Similarly, the combined
hinterland regions (1, 7, 8, and 9) also continue to receive low levels of testing. See details in
table 11 below.
Table 11: HIV Testing by Regions
Region
Populat‐
ion (2012
census)
Regional
Proport‐
ion of
Populat‐
ion
2010 2011 2012 2013 2014
# of
tests
done
Prop‐
ortion of
testing
by
region
# of
tests
done
Prop‐
ortion of
testing
by
region
# of
tests
done
Prop‐
ortion of
testing
by
region
# of
tests
done
Prop‐
ortion of
testing
by
region
# of
tests
done
Proport‐
ion of
testing
by
region
1 26,941 4 371 0.40 2318 2.2 259 0.4 521 1.0 1190 2.2
2 46,810 6 2556 2.73 3383 3.2 2662 4.2 2426 4.9 2262 4.1
3 107,416 14 4952 5.29 5705 5.3 4744 7.5 4183 8.4 3689 6.7
4 313,429 42 54794 58.57 64316 59.9 41920 66.1 32526 65.5 34569 63.1
5 49,723 7 1855 1.98 1785 1.7 821 1.3 200 0.4 573 1.0
6 109,431 15 17952 19.19 21782 20.3 8591 13.5 6000 12.1 6501 11.9
7 20,280 3 3203 3.42 1841 1.7 1517 2.4 1489 3.0 2202 4.0
8 10,190 1 1202 1.28 447 0.4 253 0.4 536 1.1 402 0.7
9 24,212 3 1379 1.47 1592 1.5 859 1.4 260 0.5 358 0.7
10 39,452 5 5288 5.65 4117 3.8 1837 2.9 1533 3.1 3070 5.6
Total 747,884 100 93552 100.00 107286 100.0 63463 100.00 49674 100.0 54815 100.0
In addition, the 25-49 year age group had the highest proportion of tests (45.9%) country-
wide which was somewhat similar to the figure for 2013 (47.4%). Table 12 below shows the
breakdown by age groups during the reporting period.
Table 12: HIV Testing by Age Groups: 2014
<15 15 ‐19 20 ‐24 25 ‐ 49 >49
Total
Tested
Key Population 45 842 1874 4264 586 7611
General Population 967 8230 11926 20904 5177 47204
Total Tested 1012 9072 13800 25168 5763 54815
% of Test 1.85 16.55 25.18 45.91 10.51 100.00
During 2014, there was increased focus on targeting key populations at higher risk to offer
VCT. In preparation for this, the VCT monitoring and reporting system was revised during
the latter half of 2013 which facilitated the capturing of VCT data among these populations
during 2014. Key populations focused on were mainly men who have sex with men (MSM),
sex workers (male & females), miners and loggers. VCT was offered in all 10 administrative
Government of Guyana Global AIDS Response Progress Report, 2015
44
regions through health facilities and NGOs. During 2014, key populations accounted for
13.9% (7,612/54,816) of the total number of tests done. Figure 13 below shows VCT
uptake among the different categories of the key populations.
Figure 13: Number of Tests done Among Key Populations in 2014
Among the key populations tested, the miners accounted for the greatest proportion of
positives among all positives at 8.9% (92/1034) while sex workers accounted for 7.9%
(82/1034). This was followed by MSM accounting for 7.1% (73/1034) while loggers had the
lowest proportion with 1.4% (14/1034).
In terms of the positive cases among the specific populations tested, MSM reported the
highest positive rate of 3.75% (73/1945), followed 3.65% (92/2517) for miners, 3.37
(82/2430) for sex workers and 1.94% (14/720) for loggers. This programmatic data is
similar to that reported in the BBSS 2014 with the exception of the miners which is
significantly higher. Close monitoring of this programme will continue.
Testing for HIV also occurred in the PMTCT programme and testing is mandatory as part
of the screening protocol for blood and blood products at the National Blood Bank. There
has been a progressive increase in the number of persons being tested annually in these
settings as shown in Table 13.
Government of Guyana Global AIDS Response Progress Report, 2015
45
Table 13: HIV Testing in Various Settings for the Period 2006-2014
Testing
Setting
2006 2007 2008 2009 2010 2011 2012 2013 2014
VCT 25,063 48,573 63,876 85,554 93,532 106,491 63,465 49,674 54,815
PMTCT 13,041 12,004 15,702 11,776 11,441 13,490 12,697 13,413 12,592
Blood
Screening
6,810 7,104 7,360 7,700 7,654 7,929 7,712 11,148 10,016
Total
Tested
44,914 67,681 86,983 105,030 112,62
7
127,910 83,874
74,235
77,424
Total HIV
Positive
(Notified
cases)
1,258 993 959 1,176 1,039 972 820 758 1,423
Percentage
Positive
2.8 1.5 1.1 1.1 0.9 0.8 1 1 1.8
Training
During 2014, 45 members of the Guyana Defence Force were provided with VCT training
in the effort to expand the availability of VCT to the Armed Forces and other members of
the community. VCT Refresher Training was also provided to 104 counselor/testers within
5 Regions of Guyana. In addition, Quarterly Feedback Meetings were held with
counselor/testers to monitor their progress and to address any challenges encountered.
Valentine’s Day Couples Testing
The annual Valentine’s Day Couples Testing,
continued in 2014 in 5 of the 10 administrative
regions, with the support of business partners.
Under the theme “Test of Love”, 3,292
persons (62% females and 38% males),
including 284 couples, received VCT. This
was a moderate increase compared to 2013
when 3,023 persons including 280 couples
received VCT as part of this initiative. (see
box 3). Of the persons tested in 2014, 1.1%
(36/3,292) was found to be positive and
referred for treatment.
As part of the Couples Testing Initiative, incentives in the form of romantic dinners
sponsored by the business community, were raffled and won by lucky couples.
Blood Safety Programme
An adequate and safe blood supply is a crucial element of the national strategy to control
HIV. In light of this, in adherence to the National Blood Policy developed and approved
during the previous reporting period, all donated blood was screened for infectious markers
during 2014. During 2014, 10,016 units of blood were collected compared to 11,148 units in
2013.
Box 3: Persons Tested
During Couples Testing
2008 – 2014
Year Target No. of
couples
tested
No. of
persons
tested
No. of
testing
sites
2008 200 104 477 10
2009 200 237 1,176 8
2010 250 296 939 9
2011 300 346 1,022 11
2012 350 514 1,883 13
2013 350 280 3,023 15
2014 350 284 3,292 9
Government of Guyana Global AIDS Response Progress Report, 2015
46
During 2014 the proportion of persons testing positive for HIV among all blood units
screened was 0.96% (96/10,016) compared with 0.3% in 2013. Hepatitis B remained the
most commonly occurring infectious marker among blood units screened with a proportion
of 1.37% (137/10,016) followed by Hepatitis C with a proportion of 1.04% (104/10,016).
Figure 14 below shows the proportion of infectious markers during the period 2009 – 2014.
Figure 14: Proportion of Infectious Markers 2009-2014
0.0
0.5
1.0
1.5
2009 2010 2011 2012 2013 2014
VDRL
HIV
HCV
HBsAg
HTLV
Source: National Blood Transfusion Unit
Post Exposure Prophylaxis (PEP)
During 2014, a total of 17 public health facilities and 2 private hospitals provided PEP as in
obtained in 2013. All PEP sites are equipped with a special PEP kit which includes the
Standard Operating Procedures/Guidelines, ARVS, medications for emergency
contraception and for treatment of other sexually transmitted infections (gonorrhea and
chlamydia). The sites are supported with standard operating procedures and quick
references.
In 2014, 5 government health facilities and
one private hospital reported a total of 69
PEP cases. Fifty two (52) of these were due
to needle stick injuries (occupational) and 17
due to sexual assault (non occupational).
Persons were assessed and placed on the
required prophylaxis. Box 4 shows the
number of needle stick injuries versus the
number of sexual assault cases by Regions.
Box 4: Needle Stick Injuries Versus Sexual
Assault 2014
Region
Need Stick
Injury
Sexual
Assault
Number of
persons
3 11 1 12
4 37 16 53
6 2 0 2
10 2 0 2
Total 52 17 69
Government of Guyana Global AIDS Response Progress Report, 2015
47
Figure 15 below shows the number of cases reported during the period 2010 – 2014.
Figure 15: Number of Reported PEP Cases 2010 – 2014
An analysis of the PEP cases reported over the period 2010 – 2014 indicates that needle
stick injuries (occupational) among health care workers is a commonly occurring factor in
PEP cases as indicated in box 5 and Figure 16 below. Sexual assault cases (non
occupational) receiving PEP have also increased over the years.
Figure 16: Needle Stick Injuries vs Sexual Assault in PEP Cases
12
9
27
53
52
10
2
13
16
17
0 10 20 30 40 50
60
2010
2011
2012
2013
2014
Needle Stick Injuries vs Sexual Assault
Sexual Assault Needle Stick
Box 5: Needle Stick Injuries Versus Sexual Assault
2010 ‐ 2014
2010 2011 2012 2013 2014
Needle Stick 12 9 27 53 52
Sexual Assault 10 2 13 16 17
Government of Guyana Global AIDS Response Progress Report, 2015
48
To address this situation there has been ongoing training among health care workers to
avoid occupational exposure. During 2014, a total of eighty-two health care workers of
different categories from regions 2, 5, 9 and 10 received training in this regard along with
training in the delivery of PEP.
Prevention and Control of Other Sexually Transmitted Infections (STIs)
During the reporting period, efforts to prevent and control STIs continued in accordance
with Guyana’s STI Strategic and Monitoring and Evaluation Plan 2011-2020. The main goal
of the plan is to “reduce the transmission and morbidity and mortality caused by STIs and to
minimize the personal and social impact of the infections.” This plan was implemented in
conjunction with the HIVision 2020 which was launched in 2013.
There were 5,127 STI cases reported in 2014 representing a significant decrease (24%) from
the 6,777 cases reported in 2013 (MoH Surveillance Unit). The 2014 figure was a deviation
from the trend seen during the period 2007 – 2013 when there was a steady rise in the
number of STI cases recorded. Figure 17 below shows the number of STI cases reported
during the period 2007 – 2014.
Figure 17: Number of Reported STI Cases 2007 – 2014
2007 2008 2009 2010 2011 2012 2013 2014
TOTAL NUMBER OF CASES 3481 4079 6021 5882 5671 6377 6777 5127
0
1000
2000
3000
4000
5000
6000
7000
8000
N
u
m
b
e
r
o
f
re
p
o
rt
e
d
c
a
se
s
Surveillance Unit, MoH
Genital discharge syndrome (GDS) remains the most frequently reported syndrome during
the period 2010-2014 (95% of STIs) in 2014 which is almost the same as in 2013 with its
94.7%). Overall, cases of genital ulcer disease (GUD) have been decreasing over the past
five years (6.5% in 2010 steadily decreasing to 3.3% in 2014). Table 14 shows the frequency
of occurrence of the various STIs during the period 2010-2014.
Government of Guyana Global AIDS Response Progress Report, 2015
49
Table 14: STI by Type 2009 – 2014
STI 2010 2011 2012 2013 2014
No. % No. % No. % No. % No. %
GDS 5,419 92.1 5,231 92.2 5920 92.8 6421 94.7 4863 94.9
GUD 385 6.5 344 6.1 364 5.7 260 3.8 167 3.3
Gonorrhea 19 0.3 35 0.6 23 0.4 30 0.4 30 0.6
Chlamydia 6 0.1 6 0.1 8 0.1 8 0.1 5 0.1
Syphilis 7 0.1 22 0.4 25 0.4 26 0.4 23 0.4
Trichomoniasis 30 0.5 14 0.2 22 0.3 11 0.2 16 0.3
LGV 0 0 0 0.0 0 0.0 1 0.0 0.0 0.0
Herpes Simplex 16 0.3 19 0.3 15 0.2 20 0.3 23 0.4
Total 5,882 100.0 5671 100.0 6377 99.9 6777 99.9 5127 100
Surveillance Unit, MoH
The majority of the STI cases reported continued to be among females; 82% in 2014 and
85% percent in 2013 (MoH Surveillance data), see Figure 18 below. The higher figures
recorded for females might be due to the observation that females access government STI
services (and also general health services) more frequently than men who are more likely to
access services from private hospitals and pharmacies. As such, all STI cases among men
might not have been fully captured within the public reporting system. Figure 18 below
illustrates the gender distribution of STI cases for the period 2010 – 2014.
Figure 18: Distribution of STI Cases According to Sex 2010 – 2014
Surveillance Unit, MoH
As in previous years, the majority of STI cases were among persons 15 yrs of age and above,
with 95% occurring among this age group in 2014. Data from the National Care and
Treatment Center (NCTC) in Region 4, which is the main sentinel site for monitoring STIs,
showed the highest occurrence (42%) of STIs within the 15-24 years age group. Region 4,
which is the most populated region, also accounted for the highest proportion of STI cases
nationally (26.5%). During 2014 there was an HIV prevalence of 12% among STI patients
visiting the NCTC. This amounted to 105 cases of HIV co-infected with other STIs
reported compared with 112 in 2013.
During 2014, all blood donors were screened for STIs as part of the National Blood
Transfusion Protocol. The percentage of screened blood that tested positive for STIs was
Government of Guyana Global AIDS Response Progress Report, 2015
50
5.12% (513/10,016) compared with 2.8% in 2013. Hepatitis B remained the most
commonly occurring STI with a proportion of 1.37% of all blood screened followed by
Hepatitis C with a proportion of 1.04%.
During 2014, 117 health care workers of different categories and 28 support personnel
including Social Workers, Welfare, Child Protection, and Probation Officers were trained in
STI Prevention Management and Control. Several technical documents were also revised,
updated and disseminated including the STI training manual, STI and OI booklet, and
posters.
Screening for cervical cancer
With clear association between cervical cancer and HIV, screening for cervical cancer has
been scaled up with the expansion to 19 sites in 10 regions in 2014 compared to 17 sites in 9
regions in 2013. Visual Inspection with Acetic Acid (VIA) screening continued at the
Maternity Unit of the National Referral Hospital as part of the Ministry of Health’s national
cervical cancer management programme which seeks to identify women with a higher risk
for cervical cancer. In addition screening was done through outreaches to work places and
other organisations.
In keeping with Guyana’s HIV treatment guidelines which recommend VIA as a baseline
screening for all HIV infected women, screening is implemented at all HIV treatment sites
through onsite administration using a Single Visit Approach (SVA). In ensuring that this is
now a defined standard of care, VIA documentation has been incorporated into the patient
monitoring system.
As part of the VIA process, smaller
precancerous lesions are removed
using cryotherapy, while larger
lesions are removed using
Electrosurgical Excision Procedure
(LEEP) at the National Referral
Hospital. Clients with suspected
cancer cells undergo biopsy and are
referred to the Oncology Clinic at the
referral hospital for management.
During 2014, 3,678 persons,
including 505 HIV positive patients
received VIA. Of the 3,678 persons
screened, 392 received a positive
VIA. Of these, 310 received
cryotherapy, 51 received LEEP and
14 were referred to oncology. Box 6
shows the number of persons
screened and the follow up provided
during the period 2012-2014.
Box 6: VIA Services Provided
2012 – 2014
2012 2013 2014
Total receiving
VIA
6,937 5,363 3,678
Number of HIV
positive clients
who received
VIA
969 648 505
Total of all
clients with
Positive VIA
639 466 392
Percent with
positive VIA
findings
9.2% 8.7% 10.7%
Received
cryotherapy
522 353 310
Received LEEP 26 55 51
Referred to 48 45 14
Government of Guyana Global AIDS Response Progress Report, 2015
51
As is evident, the total number of VIA screening declined over the last 3 years with a parallel
decline in the number of HIV positive clients screened. Importantly the proportions with
positive VIA findings remain significant at 10.7% in 2014.
During 2014, there was a Regional training of the trainer activity in Guyana to provide
training in performing the VIA procedure. Representatives from Caribbean countries
included 1 from Trinidad, 2 from Suriname, 1 from Antigua, 1 from St. Lucia and 5 from
Guyana. Training involved both lectures and practicals which included each participant
having to conduct the procedure on a specific number of persons.
Guyanese girls, aged 11 to 13 years old continued to benefit from the administration of
Human Papilloma Virus (HPV) vaccine. This service is provided at health centres and in
schools with the consent of parents. To ensure an effective vaccination programme, an
accompanying comprehensive Information, Education and Communication programme was
developed and implemented. This included the development and distribution of educational
brochures, posters and booklets, and mass media activities such as panel discussions,
documentaries and others. The IEC materials targeted parents, families, teachers, young girls
and the general public.
Community Mobilization
Community mobilization activities during 2014 were generally done in collaboration with
Government Ministries, grassroot organizations, service organizations and civil society
members such as religious leaders and other members of the community. Most of the
trainings and outreaches were done in the outlying regions of Guyana where the population,
are relatively underserved due to geographic barriers. Community mobilization efforts were
also generally interwoven into the various components and technical areas of the national
programmes (as indicated in various other parts of this report).
The community mobilization programme during 2014 included training and sensitization of
in and out-of-school youth across Guyana and focused on: identifying ways in which young
people can get HIV/AIDS; sensitizing young people about the ABC of HIV/AIDS
prevention; emphasizing the importance of eradicating stigma and discrimination and;
equipping the participants with peer education skills. A total of 207 youth (151 females and
56 males) from five (5) Regions of Guyana were trained.
Government of Guyana Global AIDS Response Progress Report, 2015
52
Figure 19 shows the number of persons trained as peer educators during 2009 – 2014.
Figure 19: Number of Peer Educators Trained 2005 – 2014
Source: NAPS Programme Reports
Table 15 below shows the number of peer educators trained by Region.
Table 15: Number of peer educators trained by Region
REGIONS 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total
1 ‐ 36 ‐ 25 ‐ 27 26 52 27 45 238
2 21 ‐ ‐ ‐ 21 28 0 38 ‐ ‐ 108
3 31 61 30 26 ‐ ‐ ‐ 26 ‐ ‐ 174
4 21 20 52 153 76 97 38 66 22 27 572
5 ‐ 23 45 ‐ ‐ ‐ ‐ 25 ‐ 93
6 ‐ 33 29 30 27 88 56 94 81 70 508
7 ‐ 27 34 ‐ ‐ 27 ‐ ‐ 60 ‐ 148
8 ‐ 21 ‐ ‐ ‐ ‐ ‐ ‐ 49 ‐ 70
9 ‐ 22 30 ‐ ‐ 22 32 ‐ 99 34 239
10 ‐ 34 30 ‐ 21 ‐ 22 ‐ 31 138
Total 73 277 250 234 145 289 152 323 338 207 2288
During the year, Peer Educators complemented and supported a number of activities
implemented by MoH/NAPS. In addition, these Peer Educators also implemented activities
independently in their respective Regions, with support from the national programme.
In the effort to update the peer education programme, during 2014 a draft “Standards &
Guidelines for Peer Education in Guyana” was prepared and submitted to the Peer
Education Committee comprised of representatives from MoH/NAPS, UNICEF and the
national Rights of the Child Committee. Arrangements to conduct a study in all ten Regions
of Guyana to determine the impact of Peer Education Trainings during the period 2007 –
2013, are also in train.
Government of Guyana Global AIDS Response Progress Report, 2015
53
Interventions with Key Populations at Higher Risk
The Guyana National Programme acknowledged the need for a strengthened response to
the Key Populations at Higher Risk. These populations in HIVision2020 were defined as
“populations at higher risk of HIV exposure which refers to those most likely to be exposed to HIV or to
transmit it due to the number of partners they have or the type of high risk sex they engage in”. The
populations identified included PLHIV, MSM, Sex Workers and their clients, transgender
persons, prisoners, miners and loggers.
During 2014, there was a significant scale-up of interventions targeting key populations as
a result of increased funding allocations. This was particularly in relation to the refocusing
of the Global Fund HIV Grant with its minimum of 50% grant allocation to Key
Populations. The signing of the sub recipient agreements with three agencies in Guyana,
resulted in the accelerated implementation of interventions targeting key population during
the latter half of 2014. The combined efforts of these agencies, have for the first time
ensured national coverage to all 10 geographic regions of Guyana.
During 2014, MoH/NAPS continued to coordinate the national response targeting the key
affected populations (KAPs) in close collaboration with civil society organizations, NGOs,
technical agencies, PEPFAR and other donors. To effectively reach key populations with
combination prevention, a key prevention package of service was defined in the national
Most at Risk Population (MARPs) guidelines of 2012, and more recently in HIVision2020,
and this package continues to be delivered to KAPs. This package includes: peer education
and outreach; risk reduction counseling and skills building; promotion, demonstration and
distribution of male and female latex condoms and water based lubricants; screening and
treatment for drug and alcohol abuse; voluntary counseling and testing; STI screening and
treatment; HIV care and treatment and; reproductive health services.
During 2014, a curriculum and teaching aids for introducing the new national guidelines and
SOPs for working with KPs were developed and master trainers oriented in the use of this
curriculum. Quarterly feedback meetings were held with peer educators who reach out to
sex workers, MSM, miners and loggers and there were regular feedback meetings among
CSOs that provide services to key populations. In addition, with NGO support, GBV
education and coping strategies are provided to FSWs, MSM, their clients and partners and
the broader community. During the period, a campaign focusing on HIV testing and
condom use among MSM and FSWs, included the development of IEC materials with the
active involvement of this target group to obtain their inputs into the design of these
materials (see section on IEC)
A workshop attended by 22 members of the Lesbian, Gay, Bisexual and Transgender
(LGBT) community was also held to increase LGBT activists’ knowledge in human rights
and advocacy, and to increase their skills in advocating for their rights in monitoring changes
in the environment. With NGO support, an LGBT Mental Health Fact Sheet was drafted
and finalized, and facts sheets on Human Rights, and Sexual Health were drafted and are
being reviewed. The Mental Health Fact Sheet provides basic facts about LGBT persons,
Government of Guyana Global AIDS Response Progress Report, 2015
54
their mental health challenges including double stigma, lack of family support, violence
experienced, and internal homophobia. It further highlights the need for emotional support
in these situations.
During 2014, training for key populations at higher risk included training for MSMs and SWs
(22 from Regions 3 and 4) in Post Exposure Prophylaxis, basics of HIV and positive health
and dignity. A two-day training on the MARPS Guidelines and Standards for Non-
Governmental Organizations was also held for twenty five (25) MSM and SW peer educators
taken from NGOs from 7 Regions. Training was also provided to Monitoring and
Evaluation Officers and Prevention Officers (total of 11 from 10 organizations) in the use of
monitoring and reporting tools used to capture information relating to SWs, MSM, and
Miners and Loggers.
Work continued in sensitising the proprietors of venues (bars, clubs and other places) on
HIV prevention. Venues were equipped with brochure holders and IEC materials and
condoms were made readily available.
In addressing increased access to clinical services (STI screening and treatment, VIA, VCT
and HIV care and treatment), an initiative was introduced in November 2014 and piloted up
to December 2014 at the National Care and Treatment Center (NCTC) whereby the hours
of service provision were extended beyond the regular working hours (total of 50 extra
hours provided). These extended hours specifically targeted key populations through a
referral system established with NGOs, with direct accompaniment of clients to the NCTC
where possible. An evaluation of this pilot indicated that 7 clients visited and accessed STI
screening and treatment. Among these, no one was identified as a member of the key
populations.
A major activity during 2014, was the conclusion and dissemination of the findings of the
Biological and Behavioural Surveillance Survey (BBSS) which focused specifically on key
populations. This was conducted in the effort to obtain data that would guide the design of
interventions targeting these populations. The results of the BBSS were shared with key
stakeholders during the latter half of 2014 and these are currently being fine-tuned for final
dissemination.
Guyana Biological Behavioural Surveillance Survey 2014
Background
During 2014, a Biological Behavioural Surveillance Survey (BBSS) was conducted in Guyana
to better understand the dynamics of HIV transmission and in addition, to gauge the level of
knowledge of HIV and attitudes and behaviours among key populations. MSM, CSWs,
miners, and loggers were specifically targeted. The survey was accomplished through a
collaborative effort involving MoH/NAPS, its donor partners, various other MoH
departments, and with critical support provided by the Guyana Forestry Commission (GFC),
Guyana Geology and Mines Commission (GGMC), and the Guyana Bureau of Statistics
(GBoS).
Government of Guyana Global AIDS Response Progress Report, 2015
55
Methodology and sample selection
The PLACE methodology which was used for the survey involved identifying public places
(such as hotels, bars, and events) where the target groups met new sexual partners and which
were potential intervention venues where individuals most likely to transmit HIV could be
accessed. Venues and events were identified by informants within selected communities,
then mapped accordingly. The survey sample was selected through a combination of random
sampling in addition to the selection of priority locations which were felt to be high risk
areas. The locations (venues) were identified by Community Informants and mapped using
a GPS device. A comprehensive de-duplicated list of venues was developed and verified. At
each venue selected, a knowledgeable person was interviewed followed by interviews of the
patrons and workers regarding their sexual behaviours and exposure to HIV prevention
measures. Respondents were also offered testing for HIV, syphilis, hepatitis B and
haemoglobin. Malaria testing was conducted in the hinterland locations.
During the study, interviews were conducted with 3804 individuals from 153 sites in 9 out of
10 administrative regions. These included: 2,248 males; 1,435 females; 2 trans males and; 119
trans females. In terms of key and other vulnerable populations, the study sampled: 530 sex
workers (both male and female); 545 MSM (including transgender) and; 1417 miners and
loggers
Survey questions focused on: socio-demographic characteristics; mobility and employment
of the target populations; knowledge and use of health services and; sexual partnerships and
condom use. All ethical study procedures were adhered to and confidentiality maintained
throughout the study, including the omission of names or other explicit identifiers in the
questionnaires given the sensitive nature of many of the questions administered.
Findings
HIV prevalence was found to be highest among transgenders with an overall prevalence of
8.4%. Transgenders involved in sex work had an even higher prevalence at 10.4% while
those not involved in sex work were found to have a prevalence of 4.8%. FSWs had the
second highest prevalence at 5.5% followed by MSWs at 5.13%. MSM were next with a
prevalence of 4.9% while loggers had a prevalence of 1.3% and miners had the lowest
prevalence at 1%.
The general findings of the survey were as follows:
Use of health services: Respondents felt that health services were more widely available in
the Coastal Regions and approximately 50% of those in the Coastal Regions knew of
HIV/AIDS treatment services in their area. In comparison, 1 in 10 of the respondents in
the Hinterland Regions reported knowing of the availability of these services within their
regions and less than half felt that the available general health services met their needs.
Study participants were more likely to have visited a public health facility within the past year
compared to any other type of health facility.
Government of Guyana Global AIDS Response Progress Report, 2015
56
HIV knowledge and attitudes: Populations from smaller and more rural villages from
randomly selected areas within the Coastal Regions had a lower knowledge of HIV
prevention measures and had common misconceptions about HIV. Knowledge of condoms
as prevention was high throughout Guyana however, only 3 out of 4 persons knew that
abstinence can prevent HIV transmission. Approximately 1 in 10 persons in the larger
towns and cities experienced stigma and discrimination regularly because of their HIV-
positive status, being LGBT, or being a minority.
Sexual partnerships and behaviour: 30% of men, 20% of women and 50% of transwomen
reported at least one new sexual partner within the four weeks preceding the survey. Vaginal
sex was the most common form of sex with oral and anal sex reported in much smaller
proportions. Approximately 1 in 5 men in the larger towns and cities and HIV priority areas
reported having sex with men within the past year compared with 1% of men within the
Hinterland Regions. Commercial sex (receiving cash or gold for sex) within the past 12
months was reported by 12% of men and 15% of women in the larger towns and cities.
Approximately 1 in 5 men in the Hinterlands paid for sex within the past three months.
HIV prevention: Condom use as prevention was common with nearly half the respondents
having used a condom within the last six months and approximately 1 in 4 reported having
used a condom every time they had sex in the past six months. 33% of the survey sites were
seen by the interviewers to have condoms for distribution and one quarter of the site
informants said that there was HIV testing onsite within the past year. Knowledge of where
to access VCT was 80% in the Coastal Regions compared to 68% in the Hinterlands.
Despite this, similar rates for having ever been tested were found among these populations.
HIV information was widely available to respondents with 95% of Coastal respondents
having received some form of information within the past year compared to 86% in the
Hinterlands.
Sexually transmitted infections: More than 1 in 10 respondents reported at least one
symptom of an STI during the time of the interview. Of those who sought treatment, most
did so within their respective regions however but 2 out of 5 persons in the Hinterlands
sought treatment in another region or country.
HIV prevalence: HIV prevalence was found to be highest in the larger towns/cities (2.4%)
and the HIV priority areas (1.9%). The highest HIV prevalence rates were found among
transgender respondents with rates as high as 30% in the priority areas. Higher prevalence
rates were also found in the larger towns and priority areas among MSWs, FSWs and MSM
in comparison to the randomly-selected sample areas and the Hinterlands.
Limitations of the study
Limitations to the survey included: the reluctance of some members of the key populations
to report behaviours that are seen as stigmatizing or illegal, thus avoiding participation in the
survey; some persons who knew themselves to be HIV positive might have avoided being
interviewed because they did not want to be tested again and; members of the target
populations who did not visit the survey sites would have been missed during the survey.
Government of Guyana Global AIDS Response Progress Report, 2015
57
Men who have sex with men
The results of the 2014 BBSS indicated that HIV prevalence among MSM had decreased
from 21.2% in 2005 to 4.9% in 2014. HIV prevalence among male sex workers was found
to be 5.1% in 2014 and condom use was low when with clients (52.4%). HIV prevalence in
both these groups was still high when compared with that found in the general population.
Other findings of the survey among MSM indicated: approximately 66% knew of the three
methods of prevention; misconceptions existed regarding HIV transmission; 84% did not
feel stigmatized; approximately 33% had an HIV test during the previous 12 months; the
majority of MSM obtained their HIV/AIDS information from the media, friends and
family; approximately 21% were victims of physical violence from their partners or were
raped and; a large proportion acknowledged having a low or no HIV risk perception.
Due to the significant scale up of interventions aimed at MSM during 2014, there was a
382% increase in MSM reached (2,629) with HIV prevention programmes, when compared
with 2013 (see Box 7). With NGO support, interventions focusing on (MSM) during 2014
were mainly through the “Path for Life” initiative which aims to prevent the spread of
HIV/AIDS among MSMs and the rest of the population.
Peer education was used as the primary mechanism
through which MSM were reached and fifteen (15) new
MSM peer educators were trained. In addition to direct
service delivery through community mobilization and
outreach sessions at bars, brothels, night spots and street
corners where MSM congregate., significant efforts were
made at targeting the proprietors of these venues who
were sensitized on HIV, STIs and stigma reduction. These
proprietors also became involved in the distribution of
IEC materials and condoms on behalf of MoH. The main
objectives of these interventions were to advocate for
behavior change and to educate on risky behavior and its
association with HIV and STIs. To complement these
behavior change activities, the local radio series drama
Merundoi, also included educational messages for MSM.
HIV testing for MSM remained a priority for the programme in 2014 with 1,945 MSM being
tested, even though challenges were encountered in getting this population to seek VCT
services.
In the effort to build their capacity to earn, computer training was provided to 6 MSM (and
also SWs). In 2014 the first national forum on Prevention for MSM was hosted with thirty
seven (37) MSM from seven (7) Regions in attendance. Topics included: Update the HIV
Epidemic; the UNAIDS Gap Report; 90-90-90 Targets; Myths about MSM and
Transgenders; Healthy Living; Substance Abuse and; New Strategies for Reaching MSM.
Group discussions on barriers to testing, myths about MSMs and strategies to dispel these
myths were also held. A major outcome of the conference was the consensus to use the
Box 7: MSM
population reached
2009 – 2014
Year MSM
2009 1,375
2010 1,354
2011 763
2012 722
2013 597
2014 2,629
Government of Guyana Global AIDS Response Progress Report, 2015
58
feedback from these discussions to develop a workplan to address the challenges
encountered by MSM.
During 2014, a Mini Consultation with White-Collar MSM was also held with 18 members
of the white-collar community (media personnel, senior public servants, business
professionals, lawyers, etc.) to discuss and document strategies to reach white–collar MSM,
their peers and partners with holistic HIV services. The sample of attendees was selected
based on the considerable influence and social reach that they have within society. During
this consultation, effective strategies for meeting and engaging the rest of this MSM sub-
population were devised.
Female sex workers
The BBSS 2014 showed a sharp decrease in the HIV prevalence among female sex workers
(FSWs), from 26.6 percent in 2005 (BBSS 2005) to 5.5% in 2014, even though this was still
relatively high when compared with the prevalence within the general population. Other
findings of the survey among FSWs revealed: comprehensive knowledge of HIV had
decreased; condom use decreased when with clients; alcohol used decreased; STI reported
symptoms decreased and; engagement in anal sex had increased.
Due to the significant scale up of interventions aimed at FSWs during 2014, there was a
150% increase in FSWs (3,327) reached with HIV prevention programmes, when compared
with 2013 (see Box 8).
During 2014, interventions focused on female sex
workers (FSWs) through the “Keep the Light On”
initiative which aims to prevent the spread of HIV/AIDS
among FSWs and the rest of the population. Peer
education was used as the primary mechanism for
reaching FSWs and activities also included community
mobilization and outreach sessions at bars, brothels,
night spots and street corners where FSWs congregate.
The proprietors of these establishments were also
sensitized with regard to HIV, STIs and stigma reduction
and were engaged in the distribution of IEC materials
and condoms on MoH behalf. The main focus was to
advocate for behavior change and educate on the risky
behavior and its association with HIV and STIs. The
local radio series drama, Merundoi also targeted CSWs in
providing educational messages.
HIV testing for SWs remained a priority for the programme in 2014 with 2,430 FSWs being
tested. The building of capacity to encourage behavior change among Sex Workers also
continued to be a priority in 2014 with skills building activities such as craft production (5
sex workers) and computer training being provided (6 MSM and SWs). In order to sensitive
sex workers about their rights to representation in matters involving the police, court and in
instances of violence, a workshop on Human Rights, HIV and Sex Work was conducted
with nineteen (19) CSWs in attendance.
Box 8: FSW
population reached
2009 – 2014
Year FSW
2009 968
2010 1,192
2011 1,644
2012 909
2013 1,332
2014 3,327
Government of Guyana Global AIDS Response Progress Report, 2015
59
Figure 20: FSWs and MSM Reached with Prevention Programmes During 2009 – 2014
The promotion of correct and consistent condom use remains a key component of the
prevention package designed for the key affected populations at higher risk. During 2014, a
total of 697,905 male condoms, 22,266 female condoms and 76,294 lubricant packets were
distributed among these populations.
Figure 21: Regional Distribution of Condoms/Lubricants Among Key Populations
Table 16 below presents a list of the organizations that provided services to key affected
populations during 2014.
Government of Guyana Global AIDS Response Progress Report, 2015
60
Table 16: Organizations that Provided Services to Key Affected Populations during 2014
Organization Regions Target Populations
Cicatelli Associates Incorporated 2,3,4,5,6,10 FSWs, MSM
International Organization for Migration 1,7,8,9 Miners & Loggers
Guyana Business Coalition 3,4,6,10 FSWs, MSM, Miners & Loggers
Youth Challenge Guyana 1,7,8,9 FSWs, Miners & Loggers
G+ Network 3,4 PLHIV, FSWs, MSM
Artistes in Direct Support 3,4 FSWs, MSM, Transgenders
Hope For All 1,2 FSWs, MSM, Miners & Loggers
SASOD 4,6 MSM
Guyana Sex Work Coalition 3,4,6,10 SWs
Guyana Trans United 3,4 Transgenders, MSM
Hope Foundation 7 FSWs, MSM, Miners & Loggers
FACT Upper 6 FSWs, MSM
United Bricklayers 5, Lower 6 FSWs, MSM
Linden Care Foundation 10 FSWs, MSM, Miners & Loggers
Merundoi 3,4,5 General Population
Interventions among the transgender groups
During the 2014 BBSS, HIV prevalence among the transgender population was found to be
8.4%. Other findings revealed that: 35.9% had a low perception of HIV infection; the
average age of sexual debut was 15 years; 23.3% were not stigmatized; 3.7% use illicit drugs;
76.8% solicit commercial partners and; 41.2% were tested within the previous 12 months.
HIVision 2020 recognises the transgender groups as a key population and identifies them for
strategic intervention. The Trans Guyana United group formed during the previous
reporting period, continued to conduct HIV sensitization and prevention activities during
2014. During the reporting period, 4 transgendered persons were reached with the
prevention package of services including peer education, risk reduction counseling,
promotion, demonstration and distribution of condoms and water-based lubricants.
United Bricklayers Reaches Key Populations through Peer Networks and Social
Media
Reaching MSM, transgenders and sex workers with HIV prevention education and early care
is difficult because of the high levels of stigma and discrimination they experience. Fear of
moral judgements and abuse make them reluctant to seek help when the price of help is
disclosure of sexual behaviours that the society considers immoral and illegal. There is
however, a growing body of evidence that suggests that outreach through social media is a
promising strategy for reaching key populations, particularly when it is rooted in peer
networks. This type of approach can offer anonymity (which engenders truthfulness/trust);
endorsement of key populations-friendly services and; user-led two-way communication.
United Bricklayers (UBL), an NGO actively involved in HIV prevention among MSM,
transgenders and CSWs in Regions 5 and 6 Guyana, ventured into the use of social media as
one of its approaches for reaching transgenders and MSM in January 2014. In initiating this
venture, UBL NGO worked with an already established social network of transgenders and
Government of Guyana Global AIDS Response Progress Report, 2015
61
MSM via Facebook to host weekly two-hour chats which integrate HIV prevention
information into the discussions of everyday topics important to MSM and transgenders.
Through the use of social media, UBL has been able to provide greater assurance of privacy
to MSM and transgenders and to respond to the broad health concerns of these groups –
beyond their individual sexual risk behaviour. Topics discussed include gender enhancing
hormones, sources of lubricants, VCT, relationships, and suicide. Opinion leaders inform
peer groups on how to stay HIV-free and where to find services that are LGBT-friendly.
A small, even though early measure of success for UBL, is that the group chat receives
repeat visitors who in turn refer others to join (eleven such referrals made at the time of
writing). UBL also invited chat members to join their support group which 3 of the 10 chat
members have since done while 2 others have indicated their intention to join. UBL’s
venture with the social media is still relatively new, however these preliminary results with
the 10 chat members are encouraging. Their experience suggests that online platforms can
be promising avenues for engaging key populations in learning more about HIV prevention,
care and treatment.
Interventions Targeting Miners and Loggers
The 2014 BBSS revealed an HIV
prevalence among miners of 1%.
Whilst the methodology of this
survey is not comparable, this
BBSS is seen as a more
representative survey than the
HIV Seroprevalence survey
conducted among miners in 2004
which revealed an HIV prevalence
of 6.5%
Loggers showed a prevalence of
1.3% (BBSS 2014). Other
findings during the survey among
miners and loggers revealed:
secondary education was high among this group; miners showed greater knowledge of HIV
than loggers; miners consumed alcohol more frequently than loggers; circumcision was
practiced by both miners and loggers; marijuana use was higher among miners than loggers;
health facilities, family members and the media were the main sources of HIV information
for miners and loggers.
During 2014, services to miners and loggers continued to be provided by health care
facilities and the CSOs primarily through outreaches in the hinterland regions where mining
and logging activities dominate. The Ministry of Health through its Global Fund HIV Grant
signed a sub recipient agreement with the International Organisation for Migration to work
with miners and loggers in regions 1,7,8 and 9. During 2014 a total of 1,895 miners and
Government of Guyana Global AIDS Response Progress Report, 2015
62
loggers were reached with HIV prevention programmes while a total of 3,129 miners and
loggers were tested for HIV.
Training for miners and loggers was conducted in mining camps in 4 Regions through
outreaches and miners and loggers also attended a two-day workshop covering a broad range
of topics including: HIV and STI Education; Stigma and Discrimination and; Risk
Reduction.
Project to Improve Access to HIV Services for Mobile and Migrant Populations
During 2014, the Government of Guyana with support from PANCAP/GIZ continued
implementing a Migrant Population Project to enhance the accessibility and the quality of
HIV prevention, care and treatment services for migrant and mobile populations. This
project was being implemented in 7 pilot countries within the Caribbean, including Guyana.
The Migrant Population Project consists of four components: policy guidelines & legal
framework; health financing mechanism; empowerment of organizations supporting
migrants and; improvement & adaptation of HIV services to targeted populations. The
broad-based Technical Working Group (TWG) established for this project continued to
meet during 2014. The TWG comprised focal persons from: NAPS; Ministry of Amerindian
Affairs; National Malaria Programme; National Tuberculosis Programme; Ministry of
Health; PAHO-WHO; Guyana Bureau of Statistics; Guyana Geology & Mines Commission;
Guyana Forestry Commission; and Institute of Migration; Guyana Red Cross; and Youth
Challenge Guyana.
Among the activities identified for the Migrant project were: enhancement of the policy and
legal framework constituting the access rights of mobile and migrant populations with regard
to HIV & AIDS services at the national level and; identifying and piloting effective financing
mechanisms/models to secure the access of mobile and migrant populations to HIV.
During 2013, an assessment of “The Legal and Policy Framework Influencing Access to
HIV Services by Migrants in Guyana” was conducted. In addressing sustainability of the
HIV response with specific focus on access to services to the migrants and mobile
populations, Innovative Health Financing Mechanisms were explored and options
recommended. These two reviews are currently under consideration by the Ministry of
Health.
As part of the Empowerment of Organizations Supporting Migrants, a training of trainers
manual on “Stigma, Discrimination, Cultural Sensitivity and Human Rights Related to Health and
Migration” was developed in 2013 and finalized in 2014 for the pilot countries under this
project. Validation training using this manual was conducted in Guyana during January 2014
with trainers from these countries. Participants included immigration officers, the Police,
health care workers and personnel from NGOs that interact with migrants. Subsequent to
this validation training, with the use of the manual, four (4) sensitization training workshops
(60 persons trained) and one training of trainers workshop (14 persons trained) were
conducted in Guyana through a collaborative effort with the funding partner, NAPS and an
NGO.
With regard to Improving and Adapting HIV Services to Targeted Populations, the Bartica
Hospital, representing a gateway to the mining and logging communities, was selected in
Government of Guyana Global AIDS Response Progress Report, 2015
63
2014 as a pilot site. In July 2014 a baseline survey was conducted to assess the accessibility
to health services (including HIV services) for these populations. An action plan was then
developed based on recommendations made by members of mobile/migrant population and
the hospital staff. The focus of the action plan was to address the needs of both the hospital
staff and patients in the attempt to provide migrant-friendly services – in particular to the
relatively large proportion of Brazilians who comprise the migrant population. As part of
the action plan, training was conducted for the hospital staff in Customer Service Excellence
(32 persons trained), Basic Portuguese (34 persons trained), and HIV-related topics (34
persons trained). Wallcharts targeting patients were also developed in English and
Portuguese for posting up in the hospital waiting areas.
Under this project, the BBSS 2014 was also supported for miners and loggers (see findings in
section above).
Interventions Targeting Prisoners
HIVision 2020, National HIV Strategic Plan (2013 – 2020), identifies prisoners among the
key populations at higher risk and aims to provide strengthened HIV prevention, care and
treatment services for this population in the effort to ensure equitable access to health
services. HIV prevalence among prisoners was found to be 5.2% during a survey conducted
in 2004.
During 2013, a permanent VCT site was established within the Camp Street Prison, the
largest prison in the country. VCT was provided to 502 inmates of this prison through a
VCT visiting team. In addition, a team comprising a physician, social worker and a
multipurpose technician/phlebotomist made monthly visits to this prison to provide
treatment, care and support for HIV positive inmates. Inmates from two other prisons
outside of the city were also brought to this prison for treatment. Through this system, 33
prisoners were provided with HIV care and treatment. Prisoners from other parts of the
country were escorted to the treatment sites nearest to their prison to obtain treatment.
As part of the package of services provided to prisoners, TB and TB/HIV co-infected
patients are routinely monitored by the TB/DOTS prison supervisor who oversees all TB
control activities in correctional facilities country-wide. Inmates are screened for TB upon
entry into prison and screening is also conducted periodically. During 2014, three TB
Collaborative Meetings for Prisons were held with key stakeholders from MoH and
representatives from the correctional facilities.
During 2014, 51% of 2,023 prisoners were screened for TB and 12 were diagnosed with TB
disease. Of these 3 (25%) were found to be co-infected with HIV. Figure 22 shows
TB/HIV co-infection among prisoners.
Government of Guyana Global AIDS Response Progress Report, 2015
64
Figure 22: TB/HIV Co-Infection Rate in Prison During the Period 2007 – 2014
Prevention Among Youth
HIV prevention among youth remains a priority as whilst knowledge on HIV is reported as
high, behavior change remains a challenge. The two rounds of BSS conducted among the
in-school youth demonstrated that knowledge of HIV was reported at over 95% (BBSS
2005, BBSS 2009) among youth. Further findings however indicated that this knowledge
does not necessarily translate into behaviour modification as evidenced by the decrease in
age of sexual debut from 15 to 14 (BBSS 2005, BBSS 2009).
Data from the National Care and Treatment Center (NCTC) in Region 4, which is the main
sentinel site for monitoring STIs, showed the highest occurrence (42%) of STIs during 2014
to be among the 15-24 years age group. This data further supports the importance of
maintaining the focus on the youth population. With this evidence, the national HIV
programme, including the MoH Adolescent Health Unit, in collaboration with MoE and
other stakeholders continued to target the youth population.
A draft Sexual and Reproductive Health Policy and Strategy developed during the reporting
period and which is currently being finalized, provide overall guidance for the provision of a
basic package of SRH services to youth among other age groups. These services include:
adolescent sexual and reproductive health; family planning; pregnancy-related services; HIV
prevention and diagnosis and treatment of STIs; prevention and early diagnosis of breast and
cervical cancers; and care for survivors of gender-based violence. The strategy also
addresses the integration of HIV prevention, management and care into SRH services.
During 2014, the Adolescent Health Unit of MoH continued to engage adolescents in
activities to educate them on sexual and reproductive health, healthy lifestyles and in
increasing access to essential services through the promotion and implementation of
adolescent friendly services.
As part of the Youth Friendly Services Initiative, the 6 pilot health centres previously
established along with 1 District Hospital provided adolescent-friendly antenatal services to
151 pregnant adolescents. In addition to the routine antenatal services, these adolescents
were educated on: the psychological changes of pregnancy; nutrition; labour; care of the
Government of Guyana Global AIDS Response Progress Report, 2015
65
newborn; family planning; self and personal development; reintegration into school and
gender-based violence.
In focusing on Health, Literacy, Attitude and Behaviour, the Adolescent Unit during 2014:
provided sports equipment to 3 dormitory schools within the hinterland with the aim of
encouraging sports as a form of healthy living as part of the initiative introduced during
2013; participated actively along with a wide cross-section of stakeholders in Water and
Sanitation and Hygiene (WASH) the review of the Health and Family Life Curriculum
implemented in schools, to introduce changes in the content and teaching methods
employed; collaborated with the Ministry of Education in training teachers in Region 4 to
address Drug Use Among the in-School Population and; provided active support to the 18
School Health Clubs established in Regions 3,4 and 10 in addition to training 24 teachers
from these Regions.
During 2014, in the effort to educate parents, teachers and other stakeholders on how to
respond to the health needs of adolescents, training activities included: focus group
discussions with teachers in 4 hinterland areas to discuss the topic of teenage pregnancy; 4
trainings in Adolescent Health in Region 1 and one training in Region 9 with the
participation of Community Support Officers, Teachers and School Welfare Officers and;
training of 68 health care professionals and 32 peer educators from Regions 4 ,5, 6 and 10 in
Adolescent Sexual and Reproductive Health.
The Ministry of Education’s Health and Family Life education (HFLE) programme that was
piloted during the 2010-2011 reporting period, continued during 2014 with its
implementation in all secondary schools across the country. The programme was
implemented as a time-tabled subject focusing on life skills education including topics such
as: decision-making; self-esteem; disease prevention (include HIV); sexual and reproductive
health; anger management; peer pressure; substance abuse and; teenage pregnancy. An
extensive review of the HFLE programme was undertaken in 2014 by a wide cross-section
of stakeholders to examine the progress achieved by the programme and to plan the way
forward.
In support of the HFLE module on sexual and reproductive health, the YES programme
(Youth Educators Safe-Guarding our Work Force) also continued during 2014. The goal of
this programme is to reduce the vulnerability of in-school youth to HIV; to reduce the
number of new infections among in-school youths and; to build the capacity of out-of-
school youth to reduce risky sexual behaviours. These sessions were conducted weekly by
young adults in schools in Regions 3, 4, 6 and Georgetown, targeting 1,168 students in
providing HIV/AIDS education.
The Ministry of Education continued to train and sensitize head teachers, teachers and
sector management staff on issues related to HIV&AIDS. HFLE teacher training was
conducted for 37 primary school HFLE teachers from across the regions and 310 pre-
service teachers. Teaching materials were provided during these training sessions. In
addition, 2146 pieces of HIV resource materials were made available to teachers within the
MoE system to be used in classroom discussions and for parent-child HIV education.
Government of Guyana Global AIDS Response Progress Report, 2015
66
The Guyana Responsible Parenthood Association (GRPA) whose focus is on providing
sexual and reproductive health services, during 2014 provided family planning services for
1190 persons of child-bearing age, performed STI screening for 692 persons and provided
STI counseling for 801 persons.
During 2014, three Capacity Building Workshops were held in the areas of Sexual &
Reproductive Health, Gender Based /Sexual Violence and Advocacy Skills and Techniques
to enable youth organisations to integrate SRH and GBV/Sexual Violence into their
programmes. In addition, 28 persons between the ages of 15 – 24 participated in a Youth
Advocacy Workshop on family planning, contraceptive modalities and the need for
Comprehensive Sexuality Education. Twenty eight representatives from Faith Based
Organizations were also engaged in a discussion on the importance of family planning and
their role in promoting this within their communities. Through collaboration with partner
agencies and NGOs, the national programme, reached approximately 3,000 persons within
the 15-49 age group in 14 communities in Regions 2,3,4,5 and 6, with family planning
information and services. Of these, approximately 1,500 were persons among the 14-35 age
group. Twenty Community Facilitators and sixty nine health care workers from the targeted
communities benefited from Capacity Building training to deliver the family planning
information and SRH services.
Prevention of Gender Based Violence
Within recent years, the Government of Guyana has intensified its response against gender
based violence. A National Domestic Violence Oversight/Policy Committee, established by
the Ministry of Labor, Human Services and Social Security oversees the effective
implementation of the Domestic Violence Policy (2008-2013). The Committee also provides
guidance to regional and local domestic violence committees to monitor and evaluate their
work. The Committee comprises senior officials of various Government Ministries
(Ministries of Health, Education, Human Services and Social Security) and agencies, civil
society and non-government organizations (Help and Shelter, Red Thread) who are involved
in programmes aimed at reducing domestic violence, magistrates, the Guyana Police Force,
and individuals with appropriate skills and experience.
The public awareness campaign launched by the government during the previous reporting
period to facilitate implementation of the Domestic Violence Legislation and the Sexual
Offences Legislation, continued during the current reporting period. To support the
government’s efforts against gender based violence, the Women’s Affairs Bureau that forms
part of the MoLHS&SS structure, continued during the reporting period to engage in public
awareness efforts against gender based violence and also continued to provide support to the
victims and survivors of gender based violence. To facilitate this latter process, the free
emergency 24 hrs hotlines continued to be publicized.
The Men’s Affairs Bureau that also forms part of the MoLHS&SS structure, continued
during the reporting period to address violence against women, with the involvement of men
as part of the holistic response. As part of its public education and outreach programme, the
Bureau held a number of sensitization workshops across the country, which focused on
helping young men understand issues relating to their own gender, such as anger
Government of Guyana Global AIDS Response Progress Report, 2015
67
management and self esteem. The workshops also focused on understanding the emotional
needs of spouses and the issue of gender equality.
During 2014, MoH continued to support the victims of gender based violence through its
programme which focused on primary prevention (promoting awareness at health facilities,
schools and within communities), secondary prevention (early identification of GBV) and
referral to social, economic and legal support services. During the reporting period, 140
Nursing students were trained in the new Sexual and Domestic Violence Protocol for health
care providers. Life skills training using the HFLE training modules on violence prevention,
was also provided to 228 students during football competitions and 31 students through
essay writing and a poetry competitions. GBV sensitization sessions were held with 99
fathers using the tools developed by the Ministry of Human Services for addressing GBV.
In addition, 4 Public Service Announcements in the form of television advertisements, were
developed and aired.
During the period under review, a number of non governmental entities also provided a
range of programmes and services to women and children who were the victims of domestic
violence. These included legal assistance through the Guyana Legal Aid Clinic and
counseling and temporary refuge through other entities. The Guyana Responsible
Parenthood Association, one such entity, provided gender based violence screening and
counseling for approximately 3,500 persons during 2014. Help & Shelter, another entity,
as part of its project on the Promotion of Human Rights of Victims of Domestic & Sexual
Violence and Child Abuse, provided victims with temporary shelter, face-to-face and hotline
counselling services, free court support services, and referral services. Help and Shelter’s
mission is to work towards the elimination of violence in all its forms. During 2014, Help
and Shelter provided services to 8000 persons – mostly women who were in abusive
relationships. The organisation also ensures that the public is adequately educated and
sensitised on the issues of abuse and domestic violence.
Other key Initiatives Implemented Under the National Prevention
Programme
Workplace Programme
A major breakthrough with regard to workplace policy was the tabling in Parliament in
January 2014 of the HIV and AIDS Regulations, made under the Occupational Safety and
Health Act 1997. These Regulations seek to enforce the National Workplace HIV and
AIDS Policy and includes the right of PLHIV to secure employment and be provided with
the same health and other benefits accorded to other employees.
The thrust of the workplace programme within recent years has been to propel enterprises
towards sustaining their own programmes through the implementation of comprehensive
health and wellness programmes which include addressing issues such as HIV, promotion of
human rights and social security, and gender based-violence including male norms and
behaviors.
A wide range of public and private sector organizations continue to benefit from workplace
education programmes implemented by the Ministry of Labor. This Ministry continued to
Government of Guyana Global AIDS Response Progress Report, 2015
68
be proactive at its weekly Training and Educational Awareness programmes for Employers,
Trade Unions and Informal sectors in heightening and sensitizing key stakeholders on
HIV/AIDS in the workplace. A total of thirty (30) sessions were held at the Ministry of
Labour and other locations with the participation of over three hundred persons. These
sessions allowed for discussions on negative behaviour, behavior change, and the knowledge
and skills required to address these. Training on HIV/AIDS was also tailored to assist
persons in understanding the dynamics involved in implementing an HIV in the workplace
programme.
The Guyana Business Coalition on HIV and AIDS (GBCHA) which has a membership of
over 47 companies, continued to be a key agency in supporting the HIV workplace
programme in keeping with Guyana’s National HIV Policy. Prevention programmes were
planned and implemented by both the Secretariat staff and peer educators within companies
to highlight issues related to HIV and gender based violence. These activities included
awareness sessions, trainings for peer educators, peer educator support group meetings,
health fairs, HIV testing and counselling, and the distribution of condoms and HIV
information brochures distribution. GBCHA also partnered with Help & Shelter and the
Ministry of Human Services & Social Security to raise awareness among workplaces on
violence. During 2014, the Coalition made significant strides in responding to general health
and wellness workplace programmes for member organizations and partnership with the
Ministry of Health is being expanded to increase understanding on the issues of diabetes,
heart disease and other diseases affecting Guyanese.
The Supermarket Initiative that was launched in 2010 to aggressively promote awareness of
HIV and AIDS and general health and wellness, continued during the reporting period with
the collaboration of 19 participating supermarkets. The participating supermarkets were
required to identify and assign an employee as a popular opinion leader/focal point
responsible for training staff and reinforcing health prevention information, HIV and
general health sensitization sessions for employees of the supermarkets. As part of this
initiative, condoms and IEC health materials are also provided for free distribution to the
public. Staff of the supermarkets also wear T-shirts with HIV messages as a strategy to
create greater HIV awareness among customers. During 2014, an awareness session on
Modes of HIV Transmission and Stigma and Discrimination was conducted for the popular
opinion leaders of three of the participating supermarkets.
Reducing Stigma and Discrimination
Like many other countries, stigma related to HIV continues to affect the National
Programme in reaching persons who most need prevention, treatment, care and support
services. Stigma and discrimination have been identified as significant factors that impede
the prevention of the spread of HIV particularly among the LGBT population. In light of
this, Guyana has worked assiduously in combating stigma and discrimination using a
multipronged approach. The high level of political support to the HIV programme and the
proactiveness and involvement of leaders in making statements on HIV stigma and
discrimination and on accessing services for HIV have been ongoing as was evidenced
during the previous tabling in Parliament of the HIV and AIDS Regulations that sought to
enforce the National Workplace HIV and AIDS Policy.
Government of Guyana Global AIDS Response Progress Report, 2015
69
Despite the strides made, Stigma and Discrimination remain a key challenge in Guyana,
especially among key populations. The national programme continues to address this issue
in a comprehensive manner with all stakeholders to ensure that there is unhindered access to
prevention, care, treatment and support services. Over the years, mass media efforts appear
to have had some impact in reducing stigma and discrimination within society as evidenced
by the overwhelming response to the National Day of Testing and Couples Testing activity
whereby couples and individuals from across the Guyana openly participate without fear of
stigmatization or discrimination. There are ongoing efforts within the health sector to
incorporate stigma and discrimination modules in all pre-service training curricula for health
care personnel. In addition, health care staff who work with some of the most at risk
populations, specifically MSM and FSWs continue to be trained in stigma and
discrimination. During 2014, a number of members of the Guyana Defence Force were
trained as trainers to address stigma and discrimination.
During 2014, the findings from a rapid assessment on HIV stigma, discrimination and
GBV against PLHIV, MSM, FSWs and women in general were shared with a wide
cross-section of stakeholders. Resulting from this forum, a number of recommendations
were offered for reducing stigma, discrimination and GBV under two thematic areas —
New Structural Directions and New Programmatic Directions.
During 2014 forty seven (47) health care workers of different categories from Regions 2 and
3 received training in stigma and discrimination which focused on: positive health and
dignity; understanding stigma and discrimination; real life experiences; attitudes to MSMs
and Sex Workers; personal values and behavior toward PLHIVs and; the needs of health
care workers. In addition to this training, a one-day activity on Stigma and Discrimination
and its effects on marginalized populations seeking health care, was also held for health care
workers of different categories at the Regional Hospital in Region 3.
During 2014, Stigma and Discrimination Awareness sessions were conducted with health
care workers and CSWs at three hospitals in the hinterland area of Region 1. These were
done in collaboration with a donor and NGO partner and the main objective was to support
the institutional strengthening of primary health care providers to improve access to services
in underserved communities, including among adolescents and marginalized groups. The
participants for these sessions were staff of different categories of these hospitals. Topics
included HIV/AIDS related Stigma, Discrimination and Confidentiality. Upon conclusion
of these sessions, each hospital was presented two plaques: “Stigma and Discrimination
Policy” and; “Code of Ethics”. A suggestion box was also presented to each hospital.
During each of these hinterland trips, outreaches were also conducted within the
surrounding communities and interactions were held with CSWs, miners, shopkeepers,
youths, and the Police to provide education on HIV/AIDS and to offer VCT.
Government of Guyana Global AIDS Response Progress Report, 2015
70
Wall Plaques and suggestion box being presented to Doctor in Charge of the Matthew’s Ridge
Hospital, Region 1
An interactive session involving role play and focusing on Stigma and Discrimination, was
also held for members of key populations groups. At both of these sessions, persons
recounted their personal experiences with stigma and discrimination.
Justice for All Programme
In response to the compelling epidemiological evidence that key populations continue to be
vulnerable to HIV, PANCAP in collaboration with UNAIDS, mounted a programme of
activities, which is continuing, under the theme, Justice for All (JFA). The aim of the
programme is to promote activities consistent with the United Nations Universal
Declaration of Human Rights to which all countries are committed. More specifically, it is
intended to achieve one of the goals of the United Nations High Level Meeting Political
Declaration (2011) to eliminate stigma and discrimination against people living with HIV by
2015, and to uphold the human rights and dignity of all. Phase 1 of the programme involved
a series of National Consultations in Grenada, Guyana, Jamaica, St. Kitts and Nevis and
Suriname, and a Caribbean Consultation on Justice for All and Human Rights Agenda
involving Parliamentarians, Faith-based leaders, Youth, Private Sector and Civil Society
Leaders. Outcomes of the Caribbean Consultation was a PANCAP Justice for All Roadmap
2014-2018 and a PANCAP Declaration: Getting to Zero Discrimination through Justice for
All.
During 2014, CARICOM Heads of Government reviewed the PANCAP Declaration of
“Getting to Zero Discrimination Through Justice For All” and agreed to defer full
consideration pending consultations at the national level. At the 2014 Special Council for
Human and Social Development (COHSOD), PANCAP provided an update on the Justice
for All initiative which also highlighted important considerations for continuing discussions,
especially in light of the upcoming transition from the MDGs to the SDGs. It was agreed
that PANCAP should continue the consultations on the JFA proposals at the national and
regional levels to clarify issues, especially those related to eliminating discriminatory laws. It
was also agreed that the JFA discussions should take into consideration the developments
arising out of the 20th International AID Conference, in particular the UNAIDS 90-90-90
goals and that the elements of the JFA Declaration be revised accordingly. In keeping with
this decision, PANCAP will begin a second wave of national consultations in Belize and
Trinidad and Tobago in January 2015.
Government of Guyana Global AIDS Response Progress Report, 2015
71
While retaining its original elements, the JFA initiative now focuses on: What will it take to
end AIDS by 2030?; what role can stakeholders – parliamentarians, faith leaders, civil
society, private sector, youth and media – play to achieve the goal of ending the AIDS
epidemic? and; What would a road map look like with immediate, medium and long term
actions to end AIDS?; Five major elements of a proposed JFA roadmap are now included:
1. paying attention to family life and those in need; 2. accelerating affordable treatment as an
important ingredient of 90-90-90; 3. eliminating gender inequality including violence against
women and girls; 4. promoting sexual and reproductive health and rights. Including
education at all levels; and 5. addressing legislative and other reforms to eliminate AIDS
related stigma and discrimination.
Guyana National Faith Coalition on HIV and AIDS (GFCHA) comprising representatives
from 5 different religions in Guyana, has as its mandate to address issues relating to the
family as a unit, including issues related to faith and HIV. As such, disclosure and sharing is
facilitated at the family level. included components on HIV prevention and reduction of
stigma and discrimination.
TREATMENT AND CARE
Guyana’s National HIV Treatment programme commenced with the first HIV case
diagnosed in 1987 being offered care and support services. The treatment programme
expanded over the years to include management with antiretroviral therapy and enhanced
capacity for the diagnosis of opportunistic infections and for laboratory monitoring of
patients.
The National Care and Treatment Reference Group as well as a Special Tuberculosis and
HIV Sub Group provide oversight to the implementation of the care and treatment
programme.
The HIV Treatment and Care Programme
During 2014, HIV treatment and care continued to be provided at 22 treatment sites across
the 10 Regions of Guyana. Efforts also continued to integrate the HIV treatment
programme within the general health services.
As at end of December 2014, the total number of persons enrolled in the national care and
treatment programme stood at 5,041persons (55.8% females and 44.2% males) compared to
4,896 (51.1% females and 48.9% males) in 2013. Of the persons enrolled, 3.5% (174/5,041)
were children compared to 3.2 % in 2013. Figure 23 below shows the trend in enrollment
by gender during the period 2010 – 2014.
During 2014, there were 605 new enrollments, including 17 children. The National Care and
Treatment Centre (largest treatment site) enrolled 26.3% of these persons, 49.9% were
distributed among 16 other government treatment sites, and the remaining 23.8% were
distributed among the two private hospital treatment sites.
Government of Guyana Global AIDS Response Progress Report, 2015
72
Figure 23: Persons in Care and Treatment Disaggregated by Gender, 2010-2014
Source: NAPS Programme Reports
In 2014, the number of persons receiving antiretroviral therapy was 4,295 (85.2% of HIV
patients) compared to 4,054 (82.8% of HIV patients) in 2013. 174 (4%) of the recipients of
ART in 2014 were children. Of the persons on ART in 2014, 88.4% were on first line
therapy compared to 89.6 % in 2013. There has been a steady increase in the proportion of
patients on second line therapy, rising from 3.6 % (58/1,611) in 2006 to 11.6% (497/4,295)
in 2014, with only a slight drop (8.9%) in 2011. Of the 497 patients receiving second line
therapy in 2014, adults account for 470 while children account for the remaining 27.
Figure 24 below shows the trend in care (non ART) and treatment (ART) for the period
2009 – 2014.
Figure 24: Persons in Care (non ART) and Treatment (ART) for the Period 2009-2014
Source: NAPS Care and Treatment Report 2014
Government of Guyana Global AIDS Response Progress Report, 2015
73
Table 17 below shows the number of persons on ART during the period 2003 (ART
commenced in Guyana from 2002) to 2014.
Table 17: Persons on ART for the Period 2003-2014
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number of
persons on
ART
123 497 1,002 1,611 1,965 2,473 2,832 3,059 3,432 3,717 4,054 4,295
Increase
over
previous
year
NA 374 505 609 354 508 359 227 373 285 337 241
Percentage
(%) increase
over
previous
year
NA 304 101 60.7 21.9 25.8 14.5 8.0 12.2 8.3 9.1 5.9
Number of
persons on
2
nd
line
ARVs
NA NA NA 58 69 169 262 296 305
375
441
497
Source: NAPS Care and Treatment Reports
National Cohort – Survival and Retention on ART
The 2013-2014 national cohort
report revealed 536 persons were
initiated on ART with 81.2%
(435/536) 12 months survivability
and retention on ART. This
represents a slight increase from the
79.7% reported for the 2012-2013
cohort. Of the remaining 18.8%,
mortality accounted for 5%, those
who stopped treatment accounted
for 6% and 7.8% were lost to
follow-up. Box 9 shows the
survivability and retention on ART
by gender and age group for the
national cohorts during the period
2010 – 2014.
With regard to survivability among adults, for the first time it is noted that the 12 months
survivability and retention in care is greater among the male cohort when compared to their
female counterparts. Whilst this is optimistic development, it would be important to monitor
this so as to establish any trends. An examination of the programme attributes this increase
to the intensified focus of the treatment programme on improving treatment outcomes
among the male population, through the increased capacity building of social workers and
other clinical practitioners.
Box 9: Twelve month Survivability among the
National Cohort (%)
Indicators 2009‐
2010
2010‐
2011
2011‐
2012
2012‐
2013
2013‐
2014
Total 80.7 80.4 81.5 79.7 81,2
Adult
Male
77.3 76.9 80.8 78.8 82.8
Adult
Female
83.4 83.8 80.7 81.4 79.1
Children-
Male
90.0 80.0 92.9 66.7 100
Children-
Female
78.6 85.7 94.1 57.1 86.7
Government of Guyana Global AIDS Response Progress Report, 2015
74
There was a marked increase in survivability in both male and female children when
compared with the 2012-2013 cohort. Of the 22 children in the 2013-2014 cohort, there
was 100% survivability and retention on ART among male children, compared with 66.7%
in the previous cohort. Similiarly survivability among female children increased to 86.7% in
the 2013-2014 cohort compared to 57.1% in the previous cohort.
Figure 25: Trends in Outcomes for Patients not Included in the Survivability Measure
Source: NAPS Care and Treatment Report 2014
In fact, treatment interruption (Stop) has more than doubled since the 2009-2010 cohort
with an increase to 6.8% when compared to 2.8% in the 2009-10 cohort. Loss to follow up
(LTFU) has fluctuated over the last five cohorts while the percentage of patients who died
decreased gradually during successive cohorts achieving a low of 5% for the 2013-2014
cohort. In the effort to improve treatment adherence, pre-initiation and adherence
counselling is provided to patients on an ongoing basis by members of the multidisciplinary
care and treatment team at the various treatment sites country-wide. In addition, the team
follows up on defaulters, does contact tracing, and provides psychosocial support, including
referral for support services.
Survivability for 24, 36 and 60 months is reported at 75%, 72.4% and 63% respectively.
A closer examination of the other treatment outcomes indicates that with the exception of
the most recent 12 months cohort (2013-2014), there are less deaths among women
compared to men, see Figure 26 below.
Government of Guyana Global AIDS Response Progress Report, 2015
75
Figure 26: Deaths by Gender and Time Cohorts
On the contrary, all cohorts examined indicate that stopped rates among females are
significantly higher than that among males, see Figure 27 below. The reasons for this have to
be explored and modifcations considered to ensure improves. The possibility that these
stopped rates are associated with women using ARVs for prophylaxis and discontnuing post
pregnancy has to be explored as Option B+ has to be optimised in- country.
Figure 27: Stop Rates by Gender and Time Cohorts
Government of Guyana Global AIDS Response Progress Report, 2015
76
Whilst relatively good treatment outcomes are noted, clinical monitoring indicates that
significant additional work is required to further strengthen the programme. A rapid
assessment indicates that there is a trend in the average CD4 at initiation reporting at about
300 cells at the end of 2012 as seen in figure 28 below.
Figure 28: Average CD4 at Initiation
Based on the HIV treatment guidelines, each HIV positive person should be receiving at
least 2 CD4 tests per year. With a treatment programme accounting for
5041
patients, then
the estimated minimum CD4 testing to be done equals 10,082. In 2014, a total of 8,360 CD4
tests were done, addressing 83% of the needs and presenting a deficit of 17%. Of all
persons receiving a baseline CD4 for 2014, 37.5% (197/526) had CD4 less than 200 cells,
presenting with AIDS.
The national treatment guidelines recommend that each person on treatment receive at least
2 viral load tests per year, thus translating to the need in 2014 for 8,360 tests to be done for
the 4,295 patients on ARVS. In actuality, a total of 3482 tests were done in 2014
representing 41.6 % of the estimated needs and presenting a deficit of 58.4%. Further
analysis indicated that among all persons receiving a viral load test during 2014, there is
70.15% (940/1340) viral suppression of <1000 copies. Further viral suppression is reported
at 78.7% (381/484) for patients after 12 months of ARVs.
Both CD4 and Viral load testing were affected by the high staff attrition from the National
Public Health Reference Laboratory as well as sick-outs and equipment
malfunctioning/nonfunctioning.
During the year, senior personnel from the national programme continued to make
monitoring visits to the various treatment sites in order to provide oversight, obtain
feedback and conduct training. Chart reviews were conducted at 12 treatment sites by senior
HIV clinicians. The results of these reviews were shared with the site staff and
Government of Guyana Global AIDS Response Progress Report, 2015
77
recommendations made for improvement in the delivery of patient care. As part of an
ongoing clinical mentorship program, the national programme continued to mentor
additional physicians and medex from the outlying regions, including the hinterland regions,
to increase the pool of medical personnel providing HIV care and treatment. This
programme comprised both on-site mentoring and attachments at the National Care and
Treatment Centre (largest treatment site) along with formal training in the use of the Patient
Monitoring System, etc. Through this programme, 8 medex and 4 physicians received
training during the year through a 2 weeks attachment at the National Care and Treatment
Center.
During 2014, the clinical management of HIV was further strengthened through a number
of training programmes: Clinical Management of HIV/TB (35 HCWs); Quantimed Training
for Medication Consumption Projections (17 HCWs); Completion of Patient forms
(20 social workers/counselors); profiling the HIV Care Continuum (19 staff); continuum of
care 90-90-90 targets (60 HCWs/civil society members); patient monitoring system (16
social workers/data entry clerks).
Profiling the HIV Continuum of Care in Guyana
Since its first discovered case of HIV in 1987, Guyana has made significant strides in
combatting HIV through its multisectoral response. Based on the UNAIDS 2013 estimation
exercise, Guyana’s adult HIV prevalence is 1.4%. This represents a steady reduction from
the 2.4% prevalence found in 2004. The proportion of deaths attributable to AIDS has also
declined steadily from 9.5% in 2002 to 4.8% in 2012 (preliminary data from MoH Statistics
Unit). An integral part of the national response to HIV is surveillance to obtain more robust
data on the state of the epidemic to accurately inform program planning and decision
making. The National Alliance of State & Territorial AIDS Directors (NASTAD) through
PEPFAR support, provided technical assistance in the use of the HIV Continuum of Care
Framework as a tool to identify existing needs and measure progress towards increased
access to and retention in treatment and care. Through a collaborative effort with
MoH/Surveillance Unit/NAPS, a workshop on “Profiling the HIV Care Continuum” was
designed and implemented in recognition of the need for a more robust method for
demonstrating the movement of patients through the HIV Continuum of Care – from the
entry point of testing to the point of enrollment into care and treatment, and finally to
retention in care and treatment and viral suppression.
Nineteen participants representative of the various government health care units involved in
the collection and use of HIV-related data, attended the workshop. These included the staff
of MoH, NAPS/MoH, the National Blood Transfusion Center and NPHRL. The objectives
of the workshop were to:
1. Foster cross-programmatic understanding of existing HIV data in Guyana.
2. Expand and develop knowledge and skills required for triangulation of existing data.
3. Build the capacity of participants to develop an HIV Continuum of Care so as to better
profile the HIV epidemic in Guyana.
Government of Guyana Global AIDS Response Progress Report, 2015
78
During the workshop, a series of exercises related to data triangulation were conducted,
including a SWOT analysis of the current HIV data triangulation practices. Participants also
brainstormed on the plausibility of linking HIV/AIDS data in Guyana given the numerous
personal unique identifiers (PUIDs) used in the different programs. They also identified
data sources available for key measures of the HIV epidemic and response (e.g. prevalence,
impact, etc.) and developed key definitions required for the construction of the HIV Care
Continuum in Guyana. Emphasis was placed on the need to maintain cross-programmatic
communication and collaboration in drafting the HIV Care Continuum. In developing an
action plan for profiling the HIV Care Continuum, it was proposed that its construction be
piloted at one high-volume site and that the collection of data commence to draft a national
HIV Care Continuum.
Since the conclusion of the workshop, participants have demonstrated ownership in the
execution of the action plan developed. MoH has begun planning for the HIV Care
Continuum pilot as well as the convening of a Technical Working Group (TWG) to discuss
the possibility of moving to a name-based HIV case surveillance system and the
establishment of a uniform PUID across all other HIV programs. With a clear
understanding of the elements of the continuum of care, a 90-90-90 meeting was convened
and a roadmap developed to address the gaps in reaching 90% of persons knowing their
HIV status, 90% linkage into care and 90% viral suppression. An annual follow up meeting
will be conducted to gauge progress against this roadmap.
The initiation of the process for profiling the HIV Continuum of Care has resulted in the
building of capacity to collect, link, triangulate, and use HIV program data across the various
entities involved in the national HIV programme. It will also support a better understanding
of the Continuum of Care in Guyana which will in turn help to drive the public health
response.
Management of TB-HIV Co-infection
During the reporting period, the TB/HIV committee continued to hold meetings and
provide oversight for the TB HIV response as aligned with the WHO 12 Point Policy. This
committee comprises representatives from NAPS, the National Tuberculosis Programme
(NTP), clinicians from HIV and TB programmes, and representatives of technical agencies
such as PAHO and US Centers for Disease Control (CDC) and the NPHRL.
During 2014, efforts continued towards improving the management of TB-HIV co-infected
persons in accordance with the national guidelines. Health care personnel attached to the
NTP continued to be trained in the co-management of TB/HIV infection and outreach staff
were equipped to provide DOT-HAART services, reaching more than 90% of the patients
during the reporting period. As aligned to the guidelines, HIV counseling and testing was
routinely provided to TB patients and TB screening was provided to HIV-infected patients.
During 2014, a total of 449 (91%) of the new TB cases (494) were tested for HIV and 109
(22%) of the new TB cases were found to be HIV positive. 73 (66%) of the TB/HIV cases
were placed on ART and 98 (90%) were placed on Cotrimoxazole.. The TB/HIV co-
infection rate of 22% found during 2014 represents a reduction when compared to 25%
Government of Guyana Global AIDS Response Progress Report, 2015
79
occurring in 2013. Data for the period 2005 – 2014 indicate that the rate of co-infection
fluctuated between 36 % to 22% during that period as shown in Figure 29 below.
Figure 29: HIV/TB Co-infection Among New TB Patients: 2005 – 2014
36
28
35
24 28 26 23
31
25
70 82
80
83
89 91 93
96
92
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010 2011 2012 2013 20
P
e
rc
e
n
ta
g
e
Years
Proportion of new TB cases tested for HIV
HIV Seroprevalence among TB patients
Source: NTP Programme records
Enabler support in the form of hot meals, nutritious drinks and food vouchers (food
voucher provided through the NAPS Food Bank) continued to be provided to TB/HIV
patients during 2014. During the period 4,121 units of nutritious drinks, 160 hot meals and
309 food vouchers were provided to these patients.
The integration of tuberculin skin testing (TST) into the package of services provided at
health care facilities during 2014 was further strengthened with a total of 44 healthcare
workers (Regions 3, 4, 6, 10) being trained in the administration of TST. This also enhanced
the referral process between HIV treatment sites and TB treatment sites. Other training
activities included: the training of 17 physicians in TB/HIV Management and Infection
Control and; TB/HIV Peer Education training provided to 34 representatives of the private
and public sector in Regions 2, 4, and 9.
Additional activities undertaken during the period included: regular outreaches in the prisons
to screen for HIV and TB (see section on prisoners); revision and dissemination of the
DOT/HAART manual; monthly HIV/TB support group meetings for clients; completion
of the protocol for a retrospective study to assess the determinants of high mortality among
TB and TB/HIV patients; and infection control assessments conducted in collaboration
with the MoH Standards and Technical Services Department at 5 facilities providing DOTS
and ART services (Regions 2, 3, 6, and 10).
Monitoring Quality Treatment and Care
The national programme continued to monitor quality care during the reporting period
through a series of quality programmes.
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80
Patient Monitoring System (PMS)
The Patient Monitoring System which was developed in 2007 continues to be implemented
at all treatment sites and this operates as a paper-based system with oversight from the
National Level through a PMS Steering Committee. This Committee meets regularly and
conducts ongoing regular data verification and validation of monthly cross-sectional and
cohort reports and provides mentoring to the site staff through supervisory visits.
With partner support, the development of an electronic medical records and a Health
Management Information System (HMIS) for the HIV programme is being addressed.
Initial discussions surrounded a modular system with the introduction of an Electronic
Medical Record system (EMR) and the addition of subsequent modules. An assessment of
the existing system is slated for the first half of 2015 with the overall objectives of
understanding the current system and providing viable alternatives to this system.
Supportive Supervision
During 2014, supportive supervision for the clinical teams continued with monitoring visits
made to 12 treatment sites. This process was led by experienced HIV clinicians who
conducted mentoring and training through a didactic on-site mechanism whereby patients
were seen jointly, and cases were consulted and discussed. In addition, chart reviews were
conducted, the results shared with the site staff and recommendations made for
improvement in the delivery of patient care.
Client Satisfaction Survey
Since the release of the results of the previous client satisfaction during the last reporting
period which showed a relatively high percentage of satisfaction (93.4%) in the provision of
services to HIV patients attending HIV and TB clinics, another survey was conducted during
the 2014 period. The objectives of the survey were to both determine the patients’
satisfaction with the services provided and also to adopt the actions necessary for quality
improvement in the ongoing effort to provide optimum care to PLHIV. This survey was
conducted at all HIV and TB sites, including private facilities but excluding the hinterland
regions. The results of this survey are currently being compiled and will be disseminated in
the second quarter of 2015.
HIV Drug Resistance Survey
An HIVDR survey conducted at the National Care and Treatment Center, Guyana’s largest
and most representative HIV treatment site concluded its data collection in September 2013.
This survey is guided by a National HIV Drug Resistance Working group with technical
assistance as required from PAHO/WHO. Much of 2014 was expended on attempting to
solve the many problems encountered with the database supporting this survey. As no
solution to the database problems was achieved, an alternative approach was agreed with
PAHO in conducting the data analysis. The report will be completed in 2015.
Laboratory Support
The diagnostic capacity of the treatment and care programme continued to be supported by
the National Public Health Reference Laboratory (NPHRL). The NPHRL provides CD4
testing for the national treatment programme and began providing early infant diagnosis and
viral load testing for the national programme in 2010. During the reporting period, CD4
Government of Guyana Global AIDS Response Progress Report, 2015
81
testing was also provided by 5 other government laboratories located within Regional
hospitals: New Amsterdam (Region in 6); Linden (Region 10); West Demerara (Region 3);
Bartica (Region 7) and; Suddie (Region 2). Additionally TB identification and drug safety
testing is conducted. TB diagnosis received a special boost during 2014 with the
introduction of GeneXpert Technology which enables a much more rapid detection of TB
and drug-resistant TB.
GeneXpert Technology Introduced in Guyana to Enable Rapid Diagnosis of TB
Through the Global Fund Grant to the Ministry of Health, a
Gene Xpert MTB/RIF equipment was procured to support
the TB/HIV programme. This machine enables the rapid
diagnosis of TB which presents a challenge for Guyana
which has an incidence rate of 109 cases per 100,000
populations (WHO 2013). HIV/TB co-infection rates have
also fluctuated between 36% and 22% during 2005 to 2014.
The rapid diagnosis of TB will enable timely management of
co-infected patients in addition to accelerating the implementation of MDR-TB control
measures.
During 2014, through ASM personnel support, four technicians from the National Public
Health Reference Laboratory (NPHRL) in Guyana received comprehensive training in using
the GeneXpert MTB/RIF machine. Training comprised lectures and practicals using the
Global Laboratory Initiative of the StopTB department/WHO GeneXpert training package.
Training included:
Xpert MTB/RIF verification tests
Development of Xpert MTB/RIF testing algorithm
Assessment of competence among the trainees to do the Xpert MTB/RIF assay
In addition, an Xpert awareness stakeholders meeting was held to sensitize the relevant
parties with regard to the introduction of the new technology to rapidly diagnose TB.
This implementation, validation, and training in the GeneXpert technology will have a
positive impact on the future of TB diagnostics in Guyana—the technicians were eager to
apply the new technique and support is strong from both the laboratory network and the
MoH. The introduction of this technology will be further expanded during the coming year
with the provision of 2 additional Gene-Xpert machines.
Home Based Care
The aim of the home-based care programme is to enable PLHIV to receive quality care and
services in their homes, most often provided by family members. During 2014, health care
personnel from treatment Sites and NGOs, continued to work with caregivers to improve
their skills and capacity to provide such care to PLHIV.
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During 2014, twenty (20) sites provided home based care (HBC) services. These included
two private hospitals, seven (7) NGOs, and eleven (11) treatment sites. A total of 716 new
persons were enrolled into the HBC programme in 2014 (325 at government treatment sites
and 391 at NGOs). In comparison, in 2013, 1104 new persons were enrolled into the HBC
programme (425 at government treatment sites and 679 at NGOs). One key factor
attributed to this reduction, is the improved quality of life of persons living with HIV.
HBC services included: nutritional support; shelter and care; protection and legal services;
general health care; HIV prevention; psychosocial support and; education/vocational
training.
In general more clients were enrolled at the NGOs than the treatment sites. The proportion
of females to males was also greater at both the treatment sites and the NGOs as illustrated
in Figure 30 below.
Figure 30: Patient Enrollment at NGOs and Government Treatment Sites 2010 – 2014
Source: NAPS Programme Report
Region 4 had the largest number of persons enrolling for HBC in 2014 (330) followed by
Region 6 with 249. This pattern has generally been maintained over the period 2010 – 2014
as shown in Figure 31 below due to the number of treatment sites and NGOs operating in
these regions.
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83
Figure 31: Patient Enrollment by Regions During 2010-2014
During 3014, 29 caregivers were provided with HBC refresher training aimed at assessing
their knowledge, attitude and practice of basic nursing techniques to meet the needs of the
patient. During the year, HBC nurses held regular meetings to discuss issues pertaining to
their clients’ wellbeing in areas such as clinic appointments, disclosure, attendance to support
group meetings, nutrition, and other social issues.
MITIGATION
Support to Orphans and Vulnerable Children (OVC)
The OVC steering Committee that was reconstituted in 2010 with members representing a
broad range of disciplines required for the OVC program, continued its coordinating
function in 2014. This committee continued to guide both the Ministry of Health’s OVC
response in addition to providing guidance for its constituent member organizations. The
OVC policy continued to guide the national efforts to provide services to OVC.
In the attempt to avoid stigmatization of children infected with HIV, the government’s
Child Care Protection Agency (CCPA) integrates these children into their overall programme
for children requiring care, with due regard paid to their specific medical needs (all children
entering care under the CCPA are required to do a medical). A One Stop Advocacy Centre
for Children’s Rights introduced in 2013 is currently working towards facilitating children
who are the victims of rape, in telling their story only once, without having to rehash their
experiences on multiple occasions to the different authorities. At this One Stop Centre,
victims tell their story in the presence of all of the relevant authorities and follow up action is
taken.
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84
During 2014, a number of non governmental entities also provided a range of programmes
and services to children who were the victims of domestic violence. These included legal
assistance through the Guyana Legal Aid Clinic and counseling and temporary refuge
through other entities. Help & Shelter, one such entity, provided children with temporary
shelter, face-to-face and hotline counselling services, free court support services, and referral
services. During 2014, Help & Shelter commenced a new Child Protection Project aimed at:
drafting inter-agency protocols for child protection; establishing multi-sector community
teams for child protection; building parents’ capacity to provide safe family environments for
children; monitoring of child abuse and; development of community action plans to demand
intervention and protection for children who are the victims of abuse. Through this
programme, 6 sensitization sessions on parenting, early childhood development, child abuse,
were conducted during 2014 within two rural communities for 106 persons, including
parents and teachers.
During 2014, seven NGOs provided care and support services for children infected/affected
by HIV, in Regions 1, 2, 4,5,6,7 and 10. Community-based care to clients, case navigation to
care and support across various service agencies, nutritional supports, adherence and viral
load monitoring and retention in care and treatment programs were integral components of
care and support. In addition, there were also linkages to child protective services, youth-
centred services and other social services through the distribution of comprehensive service
directories. NGOs also offered psychosocial counselling and after-school homework
assistance to OVC and were able to incorporate HIV prevention education into the package
of services being offered to OVC..
During the reporting period, a Children’s Day march to commemorate the 25th anniversary
of the UN Child Rights Commission, saw hundreds of children marching through the streets
of Georgetown to raise awareness of the importance of prevention child abuse, empowering
children and ensuring their safety and care. The march concluded with celebrations and a
public panel discussion in which children, their families, child protection officials and
community members talked about why child rights, care and protection matter to them.
Psychosocial Support to Persons Living with HIV
Several initiatives continued during the current reporting period and these included Public
Assistance through the Ministry of Labour, Human Services and Social Security
(MoLHS&SS), psychosocial support through support groups at HIV treatment sites, and
nutritional support through the Food Bank.
Public Assistance
During 2014, PLHIV who were eligible, along with their family members were provided
with public assistance through the (MoLHS&SS). Eligibility was determined by both a
means test and the CD4 level of PLHIV which was used as a measure of their physical
capacity to earn an adequate living. After receiving public assistance for a period of six
months, each PLHIV’s situation was evaluated to determine the need for continued
assistance and support provided as appropriate.
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85
PLHIV Support Groups
During the period, the HIV/AIDS support group programme which commenced in 2004,
continued at 14 HIV treatment sites country-wide and 6 NGO sites. The aim of the
programme is to provide support services to PLHIV and their affected families in the effort
to improve quality of life and reduce morbidity and mortality.
The 20 support groups (including NGO support groups) reported on during 2014 had a
total membership of 538 (30% males, 70% females). Of special note was that the adolescent
support group membership at the largest treatment site increased by 36% (from 22 to 30).
Figure 32 below shows overall support group membership over the period 2010 – 2014.
Figure 32: Membership of the Support Groups – 2010 – 2014
Source: NAPS Programme Reports
The support groups continued to provide a forum for PLHIV to meet monthly to discuss
health issues, common challenges and personal experiences. During meetings, topical issues
were also discussed. These included: adherence; nutrition; positive health; mental health;
stigma and discrimination; domestic violence; disclosure; condom use; STIs; prevention with
positives; substance abuse and: personal hygiene.
The groups were also engaged in recreational activities, skills building and income generation
activities. With some assistance provided through the national programme, the capacity of
the support group members was strengthened in the effort to empower them to achieve
sustainability within their own lives. Training was provided to group members in the areas
of craft production, and with NGO support in hydroponics and ‘kitchen gardening’. With
the skills gained, a number of PLHIV were able to embark on income generation activities.
In addition, a support group that was previously provided with grass-cutting machinery to
facilitate its venture into the provision of sanitation services, continued to generate
employment for a number of its group members. Assistance was also provided in finding
employment for group members within various business establishments. Other income
generation activities embarked upon by support groups included take-out lunches, cake sales,
etc. In-house efforts among group members to support one another included the
contribution toward food baskets for members and penny banking to raise seed money for
small-scale business activities.
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86
As of 2014, in the effort to promote sustainability and build leadership skills, the leadership
of each group was transitioned to the President of the group, with guidance provided by
NAPS personnel through oversight and feedback meetings. Leadership by a peer was also
instituted in the attempt to attract more group members whose comfort level appeared to
increase with such leadership. In the ongoing move towards sustainability, refreshments for
support group meetings were also provided by group members instead of the national
programme.
Nutritional Support for Persons Living with HIV/AIDS
The MoH/NAPS Food Bank was established in September 2006 with the aim of providing
nutritional support to PLHIV in order to have improved treatment outcomes and thus
improve the quality of life of PLHIV. The Food Bank continued to provide nutritional
support for HIV and HIV/TB co-infected patients during 2014, with 937 patients receiving
a total of 3,689 hampers compared to 1,202 patients who received 3524 hampers in 2013.
While the number of patients receiving hampers decreased in 2014, the average number of
hampers received per patient increased to 4 (3,689/937) compared to 3 (3,524/1,202) per
patient in 2013. The reduction in number of patients was partially due to strict adherence to
the eligibility criteria which was revised within the past year to allow for preference to be
given to PLHIV whose economic, social and medical circumstances were comparatively
more severe than others. A patient’s eligibility for nutritional support is also reviewed every
six months and a decision made as to whether to continue providing support
The years 2007-2014 showed a steady increase in patients that accessed the Food Bank, with
fluctuations during the period 2011 – 2014. A total of 937 patients (HIV and HIV/TB co-
infected) benefitted from 3689 food hampers from the Food Bank during the year 2014. The
trend in distribution between 2007 and 2014 is illustrated in Figure 33. This shows that a
total of 28,474 food hampers were distributed to eligible HIV/TB co-infected patients,
during the period 2007 – 2014.
Government of Guyana Global AIDS Response Progress Report, 2015
87
Figure 33: Hamper Distribution: 2007 – 2014
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2007 2008 2009 2010 2011 2012 2013 2014
HAMPERS 952 2060 3984 4725 4540 5000 3524 3689
N
U
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O
F
H
A
M
P
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HAMPER DISTRIBUTION BY YEAR: 2007 ‐ 2014
During 2014, while patients from all ten of Guyana’s administrative regions had access to the
Food Bank, Region 4 which has the largest number of treatment sites accounted for 84%
(3,112/3,689) of the hampers distributed. The vast majority of beneficiaries to the Food
Bank were unemployed (72.92%) while beneficiaries within the age group 30-49 years,
accounted for 57% (534/937) of all beneficiaries in 2014. A similar situation obtained in
2013 when this same age range accounted for 55% of the beneficiaries. The proportion of
children 0-14 years old accessing the Food Bank in 2014 decreased to the lowest ever
(58/937 = 6.19%) since the commencement of the Food Bank. The increasing success of
Guyana’s PMTCT programme is felt to have had some impact on the decreasing number of
children seeking nutritional support. During 2014, 34%% (320/937) of the beneficiaries
were single parents compared to 22% (264/1202) in 2013.
During the period 2007 – 2014, females continued to be the major beneficiaries of the
programme as illustrated in Figure 34 below. During 2014, 499 (53%) females benefitted
from the Food Bank while 438 (47%) males benefitted.
Government of Guyana Global AIDS Response Progress Report, 2015
88
Figure 34: Gender Disaggregation of Beneficiaries 2007 – 2014
1 2 3 4 5 6 7
MALE 150 319 455 677 466 502 506
0
100
200
300
400
500
600
700
800
N
U
M
B
ER
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B
EN
EF
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A
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S
GENDER DISAGGREGATION OF BENEFICIARIES: 2007 ‐2014
Source: NAPS Programme Reports
During 2014, 79% (743/937) of the patients that benefitted from the Food Bank were on
treatment while 21% (194/937) were in pre-ART or care. The proportions were somewhat
similar in 2013 with 82% on treatment and 18% in care. During 2014, 8% (74/937) of the
beneficiaries were HIV/TB co-infected compared with 19% in 2013. Figure 35 shows the
proportion of patients in pre-ART and in treatment who benefitted from the Food Bank
during the period 2007-2014.
Government of Guyana Global AIDS Response Progress Report, 2015
89
Figure 35: Beneficiaries in Treatment and Care: 2007 – 2014
There was a steady increase in private sector sponsorship of the food bank during the period
2009 – 2014. While the number of private sector agencies reduced from 32 in 2013 to 30 in
2014, the year 2014 witnessed the highest ever private sector contribution towards the food
bank of 40.98% compared to 35.36 % in 2013. See Figure 36 below which illustrates the
private sector sponsorship.
Figure 36: Private Sector Sponsorship of Hampers:2007 – 2014
This is what we as leaders of municipalities
should do, work on issues like HIV that
affects our citizens. I am pleased that we
can invite all stakeholders especially
persons from the vulnerable population to
meetings where we sit and discuss
strategies to address this issue in our town.
We all need to address this issue and many
times we get caught up in all other kinds of
activities which are also important and have
not recognized that HIV is a critically
important platform to be addressed by us
as leaders within our municipality”
Statement by Councilor, January 2014
IV. BEST PRACTICES
1. HIV CITIES Project: Engaging Local Government as Critical Allies
in Addressing Discrimination Against Key Populations
During 2013-2014, UNDP in a historic collaborative effort with MoH/NAPS and the
leadership of two major municipalities in Guyana – Linden and New Amsterdam –
implemented a project that sought to address discrimination against key populations within
these townships. This project was initiated against a backdrop of existing stigma and
discrimination which hindered access to HIV services. Of particular concern was the
discrimination displayed against LGBT persons and commercial sex workers within these
communities, and the lack of recourse for these groups when lodging complaints in cases of
violence encountered within the community. This was especially given the existing laws that
prohibited same sex relationships and commercial sex work. The HIV CITIES Project
which had a strong focus on Human Rights and Gender and Sexual Diversity, was aimed at
strengthening the governance of AIDS responses by government, municipalities, civil society
and community groups. In particular, this project focused on addressing HIV programming
for marginalized and vulnerable populations. Approximately one year after the
commencement of this project, members of these marginalized populations are now able to
sit around the table to have discussions with key institutional stakeholders who have become
their allies in championing their cause within the Linden and New Amsterdam communities.
In initiating the project, consultations were held
with the leadership of the two municipalities and
other key stakeholders within Linden (population
approximately 20,000) and New Amsterdam
(population approximately 35,000) to identify the
populations most vulnerable to HIV, to assess their
access to HIV services, and to identify the gaps in
the provision of these services. The municipal
leaders soon recognized that in pursuing
their substantive roles as service providers
in creating a clean and healthy environment
for their citizenry, they had a critical role to play.
Together with the other key stakeholders, they also
recognized that stigma and discrimination negatively
impacted access to HIV services for vulnerable members of their communities and that this
access was integral for the economic development of their townships. It became evident,
that a broad-based multi-sectoral approach involving municipal leaders and civil society
organizations, was required in addressing this important issue.
As a follow up step, there was a ground-breaking signing of the Municipal Declarations by
leaders of the Linden and New Amsterdam municipalities at a symbolic ceremony attended
by representatives of MoH/NAPS, other government Ministries, donor agencies, NGOs
involved in HIV, the Police Force and other key stakeholders from the New Amsterdam and
Linden townships. This powerful six-point declaration which was locally inspired and
designed by the Mayors of the two townships and their stakeholder groups, embodied
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91
Article 1 of the Universal Declaration of Human Rights which states that “All human beings
are born free and equal in dignity and rights”. The Declaration also secured the
Municipalities’ commitment to “the fundamental principle of respect for the human rights of
all those who suffer from stigma and discrimination and reaffirms the spirit of the universal
access to HIV prevention, treatment, care and support under a human rights frame as we
collectively work towards getting to Zero”. As a reminder of this commitment, a framed
copy of the signed Declaration was posted up in the town halls of Linden and New
Amsterdam.
A major activity implemented during this project was a series of workshops for various
sectors of society, to create an awareness of the issues affecting diverse groups, to address
Government of Guyana Global AIDS Response Progress Report, 2015
92
I have never
interacted with
…with ….well
gay people
before, so this is
a new
experience.
Imagine we are meeting regularly in the Council
Chamber, sitting around the Council table and
talking…planning with police officers, nurses,
Councilors and other important people. This is a
real breakthrough. It shows that the municipality,
the town council respects us and for me, as an
MSM, that is important.
Statement by Participant, March 2014
these issues and, to orient participants to human rights concepts which
negate discrimination in all forms. This training was seen to be crucial in
light of the homophobia that existed within the two townships in which
it was recognized that discrimination occurs at multiple levels – by
families, religious bodies, and even institutions whose mandates were to
provide care for members of the society. During the first wave of
training, 40 members of each municipality, including members of key
populations, were trained. These initial sessions brought to light the
fractured relations between the citizenry and the Police Force and served to obtain the
commitment of the Force in providing non discriminatory services to the LGBT community
when their assistance is being sought. A follow-up training of trainers workshop included 27
participants from various sectors including the LGBT community, NGOs, municipalities,
Police, health services and other government Ministries. Training focused on human rights
and facilitation techniques which was later followed by field practicum in delivering training
at the Police College and the Nursing School. With members of the LGBT community
equipped as trainers, they were able to conduct sessions that spoke to their realities whilst
the Police officers and nurses trained, were able to serve as advocates beyond the training.
The third wave of training was provided to 650 persons including health care professionals,
Police and other security personnel. While religious views on homosexuality remained a
challenge during these training sessions, participants recognized the right of key populations
to equal treatment.
A Human Rights Training Manual was also prepared as part of this project and in
observance of the International Day Against Homophobia and Transphobia on 17 May
2014, a Media Encounter on Human Rights and Homophobia was hosted to publicly
address discrimination against key populations. Another accomplishment of this project was
the setting up of a 24-hour VCT site within the New Amsterdam Municipal Complex
through collaborative efforts between Local Government, NGOs, and the business
community.
A major success of this project was the
willingness of all stakeholders to commit to
pursuing change – both at a personal and an
organizational level. Discrimination by the
Police against the LGBT community and sex
workers has decreased somewhat and these
groups are now able to obtain redress
through the Police Complaints Desk. In
addition, key alliances were formed between
institutional stakeholders and marginalized
groups in addressing their challenges and these marginalized groups have now become part
of a system in which their opinions are valued and which increases their confidence level.
Moreover, the media who participated in the trainings, are now sensitized to the issues facing
key populations and are now better equipped to advocate on their behalf.
Moving forward in this ongoing project, the level of ownership demonstrated by the
municipalities and stakeholder communities within the Linden and New Amsterdam
townships throughout the HIV CITIES Project, highly favours its sustainability!
Government of Guyana Global AIDS Response Progress Report, 2015
93
2. The Private Sector as a Major Partner in Providing Nutritional
Support for PLHIV
In September 2006, the Ministry of Health/National AIDS Programme Secretariat
established a Food Bank as part of the National HIV/AIDS response, to provide nutritional
support to persons living with HIV (PLHIV). This initiative was aimed at achieving
improved treatment outcomes and enhancing the quality of life of PLHIV. Through this
initiative, PLHIV enrolled at care and treatment sites in the different Regions of Guyana,
and who satisfied the criteria for eligibility, were able to obtain a nutritious food hamper
through a referral system. Over the period 2007-2014, a total of 28,474 food hampers were
distributed with the average number of hampers received per patient in a given year rising
from 2 in 2007 to 4 in 2014. Eighty five percent of the Food Bank beneficiaries surveyed in
2013 (2013 Client Satisfaction Survey), reported being either satisfied or very satisfied with
the contents of the hamper. Throughout the period, the private sector has continued to be a
major partner in this venture, commencing with 12 companies coming on board in 2007 and
rising to 30 companies in 2014. During 2014, the private sector contributed 40.98% of the
overall costs of the Food Bank.
Eligibility for the receipt of a food hamper is determined through a clinical evaluation along
with an assessment of the patient’s socioeconomic conditions – status of employment,
whether single parent, family size, and number of dependents. Patients are re-assessed every
six months to determine their continuing eligibility. Over the years, a slightly higher
proportion of females have accessed the Food Bank compared to males. The Food Bank
continued to benefit unemployed PLHIV who comprised approximately two thirds of the
beneficiaries while single parents made up approximately one third. In addition to 85% of
the beneficiaries expressing their satisfaction with the contents of the hamper in the 2013
survey, more than half felt that the hamper contributed to an improvement in their health
and of special significance, was that the same proportion had changed their diets to a
healthier one since receiving the hampers (2013 Client Satisfaction Survey). Based on both
observation and the feedback received from patients, it was evident that the socioeconomic
support provided through the Food Bank was complementing their medical care and
treatment.
A major success of the Food Bank initiative was the engagement of the private sector in
making contributions to the Food Bank. In engaging their support, the impact of HIV on
members of the working population was placed at the forefront of the discussion. The 30
companies currently providing support to the Food Bank span a variety of business interests
ranging from food-related establishments to clothing stores, exporting agencies, etc. Over
the years, there was a steady increase in private sector contributions with the 40.98%
contributed in 2014 being the highest ever. Quarterly feedback sessions between the
National AIDS Programme Secretariat and private sector contributors, serve to keep the
contributors abreast with the national response to HIV and in particular, to highlight the
important role played by their contributions.
The involvement of the private sector in the Food Bank initiative is an outstanding example
of a Public Private Partnership in which the business community can play its role as good
corporate citizens. This is especially crucial at a time when donor support is being
Government of Guyana Global AIDS Response Progress Report, 2015
94
reprioritized thus highlighting the need to explore innovative ways of sustaining the national
HIV response.
3. The Guyana Defence Force Actively Promotes HIV Prevention
Among its Military Officers and Ranks
The Guyana Defence Force (GDF) HIV/AIDS Prevention Programme commenced in
March 01, 2006 focusing on prevention activities as part of the PEPFAR-supported
initiatives. The goals are to promote HIV/AIDS prevention measures, reduce the incidence
of HIV/AIDS and facilitate access to care, treatment and support for PLHIV within the
military. The GDF’s HIV programme constitutes part of the national HIV response and is a
collaborative effort with MoH/NAPS through which it obtains technical and material
support for its prevention, care, treatment and support services. Within the military
hierarchy of the GDF, there is strong buy-in and open lines of communication regarding the
GDF HIV/AIDS Prevention Programme in full recognition of the need to maintain a
healthy defence force. As such, it was mandated that HIV education and behaviour change
communication be an integral part of all military training sessions. The strong commitment
demonstrated by the GDF hierarchy will also ensure the sustainability of the army’s HIV
prevention programme well after PEPFAR’s support is concluded.
On average 660 new recruits pass through the GDF each year, even though the Force has
approximately 2,500 members at any given time. As part of the compulsory programme of
prevention education for every new recruit and existing officer, 5,098 army officers and
ranks received the GDF’s standardized package of intervention during the period 2006-2014.
This package includes information on gender-based violence, STIs/HIV, modes of
transmission, stigma and discrimination, and prevention measures including partner
reduction and consistent and correct use of male and female condoms. In addition, VCT
and IEC materials focusing on prevention measures and specially adapted for the military are
provided. Prevention and risk reduction activities are conducted at all military bases and
locations throughout the country through peer education, educational outreaches and
sensitization activities, including the distribution and display of specially adapted posters at
all military locations.
Peer educator in action during an HIV Prevention awareness session
Government of Guyana Global AIDS Response Progress Report, 2015
95
As part of the army’s HIV prevention programme, there is heavy emphasis on the consistent
and correct use of condoms through condom demonstrations and the availability of free
condoms at all military locations. During 2014, 32 army officers and ranks received VCT
training to add to its existing cadre of trained counsellor/testers. During the period 2006 –
2014, a total of 180 members of the GDF were trained and certified as Voluntary Counselor
Testers. VCT services are provided at 4 stand-alone sites at the main bases and military
locations across the regions, given the mobile nature of military work. In addition, VCT is
provided during medical outreaches. Over the years, the MoH has been able to tap into the
pool of GDF Counselor Testers during collaborative activities such as the National Week of
Testing, when a large number of these testing personnel are required.
Box 10 below shows VCT conducted within the military since the commencement of its
HIV/AIDS programme. As indicated, established targets were surpassed by over 200%
during certain periods. Any army officer or rank found to be HIV positive was referred to a
care and treatment site of his/her choice within the national system.
*Competing military operations impacted the numbers tested
In addition to targeting the military, the GDF’s HIV/AIDS prevention activities also
includes outreaches, often in collaboration with the MoH/NAPS e.g. in observing World
AIDS Day. A major activity of the GDF is its annual health fair which is open to the public
and which has a heavy focus on HIV and wellness programmes targeting family members
and the general public. The health fair is a major collaborative effort between the GDF and
its various partners involved in HIV/general health care in setting up booths, performing
medical tests, and disseminating information on healthy living. The GDF health fair over
the years, has seen the participation of an average of 59 partner organizations on each
occasion including NGOS, hospitals, pharmacies, laboratories, suppliers of medical
equipment, gyms and 2,800 members of the public in attendance including health care
workers, school children and families.
Box 10: VCT Among the Military:
2006-2014
Year Target Persons
tested
Percentage
of target
2006-2007 400 223 56
2007-2008 200 673 337
2008-2009 700 1266 181
2009-2010 1200 1031 86
2010-2011 1200 550 *46
2011-2012 500 1209 242
2012-2013 800 673 84
2013-2014 700 2102 300
Government of Guyana Global AIDS Response Progress Report, 2015
96
An HIV and STI Seroprevalence and Behavioural Epidemiology Risk Survey (SABERS)
conducted within the military in 2011, revealed that there was a low HIV prevalence of 0.2%
with approximately 86.2% of the military ever having taken an HIV test. HIV Knowledge
was found to be relatively high with an average of 81.7% and male condom use was reported
at 93.3%. The recent introduction of the Military Electronic Health Information Network
will further facilitate improvements within the GDF medical facilities in reporting, patient
registration, data quality and operational management of infectious diseases, chronic diseases
in leading to further research within the GDF’s health programmes. This network is the first
of its kind within the South American continent and will further enhance the GDF’s HIV
programme through tracking of prevention services, VCT, and care services.
The sustainability of the GDF’s HIV prevention programme beyond PEPFAR is assured
through the commitment of the military’s hierarchy towards maintaining a healthy army
coupled with the ongoing training of trainers within the military to create a pool of resource
personnel capable of imparting the standard package of HIV prevention services to army
officers and ranks. This is especially evidenced through the ongoing training of Counselor
Testers in developing a culturally sensitive and sustainable programme. The ongoing training
of GDF laboratory personnel to expand and strengthen their capabilities, in addition to the
continuous scaling up of laboratory systems and facilities to support HIV/AIDS related
activities, also augurs well for sustainability.
4. BBSS 2014 Completed through Strong Multisectoral Collaboration
During the period 2013-2014, MoH/NAPS in collaboration with key partners, conducted a
Biological and Behavioural Surveillance Survey (BBSS) among key populations at greater risk
of HIV. The purpose of this BBSS was to understand the dynamics of and garner
information on HIV transmission, level of knowledge, attitudes, and behaviours among
these groups to better inform HIV prevention programming. Key populations selected were
CSWs, MSM, miners and loggers. This was the first attempt by the country to include
miners and loggers in a study of this magnitude.
A remarkable feature of this BBSS was the level of multisectoral multi-partner collaboration
involved which was key to the successful completion of this survey. The tremendous effort
involved in designing the survey, interviewing 3804 individuals within 9 out of 10 regions,
and analyzing this data, would not have been achieved without this demonstration of
support from among donor agencies, government agencies, NGOs and community
members. Most of all, the willingness of the survey population to participate in the study,
despite the sensitive nature of many of the questions administered, was crucial to
accomplishing the goals of the study.
During the survey, leadership and direction were provided by MoH/NAPS throughout the
process of planning, securing funding, determining the technical content, implementation,
and dissemination of information. MEASURE Evaluation through PEPFAR and USAID
funding provided technical assistance in designing and roll out of the study based on the
Priorities for Local AIDS Control Efforts (PLACE) methodology, a tested methodology for
reaching high risk populations. Despite the challenges and limited infrastructure within the
far-flung regions of Guyana, MEASURE Evaluation was able to assist MoH/NAPS in
creating an appropriate sampling design to reach miners and loggers in the places where they
Government of Guyana Global AIDS Response Progress Report, 2015
97
socialize within these hinterland areas. Data was also collected in the coastal regions,
capturing disease burden and high-risk activities in the bigger towns and cities. Completed
questionnaires and test results were transferred to NAPS/MoH for data entry and securely
transferred to the University of North Carolina where MEASURE Evaluation completed the
data analysis.
Additional funding and collaboration during the BBSS were provided by the PANCAP/GIZ
through the Migrant Project, the Global Fund, UNAIDS, PAHO, and MoH, all of whom
participated in the designing, planning and implementation of the survey. Several
departments within the Ministry of Health performed critical roles. These included the
National Public Health Reference Lab, Department of Standards & Technical Services, and
Vector Control Services. The Guyana Forestry Commission and the Guyana Geology and
Mines Commission were central to identifying the locations and facilitating an understanding
of the workings of the “landings” in the hinterland regions where the miners and loggers
congregate and socialize on a regular basis. The Guyana Bureau of Statistics provided vital
oversight and management of the implementation of the study within the hinterland regions.
In designing the study, obtaining external buy-in to the process at the community level was
essential and was brought about through sensitization visits to the Regional Democratic
Offices and communities within the hinterland regions. The study protocol was also
discussed with logging and mining company representatives such as the Guyana Gold and
Diamond Miners’ Association. Several successful consultations with camp leaders, miners
and loggers were conducted. Civil society members and members of the key populations
were also actively involved in the technical working groups for the BBSS in addition to
serving as key members of the mobilizing and interviewing teams. Data collection tools
were translated into Portuguese and interviewing teams in the hinterlands comprised a
Portuguese speaker in the effort to reach Brazilian miners/loggers. During the data
collection phase, the participation of key community informants, civil society groups and
NGOs, was invaluable in contributing their knowledge, expertise, and staff to ensure that the
survey team reached the right people and asked the right questions.
The dissemination of the findings of the BBSS was conducted by the MoH with support
from USAID. The final report of the survey will be printed by CDC and disseminated in
2015. It is planned that relevant secondary data analysis would be supported by MEASURE
through USAID and that CDC will support further qualitative assessments based on the
BBSS findings.
The BBSS 2014 is an excellent demonstration of how collaboration across sectors can allow
each sector to provide the essential components required for completing the machinery to
be used in achieving a seemingly monumental task. The coordination of activities and the
manner in which the various entities complemented each other in the chain of activities
leading to the completion of BBSS 2014, is worthy of replication in undertaking other major
activities.
Government of Guyana Global AIDS Response Progress Report, 2015
98
V. MAJOR CHALLENGES AND REMEDIAL ACTIONS
Whilst acknowledging the major progress made by the Government of Guyana in its
response to HIV, the Guyana AIDS Response Progress Report 2012-2013 identified the
following challenges as being critical in needing to be addressed in moving forward post
2015. These included:
1. Access to the hinterland communities: The difficulties associated with the
geographic terrain as well as the mobility of the miners and loggers present significant
challenges in delivering the key prevention package of services. Donor funded
programmes continue to fund NGOs to work in these communities. The
PANCAP/GIZ project is also working in ensuring that these populations receive
culturally appropriate services. During the reporting period, significant strides were
made in transitioning a centrally operated mobile treatment unit to fixed treatment sites
within the hinterland regions. This model of integration is also challenged by the lack of
adequate support, as limited laboratory infrastructure often requires the shipment of
samples to the NPHRL for processing. This too poses additional difficulties associated
with the logistics of sample collection, storage, shipment, processing and return of
results.
2. Repeated pregnancies among the HIV positive pregnant women. Data over the
last 3 years indicate that among the antenatal population testing HIV positive, the
majority are actually known HIV positive women. This sub population is increasing
annually, thus showing an increase in the HIV prevalence among the antenatal
population. Parallel to this, the number of new HIV positive cases is reducing. To better
understand this phenomenon, the PMTCT programme has initiated research for which
results will be made available in 2014. Without the data, considerations have already been
given to intensification of counseling and the introduction and roll out of family
planning services to the HIV positive women.
3. Retention of patients on ARVs: The 2012-2013 12-months survivability and retention
on ART represented a reduction from the previous three 12-months cohorts. A closer
examination of the data suggested that the reduction was across the board i.e. by males
and females and by adults and children. Greater reductions were noted in the 2012-2013
cohort for the children population. There was an apparent association between the
reduction in 12-months survival and retention on ART, with an increase in the stopped
and loss to follow up cases, even though there continued to be a decline in the number
of deaths over the years. In 2013, the national programme formally introduced
supportive supervision for the clinical teams throughout Guyana. Through this process,
experienced HIV clinicians conducted mentoring and training through a didactic on-site
mechanism whereby patients were seen jointly and cases discussed. This also included a
mandatory chart review, especially for children. This process will continue during the
upcoming period, in addition to strengthened efforts for tracking defaulters and
promoting adherence to treatment.
4. Laboratory support for the ART Programme: The National Public Health Reference
Laboratory continues to serve the HIV programme and also to provide quality assurance
Government of Guyana Global AIDS Response Progress Report, 2015
99
to regional labs. During the reporting period many challenges were encountered that
resulted in gaps in laboratory monitoring of patients in care and on treatment. The
NPHRL experienced significant attrition of highly skilled technical persons. This
situation is currently being considered in the wider MoH discussion on transitioning of
staff. The staff issue was compounded by the difficulties experienced with the supply
chain management systems resulting in interruptions of critical services. Efforts are
being made to strengthen this area as PEPFAR now supports a highly skilled warehouse
manager positioned at the National Warehouse, and SCMS continues to provide high
quality technical assistance and implementation throughout the supply chain. The
NPHRL works with a network of regional and district laboratories in collaboration with
the Department of Standards and Technical Services. These laboratories are also faced
with the same issues. The Department of Standards and Technical Services has
commenced the drafting of a National Laboratory Strategy while at the same time a
strategy is also drafted for the NPHRL. Both strategies will be finalized and
implementation started in 2014.
5. Data collection system: The data collection system is clearly outlined in the
Operational Plan to the National M&E Plan for all sub programmes with the HIV
response. Over the years the data collection system was refined on several occasions to
adequately capture information to enhance service delivery and clinical monitoring in
addition to ensuring that the system was robust enough to facilitate donors, international
and other reporting requirements. The system has evolved into a comprehensive one
collecting huge volumes of data. This system being a manual paper based system is
labour intensive for data collection, data entry and analysis and it leaves much room for
human error. There are several stand alone data bases that provide limited utility. This
situation has to be addressed if the monitoring and evaluation system is to remain robust
and relevant.
In response to the challenges identified, the national programme committed to taking
remedial action to address some of the challenges mentioned above. These remedial actions
are reflected in table 18 below.
Table 18: Remedial Actions in Response to Challenges
Challenges Remedial Actions
1. Access to the
hinterland
communities
In 2014, the Ministry of Health as the principal recipient to the
Global Fund signed a major sub recipient agreement with the
International Organisation for Migration. This will ensure that
there is a significant scale up of prevention, care and support
services to the miners and loggers and adjacent communities. The
work started in 2013 in transitioning the HIV treatment
programme from a mobile unit centrally led, to a more
sustainable approach of local ownership. This was consolidated
in 2014 with the establishment of fixed treatment sites within
these hinterland communities. The functioning of these sites was
strengthened through training of the health care workers, clinical
mentoring, and oversight.
The BBSS concluded in 2014 provided key data on miners and
Government of Guyana Global AIDS Response Progress Report, 2015
100
Challenges Remedial Actions
loggers and adjacent populations in the hinterland regions.
Importantly whilst the BBSS measured knowledge, attitudes and
practices; access to services was also explored in a significant
way. Further qualitative assessments will be conducted and this
information would be used to further strengthen the delivery of
services to the hinterland communities.
2. Repeated
pregnancies among
the HIV positive
pregnant women
High rates of repeated pregnancies among the HIV positive
women continued in 2014. The PMTCT programme in
collaboration with partner agencies concluded a research to
understand the factors associated with the repeated pregnancies.
The data analysis is being conducted and a final report will be
presented in 2014 and will be used to guide any changes in
programming.
3. Retention of patients
on ARVs
2014 presented its significant challenges to the HIV treatment
programme; the programme operated without a treatment
coordinator and significant staff attrition was noted with the
transitioning of HIV treatment staff from donors to government.
Despite this, compared to 2013 a small increase in 12 months
survivability is noted with improvement in loss to follow up and
death rates. Interestingly, for the first time, survivability among
males was significantly improved and is reported as being greater
than that of females. One of the factors attributed to this
phenomenon is an increased strengthening of the social work
component of clinical management in addressing issues affecting
the male population.
4. Laboratory support
for the ART
programme:
This factor, acknowledged as a challenge in 2012-2013, continued
as a greater challenge in 2014. The NPHRL experienced greater
attrition of technical staff as a result of transitioning of staff from
donor to Government. This has resulted in interruption in CD4,
Viral Load and DNA PCR testing in addition to routine
hematology and biochemistry. The situation is currently deemed
a priority in the Ministry of Health and is being addressed
accordingly.
5. Data collection
system
The Global Fund and CDC were engaged in 2014 and
commitment made towards the development of a Health
Management Information Systems and an Electronic Medical
Record System. An initial assessment of the current situation
with recommendations on the way forward including viable
alternatives, will be conducted early 2015 with support from
CDC.
Despite the progress referred to above, many of the challenges reported during the 2012-
2013 period remain since long term solutions are required. In addition to these, new
challenges were identified during this reporting period. Cross cutting these challenges is the
issue of staff attrition. The following key challenges are noted:
Government of Guyana Global AIDS Response Progress Report, 2015
101
1. Human resource transitioning: The Ministry of Health has commenced the
transitioning of several aspects of donor funded support to the Government of Guyana’s
budget. The transitioning of training, procurement of medical supplies, consumables and
ARVs and other programmatic functions, has been a relatively smooth process. The staff
transitioning however has been challenging and has resulted in interruptions in service
delivery. This has been most evident in the PMTCT programme with a reduction in
coverage for HIV testing among that population, the HIV treatment programme with a
shifting of the workload from the site level to a more centrally driven one as in the case
of date entry and laboratory support. The latter resulted in interruptions of viral load,
CD4, DNA PCR and other testing which had the potential to result in suboptimal care.
Whilst approval has been given for a phased three years transition plan for Human
Resources, the Ministry of Health has prioritized the optimization of this plan.
2. Reaching the key populations: Despite the significant progress made during this
reporting period, reaching the key populations remains a challenge. Issues identified in
this regard include a reluctance of individuals to identify themselves as FSW or MSM
and lack of disclosure of sexual orientation or sexual identity, fuelled by stigma and
discrimination. Other issues were high cost and difficult terrain associated with reaching
remote areas in addition to safety issues. The BBSS of 2014 provided significant
information on these populations and the planned additional follow up with qualitative
assessments, will further consolidate the understanding of these issues identified.
3. Linkage into care: Programmatic data suggest that there is a gap between persons
testing positive for HIV and early linkage into care and treatment. Further to this, a
rapid assessment of the HIV treatment data indicate that 37.5% ( 197/596) of persons
entering the treatment program within the last year had a CD4<200 cell. Efforts are
being made to address this issue at several levels: at HIV testing sites through training of
counselor testers to adequately discuss CD4 testing and the impact of early treatment
and through the expansion of the case navigator programme and: at the general
population level with increased campaigns on early testing and linkage to care and
through addressing issues of stigma and discrimination and disclosure. The client referral
system will undergo a review to ensure that it is sufficiently robust to capture the
required information to monitor linkage into care.
4. Inequity in treatment and care: An increase is noted in the 12 months survivability
with a parallel reduction in loss to follow up and deaths. An examination of the
treatment data with regard to these outcomes indicate that several treatment sites are
underperforming in almost every measure. It is therefore critical that an assessment be
conducted to establish the factors associated with this underperformance and that
appropriate follow up actions and supportive mechanisms be introduced to ensure that
there is uniformity in the quality of care being provided to all patients.
5. Opportunistic infections and chronic diseases comorbidities, cervical cancer
screening: As the HIV treatment programme matures, there is increased focus on
quality of care not only for the management of HIV and opportunistic infections but
also for other chronic diseases and co morbidities. There is clear evidence that women
living with HIV are at an increased risk for cervical cancer compared to their
counterparts. The Ministry of Health has approved a policy decision on the use of VIA
Government of Guyana Global AIDS Response Progress Report, 2015
102
and Single Visit (SVA) approach to screening for cervical cancer and treatment for
atypical cervical lesions. This guidance was incorporated within the HIV treatment
guidelines recommending annual screening for the population. As indicated, the total
number of VIA screen declined over the last 3 years with a parallel decline in the number
of HIV positive clients screened. Importantly the proportions with positive VIA
findings remain significant at 10.7% in 2014. This programme continues to be
challenged by limited human resources.
6. The TB/HIV co epidemic: There continues to be progress in addressing the
TB/HIV co-epidemic with the maintenance of high levels of HIV testing among the TB
population and increased ART coverage among the population. The high rates of
co-infection and the relatively low (despite significant increase in 2014) ART coverage
continues to engage the TB and HIV programmes. Linked to this is the reported high
mortality and low treatment success related to this co-morbidity. Efforts have
commenced in considering the WHO recommendation for IPT prophylaxis for HIV
patients for whom active TB is ruled out. Additionally, there will be intensified clinical
mentoring and collaboration between the TB and HIV staff.
7. Laboratory Support: Interruption in testing support for treatment continued to a
greater extent in 2014 compared to 2013. This is evident as the data shows a reduced
number of Viral load, CD4, DNA PCR and other testing. Two critical factors were
associated with this; the continued attrition of technical staff of the NPHRL linked to
the transitioning process and stock out of reagents and supplies. These were further
compounded by the fact that there were occasions when the equipment was not
functional for a variety of technical issues. Evidently, this has resulted in the provision
of some level of sub optimal care being delivered to the population of PLHIV. The
Ministry has prioritized all issues relating to the NPHRL and these are being addressed
accordingly.
VI. SUPPORT FROM COUNTRY’S DEVELOPMENT PARTNERS
The progress reported herein is directly related to the significant amount of financial
resources provided by donors and technical partners to Guyana. The Government of
Guyana is appreciative of the support provided by development partners and would like to
acknowledge these partners in this section.
US President’s Emergency Programme for AIDS Relief (PEPFAR):
PEPFAR/USAID Partner – Advancing Partners and Communities (APC); United
States Government (USG) partners include United States Agency for International
Development (USAID), MEASURE, MEASURE Evaluation, US Centers for
Disease Control (CDC), Peace Corps, Supply Chain Management Systems (SCMS),
Positively United to Support Humanity (PUSH), US Department of Defence.
The Global Fund to Fight AIDS, Tuberculosis and Malaria
UN Agencies: UNAIDS, PAHO-WHO, UNICEF, UNFPA, UNDP, UNESCO
Government of Guyana Global AIDS Response Progress Report, 2015
103
Pan Caribbean Partnership against HIV/AIDS (PANCAP)
Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ)
The Government of Guyana looks forward to continued support from these partners. Such
support includes:
1. Continued acknowledgement and appreciation that the HIV response is a country led
process and thus support for the HIVision 2020 and alignment with national policy and
strategic guidances.
2. Support the Ministry of Health on resource mobilization for the response.
3. Continuing support in working towards a mutually agreeable, phased transition plan
from donors to Government.
4. Collaboration on initiatives in charting the way forward on sustainability of the HIV
response.
5. Ensuring that there is health systems strengthening – a key component for sustainability
of the HIV response
6. Provide technical assistance in coordination, policy development, prevention, care
treatment and support, strategic information and all other coordination and technical
areas aligned to the HIVision 2020.
7. Update the national response on new international and regional evidence, policies,
guidelines and standards.
8. Conduct joint planning, monitoring and evaluation with the Ministry of Health.
9. Prioritize and support the National response in areas where there are gaps, including but
not limited to policy development, research, surveillance.
10. Provide technical guidance through the sub-programmes technical working groups.
VII. MONITORING AND EVALUATION ENVIRONMENT
Monitoring and Evaluation continued to play an integral role in the management of the HIV
and AIDS response in order to track and report on the successes and weaknesses of the
national programme. Coordination of the HIV M&E agenda in 2014 was led by the NAPS
M&E Unit with support from technical partners in the local UN and PEPFAR/USAID
offices who were fully represented on the Monitoring and Evaluation Reference Group
(MERG) which aims at streamlining monitoring and evaluation efforts among the various
partners. The MERG met throughout the year to plan M&E related work and to
disseminate information.
The following were key areas of progress during 2014:
Biological & Behavioral Surveillance Survey (BBSS) Round 3: A major
achievement during 2014 was the completion of the BBSS through supportive
collaboration with MEASURE Evaluation and partner agencies.
Government of Guyana Global AIDS Response Progress Report, 2015
104
MAP showing Sites visited during the BBSS 2014
Data collection and data entry for the BBSS which commenced in 2013, was concluded
in July 2014. A preliminary analysis of the data was done by MEASURE Evaluation,
followed by the collection of supplemental data to validate the preliminary results after
which the data analysis was completed.
In November 2014, a Stakeholder Dissemination meeting was held to share the findings
of the BBSS and to receive feedback. The wide cross-section of stakeholders in
attendance included representatives from the Ministry of Health/NAPS, civil society
organizations, the Guyana Forestry Commission, technical partners and funders, and the
media. The findings were presented according to the populations surveyed: Miners &
Loggers; Female Sex Workers; Men who have Sex with Men and; Transgenders.
Estimates for Key Populations (namely MSM and FSWs) were also developed using the
BBSS data, and presented during the Dissemination meeting. The final report of the
BBSS is currently being prepared and this will be made available in 2015.
Government of Guyana Global AIDS Response Progress Report, 2015
105
Development of 2014 HIV Estimates: Using Spectrum the M & E Unit developed HIV
estimates for 2014 (see table 19 below).
Table 19: HIV Estimates: Guyana 2014
Indicator
Estimate
HIV Adults + Children 7700
New HIV infections <1000
Annual AIDS Deaths <200
Prevalence Adult (%) 1.4
Incidence (15‐49) (%) 0.11
HIV Adults (15+) 7500
HIV Adult Female (15+) 4000
New HIV infections ‐ Adults (15+) <1000
Annual AIDS deaths ‐ Adults (15+) <200
Prevalence Young Male (15‐24) 0.6
Prevalence Young Female (15‐24) 0.9
HIV Children (0‐14) <200
New Infections (0‐14) <100
Table 20 below shows ART coverage estimates for 2014. As indicated, using the national
criteria for ART eligibility (CD4<= 350), Guyana achieved 79% coverage among adults
living with HIV and more than 95% coverage among children.
Table 20: Key Coverage Indicators: Guyana 2014
Indicator Estimate
People receiving ART as a percentage of total HIV population (%)
Adults 52
Children >95
ART Coverage ‐ National HIV Eligibility Criteria (%)
Adults 79
Children >95
Number of people eligible for ART ‐ National HIV Eligibility
Criteria
Adults 4900
Children <200
Mothers receiving PMTCT (% Coverage) >95
Mothers needing PMTCT <200
Client Satisfaction Survey (CSS) 2013: Data entry and cleaning of the CSS 2013
dataset was completed in 2014. The data was inputted into Excel and imported into
SPSS for analysis. Data analysis commenced and a number of tables were prepared for
the National Report. The CSS data will be analyzed further to generate two reports: (1) a
national report on all data collected and (2) a TB report on data collected at all TB sites.
These reports are scheduled for completion and dissemination by June 2015.
Preparation of HIV M & E Plan: With the launching of the HIVision 2020, work
commenced in 2014 in preparing a national HIV M&E Plan to accompany the Strategic
Plan. A draft M&E Plan was completed by the M&E Unit and reviewed by MEASURE
Government of Guyana Global AIDS Response Progress Report, 2015
106
Evaluation. The MERG also provided feedback on the draft plan which will be finalized
during the first Quarter of 2015.
Revision of Monitoring Tools: The monitoring tools for conducting outreaches to key
populations were updated in 2014 with partner support. The staff from CSOs and USG
sub-recipients were then trained in the rollout of these tools through further partner
collaboration and the tools are to be further updated based on the feedback received
from the users.
Capacity Building: During the year, the skills of the M&E staff were further upgraded
through participation in the following training:
o Methodology for Surveillance on HIVDR in the Caribbean
o Profiling the HIV Continuum of Care
o Applied Public Health Leadership and Management Training
o Leadership for Data Demand & Use
Completion of Key Reports: During 2014, the M & E Unit was actively involved in
coordinating the data collection and submitting this data online to UNAIDS during the
preparation of the 2014 Global AIDS Response Progress Report and the Score card on
Gender Equality in the National HIV Response. The Unit was also involved in the
collection, collation and presentation of data for the Global Fund Semester seventeen
(17) and eighteen (18) reports.
ANNEXES
ANNEX 1: Training Activities Conducted During the Reporting Period
Region Topic
Number of
Persons
Trained
Target
Audience
Training
Category
Leadership and Coordination
Tanzania PEPFAR Impact Evaluation
Workshop
1 HBC Coordinator
Leadership and
Coordination
Jamaica Strengthening Prevention in HIV
and Public Health Programmes
1 NAPS Prevention
Coordinator
2, 3 4, 5,
6, 7, 10
Training on the MARPS Guidelines
and Standards for Non‐
Governmental Organizations
25 MSM and SW
Peer Educators
from NGOs
Prevention
3, 4, 6 HIV YES Programme
1168 5 primary and 1
secondary school
students
Adolescent
Health
HIV/STI education 61 Secondary school
students
Sensitization HIV&AIDS Teachers and
education sector
management staff
Career/Knowledge Fair (to sensitize
youths regarding career choices)
79 In and out‐of‐
school youths
1, 9 Adolescent Health
(4 sessions)
Community
Support Officers,
Teachers and
School Welfare
Officers
1, 4, 6, 9,
10
HIV Sensitisation using Ready Body
Manual
207
Youths
4 Drug Use Among in‐School
Population
Teachers
Health and Family Life Education
using HFLE Modules
Students of all
secondary schools
Adolescent Health 24 Teachers
Peer Coaching in Expressive Arts
Therapy and Parent Education
15 School welfare
officers
Capacity Building to Deliver Family
Planning Information and SRH
Services
89 Community
facilitators and
health care
workers
Sexual and
Reproductive
Health
Government of Guyana Global AIDS Response Progress Report, 2015
108
Region Topic
Number of
Persons
Trained
Target
Audience
Training
Category
Youth Advocacy on Family Planning,
Contraceptive Modalities and
Comprehensive Sexuality Education
28 Youths of 15‐24
age group
Hinterland
Regions
Focus Group Discussions on
Teenage Pregnancy
Teachers
Family Planning and the Role of
Religious Leaders in Promoting
Family Planning Within
Communities
28 FBO
representatives
4, 5, 6, 10 Adolescent Sexual and
Reproductive Health
100 68 HCWs
32 peer educators
Sexual Reproductive Health and
HIV/AIDS
310 Pre‐service
teachers
Training in Sexual and Domestic
Violence Protocol for health care
providers
140 Nursing students
Gender Based
Violence
GBV Sensitization Using Tools
Developed for Addressing GBV
99 Fathers
Capacity Building for Integration of
SRH and GBV/Sexual Violence into
Youth Programmes
Youths
4 Public Education on Gender Based
Violence and HIV
49 Members of the
public
Life skills Training using HFLE
Training Modules on Violence
Prevention
259 Secondary
Students
4 Stigma and Discrimination, HIV
Transmission
Popular opinion
leaders of 3
supermarkets HIV
sensitization
and stigma and
discrimination
1,2,3 Stigma and Discrimination 69 HCWs of different
categories
3, 4 PEP, Basics of HIV, Positive Health
and Dignity
22 MSM/SW
Sensitization on HIV/AIDS in the
Workplace (30 sessions)
300 Employees of
various agencies
Workplace
wellness
7 Regions Prevention for MSM: 90‐90‐90
Targets, Myths about MSM and
Transgenders, Healthy Living,
Strategies for Reaching MSM
37 MSM
Key Affected
Populations
3, 4, 6, 10 LGBT: Advocacy and Human Rights 22 LGBT members
6 Human Rights, HIV and Sex Work 19 SWs
4 HIV and STI Education, Stigma and
Discrimination, Risk Reduction
Miners and
loggers in mining
camps
Government of Guyana Global AIDS Response Progress Report, 2015
109
Region Topic
Number of
Persons
Trained
Target
Audience
Training
Category
2, 3 Stigma and Discrimination Against
Key Populations, Positive Health
and Dignity
47 HCWs
6, 10 Key Affected Populations and
Human Rights
40 Residents of New
Amsterdam and
Linden
municipalities
including key
affected
populations
6, 10 Training of trainers workshop on
Key Affected Populations, Human
Rights and Facilitation Skills.
27 Representatives
of LGBT, NGO,
Police, health
services
6, 10 Key Affected Populations, Human
Rights
650 HCWs, Police,
other security
personnel
6 Computer training 6 MSM and SWs
4 Craft production (floral
decorations)
5 SWs
Training‐of‐trainers workshop on
Case Tracking Management System
18 HCWs from public
and private health
care facilities
PMTCT
Integrated Paediatric Care 15 HCWs including
health centre
supervisors
Review of draft Integrated PMTCT
Curriculum
15 HCWs
Review of Safe Motherhood and STI
Training
33 Different
categories of
HCWs including
training
facilitators
VCT training 45 Staff of Guyana
Defence Force Voluntary
Counselling and
Testing
1, 3, 4, 8,
9
VCT Refresher Training 104 Counselor/
Testers
2, 4, 5, 9,
10
STI Syndromic Management
145 117 HCWs of
different
categories
28 Education
officials
STI
4 Regional training of the trainer
exercise to provide training in
performing the VIA procedure
10 Participants from
Trinidad,
Suriname,
Government of Guyana Global AIDS Response Progress Report, 2015
110
Region Topic
Number of
Persons
Trained
Target
Audience
Training
Category
Antigua, St. Lucia
and Guyana
5, 6 Peer Education on Key Affected
Populations
15 MSM
Peer Education
1 Peer Education 24 In and out‐of‐
school youth
6 Peer Education (training done in
collaboration with MCYS)
39 In and out‐of‐
school youth
10 Peer Education 31 Kids Sake
Foundation peer
educators
4 Peer Education 27 Members of
Guyana Society
for the Blind,
other disabled
persons
1 Peer Education 21 In and out‐of‐
school youth
belonging to an
FBO
9 Peer Education 34 Students,
including those
from remote
areas in Region 9
1 Peer Education 24 HCWs of different
categories
attached to
Mabaruma
Hospital
2, 4, 9 TB/HIV Peer Education
34 Representatives
of the public and
private sectors
2, 5, 9, 10 PEP Sensitisation 82 Different
categories of
HCWs
Post Exposure
Prophylaxis
3, 4, 6 Tuberculin Skin Test 44 HCWs Tuberculosis
Treatment and Care
6 Regions HIV Continuum of Care in Guyana 60 NAPS/MoH staff,
civil society
members
Clinical
management of
HIV
4 Clinical Management of HIV/TB 35 HCWs
7 Customer Service Excellence (with a
focus on migrants)
32 Different
categories of
Bartica Hospital
staff
Migrant
services
Government of Guyana Global AIDS Response Progress Report, 2015
111
Region Topic
Number of
Persons
Trained
Target
Audience
Training
Category
7 Basic Portuguese 34 Different
categories of
Bartica Hospital
staff
7 HIV Basics, VCT, S & D,
Confidentiality of Patient
Information
34 Bartica Hospital
staff
Stigma, Discrimination, Cultural
Sensitivity and Human Rights
Related to Health and Migration (4
workshops)
60 HCWs,
government
Ministries,
Guyana Defence
Force
Training of Trainers: Stigma,
Discrimination, Cultural Sensitivity
and Human Rights Related to
Health and Migration
14 HCWs,
government
Ministries, NGOs
TB/HIV Management and Infection
Control
17 Physicians TB Infection
Control
7, 8 Dried Blood Sampling (for DNA/PCR
Testing)
22 Different
categories of
HCWs
Laboratory
Training
4 Quantimed Training on Forecasting
of ARVs and Other Supplies
17 HCWs Forecasting for
ARVs
Support Services
3 locations
in Region
3
Sensitization on Parenting, Early
Childhood Development, Child
Abuse (3 sessions)
106 Members of the
community,
including parents
and teachers
OVC Care and
Support
Refresher Training in Home Based
Care
29 Caregivers Home Based
Care
Strategic Information
4 Methodology for Surveillance on
HIVDR
1 MoH/NAPS M&E
staff
Data
Management Completion of Patient Forms (at
HIV treatment sites)
20 Social Workers/
Counselors
Patient Monitoring System 16 Social workers
and data entry
clerks
4 Applied Public Health Leadership
and Management
1 MoH/NAPS M&E
staff
Government of Guyana Global AIDS Response Progress Report, 2015
112
Region Topic
Number of
Persons
Trained
Target
Audience
Training
Category
2, 4, 6, 10 Monitoring and Reporting Tools for
Capturing Information on Key
Affected Populations
11 M & E and
Prevention
Officers from 10
organizations
4 Profiling the HIV Continuum of Care 19 Staff of
NAPS/MoH,
NPHRL, NBTS
4 Leadership for Data Demand & Use 2 MoH/NAPS M&E
staff
Total number of persons trained *5,217
* This number excludes persons who were trained but the numbers of persons trained were not
recorded for the specific training activity (as in the case of some of the above activities)
ANNEX 2: Core Indicators for Global AIDS Response Progress Reporting
Targets Indicator Data
origin
Period Value Remarks
Target 1: Reduce
sexual transmission
of HIV by 50 percent
by 2015
General Population
1.1 Percentage of young
women and men aged 15‐24
who correctly identify ways of
preventing the sexual
transmission of HIV and who
reject major misconception
about HIV transmission
DHS 2009 51.10% No new survey
1.2 Percentage of young
women and men aged 15‐24
who have had sexual
intercourse before the age of
15
DHS 2009 13.60% No new survey
1.3 Percentage of adults aged
15‐49 who have had sexual
intercourse with more than
one partner in the last 12
months
DHS 2009 4.90% No new survey
1.4 Percentage of adults aged
15‐49 who have had more than
one sexual partner in the past
12 months who report the use
of a condom during their last
intercourse
DHS 2009 ‐ No new survey
Note: There were fewer than
25 unweighted cases for
females 15‐19 and 20‐24, 25‐
29, 30‐39, 40‐49, and have
Government of Guyana Global AIDS Response Progress Report, 2015
114
Targets Indicator Data Period Value Remarks
been suppressed in DHS report.
All Females DHS 2009 ‐
All Males DHS 2009 65.50%
1.5 Percentage of women and
men aged 15‐49 who received
an HIV test in the past 12
months and know their results
DHS 2009 24.80% No new survey
1.6 Percentage of young
people aged 15‐24 who are
living with HIV
ANC
Programm
e data
2014
1.9%
Data reported is from the total
pregnant woman population
and is not only reflective of
women 15‐24. Additionally, the
reported data reflects women
who were newly tested HIV
positive during the reporting
period as well as women with
known HIV positive status who
accessed ANC services.
Note: Data not disaggregated
by sex
Sex Workers 1.7 Percentage of sex workers
reached with HIV prevention
programmes
BBSS 2014 48.2% Data reflects male, female and
Transgender Sex Workers
1.8 Percentage of sex workers
reporting the use of a condom
with their most recent client
BBSS 2014 75.7%
Government of Guyana Global AIDS Response Progress Report, 2015
115
Targets Indicator Data Period Value Remarks
1.9 Percentage of sex workers
who have received an HIV test
in the past 12 months and
know their results
BBSS 2014 47.6%
1.10 Percentage of sex workers
who are living with HIV
BBSS 2014 6.1%
Men who have sex
with men
1.11 Percentage of men who
have sex with men reached
with HIV prevention
programmes
BBSS 2014 37.5% Data includes Transgender
1.12 Percentage of men
reporting the use of a condom
the last time they had anal sex
with a male partner
BBSS 2014 64.4%
1.13 Percentage of men who
have sex with men that have
received an HIV test in the past
12 months and know their
results
BBSS 2014 37.8%
1.14 Percentage of men who
have sex with men who are
living with HIV
BBSS 2009 4.9%
Target 2: Reduced
transmission of HIV
among people who
inject drugs by 50
percent by 2015
2.1 Number of syringes
distributed per person who
injects drugs per year by
needle and syringes
programmes
‐ ‐ Target 2 is Not applicable to
Guyana
2.2 Percentage of people who
inject drugs who reported the
use of a condom at last sexual
intercourse
‐ ‐
Government of Guyana Global AIDS Response Progress Report, 2015
116
Targets Indicator Data Period Value Remarks
2.3 Percentage of people who
inject drugs who reported
using sterile injecting
equipment the last time they
injected
‐ ‐
2.4 Percentage of people who
inject drugs that received an
HIV test in the past 12 months
and know their results
‐ ‐
2.5 Percentage of people who
inject drugs who are living with
HIV
‐ ‐
Target 3: Eliminate
mother‐to‐child
transmission of HIV
by 2015 and
substantially reduce
AIDS‐related
maternal deaths
3.1 Percentage of HIV‐positive
pregnant women who received
antiretrovirals to reduce the
risk of mother‐to‐child
transmission
ANC
Programm
e Report
2014 188
Numerator is inputted and
reflects data from the National
Care and treatment programme
and the PMTCT programme.
183 women received ARVs and 5
women single dose nevirapine.
Denominator is derived from
Spectrum file and will be
finalized in May 2015
3.1a Percentage of women
living with HIV who are
provided with antiretroviral
medicines for themselves or
their infants during
breastfeeding period
PMTCT
Programm
e Report
&
Spectrum
2014 NA 2 babies were being exclusively
breastfed at admission during
2014. The denominator is
derived from Spectrum file and
will be finalized in May 2015
3.2 Percentage of infants born
to HIV‐positive women
receiving a virological test for
HIV within 2 months of birth
NPHRL &
PMTCT
data
2014 59.5% 115 samples were processed
within 2 months; 159 between 2
to 12 months and 16 samples
beyond 12 months.
Government of Guyana Global AIDS Response Progress Report, 2015
117
Targets Indicator Data Period Value Remarks
3.3 Mother‐to‐child
transmission of HIV modeled
Modeled
using
Spectrum
2014 Not
Available
This indicator will be updated
from the finalized Estimates File
in May 2015.
Denominator: 193 HIV positive
pregnant women who delivered
in 2014
Target 4: Have 15
million people living
with HIV on
antiretroviral
treatment by 2015
4.1 Percentage of eligible
adults and children currently
receiving antiretroviral therapy
NAPS
Programm
e Reports
2014 4295 4295 persons were receiving
treatment at the end of 2014.
Denominator will be available in
May 2015 from finalized
Spectrum file.
Modeled
using
Spectrum
4.2 Percentage of adults and
children with HIV known to be
on treatment 12 months after
initiation of antiretroviral
therapy
Patient
Monitorin
g System
(NAPS
2014 81.2%
Note: This is the average
survival values of 16 cohorts
after 12 months on treatment.
The cohorts cover the period
January to December 2010.
Government of Guyana Global AIDS Response Progress Report, 2015
118
Targets Indicator Data Period Value Remarks
Target 5. Reduce
tuberculosis deaths
in people living with
HIV by 50 percent by
2015
5.1 Percentage of estimated
HIV‐positive incident TB cases
that received treatment for
both TB and HIV
Chest
Clinic
Programm
e Reports
2014 103 Numerator reflects number of
co‐infected patients at TB sites
who received ART (both new
and retreatment cases).
Denominator will be available
from WHO later in 2015.
Programme coverage reflects
69.6% (103/148)
Target 6: Reach a
significant level of
annual global
expenditure (US22‐
24 billion) in low and
middle‐income
countries
6.1 Domestic and international
AIDS spending by categories
and financing sources
‐ NASA report is appended to the
online submission of the GARPR.
Target 7: Critical
Enablers and
Synergies with
Development
Sectors
7.1 National Commitments and
Policy Instruments (prevention,
treatment, care and support,
human rights, civil society
involvement, gender,
workplace programmes, stigma
and discrimination and
monitoring and evaluation)
Key
informant
interviews
The NCPI was not required for
the 2015 GARPR report
7.2 Proportion of ever‐married
or partnered women aged 15‐
49 who experienced physical
violence from a male intimate
partner in the past 12 months
Data not available. The DHS
2009 asked about women’s
attitude towards wife beating:
16.3% of women 15‐49 agree
with at least one specified
reason.
Government of Guyana Global AIDS Response Progress Report, 2015
119
Targets Indicator Data Period Value Remarks
7.3 Current school attendance
among orphans and non‐
orphans aged 10‐14
‐ Indicator relevant but data not
available
7.4 Proportion of the poorest
households who received
external economic support in
the last 3 months
‐ Indicator relevant but data not
available
Target 8: Eliminating
Stigma &
Discrimination
8.1 Percentage of women and
men aged 15–49 who report
discriminatory DHS 2009 women 20.10%
attitudes towards people living
with HIV men 23.90%
Government of Guyana Global AIDS Response Progress Report, 2015
120
ANNEX 3: Core Indicators for Universal Access Reporting
Indicator
#
Indicator
Data Source Period Value
Comments
Target 1.
Reduce sexual
transmission
of HIV by 50
percent by
2015
Testing &
Counseling
1.15 Number of health facilities that provide HIV
testing and counselling services
VCT Programme
report
Jan‐Dec
2014 60
Public: 47; private: 2; NGO: 11; TB
clinic: 16; STI Clinic 21
1.16 HIV Testing and counseling in women and men
aged 15 and older
VCT and PMTCT
Programmes
Jan‐Dec
2014 68,655
Total Number of persons tested
(68,655) represents testing
through VCT sites (54,815 with
1034 positives) and pregnant
women tested in the ANC/PMTCT
setting (12,416 with 123 positives
) AND male partners of pregnant
women who were also tested in
the ANC/PMTCT setting (1,424
with 17 positives)
Number of women and men aged 15 and older
who received HIV testing and counseling in the
past 12 months and know their results
VCT Programme
Jan‐Dec
2014 54,815
HIV+ out of number tested
VCT Programme
Jan‐Dec
2014 1034
Number of pregnant women aged 15 and older
who received testing and counseling in the past 12
months and received their results
PMTCT
Programme
Jan‐Dec
2014
12,621
1.16.1
Percentage of health facilities dispensing HIV
rapid test kits that experienced a stock‐out in the
last 12 months
VCT Programme
report
Jan‐Dec
2014
8.3%
Number of health facilities dispensing HIV rapid
test kits that experienced a stock‐out in the last
12 months 5
Total number of health facilities dispensing HIV
rapid test kits 60
Government of Guyana Global AIDS Response Progress Report, 2015
121
Indicator
#
Indicator
Data Source Period Value
Comments
1.17 Sexually
Transmitted
Infections
(STIs)
1.17.1
Percentage (%) Percentage of women accessing
antenatal care (ANC) services who were tested
for syphilis at first ANC visit
ANC Programme
Jan‐Dec
2013 82.71%
2014 data is not yet available.
Numerator Number of women attending first visit
ANC services who were tested for syphilis
12403
Denominator Number of women attending first
visit ANC services 14995
1.17.2
Percentage of antenatal care attendees who
were positive for syphilis
ANC Programme
Jan‐Dec
2013
0.10%
2014 data is not yet available
Numerator Number of antenatal care attendees
who tested positive for syphilis
12
Total NA
15‐24 NA
25+
Denominator Number of antenatal care attendees
who were tested for syphilis
12403
Total
15‐24 NA
25+ NA
1.17.3
Percentage (%) Percentage of antenatal care
attendees positive for syphilis who received
treatment
2014 data is not yet available
Numerator Number of antenatal care attendees
with a positive syphilis serology who received at
least one dose of benzathine penicillin 2.4 mU IM
Government of Guyana Global AIDS Response Progress Report, 2015
122
Indicator
#
Indicator
Data Source Period Value
Comments
Denominator Number of antenatal care attendees
with a positive syphilis serology
1.17.4
Percentage (%) Percentage of sex workers (SWs)
with active syphilis
BBSS
2014
1.6%
Numerator Number of sex workers who tested
positive for syphilis
6
Denominator Number of sex workers who were
tested for syphilis
386
1.17.5
Percentage men who have sex with men (MSM)
with active syphilis
BBSS
2014
1.0%
Numerator Number of men who have sex with
men who tested positive for syphilis
4
Denominator Number of men who have sex with
men who were tested for syphilis
388
1.17.6 Number of adults reported with syphilis
(primary/secondary and latent/unknown) in the
past 12 months
MOH Surveillance
data
Jan‐Dec
2014
23 Data reflects all Syphilis cases
reported to the MOH surveillance
Unit among adults. Disaggregation
of data based on stage is not
available. There were 5 cases
among males and 18 cases among
females.
Number of adults reported with syphilis during the
reporting period
23
Government of Guyana Global AIDS Response Progress Report, 2015
123
Indicator
#
Indicator
Data Source Period Value
Comments
Number of individuals aged 15 and older 2002 Census 448,012
1.17.7 Number of reported congenital syphilis cases (live
births and stillbirths) in the past 12 months
‐
Guyana
MOH Surveillance
data Jan‐Dec
2013
0 2014 data is not currently
available. This will be updated in
May 2015.
Number of reported congenital syphilis cases (live
births and stillbirths) in the past 12 months
0
Number of live births
1.17.8 Number of men reported with Gonorrhoea in the
past 12 months
MOH Surveillance
data
Jan‐Dec
2014
Number of men reported with Gonorrhoea in the
past 12 months
17
Number of males aged 15 and older 2002 Census 207,028
1.17.9
Number of men reported with urethral discharge
in the past 12 months
MOH Surveillance
data Jan‐Dec
2014
829
Number of men reported with urethral discharge
in the past 12 months
829
Number of males aged 15 and older 2002 Census 207,028
1.17.10 Number of adults reported with genital ulcer
disease in the past 12 months
MOH Surveillance
data Jan‐Dec
2014
167
66 males and 101 females
Government of Guyana Global AIDS Response Progress Report, 2015
124
Indicator
#
Indicator
Data Source Period Value
Comments
Number of adults reported with genital ulcer
disease during the reporting period
167
Number of individuals aged 15 and older 2002 Census 448,012
1.18 Percentage of pregnant women with a positive
syphilis serology whose sexual contacts were
identified and treated for Syphilis.
‐
‐
NA
Data is not available
1.19 Diagnosis of HIV cases MOH Surveillance
Unit
Jan‐Dec
2014
HIV: 751
AIDS: 158
From 2014, AIDS cases were
reported to include persons with
CD4≤350. Previously, AIDS cases
were reported as persons with
CD4≤200
Jan‐Dec
2013
HIV: 758
AIDS: 88
Jan‐Dec
2012
HIV: 820
AIDS: 105
Jan‐Dec
2011
HIV: 972
AIDS: 62
Jan‐Dec
2010
HIV: 1039
AIDS: 146
3.3a Mother‐to‐child transmission of HIV (based on
programme data)‐ Estimated percentage of child
HIV infections from HIV‐positive women
delivering in the past 12 months
PMTCT and
NPHRL reports
Jan‐Dec
2014
2.6%
Number of children newly infected with HIV due
to other‐to‐child transmission among children
born in the previous 12 months to HIV‐positive
women
5
Number of HIV –positive women who delivered
in the previous 12 months
193
Government of Guyana Global AIDS Response Progress Report, 2015
125
Indicator
#
Indicator
Data Source Period Value
Comments
Target 3:
Eliminate new
Infections
among
Children
3.4
Percentage of pregnant women who were tested
for HIV and received their results ‐ during
pregnancy, during labour and delivery, and
during the post‐partum period (<72 hours),
including those with previously known HIV status
PMTCT/ANC
Programme
Jan‐Dec
2014
81.2%
Denominator is the actual number
of women attending antenatal
care in 2014
Numerator Number of pregnant women who were tested for HIV in the last 12 months and received their
results ‐ during pregnancy, during labour and delivery, and during the post‐partum period (<72 hours),
including those with previously known HIV status
Total number tested (including previously known
positives) 14,623
Total number tested and received results
(including previously known positives)
12,586
Total number testing positive (including previously
known positives) 293
(a) Total number of pregnant women attending ANC who were tested during ANC and received results or
knew their positive status.
Number tested (including previously known
positives)
13,370
Number tested and received results (including
previously known positives)
11,333
HIV+ out of number tested (including previously
known positives)
278
(a.i) Number of pregnant women with unknown HIV status attending ANC who were tested during ANC
and received results
Number tested 13,200
Government of Guyana Global AIDS Response Progress Report, 2015
126
Indicator
#
Indicator
Data Source Period Value
Comments
Number tested and received results 11,163
HIV+ out of number tested 108
(a.ii) Number of pregnant women with known HIV+ infection attending ANC for a new pregnancy
Number of HIV+ pregnant women 170
(b) Number of pregnant women with unknown HIV status attending L&D (labour and delivery) who were
tested in L&D and received results
Number tested 962
Number tested and received results 962
HIV+ out of number tested 10
(c) Number of women with unknown HIV status attending postpartum services within 72 hours of
delivery who were tested and received results
Number tested 291
Number tested and received results 291
HIV+ out of number tested 5
Denominator Estimated number of pregnant
women
15,494
3.5
Percentage (%) Percentage of pregnant women
attending antenatal care whose male partner was
tested for HIV in the last 12 months
PMTCT/ANC
Programme
Jan‐Dec
2014
9.2%
The number of males tested is a
reflection of the number tested at
the PMTCT programme. These
male partners could have been
tested independently at any other
HIV testing site. The reporting
system of the PMTCT programme
does not capture this information.
It is assumed therefore that this is
an under representation.
Numerator Number of pregnant women attending
antenatal care whose male partner was tested in
the last 12 months 1424
Denominator Number of pregnant women
attending antenatal care 15494
Government of Guyana Global AIDS Response Progress Report, 2015
127
Indicator
#
Indicator
Data Source Period Value
Comments
3.6
Percentage (%) Percentage of HIV‐infected
pregnant women assessed for ART eligibility
through either clinical staging or CD4 testing
Based on the national Guidelines
all HIV positive pregnant women
are eligible for treatment.
Numerator Number of HIV‐infected pregnant
women assessed for ART eligibility
Disaggregation by method of assessment
Clinical staging only
CD4 testing
*Women who were assessed both by CD4 testing
and by clinical staging should be counted only
once, as having been assessed by CD4 testing.
Denominator Estimated number of HIV‐infected
pregnant women
3.7
Percentage (%) of infants born to HIV‐infected
women (HIV‐exposed infants) who received
antiretroviral prophylaxis to reduce the risk of
early mother‐to‐child‐ transmission in the first 6
weeks (i.e. early postpartum transmission around
6 weeks of age)
PMTCT
Programme
Jan‐Dec
2014
92.2% There were 190 live births to HIV
positive women in 2014.
Numerator Number of infants born to HIV‐infected
women who received antiretroviral prophylaxis to
reduce early mother‐to‐child transmission (early
postpartum, in the first 6 weeks)
178
Denominator Estimated number of HIV‐infected
pregnant women giving birth
193
Government of Guyana Global AIDS Response Progress Report, 2015
128
Indicator
#
Indicator
Data Source Period Value
Comments
3.9
Percentage (%) Percentage of infants born to HIV‐
infected women started on cotrimoxazole (CTX)
prophylaxis within two months of birth
PMTCT
Programme
Jan‐Dec
2014
81.9%
The denominator represents the
actual number of HIV+ women
who delivered in 2014. Numerator
is the number of exposed infants
who received CTX within 6 weeks
of birth.
Numerator Number of infants born to HIV‐infected
women started on CTX prophylaxis within two
months of birth 158
Denominator Estimated number of HIV‐infected
pregnant women giving birth 193
3.10
Distribution of Outcomes of HIV‐Exposed Infants PMTCT
Programme
Jan‐Dec
2013
2013 data is reported
Number of infants born to HIV positive mothers
born in 2013(or latest data) 192
Number of infants born in 2013 to HIV positive
mothers, classified as indeterminate (i.e. lost to
follow up, death before definitive diagnosis,
indeterminate lab results) 0
Number of infants born to HIV positive mothers in
2013 that are diagnosed as positive for HIV 4
Number of infants born to HIV positive mothers in
2013 that are diagnosed as negative for HIV 188
3.11 Number of pregnant women attending ANC at
least once during the reporting period ANC Programme 15,494
3.12 Number of ANC facilities providing HIV testing and
counseling services 188
Public: 184
Private:4
Number of ANC facilities providing HIV testing and
counseling services and dispensing ARVs 20
Public:18
Private: 2
Percentage of health facilities that provide
virological testing services for diagnosis of HIV in
infants on site or from dried blood spots 3.7%
Government of Guyana Global AIDS Response Progress Report, 2015
129
Indicator
#
Indicator
Data Source Period Value
Comments
Number of health facilities that provide virological
testing services for diagnosis of HIV in infants on
site or from dried blood spots
1
On site: 0
Through DBS:1
The National Public Health
Reference lab is the only facility
that conducts virological testing
for HIV exposed infants via DBS.
Total number of health facilities that provide
follow up for HIV exposed infants 27
Target 4: 15
million people
accessing
treatment
4.2b Percentage of adults and children with HIV still
alive and known to be on treatment 24 months
after initiation of antiretroviral therapy (among
those who initiated antiretroviral therapy in
2011)
ART Programme Jan 2012‐
Dec 2014
75.1%
Lost to follow up: 60 (11.2%)
Stopped Therapy: 29 (5.4%)
Died: 46 (8.6%)
Numerator Number of adults and children who
were still alive and known to be on treatment 24
months after initiation of antiretroviral therapy
402
Denominator Number of adults and children who
initiated antiretroviral therapy during 2011 or the
specified period (including those who have died
since starting therapy, those who have stopped
therapy, and those recorded as lost to follow‐up at
month 24)
535
4.2c
Percentage of adults and children with HIV still
alive and known to be on treatment 60 months
after initiation of antiretroviral therapy (among
those who initiated antiretroviral therapy in
2008)
ART Programme
Jan 2009‐
Dec 2014 61.2%
Lost to follow up: 24 (13.5%)
Stopped Therapy: 10(5.6%)
Died: 32 (17.9%)
Government of Guyana Global AIDS Response Progress Report, 2015
130
Indicator
#
Indicator
Data Source Period Value
Comments
Numerator Number of adults and children who
were still alive and on antiretroviral therapy 60
months after initiating treatment
109
Denominator Number of adults and children who
initiated antiretroviral therapy during 2008 or the
specified period (including those who have died
since starting therapy, those who have stopped
therapy, and those recorded as lost to follow‐up at
month 60) 178
4.3a
Health facilities that offer antiretroviral therapy
ART Programme Jan‐Dec
2014
The unspecified site is the
national care and treatment
centre which is the largest care
and treatment facility and does
not fit into any of the categories
Numerator Number of health facilities that offer
antiretroviral therapy (ART) (i.e. prescribe and/or
provide clinical follow‐up)
22
Disaggregation by public/private:
Public 20
Private 2
Unknown/unspecified
Disaggregation by health centre type:
Hospital
13
Health centre 7
ANC 20
TB Service 12
STI 22
Unknown/unspecified 1
4.3b
Health facilities that offer paediatric
antiretroviral therapy
ART Programme Jan‐Dec
2014
All the HIV care and treatment
facilities offer pediatric ART.
Government of Guyana Global AIDS Response Progress Report, 2015
131
Indicator
#
Indicator
Data Source Period Value
Comments
Numerator Number of health facilities that offer
paediatric antiretroviral therapy (ART) (i.e.
prescribe and/or provide clinical follow‐up)
22
Disaggregation by public/private:
Public 20
Private 2
Unknown/unspecified
4.4
Percentage of health facilities dispensing
antiretrovirals (ARVs) for antiretroviral therapy
that have experienced a stock‐out of at least one
required ARV in the last 12 months
ART Programme
Jan‐Dec
2014
0
Numerator Number of health facilities dispensing
ARVs that experienced a stock‐out of at least one
required ARV in the last 12 months 0
Denominator Number of health facilities
dispensing ARVs 22
4.5
Late HIV diagnoses: Percentage of HIV positive
persons with first CD4 cell count < 200 cells/μL in
2013
National Public
Health Reference
Lab
Jan‐Dec
2013
37.5%
Data represents 13 out of 22 care
and treatment facilities (59%)
Number of HIV‐positive people with first CD4 cell
count <200 cells/
μl in 2013 197
Total number of HIV‐positive people with first CD4
cell count in 2013 526
4.6
Number of adults and children enrolled in HIV
care at the end of the reporting period
ART Programme Jan‐Dec
2014
746
There were 539 patients newly
enrolled in ART at the end of
2014 and 4295 patients receiving
Government of Guyana Global AIDS Response Progress Report, 2015
132
Indicator
#
Indicator
Data Source Period Value
Comments
Number of adults and children newly enrolled in
HIV care during the reporting period 605
ART.
4.7
a. percentage of people on ART tested for viral
load who were virally suppressed in the reporting
period
ART Programme
Jan‐Dec
2014
70.1%
Data represents 13 out of 22 care
and treatment facilities (54.5%)
Numerator number of people on ART tested for
viral load in the reporting period with suppressed
viral load (i.e. ≤ 1000 copies)
940
Denominator number of people on ART tested for
viral load in the reporting period 1340
b. percentage of people on ART tested for viral
load (VL) with VL level below ≤ 1,000 copies after
12 months of therapy 78.7%
Data represents 12 out of 22 care
and treatment facilities (59%)
Numerator number of people tested after 12
months therapy for VL and have suppression ( VL ≤
1000 copies) during the reporting period
381
Denominator Number of people tested after 12
months therapy for VL during the reporting period
484
c. Percentage of people on ART tested for viral
load with undetectable viral load in the reporting
period
Data is not available.
Target 5:
Avoid TB
Deaths
5.2 Percentage of adults and children living with HIV
newly enrolled in care who are detected having
active TB disease
ART and Pre ART
Registers
Jan‐Dec
2014
2.8%
Total number of adults and children newly
enrolled in HIV care who are diagnosed as having
active TB disease during the reporting period 32
Government of Guyana Global AIDS Response Progress Report, 2015
133
Indicator
#
Indicator
Data Source Period Value
Comments
Total number of adults and children newly
enrolled in pre‐ART care or on ART during the
reporting period 1114
5.3 Percentage of adults and children newly enrolled
in HIV care starting isoniazid preventive therapy
(IPT)
ART and Pre ART
registers, TB
Programme
Jan‐ Dec
2014
3.8%
Numerator Number of adults and children started
in HIV care during the reporting period (‘in HIV
care’ includes people in the pre‐ART register and
people in the ART register) who also start (i.e. are
given at least one dose) isoniazid preventive
therapy 44
Denominator Number of adults and children
started in HIV care during the reporting period (‘in
HIV care’ includes people in the pre‐ART register
and people in the ART register)
1144
5.4
Percentage (%) of adults and children enrolled in
HIV care who had TB status assessed and
recorded during their last visit
Patients’ charts
(ART Care and
Treatment Sites
Jan‐ Dec
2014
96.5%
Numerator Number of adults and children
enrolled in HIV care (‘in HIV care’ includes people
in the pre‐ART register and people in the ART
register) , who had their TB status assessed and
recorded during their last visit during the reporting
period
4864
Denominator Total number of adults and children
in HIV care in the reporting period (‘in HIV care’
includes people in the pre‐ART register and people
in the ART register)
5041
ANNEX 4: Consultation/preparation process for the national report on monitoring
the follow-up to the Declaration of Commitment on HIV and AIDS
1) Which institutions/entities were responsible for filling out the indicator forms?
a) NAC or equivalent Yes
b) NAPS Yes
c) Others (key stakeholders) Yes
2) With inputs from
Ministries Yes
Education Yes
Health Yes
Labor and Human Services Yes
Foreign Affairs No
Others No
Civil Society Organizations Yes
People living with HIV Yes
Private sector Yes
United Nations Organizations Yes
Bilaterals Yes
International NGOs Yes
Others (please specify) No
3) Was the report discussed in a large forum? Yes
Forum comprised representatives of the Government, private sector UN agencies, bilateral
Agencies, NGOs, FBOs, and persons living with HIV.
4) Are the survey results stored centrally? Yes
5) Are data available for public consultation? Yes
6) Who is the person responsible for submission of the report and for follow-up if
there are questions on the Country progress Report?
Name/title: Dr. Shanti Singh-Anthony, M.D., M.P.H.- Programme Manager, National AIDS
Programme, Ministry of Health Guyana
Government of Guyana Global AIDS Response Progress Report, 2015
135
ANNEX 5: Contributors to the Reporting Process
Country Team
1. Dr. Shanti Singh – Programme Manager, NAPS, Ministry of Public Health
2. Ms. Fiona Persaud – M&E Lead, NAPS, Ministry of Public Health
3. Dr. Morris Edwards, Director – Disease Control, Ministry of Public Health
4. Dr. Roberto Luiz Brant Campos – UNAIDS Country Director
5. Ms. Yaye Kanny Diallo – M&E Advisor, UNAIDS, Guyana
6. Ms. Stephanie Joseph De Goes – PEPFAR Coordinator
7. Mr. Oleksander Cherkas – Health Team Leader, USAID
8. Dr. Rosalinda Hernandez – FCH/HIV/STI Advisor/PAHO/WHO
9. Dr. Jean Seme Fils Alexandre, PAHO/WHO
10. Ms. Cornelly McAlmont – Child Survival and Development Officer, UNICEF
11. Mr. Dimitri Nicholson – Civil Society Representative
12. Ms. Preeta Saywack – Strategic Information Officer, PEPFAR
13. Mr. Dale Phoenix – Monitoring & Evaluation Officer, APC
14. Mr. Oswald Alleyne – Public Health Specialist, CDC
15. Ms. Mena Carto – Consultant, Country Progress Report
Agencies that Contributed Reports for the GARPR Preparation Process
1. Ministry of Public Health
2. National AIDS Programme Secretariat/ Ministry of Public Health
3. Ministry of Education
4. Ministry of Labour, Human Services and Social Security
5. Pan Caribbean Partnership against HIV/AIDS
6. President Emergency Plan for AIDS Relief
7. Advancing Partners and Communities
8. Guyana Defence Force
9. United Nations Development Programme
10. United Nations Children Fund
11. United Nations Population Fund
12. Pan American Health/World Health Organization
13. Guyana Business Coalition for HIV/AIDS
14. Guyana Responsible Parenthood Association
15. Society against Sexual Orientation Discrimination
16. Help and Shelter
Participants at the Consensus Meeting
1. Dr. Shanti Singh-Anthony, Program Manager, NAPS/Ministry of Public Health
2. Ms. Nafeza Ally, Social Services Coordinator, NAPS/Ministry of Public Health
3. Mr. Somdatt Ramessar, Food Bank Manager, NAPS/Ministry of Public Health
4. Mr. Murvin Chalmers, Data Entry Clerk, NAPS/Ministry of Public Health
5. Ms. Fiona Persaud, M & E Lead, NAPS/Ministry of Public Health
6. Ms. Gina Arjoon, Key Populations Coordinator, NAPS/Ministry of Public Health
Government of Guyana Global AIDS Response Progress Report, 2015
136
7. Ms. Deborah Success, VCT Coordinator, NAPS/Ministry of Public Health
8. Ms. Yanita Jaundoo, Care and Treatment Coordinator, NAPS/Ministry of Public Health
9. Mr. Nazim Hussain, Community Mobilization Coordinator, NAPS/Ministry of Public
Health
10. Ms. Roslyn Allen, Hotline Facilitator, NAPS/Ministry of Public Health
11. Ms. Shevonne Benn, HBC Coordinator, NAPS/Ministry of Public Health
12. Mr. Delon Braithwaite, VCT Qual Officer, NAPS/Ministry of Public Health
13. Ms. Romona Morgan, STI Coordinator, NAPS/Ministry of Public Health
14. Ms. Samantha Dhanraj, NAPS/Ministry of Public Health
15. Ms. Tamica Allen, NAPS/Ministry of Public Health
16. Mr. Joseph Hamilton, Parliamentary Secretary, Ministry of Public Health
17. Ms. Shamin Williams – PMTCT Programme, Ministry of Public Health
18. Ms. Debra Rose, Ministry of Public Health
19. Dr. Morris Edwards, Director of Disease Control, Ministry of Public Health
20. Dr. Ertenisa Hamilton, Focal Point, Adolescent Health, Ministry of Public Health
21. Dr. Bendita Lachmansingh, Epidemiologist, Ministry of Public Health
22. Ms. Diana Khan, NTP/ Ministry of Public Health
23. Ms.Oslyn Crawford, MoLHS&SS
24. Ms. Hymawattie Lagan, Women’s Affairs Bureau, MoLHS&SS
25. Ms. Janelle Sweatnam, MoE
26. Ms. Evelyn Hamilton, MoE
27. Ms. Yaye Diallo, Strategic Information Advisor, UNAIDS
28. Ms. Samantha Hall, UNAIDS
29. Mr. Oswald Alleyne – Public Health Specialist, CDC
30. Ms. Stephanie De Goes, PEPFAR Coordinator
31. Ms. Preeta Saywack, Strategic Information Officer, PEPFAR
32. Ms. Beverly Gomes-Lovell, Public Health Specialist, GDF/DOD
33. Dr. Jean Seme Fils Alexandre, PAHO/WHO
34. Mr. Dale Phoenix, Monitoring and Evaluation Officer, APC
35. Mr. Nicholas Persaud, APC
36. Ms. Sarah Insanally, PANCAP
37. Mr. Dimitri Nicholson – Civil Society Representative
38. Ms. Gloria Joseph, Executive Director, Lifeline Counseling Services
39. Ms. Roshana Rawlins, Linden CARE Foundation
40. Ms. Merica George, AIDS
41. Mr. Richard Collymore, FACT
42. John Quelch, SASOD
43. Ms. Suzanne French, Executive Director, GBCHA
44. Ms. Renuka Anandjit, GRPA
45. Ms. Shivanie Rampersaud, GINA
46. Ms. Shaundell Gomes, MTV
47. D. Daniels, Kaieteur News
48. Ms. Mena Carto, GARPR Consultant
A Qualitative Research Study on HIV
Vulnerability among Young Key
Affected Populations in Guyana
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A Qualitative Research Study on HIV Vulnerability
among Young Key Affected Populations in Guyana
Esther M McIntosh: Team Leader, Research Design, Writer □ Mena
Carto: Lead Field Researcher – HIV/AIDS Specialist □ Kevin Forgenay:
Youth Researcher □ Shanna Boodhoo: Social Researcher □ Grace
Roberts: Indigenous Researcher □ Timothy McIntosh: Data Analysis
Regional Youth Researchers and Focal Points: Paul Atkinson, Patrick Ashley,
Lauristan Choy, Ashley Van Lange, Quincy Shelto, Junior Blair
The Consultancy Group | 16 First Avenue, Subryanville, Georgetown, Guyana | +(592)-22
58771, 225 8773 | www.theconsultancygroupguyana.com
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I. Executive Summary
Adolescents in Guyana live in a fast,
technology-charged, promising,
colourful, violent, and exciting world. It
is a world with its own language, its own
values, its own pulse, its own complexity
and its own dangers. These dangers,
especially for some adolescents, include
a high risk of contracting HIV. It is a
disease, which ‘their age, biological and
emotional development and their
financial dependence’ (Kaiser 2004)
place them at a risk of contracting,
especially young women who make up
57.4 % of new infections.
The danger is also real – persons who
are younger than 25 years old, account
for more than half of new HIV infections.
Globally there are 5.4 million young
people living with HIV1. Guyana has an
HIV/AIDS prevalence of 1.1%. The
country has made significant strides in
HIV/AIDS prevention, and its efforts
have been recognized both locally and
internationally. Adolescents are viewed
as a key demographic. The 2009
Demographic and Health Survey (DHS)
in Guyana found that the age group of
15-19 years had shown a steep increase
in the proportion of HIV cases moving
from 3.66% in 2006 to 6.04% in 2009.
This study explores the vulnerability of
Young Key Affected Populations (ages
10-24) to HIV/AIDS in Guyana. It
examines the behavioural and socio-
cultural factors that make adolescents
vulnerable. The study sought to go
beyond the numbers, to explore
experiences, views and challenges
through the eyes of adolescents
themselves. The study used a
comprehensive framework to organize
the research, which included a review of
structural features (laws, policies etc.),
as well as the contextual characteristics
1 Estimates show that more than 7,400 people
become infected with HIV daily, 3,300 of whom
are young people. Source: UNAIDS
(networks, services, socio-economic
situation etc.) of adolescent
vulnerability to HIV/AIDS.
The study gathered information from
352 adolescents; in rural (124
adolescents), hinterland (88
adolescents) and urban (140
adolescents) contexts, over a three-
month period. The research team also
conducted more than 50 interviews with
key persons in the adolescents’ world
including teachers, employers, parents,
Probation Officers, religious leaders and
their peers.
The adolescents engaged in the study
included men who have sex with men, in
school youth, youth in contact with the
law, commercial sex workers and out-of-
school youth.
This report was researched at a dynamic
time when global funding is decreasing
and several programs that directly
provide services to youth are being
scaled down or terminated, which
makes Guyana’s pledge to ensure zero
new transmissions and its MDG goals all
the more challenging, especially for at-
risk adolescent populations.
Limitations
There were several limitations including
the time availability for field research,
difficulties accessing several key groups
especially MSMs and FSWs in rural and
hinterland areas, and not being given
access to schools in one region,
permission to access records and
personnel from a key ministry, in time
for the development of the report. The
range of adolescent sub-types that were
required to be included in the study was
quite broad, which made it difficult to
comprehensively focus on, or gather
data for one sub-group. The study relied
on respondents to self-report sexual
activity, although there was some
triangulation done with other sources.
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Key Findings:
Guyana’s Policy and Legal Framework
Based on the desk review, and key
informant interviews, it was found
that the institutional framework for
HIV and vulnerable adolescents in
Guyana has been strengthened by
major resource investments2 (by
both Government and donors), as
well as the introduction of key legal
acts, policies across various
ministries, and targeted agencies
(NAPS, Adolescent Health Unit etc.),
however, there are still several key
gaps.
There is no specific policy, or
strategy for YKAP, and no national
consensus on who Guyana’s YKAP
are, or specific guidelines for each
individual category of YKAP
especially those under the age of 18,
which would help to ensure that
deficiencies in policy and
programmes are addressed.
Civil society organizations are
widely recognized as having played
an important role in providing
services to vulnerable populations,
including YKAP, and this is
increasingly reflected in national
policies and programs that stress
partnerships and coordination with
NGOs. There are several national
NGOs that advocate for the rights of
key YKAP groups including MSM.
The Ministry of Health serves as the
focal ministry for HIV/AIDS, and
adopts a very practical approach to
the implementation of policy,
including provisions for MARPs.
The policies do not make an inter-
category distinction, for example
differentiating between adolescent
FSWs, MSMs etc., whose needs and
attributes are quite specific within
the MARP category.
The Public Health Ordinance
(1834), which guides HIV/AIDS
related health issues, has been
2 Though there was indication from both
government and civil society quarters that these
investments were steadily declining.
described in a 2004 report as,
“wholly incapable of addressing the
public health issues raised by
HIV/AIDS”.
Key acts such as the Sexual Offences
Act are not fully implemented and
punitive laws that negatively impact
at-risk populations, such as MSMs
and FSWs, reinforce stigma and
discrimination, and can potentially
negatively affect access to services.
A national assessment (2004) found
several legal and constitutional
gaps, which are directly relevant to
YKAP, including the criminalization
of same-sex partnerships,
confidentiality and privacy laws etc.
The empirical research revealed
that there is a sense at the local
level that the impartiality and
effectiveness with which sexual
offenders were handled by the
justice system left considerable
room for improvement, as well as
the need to monitor the outcome of
cases. It was highlighted that
systematic weakness resulted in
many perpetrators of rape and
sexual abuse going unpunished,
despite a perceived rise in these
incidences, including cases of “step-
daddy rape”.
Key policies that have been
developed to address
discrimination, such as the National
HIV Workplace Policy and the
School Health, Nutrition and
HIV&AIDS Policy, do not place any
legal obligation on institutions and
are largely voluntary. Other key
policies such as the National Youth
Policy and the National Sports
Policy have either not been drafted
or not been implemented. Policies
such as the Workplace Policy do not
refer to adolescents specifically, nor
do the policies generally reflect the
participation of adolescents/YKAP
in their development.
There are several key provisions in
the Ministry of Education’s School
Health Policy that were found to not
have been widely implemented,
such as the promotion of psycho-
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social support in schools and
capacity building for teachers and
parents.
The age of consent in Guyana is 16
years of age. This, among other
things, requires the authorization of
parents of sexually active YKAP
who are under-age to have an
HIV/AIDS test: however, this was
generally reported as a prohibitive
factor for accessing the service.
There is some indication that the
Ministry of Health has shown some
flexibility with this provision.
Although MoE and MoH were
reported to have contradictory
approaches (MoE promoting
abstinence, MoH promoting safe
sexual activity), this is not reflected
in the provisions of the MoE’s policy
regarding the distribution of
condoms, which is to be determined
by the school.
There is a prevalent gap in
knowledge of both adolescent
Rights Holders (including several
key agencies, local government
authorities, teachers and private
sector agencies), as well as that of
Duty Bearers on the legal and policy
provisions for adolescents in
Guyana. For example, among key
local government bodies such as
Village Councils and Regional
Democratic Councils, which affects
their ability to support the rights of
YKAP being upheld, as well as the
introduction of programs that may
potentially address key issues
relevant to YKAP.
Psycho-Social and Protection Issues3
Many male and female YKAP were
grappling with various psychosocial
issues (feelings of abandonment,
low self-esteem, trauma, bullying
etc.) that were bottled up, and for
3 UNICEF defines this as children who have “ exposure
to violence, disaster, loss of, or separation from, family
members and friends, deterioration in living
conditions, inability to provide for one’s self and family,
and lack of access to services can all have immediate
and long-term consequences for children, families and
communities and impair their ability to function and be
fulfilled.
which professional counselling was
generally not available, resulting in
feelings of isolation. In a few
extreme cases, cutting, overdose
and other forms of suicide had been
attempted. In-school youth also
stated that they wanted to have
confidential counselling services
available to them.
Changing socio-economic dynamics
(migration, absent mothers, single
parents) and poverty have a direct
effect on the type of support that
young people have available to
them in their homes.
Poverty was generally viewed as a
significant driver of adolescent
vulnerability.
There was a comparatively higher
reporting of violence in urban
schools than in those in the rural
and hinterland areas.
Adolescents with disabilities, and
10-14 year old adolescents who
were out-of-school were found to
be especially vulnerable and spent a
significant period of their day
unsupervised. Similarly, youth in
contact with the law (including
YPLHIV) did not have adequate
sexual and reproductive health
services and psycho-social support.
Alcohol and, to a significantly lesser
extent, marijuana/cocaine are
perceived by key informants as
being significant risk factors.
However, although some male and
female adolescents felt that
consumption did place them at risk,
others did not recognise the
connection to increased risk, “it
spruces up the night”.
Suicide (Regions 1 and 6), teenage
pregnancy (Regions 1 and 6) and
teenage marriage (Region 6) were
pronounced in both urban and rural
contexts.
There was mixed feedback on
teachers and parents; some parents
were adapting their parenting style
to meet the needs of their
adolescent children, while some did
not speak to their children about
reproductive health issues. Parents
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were generally identified as
needing to have skills to support
HIV/AIDS prevention. This is a
significant inhibitor to providing a
supportive environment for
adolescents. This was further
exacerbated by the marked lack of
formal support networks for youth
in all categories, including the 10-
14 and 15-19 age groups.
Sexual and Reproductive Health
Issues;
Although the sexual debut of
adolescents was reported by
several key informants as being at a
very young age (11 and 12 years
old), the study found that among in-
school youth there was not a
significantly high level of early
sexual debut; of those who were
sexually active in hinterland areas,
the majority of reported sexual
activity started at 14 years old for
males and 15 years old for females.
In rural areas, early sexual debut
began at 15 years old for both
sexes, and in urban areas there
were some reports of early debut
around 12 and 13 years old. Among
FSWs, MSMs and youth in contact
with the law this varied and
responses were inconsistent, but
these groups tended to be sexually
active from a young age.
Although there was sexual activity
reported among the 10-14 age
range, this tended to be more
among males than female
adolescents, and in the categories of
youth in contact with the law,
hinterland males and out-of-school
(school aged youth).
In a few cases, both male and
female adolescents reported forced
sex. Among Amerindian girls there
was a notably higher reporting of
rape and sexual abuse (from as
young as 8 years old) than among
other female cohorts in the same
age range of different ethnicities.
This was reinforced by interviews
with several key informants
including the police, School Welfare
Officers and the Regional Chairman,
who had concerns about the rate of
abuse.
FSWs and MSMs tended to have
higher levels of awareness of
HIV/AIDS than other cohorts.
However, there are still knowledge
gaps in terms of awareness and
understanding on HIV/AIDS, and
awareness efforts are still needed
among various YKAP populations
including youth in contact with the
law and in-school youth.
HIV/AIDS education was generally
reported (teachers and students) to
be taught in schools starting from
Grade 6, and schools are a central
source of information especially in
the hinterland and to a lesser extent
rural areas, where access to
television, internet and cell phones
is more limited than in urban
contexts.
HFLE and other programs that
teach life skills and provide
practical examples for youth are
essential. However, their impact
and effectiveness need to be
determined, as no evaluation has
been done of the program.
There are still no extensive facilities
or services available for adolescents
(both male and female) who have
been abused. In the hinterland
areas, although there was a VCT
present, it was used primarily for
pregnant mothers.
It was common among young girls
and boys who had become sexually
active to try to induce the same type
of behaviour in their immediate
circle, and peer pressure was
widely cited as a general factor.
Perceptions of the availability,
accessibility, and quality of
reproductive and sexual health and
HIV-related services
Guyana’s focus on youth specific
services is well founded, and it is
suggested that these need to be
expanded to widen both the scope
of the populations served and the
range of services, as well as
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providing targeted services for
specifically vulnerable youth
populations.
The quantity and variety of services
(including through communications
media) that are available to
adolescents were much higher in
urban areas than in hinterland and
rural areas.
Key groups such as out-of-school
youth, FSWs, MSMs and youth in
contact with law, have special
service needs and barriers that
make the accessing of services
difficult. These include their remote
location, stigma and discrimination
(especially in rural areas), and in
the case of out-of-school youth,
their limited engagement with key
services.
Several key services provided by
key agencies such as GGMC (Region
1) and various NGOs have been
discontinued because of a lack of
funding. Several initiatives for
youth, Youth Friendly Health
Services (YFS) and Community Care
Points (MHSSS) were found to be
critical, but HFLE is being stopped
in school at a critical age (Grade 9)
when youth are becoming sexually
active, experimenting with alcohol
or are under pressure to have sex.
There are several key points of
vulnerability in an adolescent’s life,
and one of the less obvious ones
seems to be in the period just
before they exit school and
immediately after, as they adjust to
a world without the social
reinforcement for positive
behaviour of a school environment.
Adolescents were more likely to use
NGO-run facilities and services than
MoH facilities; this is because of the
perceived poor quality of condoms
and the heightened need for privacy
and confidentiality.
The use of condoms is not high
among key YKAP groups (especially
MSM and youth in contact with the
law), the overwhelming majority of
male youth in contact with the law
(15-19 age range) respondents
have had sex, but approximately
only one third have ever used a
condom. Attitudes among YPLHIV,
and among youth in contact with
the law, ranged from denial and fear
to anger; and in one instances a
desire to re-infect by not disclosing
their status.
Across all geographic locations
there was a perception that
condoms have a high failure rate,
especially those condoms that are
sourced from NGOs and hospitals,
which meant that adolescents felt
that they had to buy condoms, but
they did not always have the
finances to do so. In hinterland
areas, there was a perceived lack of
anonymous access to free condoms,
and the relatively high price of
“good” condoms in the shops
(rough-rider: $500) was at times
prohibitive.
In rural areas, among sexually
active 15-19 year old girls and boys,
there was a significant reporting of
unprotected sex. Even among older
19-24 year old educated females
whose sexual partners were not
monogamous, unprotected sex and
unwanted pregnancies were also
reported, especially in Region 1 and
6 (hinterland and urban). It was
found that even though adolescents
were aware of the risk and of means
of protection, it did not always lead
to behavioural change.
Testing was generally found to be
very low (except among YKAP and
FSWs), especially among youth
where services are largely
unavailable (hinterland, rural).
Among sexually active males there
is a perception that condoms are
the most vital form of protection
and that testing was secondary. As
such, they were less likely to be
tested unless they were targeted in
school campaigns, or the annual
National Week of Testing, which
was generally ad hoc.
Sports and increased recreational
facilities were some of the most
requested facilities among youth, to
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provide alternatives to risky
behaviour and to promote
awareness.
Stigma and Discrimination
The School Health, Nutrition and
HIV&AIDS policy makes no mention
or provision for YKAP, and this may
serve to both marginalize among
others, LGBT and adolescents with
disabilities, and impact their ability
to enjoy their right to an education
in a safe environment, that is not
characterized by discrimination,
and in which services such as
counselling are available.
Several key Duty Bearers (including
teachers, schools, parents, Village
Councils etc.) were found to lack the
personal capabilities and
organizational capacities to
effectively support HIV/AIDS
prevention among YKAP.
Homophobia is strongest in urban
and rural areas and the quality of
life of adolescent YKAP is often
affected.
There was significant reporting of
discrimination against female FSWs
and male MSMs.
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II. Acknowledgement
This report builds on a considerable body of
experience, effort, research and commitment that
has been invested in HIV/AIDS prevention in
Guyana since the first case was documented in
1987. At the forefront of these efforts have been
various government ministries, civil society
organizations, parents, teachers and volunteers
who have often gone unrecognized in their tireless
efforts to reduce risk and vulnerability of Guyana’s
youth. Several of these persons participated in the
study, contributing their invaluable expertise and
time.
The knowledge that this report has generated was
largely made possible by the participation of
adolescents themselves. More than 300 young
persons from all walks of life across Guyana, who
travelled to venues, and took the time to share their
views, perspectives, dreams and sorrows with a
small team of researchers. Many of them did so
with an understanding that what they shared was
valued, and their contribution would help to
improve the situation of young people throughout
Guyana.
In an effort to improve the responsiveness to
HIV/AIDS in Guyana, the Ministry of Education with
funding from UNICEF’s Youth and Adolescent
Development Programme commissioned this study
and were steadfast in their support to the research
team.
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III. Abbreviations &
Acronyms
AIDS Acquired Immune Deficiency Syndrome
ARV Anti Retro Viral
CARICOM Caribbean Community
CBO Community Based Organization
CDO Community Development Officer
CRSF Caribbean Regional Strategic Framework
CRC Convention on the Rights of the Child
CSO Civil Society Organization
FSW Female Sex Worker
EVAs Especially Vulnerable Adolescents
GRPA Guyana Responsible Parenthood Association
HFLE Health and Family Life Education
HIV Human Immunodeficiency Virus
LGBT Lesbian Gay Bisexual Transgender
YKAP Most At Risk Adolescent
MARPs Most At Risk Populations
MCYS Ministry of Culture Youth and Sport
MHSSS Ministry of Human Services and Social Security
MoAA Ministry of Amerindian Affairs
MoE Ministry of Education
MoH Ministry of Health
MSM Men who have Sex with Men
NCHA National Commission on HIV and AIDS
NAPS National Aids Program Secretariat
NDS National Development Strategy
NOC New Opportunity Corps
OVC Orphans and Vulnerable Children
PANCAP Pan Caribbean Partnership against HIV/AIDS
PEPFAR The United States President’s Emergency Plan for
AIDS Relief
PEHRB People Engaged in High Risk Behaviours
PLHIV People Living with HIV/AIDS
PRSP Poverty Reduction Strategy Paper
PMTCT Prevention of mother-to-child HIV transmission
PTA Parent Teacher Association
REDO Regional Education Officer
STD Sexually Transmitted Diseases
STI Sexually Transmitted Infection
SWO School Welfare Officer
TB Tuberculosis
UNICEF United Nations Children’s Fund
USAID United States Agency for international
Development
VCT Voluntary Counselling and Testing
YKAP Young Key Affected Persons
YPLHIV Young People Living with HIV
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IV. Table of Contents
SECTION I ……………………………………………………………………………………… 13
1. Introduction …………………………………………………………………………………………………………………….. 13
1.1 Research Objectives ………………………………………………………………………………………………………… 14
1.2 Report Structure ……………………………………………………………………………………………………………… 14
1.3 Human Subject Protection ……………………………………………………………………………………………. 15
1.4 Limitations of the Study ………………………………………………………………………………………………… 15
1.5 Methodology …………………………………………………………………………………………………………………. 16
1.6 Research Methods……………………………………………………………………………………………………………. 17
1.7 Sampling ……………………………………………………………………………………………………………………………. 18
1.9 Literature Review ……………………………………………………………………………………………………………. 20
SECTION II …………………………………………………………………………………….. 26
2. Policy and Legal Framework ……………………………………………………………………………………….. 26
2.2 National Legislation and Policy …………………………………………………………………………………. 30
2.2.1 The National Development Strategy (2001-2010) and Poverty Reduction
Strategy Paper (2012-2017) ……………………………………………………………………………………………….. 32
2.2.2 PRSP Priority Sector: Health …………………………………………………………………………………….. 33
2.2.3 PRSP Priority Sector: Education ………………………………………………………………………………. 34
2.2.4 National AIDS Strategy 2007-2011 …………………………………………………………………………. 35
2.2.5 HIV/AIDS Workplace Policy ………………………………………………………………………………………. 36
2.2.6 National HIV Prevention, Principles, Standards and Guidelines ……………………… 37
2.2.8 Ministry of Education Policy ……………………………………………………………………………………… 41
2.2.9 Ministry of Culture Youth and Sport ……………………………………………………………………….. 42
2.2.10 Ministry of Human Services …………………………………………………………………………………….. 43
2.2.11 Age of Consent ……………………………………………………………………………………………………………. 43
SECTION III ……………………………………………………………………………………. 46
3. Regional Context …………………………………………………………………………………………………………….. 46
3.1.1 Hinterland Context ………………………………………………………………………………………………………. 47
3.1.2 Hinterland Context ………………………………………………………………………………………………………. 49
3.1.3 Urban Context ……………………………………………………………………………………………………………….. 50
SECTION IV ……………………………………………………………………………………… 80
4.1 Empirical Evidence on Most At Risk Adolescents …………………………………………………. 80
Key Findings ………………………………………………………………………………………………………………………… 81
4.2 What do adolescents know about HIV/AIDS? ………………………………………………………….. 86
4.4 Are adolescents using condoms and getting tested? ……………………………………………. 116
4.5 Are adolescents using alcohol and other psychoactive drugs? …………………………. 128
4.6 What are their views of self, and their world? ………………………………………………………. 132
SECTION V……………………………………………………………………………………… 145
5. Analysis and Recommendations………………………………………………………………………………… 145
Annexes
Terms of Reference
Inception Report
Report on the YKAP Report Validation Exercise
Relevant Information from the Guyana HIVision 20/20
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List of Figures and Tables
Adolescent Research Participants by Sex 17
Adolescent Research Participants by Ethnicity 17
Adolescent Research Participants by Sex and Region 17
Adolescent Research Participants by Region 17
Using Focus Groups in Program Development and Evaluation 18
Key Studies on HIV/AIDS in Guyana 23
Map Showing Population Density by Region 45
Eco-Social Framework for Assessing Adolescent Vulnerability 46
Poverty in Guyana by Region 47
Population by Sex and Region 48
Diagram – Most Coded Support and Information Responses 88
Table showing Differences in Male and Female Awareness 91
Diagram – Most Coded Sexuality Responses 100
BSS Finding on Condom Use in the Past Six Months 115
Diagram – Most Coded Social Issues Responses 128
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SECTION I
1. Introduction
Adolescents in Guyana are a key, and
significant demographic; more than fifty
percent of the total population is less than the
age of twenty-four (Census 2002). Adolescents
are a crucial catalyst for socio-economic
development, and as such their well-being is
inextricably linked to the development
prospects of the country. These realities put
into immediate perspective the potential
impact of the world’s leading cause of
adolescent mortality. As a Government of
Guyana publication has highlighted, “as in other
countries, HIV/AIDS affects the most
productive age groups (20-49) in the society.
This makes Guyana very vulnerable to the
devastating impact of HIV/AIDS. HIV/AIDS is
already the leading cause of death among these
age groups in Guyana.4”
This qualitative research study on Young Key
Affected Populations (YKAP), and their
vulnerability to HIV/AIDS was commissioned by
the Ministry of Education (MoE), with funding from
the United Nations Children’s Fund (UNICEF). The
aim of the research was to “gather and analyse
qualitative data regarding the factors that
contribute to the vulnerability of adolescents and
young people to HIV”. The research was dual
purposed in that it sought firstly to generate
information and secondly, to create an action
oriented framework to allow for identified gaps and
challenges to be addressed by Duty Bearers in
Guyana.
To that end, the study sought to generate
information to determine the level of awareness
and attitudes among 10-14 year old adolescents in
urban, rural and hinterland areas, to gather
additional data on 15-19 and 20-24 year old male
and female adolescents, as well as MSMs, YPLHIV
and FSWs in order to enable effective planning to
4 Source: Government of Guyana, National HIV/AIDS
Programme – Social Context
(http://www.hiv.gov.gy/gp_hiv_gy.php)
Guyana’s youth comprise a
significant demographic
accounting in 2002
(National Census) for 53%
of the total population
(751,223).
In 2002 the National Census
determined that there were
398,495 children and youth
between the ages of 0-24
years old. There are slightly
more females than males
and in both sexes, the 0-14
population is larger than the
15-24.
Most of the young people
who are resident in Guyana
are concentrated in Region
4.
53%
Guyana’s Population less than 24
years old
67%
of this figure that are between the
ages of 0-14
33%
Between the ages of 15-24
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deliver a comprehensive, culturally appropriate
targeted programmes for HIV prevention and other
health related activities for youth in Guyana.
The study spanned four geographical regions
(Region 1, Barima-Waini, Region 2 Pomeroon-
Supenaam, Region 4, Demerara-Mahaica and
Region 6 East Berbice-Corentyne) representing
three settlement types – rural, urban and
hinterland.
1.1 Research Objectives
The objectives of the study were to:
Gather and analyze qualitative data regarding
the factors that contribute to the vulnerability
of the most at risk and especially vulnerable
adolescents and young people.
To generate information from specific target
groups on HIV: males and females aged 10-24
among the population of men who have sex
with men, male and female sex workers,
adolescents and young boys and girls who are
out of school and unattached, boys and girls
residing in children’s homes and places of
safety, as well as those who are living with HIV.
Determine the level of awareness and attitudes
among 10-14 year old adolescents in Regions
2, 6, and 8 and gather additional data on 15-19
year old male and female adolescents in order
to enable effective planning to deliver
comprehensive, culturally appropriate target
programmes for HIV prevention and other
health related activities for hinterland youth of
regions 1, 2, 7, 8, and 9.
1.2 Report Structure
This report is divided into six (6) sections of which
this introductory section containing background
information on the project, research objectives and
methodology is the first. The second section
outlines the legal and policy framework in Guyana.
Section three provides an outline of the three
settlement typologies used in the research (rural,
hinterland, urban) and integrates information
obtained from secondary and primary sources,
most notably the key informant interviews.
Section four presents the empirical research
findings in five areas exploring knowledge and
47% 53%
Male
Participants
Female
Participants
Adolescent Participants by Sex
0 50
R 1
R 2
R 4
R 6
Mixed
Amerindian
Indo-
Guyanese
Afro-
Guyanese
0 50 100 150
R 1
R 2
R 4
R 6
88
124
85
55
Adolescent Participants by Ethnicity
RESEARCH
PARTICIPANT
PROFILE
0
20
40
60
80
Male
Female
Adolescent Participants by Region
Adolescent Participants by Region
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awareness, sexual practices, the use of condoms
and testing, alcohol and psychoactive substances,
self and the wider world. It also includes four case
studies that further explore key issues.
Section five is an analysis section which reviews the
findings outlined in the previous sections, and
incorporates a framework to explore key areas and
make recommendations. These include
comprehensive information and life skills, services,
a safe and supportive environment and
opportunities for participation. Section six outlines
a YKAP Action Plan for Guyana, developed largely
out of the findings of the study, including inputs
from key policies and development plans.
1.3 Human Subject Protection
The Ministry of Health’s Institutional Review Board
(IRB), in keeping with the guidelines of the
Government of Guyana, approved the YKAP
research project.
In instances where minors formed part of the focus
group Parental Consent Forms, outlining the
objectives and purpose of the study, were
presented to parents for approval. Care was given
to ensure that the rights of all informants to
anonymity and confidentiality is respected and
upheld. Key research ethics will be involved in how
the data is handled, attributed and shared.
All of the persons who participated in the study
were familiarized with the purpose and objectives
of the study. The identity of all adolescent research
participants has been withheld and throughout the
report pseudonyms are used.
1.4 Limitations of the Study
As with all rapid assessments there are
limitations to the scope and depth of the
research.
The research team had great difficulty in
recruiting adolescent MSMs, especially in
rural and hinterland areas. We were told by
one older MSM in Region 2 (Essequibo
Coast) that there is significant
discrimination and intimidation of MSMs
and as such many of them had relocated to
the coast. In Region 1 the research was
conducted in January and we were told that
the majority of the FSWs were not available
as they had not returned from their
HIV Prevalence in
Guyana
UNAIDS estimates that Guyana
has an adult prevalence of
2.4% (range:1.0%–4.9%).
Between 1987 and the end of
2006, a cumulative total of
7,831 AIDS cases have been
officially reported to the
Ministry of Health.
In 1987, there were
1.3cases/100,000 population,
but this increased to 56.2 cases
per 100,000 population by
2003. Cases have been reported
in all ten geographical regions
of the country. The majority of
the cases are among persons
20-44 age group. AIDS is
currently the leading cause of
death among the 20-49 age
group. Overall, about 28% of
the cases are female, but in the
age group under 24, females
account for the majority of
cases. The overwhelming
evidence is that the
transmission of HIV is primarily
through heterosexual exposure.
Source: Government of
Guyana
www.hiv.gov.gy
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holidays. The time did not permit travel to
the ‘backdam’ area. In the urban centres the
MSMs and FSWs that were sourced through
NGOs tended to be older and outside the
age range of the YKAP study.
In Region 6 the Regional Education Office
did not permit the research team to enter
schools and conduct interviews because the
research was conducted during a period of
exams. Some in-school youth were accessed
through gatekeepers, mainly local NGOs
with their parents’ permission.
Key interviews with various Ministry of
Health personnel were not conducted, since
permission from the Ministry of Health had
not been obtained at the time of writing.
1.5 Methodology
The study was commissioned as a qualitative study
(See TOR). Qualitative research is essentially social
research (the collection, analysis and interpretation
of data by observing human behaviour) and is
differentiated from quantitative research because
of its reliance on text and the analysis of data in its
textual form. It “aims to understand the meaning of
human action (Schwandt, 2001), and asks open
questions about phenomena as they occur in
context rather than setting out to test
predetermined hypotheses” (Cochrane Qualitative
Research Methods Group, 2006; Pound et al., 2005).
Qualitative methods have been successfully used in
health research although there is a recognition that
the demand for more evidence-based research and
the use of standardized assessment criteria (Little,
2007). However, although subjective, qualitative
research is also appreciated as a good complement
to quantitative research in providing greater depth
and understanding of social phenomenon.
The approach allowed the study to address two key
elements of the research requirements: the need to
understand local realities and perceptions of
adolescents across Guyana, as well as, UNICEF’s
practical need to design and implement programs
that are responsive to the needs of at-risk youth in
the country. The approach allowed for adolescents
to be studied in their “natural environment” and
allowed for the documenting of their behaviour,
perceptions and sexual health related choices.
The study aimed to capture how adolescents
interact and engage with the wider world where
Key Terms
Adolescence
Adolescence is defined as “a period
characterized by rapid physical,
cognitive and social changes,
including sexual and reproductive
maturation, gradually building up
capacity to assume adult behaviors
and roles, which involves new
responsibilities requiring new
knowledge and skills.” For the
purpose of this study, adolescent age
range spanned 10-24.
YKAP
Young Key Affected Populations
(YKAP) refer to 10-24 year olds who
are most likely to be exposed to HIV
or transmit it and whose lives are
significantly affected by HIV. YKAP
includes young people who inject
drugs, young males who have
unprotected anal sex with other
males, young females, males and
transgender people who are
engaged in sex work
and young people living with HIV
Vulnerability
According to a UNAIDS definition,
vulnerability results from a range of
factors that reduce the ability of
individuals and communities to avoid
HIV infection. These may include: (i)
personal factors such as the lack of
knowledge and skills required to
protect oneself and others; (ii) factors
pertaining to the quality and coverage
of services, such as inaccessibility of
services due to distance, cost and
other factors (iii) societal factors such
as social and cultural norms,
practices, beliefs and laws that
stigmatize and disempower certain
populations, and act as barriers to
essential HIV prevention messages.
These factors, alone or in
combination, may create or
exacerbate individual vulnerability
and, as a result, collective
vulnerability to HIV.
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their sexuality is concerned and as it relates to HIV
risk behaviours. The study will not limit youth
responses to health-related aspects of their lives
but will seek to obtain perspectives on several
aspects – psychosocial, spiritual, legal and human
rights and livelihoods (economic). The research
used a variety of participatory tools including focus
groups, mapping participant observation and semi-
structured interviews.
1.6 Research Methods
1.6.1 Focus Groups
Focus groups were one of the main sources of
knowledge generation within the project; 6-10
persons were invited to participate in focus group
sessions mainly organized through schools and
community leaders, “gate keepers”. Focus groups
can be defined as “facilitated group discussions
using scripted questions that are generally
populated by a homogenous audience of interest to
the researcher” (Holsman 2002: 4). The method is
useful for soliciting views and perspectives from a
particular group and on a particular topic. The FG
used open-ended questions and stratified
respondents by category and sex.
1.6.2 Participant Observation
Participant observation was also used to observe
local situations and interactions. These included
observing youth centres, sports activities,
entertainment areas etc.. Observation was used to
gain a more in-depth and closer familiarity with the
situation of adolescents not only from the
perspective of what they ‘say’ but also what they
‘do’.
1.6.3 Case Studies
Case studies were used to provide insight into two
types of cases: “typical” cases and situations as
reflected in focus groups and informant interviews,
as well as to cases that represent deviance from the
norm or minority issues – e.g. cases in which the
experience of the adolescent is atypical.
1.6.4 Key Informant Interviews
KIIs were conducted with other non-adolescent
stakeholders such as health and educational staff,
parents, VCT staff, and private sector businesses in
order to gain insight and perspectives of other key
actors. This partially supported the validation of
findings collected during the focus group and
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observation methods of the study.
1.6.5 Coding and Analysis
There are certain predetermined core steps that
were observed in the post-research (focus group)
phase. These are represented in the schematic
below. The responses were taped, transcribed and
coded using a computer program, MAXQDA5.
Diagram developed from Rennekamp and Nall paper
(undated) Using Focus Groups in Program
Development and Evaluation
1.7 Sampling
Purposive sampling strategies are designed to
enhance our understanding of the selected
individuals or sub-group. The research team sought
to accomplish this by selecting “information rich”
cases, that is individuals, groups, organizations, or
behaviours that provide the greatest insight into
the research question. Sampling strategies were
adopted and revised throughout the research
process, as more knowledge of the local context and
subjects was obtained, in these instances,
convenience sampling was also employed. For
example, in Region 1 there was a higher reference
to teenage pregnancy than in other regions and
whilst at the Regional Office, the Chief Nurse
facilitated interviews with a group of teenage
mothers.
The study, by its nature required multi-stage
sampling, as sampling was done at various levels.
5 MAXQDA is a professional software for qualitative and mixed
methods data analysis and allowed for the analysis of the large
number of interview data that the study generated.
• Transcribe data
• Coding of similar data
identified in the transcript
(viewpoints, issues,
concerns etc)
Indexing
• Sorting and clustering of
coded information
• Data processing
Data
Management • Use of Induction to move
from specific to general
• Identification of key
themes for reporting
• Creation of a
comprehesive report
Interpretation
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Firstly, the administrative regions in which the
study was conducted, another parameter is the
desire to reflect rural, hinterland and urban
scenarios in the research. Purposive sampling was
therefore used to identify the regions of focus. The
regions selected were based on areas of interest for
MoE and UNICEF for example, UNICEF is planning
to conduct a study on “child friendly regions” in
Region 2 which would make a strong case for
gathering data from that region6.
Once the regions were identified, random sampling
was used to select the districts/communities in
which the research was conducted using Microsoft
Excel’s Random Number Generator function.
However, purposive sampling was predominantly
employed since the study seeks to identify a
particular sub-population as outlined in the table
below and some communities/areas were
recommended for study once information is
generated.
A list of key centres and relevant institutions
(NGOs, care homes, schools etc..) in each region was
drawn up to support the identification of
areas/centres/schools. These were then either
purposively or randomly selected (communities,
schools, VCTs etc.).
1.8 Identifying Focus Group Participants
Participant Driven Recruitment (PDR) was adopted
to identify key individuals and groups (church,
NGOs etc.) in the community. To some extent,
snowball sampling was also used as adolescents
provided the contact of and introductions to other
participants. The researchers adopted a fluid and
flexible process as information was obtained in the
field and a clearer understanding of the local
context was understood. Some areas/communities
were purposively sampled based on the presence of
relevant cases as identified by key persons such as
school and health personnel, the Regional
Chairman, Toshaos, NGOs and other community
leaders.
6 When this study commenced in 2011 it was conducted
exclusively by UNICEF, as such in the initial stages UNICEF
determined the study regions this was then revisited in late
2012 and MoE took influenced the selection of sites namely
including Region 1 and Region 4.
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1.9 Literature Review
Assessing Risk among Adolescents
Central to the study is the concept of risk among
adolescents. One of the concomitant research
challenges is how best to capture and explore risk
among adolescents. One of the key areas explored
in the literature is the perception of risk by sexually
active and inactive adolescents. In the majority of
literature surveyed, there is often a close
correlation cited between HIV infection and risky
behaviour.
The joint report, Young People and HIV Opportunity
in Crisis (2002: UNAIDS, UNICEF, WHO) states that
young people in particular are at especially high
risk for contracting HIV. A 2007 study in the African
Journal of Reproductive Health highlights some of
the challenges of researching risky behaviour,
namely that adolescents can identify their
vulnerability based on their inaccurate perceptions
of riski. It therefore becomes important to identify
“between actual behavioural risk and perceptions
of risk among adolescents”7.
This is significant distinction, which speaks to the
need to both determine adolescent perceptions
about risk and compare those to what is known
about HIV behavioural risk.
The study, “Perceptions of risk to HIV Infection
among Adolescents in Uganda” also identified a
broad range of factors that play a role in behaviour
change which considered both “personal and
environmental factors”8. Personal factors included
variables such as “age, education, wealth, personal
experiences, gender, personal beliefs/attitudes and
self-efficacy,”9 and environmental factors included
social norms and practices, institutional/national
factors and infrastructure to support desired
behaviour as well as information and influence
from peers and the media.”
1.9.1 Guyana HIV Prevalence10
7 Ibid
8 Ibid
9 Ibid
10 Data on the prevalence of HIV in Guyana is taken from
several key sources including the UNGASS Progress Report
2008-2009, National AIDS Programme Secretariat (2010),
Guyana’s Demographic and Health Survey – GDHS – (2009).
Guyana Behavioral Surveillance Survey 2008/2009 Report, the
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Research on HIV among adolescents in Guyana can
be firmly situated by key data and empirical
research on the global context. The international
data on adolescent HIV infection places the rate at
11.8 million young people living with HIV globallyii.
Another key qualifier of this statistic is that
globally, young people who represent one quarter
of all persons infected by HIV are among the 15-24
year old age range. The majority of infected youth
are women (7.3 million)iii. Approximately 5-6,000
young persons are infected every day in the
developing world11. The situation is exacerbated by
several key characteristics, which are key to the
current study, namely that – youth are risk-takers,
lack awareness and women are disproportionately
affected12.
Guyana’s HIV situation is categorized as a
generalized epidemic. In 2004, UNAIDS estimated
that the prevalence of HIV infection among adults in
Guyana was 2.5% (range 0.8 – 7.7%). In 2010,
UNAIDS released a major report on HIV prevalence
in Guyana, in which it was reported that HIV rates
were stabilizing but still quite high. However,
Guyana had one of the highest prevalence rates of
HIV infection in Latin America and the Caribbean.
There are also signs of changing trends, for example
the 2006 National AIDS Strategy stated that:
The data demonstrate that while the early epidemic
affected more men than women, there is an
increasing feminization of the epidemic and more
women are recorded with HIV today than men,
especially in the age groups of 15 and 24. More than
90% of the recorded cases occur among the age
groups of 15-49 (2006: 18).
However there was preliminary evidence that by
2009 there were changes in this trend. UNAIDS
reported that Guyana was the only country in the
region with a one to one ratio of men to women
living with HIV (2009) which suggested the
importance of effectively targeting both sexes.
According to the DHS, “a larger proportion of men
15-49 (10 percent) than women (1 percent)
reported having had more than one sexual partner
in the 12 months preceding the survey.
Guyana HIV/AIDS Indicator Survey (2005) and Guyana’s 2007
Epidemiological Profile.
11 Source: World Bank: www.worldbank.org
12 Ibid
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Additionally, a higher percentage of men (30
percent) than women (17 percent) reported having
had sex with a person who was neither their spouse
nor their cohabiting partner (higher-risk sex) in the
year before the survey.” (DHS 2009: 218)
Other studies focused on the sexual health of men
(Fields and Stephney, 2006) in Guyana have
highlighted the importance of balancing the
gendering of services since “Sexual Reproductive
Services …are mainly geared towards addressing
female issues.” Fields and Stephney make the case
for targeting males from a young age since they are
a high-risk group and normally have multiple
partners.
The DHS (2009) found that knowledge of AIDS is
“almost universal” and places it at 97% and another
study (2007) places awareness among young
people at 95.6%iv. Two hinterland regions recorded
the lowest level of knowledge among women
(Region 9 – 78%) and among men (Region 7 and 9 –
92% each). The study found a positive correlation
between awareness, education and wealth among
respondents. The study also found that knowledge
and awareness was higher in urban areas than in
hinterland and rural areas. The 2008/2009 BBSS
highlighted a geographical trend in HIV cases in
Guyana; there is a high incidence among urban
centres13 – Region 4 (144.8 per 10,000 population)
has the highest rate followed by Region 10 (86.6
per 10,000).
As reflected in Guyana’s National AIDS Strategic
Plan, significant investments have been made since
Guyana’s first reported case (1987) to the present
day. This includes policy provisions, infrastructure
(VCTs etc.), increases in public health funding, NGO
facilities and personnel. There has also been a
significant role played in HIV eradication efforts by
civil society organizations such as GHARP,
Merundoi and Artistes in Direct Support. As a
USAID report stated, the number of VCT facilities
doubled between 2005-2009, an indication that the
Government of Guyana has “prioritized reducing
transmission of HIV among adolescents, using peer
education strategies to target both in-school and out-
of-school youth.”v
13 Research was conducted in two urban regions as opposed to
one rural and one hinterland region in the other contexts. This
allowed for a greater understanding of the urban context.
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There has also been some quantitative research
done on HIV generally, and to a lesser extent on
youth specifically. However, what is generally
lacking in the research are the voices and
perspectives of youth and of hinterland-specific
data and information.
1.9.2 Key Studies on Adolescents and HIV in
Guyana
The situation in Guyana reflects the international
trend, that young people are especially vulnerable
to HIV infection. A GHARP Report14 (2010) stated
that this is “because they may have shorter
relationships with more partners or engage in other
risky behaviours.” As stated in Guyana’s National
AIDS Strategic Plan 2006-2011, young people are
“disproportionately affected and there is an
increasing feminization of the epidemic”.vi More
women than men between the 15-24 age range
have HIV and this is a critical age bracket. 15
The following table provides a summary of key studies:
Year Author Title Region
2003/4 Ministry of Health Round 1 BSS+ Among In
school youth
1-7, 9, 10
2003/4 Ministry of Health Round 1 BSS+ Among Out-of-
school youth
3,4,6,10
2005 Guyana Ministry of
Health
AIDS Indicator Survey 1-10
2005 GHARP Qualitative Assessment of
Barriers and Motivational
Factors towards HIV Risk
Reduction Practices among
MARPS – Youth, FCSWs and
their Clients in Guyana
4,6,8,10
2006 Derek Fields and
Orin Stephney
Male Participation in Sexual
and Reproductive Health
3,4,6,10
2007 Brian O’Toole et al Knowledge and attitudes of
young people in Guyana to
HIV/AIDS
7 regions
2007 UNICEF PRSP Consultation Among
Most-At-Risk Youth in the Ten
Administrative Regions of
Guyana
1-10
2010 Molly
Jenkins/GHARP II
Qualitative Assessment of
MSM in Guyana
Overview and Preliminary
Findings
3, 4,6
14 This report was prepared by Molly Jenkins a PhD student
from the University of Washington. The report is titled,
“Qualitative Assessment of MSM in Guyana, Overview and
Preliminary Findings”.
15 The strategy states that 90% of HIV infected persons are in
the age range of 15-49.
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More than 4,000 young people were surveyed in
2007 (Brian O’Toole et al), to determine their HIV
Knowledge and Attitudes in 7 of 10 regions. The
study found that “one-third of the respondents
reported having had sexual intercourse, but this
figure was highest for males aged 15–20 years
(48%) and lowest for females aged 12–14 years
(15%).”vii
The study found sexual activity to be high among
young people (24% of those aged 12-14) and higher
among those aged 15 and over. In total 2 in 5
sexually active young people were using condoms.
The report stated that the findings suggest, “that a
sizeable number of young people appear to be
engaging in risky behaviour, especially as most
declared they were aware of the availability of
condoms in their area, and only a minority
considered that it lessened sexual pleasure.” These
findings are consistent with those of an earlier
study; MARPS (2005) study, which found that in-
school and out-of-school youth had knowledge of
STIs and knew where to access information but
didn’t always use condoms.
1.9.3 Guyana’s At Risk Groups
Generally, research and reports on Guyana identify
several at risk sub-populations including
commercial sex workers and men who have sex
with men (MSM).
The GHARP II study, “Qualitative Assessment of MSM
in Guyana, Overview and Preliminary Findings”,
focused on MSMs in regions 3, 4 and 6 engaging 62
MSMs. The study found that MSMs are “highly
diverse in terms of their profiles, behaviour,
experiences, and attitudes,” however the study did
not limit its participants to youth but covered a
broad age range 16-61. Most of the men were
receptive sex partners, they cited issues of stigma
as well as issues within the care system
(accusations of VCT counsellors publicly outing
persons as being HIV+). The study also highlighted
high alcohol and to a lesser extent drug use among
MSMs. Interestingly, for this study, the researcher
recommended that it was important to clarify
among MSMs that the term ‘MSM,’ “is used to
describe a behaviour, rather than an identity, and
that any male is considered a MSM if they have sex
with men—regardless of whether they are
“straight,” “gay,” “bisexual,” or are married.” This is
significant because it is possible that a very
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important at risk group may be under-represented
and not targeted effectively.
The MARPs study covered both MSMs and FSWs
and found that there was generally awareness
coupled with some confusion on HIV/AIDS “the
main STI” and how to “deal with STIs”. (2005: 184)
HIV was reported to be contracted, “if an infected
man discharges semen in you” and “if an infected
man with a rotten tooth kisses you”. (2005: 187).
Condom use among FSWs appeared to be high
based on the findings of the MARPs study.
The desk review found that women were
considered to be a key and at-risk demographic
because of the increase in infection rates reported
both in Guyana and the Caribbean. As stated in the
National AIDS Strategy:
The data demonstrate that while the early epidemic
affected more men than women, there is an
increasing feminization of the epidemic and more
women are recorded with HIV today than men,
especially in the age groups of 15 and 24. More than
90% of the recorded cases occur among the age
groups of 15-49 (2006: 18).
Central to an understanding of vulnerability of
adolescents and risks is the context in which they
live and their interactions with key actors (peers,
parents etc.), which clearly have a direct impact on
how they feel and the choices that they make. As
such, it is not just places or “hot spots” that put
them at risk, but the persons that they interact with
in the outside world.
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SECTION II
2. Policy and Legal
Framework
2.1 Introduction
The adequacy, responsiveness and relevance of
Guyana’s policy, and legal provisions for affected
youth populations and at-risk adolescents, is
central to determining the extent to which there is
an enabling institutional framework, and legal
environment to govern HIV/AIDS related matters
among vulnerable adolescents. By extension, it is
also central to ensuring that the rights of both
children and adolescents are protected and upheld
under the law. It is therefore important that
Guyana’s institutional framework is aligned with
international and regional laws, and the provisions
in conventions that Guyana is a signatory to, or
member of, such as the Convention on the Rights of
the Child.
The objective of this section of the report is to
determine what the current framework is, the
extent to which it comprehensively addresses key
issues related to youth, male and female YKAP, and
to identify gaps. The analysis in this section
integrates relevant key studies that assess the local
context16. In general, there is a paucity of legal
research and analysis that has been done on the
legal environment for Most at Risk Persons
(MARPs) or Young Key Affected Populations
(YKAP) in Guyana.
The YKAP study used a broad definition of who
were ‘most at risk’ adolescents and included
generally accepted at-risk populations (MSMs,
FSWs, drug users) with other groups such as youth
in contact with the law, out-of-school youth etc.. As
such, this section generally examines what the
provisions are for youth and where possible,
identifies key national policies, laws and
institutions that are relevant to at risk adolescents.
The documents reviewed in this analysis include:
National Development Strategy 2001-2010
16 Bulkan, Arif (2004) National Assessment on HIV/AIDS, Laws,
Ethics and Human Rights in Guyana. National Aids Committee
publication, Georgetown, Guyana.
The Convention on the
Rights of the Child (CRC)
affirms ‘the right of the child to
the enjoyment of the highest
attainable standard of health’, the
right to education and to be free
from all forms of exploitation
The CRC General Comment No. 3
compels Governments who signed
the CRC to give
children/adolescents (10/17
years old) access to ‘adequate
information related to HIV/AIDS
prevention and care.’
The CRC also acknowledges the
capacity of adolescents less than
18 years of age to make decisions
for themselves “in a manner
consistent with the evolving
capacities of the child” (Article 5).
The determination of evolving
capacity’ is important in the
receiving of care and accessing of
services by adolescents.
United Nations General
Assembly Special Session
(UNGASS) on HIV/AIDS
The United Nations General
Assembly Special Session on
HIV/AIDS (UNGASS) held in 2001,
resulted in the issuance of the
Declaration of Commitment on
HIV/AIDS (DoC) which was
adopted by all UN member states.
UNGASS recognizes the specific
vulnerabilities of young people to
the HIV/AIDS pandemic. It has six
of twenty-five indicators, which
are gendered and specifically
focused on youth.
International
Framework
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The PRSP (2011-2015)
Guyana National AIDS Strategy 2007-2011
Guyana National HIV Prevention Principles,
Standards and Guidelines
National Health Strategy 2008-2012
National HIV Workplace Policy
National Education Policy17
One challenge was that several of the key policies
are in draft including:
National Youth Policy
National Sports Policy18
National Health Vision 20/20
And therefore an analysis of the law becomes
especially important. In 2004, the National Aids
Committee commissioned a comprehensive review
of Guyana’s legal framework, which formed the
basis of the legal analysis, along with more current
reports and findings.
Key findings:
Based on the desk review, and key informant
interviews, it was found that the institutional
framework for HIV and vulnerable adolescents
in Guyana has been strengthened by major
resource investments19 (by both Government
and donors), as well as the introduction of key
legal acts, policies across various ministries, and
targeted agencies (NAPS, Adolescent Health
Unit etc.) but there are still several key gaps.
There is no specific policy, or strategy for YKAP,
and no national consensus on who Guyana’s
YKAP are, or specific guidelines for each
individual category of YKAP, especially those
under the age of 18, which would help to ensure
that deficiencies in policy and programmes are
addressed.
Civil society organizations are widely
recognized as having played an important role
in providing services to vulnerable populations,
including YKAP, and this is increasingly
reflected in national policies and programs that
stress partnerships and coordination with
NGOs. There are several national NGOs that
17 Current policies are highlighted in bold.
18 A copy of the draft Sports Policy was obtained through the
UNICEF office and reviewed.
19 Though there was indication from both government and
civil society quarters that these investments were steadily
declining.
Millennium Development
Goals
MDG 6: Combat HIV/AIDS
Target 6.A:
Have halted by 2015 and
begun to reverse the spread of
HIV/AIDS
6.1 HIV prevalence among
population aged 15-24 years
6.2 Condom use at last high-
risk sex
6.3 Proportion of population
aged 15-24 years with
comprehensive correct
knowledge of HIV/AIDS
6.4 Ratio of school attendance
of orphans to school
attendance of non-orphans
aged 10-14 years
Target 6.B:
Achieve, by 2010, universal
access to treatment for
HIV/AIDS for all those who
need it
6.5 Proportion of population with
advanced HIV infection with
access to antiretroviral drugs.
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advocate for the rights of key YKAP groups
including MSM.
The Ministry of Health serves as the focal
ministry for HIV/AIDS and adopts a very
practical approach to the implementation of
policy, including provisions for MARPs, the
policies do not make an inter-category
distinction, for example differentiating between
adolescent FSWs, MSMs etc. whose needs and
attributes are quite specific within the MARP
category.
The Public Health Ordinance (1834), which
guides HIV/AIDS related health issues, has been
described in a 2004 report as, “wholly incapable
of addressing the public health issues raised by
HIV/AIDS”.
Key acts such as the Sexual Offences Act are not
fully implemented, and punitive laws that
negatively impact at-risk populations such as
MSMs and FSWs reinforce stigma and
discrimination, and can potentially negatively
affect access to services. A national assessment
(2004) found several legal and constitutional
gaps, which are directly relevant to YKAP,
including the criminalization of same-sex
partnerships, confidentiality and privacy laws
etc.
The empirical research revealed that there is a
sense at the local level that the impartiality and
effectiveness with which sexual offenders were
handled by the justice system left considerable
room for improvement, as well as the need to
monitor the outcome of cases. It was
highlighted that systematic weakness resulted
in many perpetrators of rape and sexual abuse
going unpunished despite a perceived rise in of
the incidence of these, including cases of “step-
daddy rape”.
Key policies that have been developed to
address discrimination, such as the National
HIV Workplace Policy and the School Health,
Nutrition and HIV&AIDS Policy, do not place
any legal obligation on institutions and are
largely voluntary. Other key policies such as the
National Youth Policy and the National Sports
Policy have either not been drafted or not been
implemented. Policies such as the workplace
policy, do not refer to adolescents specifically,
nor do the policies generally reflect the
participation of adolescents/YKAP in their
development.
There are several key provisions in the Ministry
of Education’s school health policy that were
found to not have been widely implemented,
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such as the promotion of psycho-social support
in schools and capacity building for teachers
and parents.
The age of consent in Guyana is 16 years old,
and this does, among other things, require the
authorization of parents for sexually active
YKAP who are under-age to have an HIV/AIDS
test, which was generally reported as a
prohibitive factor for accessing the service.
There is some indication that the Ministry of
Health has shown some flexibility with this
provision.
Although MoE and MoH were reported to have
contradictory approaches (MoE promoting
abstinence, MoH promoting safe sexual activity)
this does not reflect the provisions in the MoE’s
policy regarding the distribution of condoms,
which is to be determined by the school.
There is a prevalent gap in knowledge of both
adolescent Rights Holders (including several
key agencies local government authorities,
teachers and private sector agencies), as well as
Duty Bearers on the legal and policy provisions
for adolescents in Guyana. As well as supporting
key local government bodies such as Village
Councils and Regional Democratic Councils to
support the rights of YKAP being upheld as well
as the introduction of socio-economic programs
that allow for alternative livelihoods.
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2.2 National Legislation and
Policy
The analysis of legislation and policy seeks to
respond to seminal questions, such as the extent to
which the HIV adolescent situation is reflected in
national development strategies, the extent to
which national poverty reduction strategies include
plans to address HIV-related vulnerabilities among
adolescents and the extent to which this informs
and guides the work of implementing ministries.
These vulnerabilities encompass a broad range of
sectors including economic (poverty,
unemployment), social (health, education, juvenile
reform, sexual abuse, gender based violence and
even political (participation in youth groups,
representative bodies etc.). One objective of this
aspect of the research was to explore the extent to
which there were policy provisions that were
supported by law. As such, this section explores the
policies and programmes of several key ministries
including health, education and youth.
There are inherent challenges in assessing a legal
Caribbean Regional HIV and
AIDS Partnership
Framework 2010-2014
This is a five-year strategic
framework to support
implementation of Caribbean
regional and national efforts to
combat HIV and AIDS. It is aligned
with the Caribbean Regional
Strategic Framework 2008 – 2012
(CRSF).
A key objective of the CSRF is to,
(1) reduce vulnerability to HIV
and (2) establish comprehensive,
gender-sensitive and targeted
prevention programs for children
(9-14) and youth (15- 24) and (3)
achieve universal access to
targeted prevention interventions
among MARPs
There are six (6) strategic goals:
1. An enabling environment
that fosters universal access to
HIV prevention, treatment, care
and support services;
2. An expanded and
coordinated multi-sectoral
response to the HIV epidemic; 3.
Prevention of HIV
transmission;
4. Treatment, care and
support;
5. Capacity development for
HIV/AIDS services; and
6. Monitoring, evaluation
and research.
It emphasizes a focus on
underserved PEHRB’s and MARPs
and at-risk-youth.
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framework for Most At Risk Adolescents, namely
because several of these behaviours are illegal,
specifically, drug use20, prostitution21 and
homosexuality22. Therefore an analysis of the law
becomes especially important.
Guyana’s policy efforts have been widely
acknowledged for being reflective of international
best practice, rights-based, practical and
progressive.
The previous National Development Strategy
identified health as a key priority and elaborated a
strategy for Guyana’s national HIV/AIDS response
based on:
Implementation of the National HIV/AIDS
Prevention Plan
20 In Guyana, illicit drug use is penalized by the Narcotic Drug
and Psychotropic Substances (Control) Act, Chapter 35:11.
According to Bulkan (2004), “the Act penalizes certain acts
relating to narcotic use. This includes the possession of any
“pipe or other utensil” used in connection with the “smoking,
inhaling, or sniffing or otherwise using” of opium, cannabis,
heroin or cocaine. The legislation contains no provisions
whereby needle or syringe exchanges could be facilitated –
quite the contrary, possession of such implements is strictly
forbidden on pain of severe penalties. Moreover, although the
Minister is empowered to make regulations to carry out the
purposes of this Act, 108 providing for needle or syringe
exchanges would NOT be included among such powers, and to
achieve this (if desired), legislative intervention would be
required.”
21 In Guyana it is illegal to keep a premises “a common bawdy
house” for the purpose of prostitution. It is also an offence to
“to loiter or importune any person in a public place for the
purpose of prostitution.115 According to Bulkan, “these
offences make it illegal to carry out commercial sex work in a
house and on the street – in other words the law seeks to
outlaw prostitution indirectly by prohibiting the means or
facilities for carrying it out.”
22 In 2012, an envoy by Dr Edward Greene to Guyana served as
a catalyst for review of Guyana’s laws concerning LGBT.
However, it is currently a criminal offence to be gay.
“According to the Criminal Law (Offences) Act of
Guyana,Section 352:Any male person who, in public or private,
commits, or is a party to the commission, or procures or
attempts to procure the commission, by any male person, of
any act of gross indecency with any other male person shall be
guilty of a misdemeanour and liable to imprisonment for two
years. Section 353: Everyone who (a) attempts to commit
buggery; or (b) assaults any person with intent to commit
buggery; or (c) being a male, indecently assaults any other male
person, shall be guilty of felony and liable to imprisonment for
ten years. Section 354: Everyone who commits buggery … shall
be guilty of felony and liable to imprisonment for life. The law
does not specifically define “buggery”, “gross indecency”, or
“indecent”. (Bulkan, 2004)
The framework advocates for
several key policy changes within
the Caribbean:
Enabling and improving access to
effective, non-discriminatory
prevention, care, treatment and
support services for PEHRBs and
MARPs
Addressing legislative barriers to
the provision of effective
prevention, care, treatment and
support services for at-risk youth
Expanding existing national policies
on counselling and testing to allow
for the accreditation of non-medical
personnel and the use of non-
traditional sites for rapid HIV
testing
Developing, implementing and
enforcing policies to reduce
attitudes of stigma and
discrimination by health care
workers, employers and other
service providers against PLHIV and
PEHRBs
Engaging religious and community
leaders and other prominent
opinion shapers as advocates in
developing a human rights advocacy
framework to reduce stigma and
discrimination
Ensuring that laws regarding sexual
abuse and gender-based violence
are implemented and enforced
Advocating for access to effective
legislative redress for HIV and
AIDS-related stigma, discrimination,
and acts of violence
Supporting policy reform to
promote partner notification of
Tuberculosis (TB), Sexually
transmitted infections (STI), and
HIV status as a public health
strategy.
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Prioritization of HIV and STIs
The development of policy documents
addressing the health needs of each
vulnerable group
Tackling of Adolescent Health through
Educational Programs
In Guyana, the 1834 Public Health Ordinance
regulates public health. This law, was assessed in
the 2004 study and found to be, “wholly incapable
of addressing the public health issues raised by
HIV/AIDS – preceding as it does the latter’s
outbreak by almost half a century”.
There were amendments in 1989 specifically to
address AIDS, however the NAC found, “the bulk of
its provisions are outdated and inappropriate for
addressing the unique characteristics of this
disease.” It concludes that, “the Public Health
Ordinance does not directly address HIV prevention
issues such as requiring the provision of
information or education, nor does it guarantee
access to treatment comprising health services,
medication and other medical procedures.
Notification is required only of AIDS and not HIV.”
The law currently brands HIV/AIDS as an infectious
disease, however, “persons suffering from an
infectious disease may be forcibly isolated and
detained until they are no longer infectious by
order of a Justice of the Peace acting on the
certificate of a sole medical practitioner, and the
lone safeguard is that the Director of Medical
Services is empowered to intervene if the detention
exceeds 6 months.”
Several international agencies, including UNAIDS
have called on states, as reflected in its
International Guideline No. 4, to “review and
reform criminal laws and correctional systems to
ensure they are consistent with international
human rights obligations and are not misused in the
context of HIV/AIDS or targeted against vulnerable
groups.
2.2.1 The National Development
Strategy (2001-2010) and Poverty
Reduction Strategy Paper (2012-2017)
Guyana’s Poverty Reduction Strategy Paper (PRSP)
2011-2015 outlines the national response to the
HIV/AIDS epidemic and demonstrates an
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awareness of the impact that HIV/AIDS can have on
Guyana’s national development and specifically its
social, economic growth. There is a clear link made
with poverty reduction and health. The strategy
outlines 8 priority areas, one of which is health, and
which directly references communicable diseases
and specifically HIV, tuberculosis and malaria. In
addition, within the education priority sector,
HIV/AIDS is also identified and strategized for as a
priority.
The strategy documents several of the successes
over the years with regard to HIV/AIDS reduction:
“HIV cases which had increased from 400 cases in
2001 to peak at 1356 in 2006 began declining and by
2008 only 959 cases were reported. Remarkably,
reported AIDS cases decreased from 435 in 2001 to
less than 24 in 2008, indicating clearly the benefits of
the investment by the Government and its partners in
providing care and treatment with Anti-Retroviral
(ARV) medicines in the fight against HIV/AIDS.
Prevalence for HIV as measured by ante natal testing
done in 1995 and three serial ANC surveys in 2000,
2004 and 2006 indicates steady decline from 5.6%
(2000) to 1.5% (2006). HIV remains concentrated in
the more populated urbanized Regions (4 and 10)
and less prevalent in the hinterland Regions of 1, 7, 8
and 9.”
2.2.2 PRSP Priority Sector: Health
Reducing Communicable Diseases: HIV,
STIs, Tuberculosis and Malaria
The health policy outlined by the government has
eight (8) priority areas of focus, of which HIV/AIDS
is one. There are also other reinforcing and related
areas of reform, including (i) improving quality
care, (ii) ensuring access to health services for
every citizen (including people with disabilities)
and (iii) health systems strengthening. The
development of policy and its prescriptions has
largely evolved during the several decades of
experience in addressing the HIV/AIDS epidemic in
Guyana.
The current policy is directed at reducing the
spread of HIV and the consequences of morbidity
and mortality rates on socio-economic
development. The policy states that, “particular
Guyana’s Labor Force
At the time of the last census,
two-thirds of the total
population was of a working
age (15-64 years old) GIn 2002
it was two-thirds of the total
population (475,219 persons)
“In Guyana, males enter the
labour force from age 15 and
their activity rate rises
sharply to 86 percent by age
20-24, and after that rises
sharply to more than 90
percent until the 45-49 age
group. From age 50, we
notice a progressive attrition
from the labour force because
of retirement and death.
Like the males, small proportion
of the females enters labour
force from age 15 which is the
legal age at work entry in
Guyana, and then the rate rises
and remains high in the main
working age groups, and
marking the maximum average
in 40-44 years (42 percent)
before declining.”
Guyana Census 2002
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attention will be paid to the needs of vulnerable and
most-at- risk populations.”
The targets for HIV are “people of all ages”, the
adult population being aware of their status,
pregnant mothers and people living with HIV. It
does not specifically reference youth or at-risk
populations. In general persons who are less than
16 years old require parental consent to be tested
in a VCT.
HIV/AIDS funding in recent years has resulted in
testing facilities (VCTs) in each region (at fixed
centres), through NGOs and mobile teams. The
policy reiterates the focus on pregnant mothers and
states that, it provides services to 90% of pregnant
women in Guyana. It also focuses on treatment –
the provision of free ARVs to PLHIV. It does
recognize some shortcomings in monitoring (page
80). It also proposes streamlining approaches
through the development of Standard Treatment
Guidelines.
The PRSP identifies the development of a new
health sector strategy (Vision 20/20). The PRSP
focuses on HIV generally and in a much more
limited way on youth specifically. Youth are
mentioned in relation to the law and then in making
the provision of health services “people-focused
and user-friendly”. The document identifies the
expansion of the Youth Friendly Health Centre
Initiative in regions 1,7,8 and 9 i.e. Guyana’s
hinterland regions.
2.2.3 PRSP Priority Sector: Education
Strengthening school health, nutrition, HIV&
AIDS in the curriculum
A core strategy for HIV/AIDS within the education
sector is the implementation of the Health and
Family Life Education (HFLE) program in schools.
Another key area is the establishment of “a
mechanism for psycho- social counselling in schools
in collaboration with NGOs and CBOs”.
Based on some recent experiences, the Ministry
plans to progressively establish a mechanism for
psychosocial counselling in schools. Teachers will
be trained in this area and the participation of NGOs
and Community Based Organizations (CBO) will be
encouraged.
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2.2.4 National AIDS Strategy 2007-2011
The National AIDS Strategy, which is the policy
instrument of the National Commission on HIV and
AIDS (NCHA) will shortly be replaced by that
National HIV Vision 20/20. Apart from the National
Commission on HIV and AIDS, the other key agency
is the National AIDS Program Secretariat. At the
time of writing there was no information available
on the content of the new policy.
The strategy was largely consistent with current
international policy principles. It expounded a
multi-sectoral, evidence-based and targeted
approach. It also endorses the role of non-state
actors such as civil society groups and the private
sector. It does not present a structure of how these
bodies will contribute to the realization of the
strategy.
The strategy identifies several key issues that are
relevant to the current study:
Young people are disproportionately
affected
It identifies issues of adequate resources to
implement the plan
Treatment is working and is being
accelerated
Lack of knowledge of one’s status was an
issue affecting a broad range of sub-
populations (Thus, only 17% of MSM, 28%
of FSW, 32% of GUYSUCO employees, 34%
of uniform services personnel, 55% of out
of school youths and 66% of In-school
youths knew of the avail- ability of VCT
(BSS 2004).
Significant numbers of in and out of school
youth did not have significant knowledge –
(between 14% and 38% of In-school and
out-of-school youths who lack a
comprehensive knowledge of the methods
of prevention for HIV. Males have less
knowledge of the prevention methods than
female. More than 50% of the rural
population, more than 30% of FSW and
MSM and 15% of the uniform services lack
this knowledge.)
Vulnerable populations identified in the document
are:
Blood donors
Pregnant women
STI Patients
FSW
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MSM
TB Patients
Miners
2.2.5 HIV/AIDS Workplace Policy
The National HIV Workplace policy was developed
to combat discrimination in the workplace for
PLHIV under the purview of the MHSSS. Key aspects
of it include:
Recognizing HIV/AIDS as a workplace issue;
Confidentiality and Non-discrimination on the
grounds of status;
Recognition that women are more likely to be
infected;
The introduction of prevention measures such
as training and awareness.
The policy does not expressly refer to adolescents
(it refers broadly to “all age groups”, employers
who may have YKAP in their employ etc.. The policy
does not require any legal obligation on the part of
employers.
This policy is a landmark development since it
seeks to address a critical issue for YKAP and
YPLHIV, that of discrimination. According to the
2004 assessment, “By far the most common instance
of discrimination directed against PLHA exists in
relation to employment.” The NAC Assessment also
clearly outlines that several of these policy
provisions have no legal basis in law.
It states that there is “no law that specifically allows
or prohibits HIV screening for employment
purposes. However, the combination of
constitutional provisions and other legislation
impact indirectly on this issue. Article 149A which
provides that no person shall be hindered in the
enjoyment of his or her right to work, that is to say,
the right to free choice of employment, and article
149D which guarantees to all persons equality
before the law, and equal protection and benefit of
the law. Although untested to date, the combined
effect of these Constitutional guarantees would
make it supremely difficult for the State to refuse
employment to someone on the basis of that
person’s HIV status, Therefore, while there is no
specific mention of HIV/AIDS, the definition of
‘disabled person’ is wide enough to capture this
condition.”
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The Workplace Policy also seeks to address, and
makes provisions for key issues related to privacy,
stigma and confidentiality.
The NAC in their 2004 national assessment
explores in great detail these issues and their basis
in the law. It noted that the 2003 amendment of the
Constitution, “inexplicably repealed article 40
(privacy), replacing it with a bare statement that
contains no mention of privacy at all. The result is
that in Guyana there is no express right to privacy
in the Constitution, and our Bill of Rights cannot be
invoked to protect the sanctity of medical
information.”
The NAC recommends:
In addition to the above, public health
legislation or general anti-discrimination
legislation should be specifically amended to
prohibit HIV screening for employment
purposes.
2.2.6 National HIV Prevention,
Principles, Standards and Guidelines
A key document within the national framework is
the guidelines developed by the Ministry of Health,
which along with the HIV strategy form the
backbone for HIV prevention in Guyana.
There are five principles with a standard and a wide
range of implementation guidelines to achieve
prevention:
1. Multi‐sectoral, multi‐dimensional and
reaches everyone
2. Based on and driven by the promotion,
protection and respect of human rights,
diversity, gender equality, and
addresses the most vulnerable and the
drivers of the epidemic
3. Based on science; is targeted, focused,
evidence-informed, and developed,
delivered and maintained at a high level of
excellence
4. Locally-adapted and prioritized according
to the epidemiological scenario and
socio–cultural contexts
5. Informed by continuous research and
innovative technologies
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Within the standards there are specific references
that are relevant for YKAP:
For example under principle 2:
Prioritizes and focuses on those most
affected by and most vulnerable to HIV
Reaches those most marginalized and
vulnerable to HIV
Takes into account economic disparities
and other inequities
Principle 3:
Is age-appropriate and relative to level of
cognitive development
Reaches people, based on established risk
profiles
Analyses the individual,
couple/relationship, group and societal
factors that impede and support healthy
relationships
Principle 4:
Is locally adapted and informed by socio-
cultural contexts
Is user-centered and user-friendly
There are also places in which adolescents are
specifically referred to usually within the context of
schools:
Focus on the needs of adolescents and
work in close tandem with the Ministry of
Education to ensure that the schools play
an active role in protecting adolescents
against HIV infection
Design appropriate HIV prevention
programs to target disproportionately
affected groups including women and
youth, that are relevant in their socio-
cultural settings
Provide sexuality and reproductive health
education to adolescents and young
adults, including HIV awareness
Design evidence-informed activities for
out-of-school youth in high-risk and high
prevalence areas
Provide sexuality and reproductive health
education to adolescents and young
adults, including HIV
Address and take gender norms and
‘masculinities’ into consideration that put
boys and men at higher risk for HIV
infection and of infecting others
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Provide information and education on
issues that impede HIV prevention, such
as HIV-related stigma and discrimination,
sexual violence and abuse, as well as
gender insensitivity and inequality,
through school and teacher college
curriculums
The Guidelines like many other key policy
documents, including the National Guidelines for
HIV Counselling and Testing, as well as the National
HIV/AIDS Workplace policy places a high premium
on confidentiality. This is a principle that is of
especial importance to youth generally and male
and female YKAP in particular. (Guyana Prevention
Guidelines, page 23).
For example the Guidelines state it is required to:
“Build trust among users of HIV prevention
services, by establishing systems to ensure that
strict confidentiality
is maintained for all persons
accessing HIV prevention services and all
information is retained securely”
However, in the NAC examination of the legal
provisions for confidentiality, it was found
instances in which these could be put at risk as
AIDS (and not HIV) was made a “notifiable disease”.
It states that the “the certificate must state the
name of the patient as well as the address of the
building where s/he lives”. The result is
potentially that, “in the event of legal challenges it
is entirely possible for inconsistent standards to be
applied”. The NAC report makes several key high-
level recommendations including that:
“Provision should be made for the
protection of the confidentiality of medical
information. The legislation should be clear
as to the types of information to which
protection attaches”
The legislation should clearly specify on
whom the duty of confidentiality is
imposed, and should include not only health
care workers but also all other persons who
may come into contact with personal
information.
The legislation should specify remedies for
breach of its provisions: be they
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disciplinary proceedings, criminal sanctions
or both.”
2.2.7 Ministry of Health
The Ministry of Health Strategic Plan
The Ministry of Health is the National focal point on
HIV/AIDS programming and policy implementation
in Guyana. Falling under the MoH is the National
AIDS Program Secretariat (NAPS).
Since the 1990s Guyana has developed and
implemented policies to address HIV/AIDS. In
1997, the comprehensive policy stated the policy of
MoH was to, inter alia, “disseminate information to
as wide a cross-section of the population as possible,
and particularly those sub-populations at greater
risk.” It also makes provision for various aspects
including prevention, condom promotion and care.
NAPS developed in 2006 policy guidelines for
HIV/AIDS in Guyana. There is also a National AIDS
Committee (NAC), which includes civil society
bodies and youth focused NGOs.
At the time of writing the MoH was in the process
of drafting its Health Vision 20/20. As such, the
basis of this analysis centers on the Strategic Plan
2008-201223.
There are a number of goals in the MoH strategy
that if achieved, will have a direct impact on youth
including (i) equity in distribution of health
knowledge, opportunities and services (ii)
consumer-oriented services: people focused and
user friendly, (iii) high quality services (and good
value for money).
It prioritizes HIV prevention and specifically key drivers
such as, “the programme will target health
promotion and risk reduction in six risk factors and
determinants of health: tobacco, alcohol,
psychoactive substances including cocaine and
marijuana, harmful diet, physical inactivity, and
unsafe sex.”
More significantly, it sets the target “60% of health
centers are youth-friendly by 2012, with at least
23 According to a UNAIDS publication, Keeping Score III: The
Voice of the Caribbean People, of the three requirements of
having a National AIDS Strategic Plan, a National Strategic Plan
with a Budget and a National M&E Plan, Guyana does not have
a Strategic Plan with a Budget but fulfils all other best practices.
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two YFS in each region” and in particular, mobile
YFSs in the hinterland regions 1,7,8 and 9, and a
School Health Plan.
A key mechanism for the MoH’s goals was the,
“Adolescent and Young Adult Health and Wellness
Programme which will improve the health and
well-being of adolescents (age 10-19 years) and
youth (age 15-24 years) by increasing access to
youth-friendly services, and promoting knowledge,
skills and healthy behaviours, thereby enabling
adolescents and young adults to make healthy
choices.”
2.2.8 Ministry of Education Policy
The seminal policy document guiding the activities of
Education institutions in Guyana is the School Health,
Nutrition and HIV&AIDS Policy. It includes an
operational framework, which outlines the roles of
various entities as well as the integration of key
international and regional policy frameworks including
the CRC, MDGs, EDUCAID and FRESH.
The policy is quite comprehensive on a broad range of
areas related to youth in government learning
institutions.
It requires education agencies to provide
information on HIV/AIDS sensitive to “gender,
religious, cultural, socio-economic diversity, age
etc.”
The main instrument is the Health and Family
Life Education (HFLE) program, which is the
vanguard program for HIV education in school.
Out-of-classroom learning through school-based
youth clubs, festivals etc. and the promotion of
peer support programs
The promotion of psycho-social support for
students and employees, in collaboration with
NGOs, FBOs etc..
Ensure no discrimination against PLHIV
(including students and teachers)
It requires that all records, notes and other
documents that make reference to an employee
or student living with HIV shall be treated as
confidential and kept in a secure place.
These requirements are in keeping with the CRC, which
states, “to ensure that primary education is available to all
children, whether infected, orphaned or otherwise affected
by HIV/AIDS.”
It requires and acknowledges the participation of youth
and parents in the design and development of policy. For
example (page 18) it states that “latex condoms shall be
The Committee on the Rights of
the Child, in a General
Comment No. 3, has identified
certain strategies that State
Parties to the Convention on
the Rights of the Child are
obliged to adopt in relation to
children.101 Some of these
strategies and interventions
are as follows:
State legislation and strategies
should address all forms of
discrimination that contribute
to increasing the impact of the
HIV/AIDS epidemics.
The child should be put at the
centre of the response to the
pandemic, adapting strategies
to children’s rights and needs.
The participation of children as
peer educators, both within
and outside schools, should be
actively promoted.
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available at the education institutions free to employees”
and leaves for interpretation risk reduction measures “in
relation to students” to be, “determined in collaboration
with parents, guardians and students of legal age”.
It also makes provisions for parents and community
education programmes. Quite importantly, the policy
makes provisions for education institutions to, “foster
networks or parenting organizations to improve parents’
access to skill building, information and services through
after-school programmes or other special initiatives”.
The MoE committed to “promote on-going education on
SHN/HIV through diverse media strategies targeting
parents, guardians and care-givers in the wider
community”.
The policy does not make specific reference to at-risk
adolescents in schools and does not specifically address
the issue of abstinence.
2.2.9 Ministry of Culture Youth and Sport
The Ministry of Culture, Youth and Sport (MCYS) is
another key agency in the national response. The
ministry has been involved in a number of activities
related to youth employment (through vocational
training) and the support of Youth Friendly Spaces.
MYCS also promoted youth participation in clubs
and training and awareness on HIV/AIDS through
its facilities.
The Ministry is currently drafting two key policy
documents:
National Youth Policy
National Sports Policy
A copy of the draft National Sports Policy was
obtained from MYCS. The sports policy has as a
specific objective: to effectively use sports as a way
to engage youth in positive activities and reduce the
incidence of HIV/AIDS infection, drug and alcohol,
smoking and criminal behaviour.
The policy in its current form does not specifically
mention YKAP, nor does it outline in great detail
how the objective will be achieved or measured.
The only actions referenced in the document are:
3.4.1 Financing for youth programs that use sport
as a tool to achieve social development goals
3.4.2 Sharing of best practices in the use of sport
for social development
“While most of the world
has been moving towards
the decriminalisation of
homosexual acts, sodomy
and same sex activity
remain illegal in Guyana
and in ten other countries in
the Caribbean.”
Dr. Christopher Carrico,
University of the West
Indies, Rights Advocacy
Project (U-RAP)
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2.2.10 Ministry of Human Services
Guyana’s legislative framework has, in recent years
reflected a strong response to countering
vulnerability among children and youth. There have
been several notable introductions of law, which
have sought to ensure the safety, wellbeing and
protection of children.
Criminal Law Offences, 2005
Child Care Protection Agency Act, 2009
Status of Children Act, 2009
Adoption of Children Act, 2009
Protection of Children Act, 2009
Sexual Offences Act, 2010
Custody, Contact, Guardianship and
Maintenance Act, 2011
Child Care and Development Services
Act, 2011
The Status of Children Act, Adoption Act and
Protection of Children Act all advance Guyana
towards meetings its obligations to the CRC to
ensuring that “legal, economic and social
protections for children orphaned and otherwise
affected by HIV/AIDS to ensure their access to
education, inheritance, shelter, health and social
service, as well as to feel secure in disclosing their
HIV status.”
The Sexual Offences (Amendment) Act was passed
unanimously by the National Assembly on January
3, 2013 but has not been brought into effect as it is
awaiting Presidential assent.
2.2.11 Age of Consent
The established Age of Consent in Guyana is sixteen
(16)24 years old, and this was an age established to
protect children from sexual and other means of
exploitation. However, as in other countries it has
created a problem in terms of access to HIV testing
and other services for young, sexually active
adolescents who are required to get parental
consent. Some NGOs such as SASOD have called for
the age of consent to be raised to 18 years25.
24 Guyana National Guidelines for HIV Counselling and Testing
(2008)
25 The Convention on the Rights of the Child (CRC) Committee
on the Rights of the Child released a general Comment on HIV
and the rights of the Child in which it stated that the
Committee, “is concerned that health services are generally still
insufficiently responsive to the needs of children under 18
years of age, in particular adolescents. As the Committee has
Removal of Punitive Laws
in a Must
“Caribbean authorities have the
opportunity to reinforce the
supportive and protective
environment for men who have
sex with men, sex workers, drug
users, young people and young
people living with HIV to
protect themselves against
stigma and discrimination and
adopt protective practices
against the transmission of HIV.
Leaders in the government and
civil society must work together
to remove punitive laws.
***
Snapshot of Caribbean Legal
Framework 2010
56% of countries report no
legal protection against HIV-
related discrimination
75% of countries report laws
and regulations that present
obstacles to HIV services for
vulnerable population groups
69% of countries criminalize
same sex activities among
consenting adults
81% criminalize aspects of sex
work
19% of countries have HIV-
related travel restrictions
19% of countries have HIV-
specific laws that criminalize
HIV transmission
Source: Keeping Score III:
The Voice of the Caribbean
UNAIDS
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A key issue among human rights and LGBT activists
in Guyana has been the criminalization of sexual
preferences. NGOs such as SASOD, have objected to
the Ministry’s decision to retain s. 351 of the
Criminal Law Offences Act Cap. 8:01 as a “violation
of the human rights to privacy, equality, non-
discrimination and health.”
A University of the West Indies Rights Advocacy
Project (U-RAP) headed by Dr Christopher Carrico
found, that “while most of the world has been
moving towards the decriminalisation of
homosexual acts, sodomy and same sex activity
remain illegal in Guyana and in ten other countries
in the Caribbean, all of which were formerly British
colonies”.26
Similarly the NAC report, found that “there is a
substantial body of anti-discrimination legislation
in Guyana, contained in both the Constitution and in
specific statutes that seek to promote equality
between the sexes and prevent discrimination” but
that do not cover those related to “sexual
orientation”.
The report also quotes a USAID finding that,
“Criminal laws prohibiting specific sexual activity
between consenting adults in private, such as adultery,
sodomy, fornication or acts ‘against the order of nature’
or social order or morality, can impede the provision of
HIV/AIDS prevention and care programmes.”
And notes that, “MSM from the lower social classes
are less able to cope with local attitudes to same-sex
relationships. This group of MSM has adopted
strategies to cope with the lack of acceptance of their
lifestyle and to survive socially. Unfortunately some
of these strategies may place them at increased
physical and psychological health risks. Practices like
picking up partners and paying for sex with one night
stands, for example, potentially increase MSM risk of
infection with STDs including HIV”. (NAC Report,
2004, page 127)
noted on numerous occasions, children are more likely to use
services that are friendly and supportive, provide a wide range
of services and information, are geared to their needs, give
them the opportunity to participate in decisions affecting their
health, are accessible, affordable, confidential and non-
judgemental, do not require parental consent and are not
discriminatory.
26 Source: Demerara Waves article, “Life is Hard for Guyana’s
Gays, Lesbians”, April 21, 2012
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The NAC report recommends:
The prohibited grounds of
discrimination in the Constitution as
well as in the Prevention of
Discrimination Act should be expanded
to include HIV status and suspected HIV
status
It also calls for reforms for another vulnerable
population – prisoners, and suggest that the Prison Act
should also be amended to address communicable
diseases such as HIV.
Specifically the NAC calls for four key legal reforms:
The provision of HIV-related prevention
information and education to both inmates and
staff
Access to means of prevention, including
condoms, and access to care and treatment
Facilitating voluntary testing and counselling
programmes
The provision of guidelines regarding
confidentiality of medical information and
The prohibition of segregation and isolation
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SECTION III
3. Regional Context
3.1 Introduction
The purpose of this section of the report is to
describe the socio-economic context in each
representative environment (rural, urban,
hinterland), and to elaborate on the factors that
influence youth vulnerability or that support and
reinforce a supportive environment. Each region
has its peculiarities, but the purpose of this section
is to identify and extrapolate general trends as
determined by their frequency in discussions with
key stakeholders. In some instances where there
was variance, or characteristics and attributes of
one area or group, which were considered to be
important or affecting a specific sub-population,
these are also captured.
The information found in this section is based on
both primary and secondary data sources. It is
based on responses drawn from numerous key
informant interviews, which included regional
officials, civil society organizations (including youth
groups), health and education personnel and
private sector representatives. The emphasis was to
reflect where there was consensus on issues, and
general themes that emerged from the dialogue.
This has helped both to understand the context as
well as community/regional norms and the
attitudes and concerns of key persons. One
limitation of this approach is that the research team
was not able to meet with every organization
engaged in activities related to youth.
This information was combined with observations
made by the research team, and secondary data
that were obtained from national or local sources.
The use of multiple sources was done to triangulate
the findings of focus group discussions, and in-
depth interviews with adolescents who participated
in the research. It also serves to provide a rich
account of the perception of youth by key persons
in their environment. Several of the contextual
characteristics, socio-economic and cultural
features highlighted here are outlined specifically
because of their relevance to the study of youth and
HIV/AIDS vulnerability.
Map showing: Population density
by Region
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The report also includes Regional Profiles
developed by Youth Researchers and Regional
Focal Points who supported the research of
facilities linked to HIV/AIDS and youth. A general
approach of the field research was to obtain the
view of key persons that interact with youth, to
have a deeper appreciation for the context and the
institutions and people that youth engage with and
that influence youth. It also helped to triangulate
information obtained from youth in the focus
groups.
3.1.1 Hinterland Context
Region 1 (Barima-Waini)
Region 1 was categorized as a hinterland location
for the purpose of the study.
The administrative region covers an area of 20,399
kilometers and has a population of 24,275 persons
(Census 2002). It has the seventh largest
population in the country and is predominantly
populated by Amerindians (largest) followed by
mixed race, and small populations of Afro-Guyanese
and East Indians. It is considered to be a region
with a very high rate of poverty (80%) Source:
World Bank.
The region has three sub-districts:Moruca,
Mabaruma and Matarkai. Region 1 has strong links
to Venezuela as persons migrate there and have
family links.
Structural
Context
Adolescent
• Laws
• Policies
• Programs
• Urban, Rural, Hinterland
• Networks
• Services
• Socio-economic factors
• Views, perceptions,
attitudes, knowledge,
experiences
Figure: Eco-Social
Framework for Assessing
Adolescent Vulnerability
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Percentage of
Poor
Share of the group in
the population (%)
Urban-rural
Urban 18.71 28.20
Rural Coastal 37.04 60.08
Rural Interior 7.47 11.72
Total 100.00
Regions
Barima-Waini 80.06 3.18
Pomeroon-Supenaam 51.94 6.25
Essequibo Island-West
Demerara
40.09 14.08
Demerara-Mahaica 24.56 42.43
Mahaica-Berbice 42.58 6.11
East Berbice-Corentyne 28.45 15.76
Cuyuni-Mazaruni 61.42 2.48
Potaro-Siparuni 94.28 1.48
Upper Takatu-Upper
Essequibo
74.38 2.96
Upper Demerara-Berbice 39.36 5.26
Total 100.00
World Bank and Guyana Bureau of Statistics using Household
Budget Survey data 2006
The research visited all three sub-districts including
Port Kaituma which is a central site for gold
exploration activities. Several of the communities
are quite central and most facilities tend to be
concentrated there – however, the region typically
has a number of satellite and remote communities
that generally rely on these hubs for a variety of
services and supplies.
The main sources of employment in the region
centre on mining, logging, copra production, and
primary activities such as small scale farming and
fishing. Many Amerindians engage in subsistence
agriculture and farming is widely practiced and a
sizeable number of the indigenous population of
Guyana is considered to live in poverty27. The
region is also the site for companies such as
Amazon Caribbean (AMCAR), which purchases
heart of palm from riverain communities.
Shell Beach, on the northernmost top of Guyana is a
site for conservation activities mainly turtle
conservation and management. The community of
Hosororo also produces cocoa for sale on the local
market and internationally. As a result of these
initiatives there are several economic
27 the World Bank reported that the Guyana poverty
assessment found that an estimated 43 percent of the
population fall below the poverty line using data from the
recent Living Standards Measurement Survey. And that the
incident of poverty was highest among Amerindians, some
estimates place the number of Amerindians living below the
poverty line at approximately 80%.
Table showing Poverty in
Guyana by region
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empowerment activities aimed at women, as well
as environmental clubs aimed at youth. These
industries employ a small number of persons. As
does administrative jobs, mainly in the capital –
Mabaruma and in communities in the positions of
teachers, community health workers and the village
administration.
3.1.2 Hinterland Context
Region 2: Pomeroon-Supenaam
Region 2 was categorized a rural location for the
purpose of the study. The vast majority of Guyana’s
territory is considered to be rural (Census 2002).
The region covers an area of 6,195 kilometres and
has a population of approximately 49,253 persons
(Census 2002) and is the fifth highest populated
region in the country. The region consists of a
varied geographic layout, which includes a capital
town (Anna Regina), several coastal villages that
cover a long stretch. between the Supenaam River
to the Pomeroon riverain communities.
There are nine (9) communities:
Mashabo
Capoey
Tapakuma/St Denny’s
Mainstay/Whyaka
Wakapoa
Kabakaburi
Akawini
Bethany
St. Monica
The largest ethnic groups are Indo Guyanese,
Amerindian, Mixed and Afro-Guyanese. The region
is a key hub with transportation points Charity and
Supenaam as gateway communities for mining
activities. The lucrative returns from mining and
other commercial activities have led to an influx of
cash and new businesses in the region.
At Charity these include various clubs and
restaurants, which are all located within a small
radius of each other. The region is also known for
its rice plantations, which employ a significant
amount of labour, among whom there is a high
prevalence of alcohol use. There has also been an
increased level of internal migration as families
leave riverain communities and the Pomeroon and
settle at Charity and other communities along the
coast. This has also resulted in new family
Population by Rural and Urban
Status, Guyana [2002]
Source: Census 2002
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dynamics such as an increase in single mothers,
stepparents and indigenous families relocating on
the coast.
There are 75 schools (Nursery, Primary and
Secondary) within the region and there are four
dormitories in the region:
Aurora (64 students)
Anna Regina (124 students)
Charity (57 students)
Wakapoa (57 students)
3.1.3 Urban Context
Region 4 and 6 (Demerara-Mahaica and
Berbice-Corentyne)
Region 4 (Demerara-Mahaica) and Region 6 (East
Berbice-Corentyne) were categorized as urban
locations for the purpose of the YKAP study and
most of the research was conducted in Georgetown
(Region 4) and New Amsterdam, Corriverton
(Region 6). Region 4 covers an area of 1,843
kilometres and has a population of 310,320 persons
(the largest of all the regions). Region 6 has the
second largest population of 123,695 and covers an
area of 36,234 kilometres.
Region 6 is the largest geographical region in the
country. Region 4 and 6 has the first and second
largest populations respectively. In Region, 4 the
largest sub-population is of Afro-Guyanese,
followed closely by Indo-Guyanese. In Region 6 it is
the reverse with a comparatively much smaller
portion of the population being Afro-Guyanese. The
size of the population is significant when
understanding the coverage and scope of the
HIV/AIDS response and issues of access.
The urban regions were generally characterized as
having comparatively higher levels of access to a
wide array of services including VCTs, youth
groups, recreational facilities, job opportunities and
social services. Unlike in rural and hinterland areas
the youth populations were much more diverse.
In Region 4 interviews were conducted with several
key stakeholders including NGOs (Lifeline
Counselling, Help and Shelter, SASOD, GRPA,
PANCAP), sports related groups (Guyana Football
[Sic]
The quotes used in this
report were all
transcribed exactly
from the spoken word,
creole. Where local
terms were used, these
are explained.
Population by Sex and Region
Source: Census 2002
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Federation), religious bodies (CIOG, Arya Samaj,
Catholic Life Centre) and teachers.
3.1.4 Perceptions of Risk and Vulnerability
Throughout the interviews there was a consistent
thread of responses in terms of what the perception
of what factors put adolescents at risk within the
region:
Ineffective parenting and lack of
parenting skills, including the ability of
parents (mothers and fathers) to
effectively communicate with
adolescents about issues related to
reproductive health, and to provide
necessary emotional support.
Lack of facilities and services
targeted at youth was also quite
frequently cited especially in rural and
hinterland areas.
Difficult home situations including
alcoholic28 parents in the home, single
parent homes, violence and poverty.
Drugs and alcohol consumption
among adolescents and its availability
in schools – There was also a clear and
explicit link made between alcohol
consumption and sex (including
unprotected sex) among young people.
The absence of recreational facilities –
including specific opportunities for
female adolescents, resulted in
adolescents not having enough
opportunities to socialize in a safe and
productive environment. Several key
programs were seen as limited in
scope/reach or un-sustained.
The lack of employment among
adolescents was identified as a
contributing factor and in hinterland
areas the, (gold) mining sub-culture
which was characterized by high levels
of alcohol consumption, casual sex and
sex with FSWs.
Use of alcohol (including bush rum)
and drugs. It was reported that alcohol
and drugs were being sold and was
present in hostels and in school
facilities.
28 As noted previously, within Region 2 youth perception of
alcohol use was extremely lenient and youth also mentioned
that they found that depression and thoughts of suicide usually
occurred around their parents fighting.
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Peer pressure was also felt to be a
contributing factor to risky behaviour
among adolescents; in addition,
pressure by adults on both female and
male youth to engage in sex was also
cited especially among social service
providers.
3.1.5 Facilities and Services
One of the significant findings of the study was the
limited availability of VCT services in hinterland
areas. Although it is generally represented in the
literature that there are VCT sites in each region, it
was found that in Region 1 these services are
primarily for pregnant mothers registered at clinics.
Some people described the region, as having “no
VCT facilities” and this is largely because the testing
facilities that do exist are not openly marketed for
the general public.
In the region, two Peace Corps volunteers had
helped to establish a Youth Friendly Space within
the Regional Administration compound. The
volunteers were concerned about the sustainability
of the space (despite having a Regional Youth
Officer involved) and lamented the fact that it was
predominantly youth from the nearby Mabaruma
area who visited. At the time of the interview, they
were trying to mobilize children from the North
West Secondary Dorms to use the facility. The
volunteers had also organized a mini-Glow Camp
for 25 girls over the summer at the PYARG, which
also organizes youth camps.
When the research team visited the hospital at Port
Kaituma and requested to have a HIV test on a
Saturday, we were told to “come back on
Wednesday” as that is when the test would be
available. It was mentioned in other interviews that
this largely centres on the availability of the Medex.
At Moruca it was reported by the Probation and
Social Services Officer that, “when we take them
[persons in their care requiring a test] to the
hospital, they sometimes don’t have the test and the
Medex told me they reserve it for pregnant
mothers”.
One Medex explained that they have a limited
number of kits. She said that “I requested kits three
times for last year from MCH,” and eventually got
some kits from Mabaruma. The Medex’s motivation
is therefore to ensure that there are enough testing
kits for pregnant mothers.
“When we take them
[victims of sexual
abuse] to the hospital,
they don’t have the
test and the Medex
told me they reserve it
for pregnant
mothers”.
Social Service
Professional
Photo: This church is the former site of the
Care Point at Charity. Several key
adolescent programs and facilities like
this one, and the Youth Friendly Health
Centre (below) were found to have been
discontinued or in danger of not being
sustained
Photo: Youth Friendly Space at
Mabaruma [hinterland]
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There are a number of HIV/AIDS related projects
that have been implemented in Region 1 but several
of them have come to an end including Youth
Challenge Guyana. The Guyana Red Cross having
the greatest coverage in the region. The Ministry of
Amerindian Affairs, the Guyana Geology and Mines
Commission (GGMC) have had projects and GGMC
up until recently provided testing in mining areas
including Five Star, Baramita, 14 Mile and
Matthews Ridge. This service was discontinued
because of the lack of funding. It was mentioned
that the older youth (older than 18 years old) and
male, were the ones getting tested.
The Guyana Red Cross concluded a project,
“Together We Can” which focused on strengthening
HIV-related skills of 10-24 years old, expanding
prevention projects and enhancing the community
environment for the adoption of safer practices.
Many of the services and approaches that were
mentioned included free testing, peer-to-peer
outreach, the introduction of youth clubs,
edutainment, and information and condom
dissemination.
Condoms were said to be more difficult to access in
far out and remote communities in the region. The
cost to buy condoms was considerably higher
($300) than in other regions (starting at $100). But
taxi drivers and shop owners mentioned that when
they received batches from the Red Cross and other
sources they would display and distribute them.
In the rural area there were no Youth Friendly
Health facilities and the CARE Point, which was
established by MHSSS with funding from UNICEF
was placed in a non-secular location (a church) and
is not currently in operation.
There are several VCT’s including one at Charity,
Anna Regina and Suddie. The main hospital at
Suddie has very good facilities and is a hub for the
region. One of the key non-governmental
organizations in the region is Hope for All, it is well
known and highly visible within the region.
The urban areas (Regions 4 and 6) had a greater
number of facilities and services than those in rural
and hinterland areas. However, these facilities
service a significantly larger population. Berbice
has a developed medical facility and several VCT
sites as well as counselling and support groups for
PLHIV. There are several active NGOS including
Photo: Youth friendly health centers
like this one at Rose Hall face an
uncertain future
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FACT (Corentyne) and Comforting Hearts and
Bricklayers United (New Amsterdam). They also
had strong links and greater awareness of
programs, funding sources etc. than in other
regions. There was also strong awareness, support
and programs being generated out of the private
sector, for example Banks DIH and the Berbice
Chamber of Commerce, to address youth and
HIV/AIDS.
Health officials and NGOs in particular had strong
linkages and worked together to capitalize on the
strengths and resources of the other. HIV/AIDS
awareness among this group was high and they
were at the forefront in providing a range of
services and activities including; health fairs,
mobile units, house-to-house testing, health walks,
peer-to-peer education, VCT, awareness raising etc..
Condom distribution was also highly profiled and
widespread with various campaigns being
mentioned; Stand Up for Condoms, “no rubber, no
ride”, and Keep the Light On.
There were also innovative facilities for youth such
as the Youth Friendly Hospital found at Rose Hall,
though unfortunately as the funding has come to an
end the facility seemed to be at risk of closing
down. The staff at the facility said that they were
uncertain of what was the future of the facility. Both
the Ministry of Health personnel and NGOs related
that it was difficult to get access to enter schools to
conduct awareness sessions.
The police service was extremely active in the
youth community and ran a scouts program that
targeted at-risk youth. The scouts also target male
and female youth of various age groups: Scouts – 7-
11 (Cubs), 12-15 Explorers and 16-19 Adventurers.
In addition there is a juvenile section within the
New Amsterdam station.
Several persons including the Regional Chairman
acknowledged the investments that were being
made to combat HIV/AIDS in the region but
questioned the impact that it was having, “We
spending a lot of money that’s not reaching the
people.”
As was related on the Essequibo Coast (Region 2)
quite strongly, “what” was being taught and done
was important as “how” it was being done. As such,
it was important to “come down to the level” of
young people of different backgrounds and
“We don’t check pon
radio hay [here].”
Respondent
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ethnicities. Persons also mentioned that some of the
ways of targeting youth were out dated, for
example Merundoi ‘s radio in an age when, it was
felt, many youth do not listen to the radio.
In general, the urban-based regions like Region 4
had physical access to a wider range of services and
facilities than those in other regions. There was
greater reference to programs, advertisements;
NGOs that deliver HIV/AIDS related services etc..
GRPA for example, organizes health fairs, career
fairs and fun days that target youth. There were
also innovative programs such as the Prevention
with Positives (PWP) program promoted by
GHARP, which was meant to reduce risk of people
being infected. Some NGOs, such as Lifeline,
mentioned that the funding for some of their
programs was reducing, which would have an
impact on their ability to provide services.
One informant mentioned that pregnant teens were
referred to Women Across Differences for services,
but that no similar facility existed for adolescent
males.
One of the priorities of the Government of Guyana
has been the rolling out of the National HIV & AIDS
Workplace Policy. To this end the ILO has provided
training to the Guyana School of Agriculture (GSA)
and Guyana Sugar Corporation (GUYSUCO) on
HIV/AIDS education to the students in the
apprenticeship program.
GHARP has a SCARF project, which included
screening for STDs, condom promotion and
distribution, adhere to medications, risk
assessment and risk reduction counselling, family
planning. Organizations such as SASOD also
advocate for youth that are gay, lesbian and
transsexual.
Several of the groups were part of a wider regional
or international network. The GRPA has a Youth
Advocacy Movement (YAM), which falls under the
International Planned Parenthood Federation.
A teacher at Multilateral Secondary School said that
the school encourages youth to join Youth Groups
and Clubs as well as Christian Clubs. And private
schools such as School of the Nations mentioned the
presence of various clubs including youth, sports
and environmental clubs at the school.
“Kamwatta does not
tolerate alcohol and I
don’t think that I’ve ever
had a report for that area
for teenage pregnancy or
molestation”.
“Young men drink and
whatever follows”.
Community
Development Officer
“Fast money, fast
everything – the fast
money is the drugs
that sells on the
street…these young
boys throw up a fancy
house. And you go to
a rum shop and see
how much of these
boys a drink. I
surprised when me
daughter tell me that
even at UG they
selling alcohol. If me
go to the beach [63
Beach] now, or on
Sunday, if you see
how many girls and
boys a drink.”
Parent
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Overall, as in other regions, there tended to be
greater collaboration between some agencies
rather than others, for example the Guyana Red
Cross has a close working relationship with the
schools as does the Welfare Officer. The police also
stated that they were conducting awareness drives
in schools, but it was not clear whether there was
communication between, for example the Guyana
Red Cross and the police and the extent to which
messages, strategies and approaches were
consistent and complemented each other.
Alcohol and Psychoactive Substances
Many key informants identified alcohol as being an
issue and connected it with sexual activity and in
particular unprotected sex among youth. This
vulnerability was identified as significant across all
contexts – urban, rural and hinterland. In
hinterland and rural areas alcohol was the most
commonly used stimulant, in contrast, urban areas
tended to have greater use of marijuana and
alcohol.
A Social Service professional in a hinterland area
stated that one village, Kamwatta, “does not
tolerate alcohol and I don’t think that I’ve ever had
a report for that area for teenage pregnancy or
molestation”. Similarly the Community
Development Officer (Ministry of Amerindian
Affairs) said that it was the culture of drinking
among young men that led to other at-risk
behaviour, “young men drink and whatever
follows”.
Various types of alcohol were mentioned with
vodka being the most common in Moruca and
Mabaruma where it retails for $500 for a quarter
bottle, which makes it comparable with buying a
meal, and relatively affordable. In addition, locally
brewed alcohol, rum and beer were also mentioned.
Informants also mentioned the influence of parents
and adults who drink in the home and in the
presence of children; this was known as the “home
effect”.
Several persons in the teaching profession
mentioned that both females and males use alcohol,
and that they begin drinking from a very young age.
Adolescents were reported to be drinking in
schools and covering it up by disguising the alcohol
by mixing it with aerated drinks. Although drug use
was mentioned, and the presence of “Amerindian
“Sometimes during the
holiday time, you get
them around you give
them a shandy, you
don’t allow them do
that outsisde. You alone
with your kids ..and
that’s not any kind of
alcohol, one shandy is
OK…that just so that
they don’t go outside
and do things”.
Father, Corentyne
“Alcohol plays a
major role”
Berbice Chamber of
Commerce
Representative
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rastas” there was some evidence to suggest that
drug abuse is less prevalent than alcohol abuse.
A Probation Officer mentioned that there was
greater stigma to marijuana that alcohol. Marijuana,
which was the most often, mentioned drug
reportedly costs $1,000 for a joint (which is
significantly more than what was reported in areas
like Georgetown and Berbice $200/$300).
The urban centres of both Region 4 and 6 had
significantly higher reporting of drug use than in
rural and hinterland areas. The Regional Chairman
pointed out that marijuana was locally cultivated in
Canje Creek and that the market for the drug was
the coast. Key informants generally painted a
picture of a drug that was highly addictive,
destructive and that was both accessible and cheap.
There were various prices quoted from GY $40 for a
‘front toe’ or stub of marijuana to between GY $100-
$200 for a joint. A “weed bag” containing
approximately 35 grams was reported to cost GY
$300. This is significantly cheaper than in the rural
and hinterland areas. The research team did not
find much reporting of drugs that were being
injected into the system and it was mentioned that
most of the drugs were inhaled and smoked. Drug
abuse [predominantly marijuana was reported]
was felt to be more prevalent among Afro-Guyanese
adolescents, and among adolescents, males were
felt to be more prone to use drugs than females.
A police sergeant related that youth as young as 17
and 18 years old were also selling narcotics in
schools. As such the police department, which is
active in the youth community, was promoting the
Drug Abuse Resistance Program (DARE) in schools.
As in all other regions, including rural and
hinterland contexts, alcohol use among youth was
identified on multiple occasions as being part of
youth culture and one that had a strong causal
driver that put youth at risk of HIV and other
negative health outcomes.
As in other contexts, the inter-generational nature
of the issue was often highlighted, as one
interviewee stated on the subject of youth and
alcohol, “it’s a tradition” and another said, “its part
of the culture”. One Indo-Guyanese parent stated
that from second form children were found
drinking alcohol in the schools. She also mentioned
“I is be like Matlock when I
take my matters [cases of
sexual abuse to the police]
cause I want justice”.
NGO Staff Member
(Urban)
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that being a shop owner who sells alcohol, children
would try to get her son to get alcohol for them.
It was also reported that there has been an increase
in the use of alcohol among female adolescents,
which several persons described as a worrying
development. One salient observation made by a
community development volunteer is that
increasingly “girls who have subjects and are
educated in high school” are observed drinking and
hanging out in bars. It was surmised that youth are
“striving to find an identity”.
Sexual Activity
The majority of respondents in hinterland areas felt
that the sexual debut among young girls and boys
was at a young age – pre-teen or early teens as
answers ranged from 11 years old to 15 years old.
In terms of the number of girls in the class or school
who were sexually active, the percentage given
ranged from between 10-50%.
Respondents also referred to the fact that youth
and young girls in particular were being pressured
by their peers, and males, to have sex and indulge in
other practices such as consuming alcohol.
It was reported by the REDO, that the region had
called all the taxi drivers together and warned them
about interfering [troubling or taunting] with
school children, as they have zero tolerance for
such interference. The REDO was of the opinion
that this had had an impact on the conduct of
transport providers.
As in other contexts, informants were generally of
the view that adolescents were sexually active from
a very young age – pre-teen and early teenage ages
were commonly given. In the rural areas of Skeldon,
Orealla and Black Bush Polder, it was felt that there
was a general culture of early sexual debut among
teens.
One nurse stated in response to the question of
when generally youth became sexually active that,
“if you have to come to an average, you have to
come down to 13”. At the Angoy’s Avenue Youth
Friendly Space the age of 11 was suggested.
Many informants painted a picture of girls who
were more emboldened and worldly, for example
one mentioned “having sex regardless of [school]
uniform or no uniform.” One informant said that
“They [Tapir conductors]
brainwash the girls and
tell them that they got this
and they got that…and the
girls are so stupid that
they take on whatever
they tell them.”
Father, #64 Village
Photo: School children and a ‘tapir’ in the
background
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girls as young as 15 years old like to “play big
woman”.
An NGO representative noted the rise in “freaky
sex” among youth, “winky blinky” the practice of
rubbing the penis on the eyeballs, and the practice
of anal and oral sex. It was widely state that girls
are, “developing faster” and were seemingly more
mature compared to youth in earlier years. In
discussing sexual practices with the Child
Protection Officer, it was stated that it was not
always the case that sex between young girls and
older men was transactional because, “some girls
just sex for sex”. One Angoy’s Avenue peer educator
reflected the flippant attitude of youth to sex by
citing a popular local saying among them that, “HIV
is in style and I have to catch it”.
It was reported that girls were “dressing according
to their size and not their age” and another person
referenced the fact that female adolescents often
dressed, “inappropriately”.
The desire for material things and even basic food
items and supplies was also cited as an example of
the new culture of consumerism and poverty
among young girls that was driving them to engage
in risky behaviour. It was reported that young girls
were increasingly partnering with older men and a
few persons mentioned relationships with powerful
businessmen (and in some instances resident
expatriates) who deliberately cultivate and pursue
much younger girls.
Along the Corentyne, a group of parents highlighted
an issue similar to that of minibus conductors in
Georgetown but with “Tapir Boys” who they viewed
as predatory in that they would entice girls with
“nice music” and “waive the fares”. It was an issue
that was raised at the Parent Teacher Association
(PTA) but not much was being done about it.
In the rural context, there was general consensus
among key informants that sexual debut among
teenagers was at a very young age and
predominantly in the early teens. Generally the ages
given were between 12-15 and several respondents
made mention of the fact that amongst Amerindian
youth the age of sexual debut was considerably
lower. However, as in other regions the study found
that though youth at young ages 10-14 and less
than 15, did report to having started to have sex at
a young age, there was nothing to suggest that this
was among a significant majority of adolescents.
“Girls are being
targeted here.
Businessmen from
Georgetown and
Berbice some and
approach the parents
and the girls.”
Community Social
Worker, Charity
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Some of the key persons who directly interacted
with youth, such as teachers and Probation Officers,
seemed to be out-of-touch with them and in some
cases prejudiced.
Sexual Predators
In hinterland areas, some persons saw hot spots, or
vulnerable areas as being those that were remote
communities, or specific villages like Rincon and
Kabura. Poverty was often used to explain
situations that were putting young girls at risk.
There were multiple references to single parents or
families that could not afford to meet the needs of
their children. In these instances the parents or
mothers, would support their children having
relationships with persons (sometimes significantly
older) who could provide for them. One informant
said that these persons were often business people
from Georgetown and Berbice. These persons
would go to the families and “whatever there is a
need of, they will offer to help with the child”. A
police sergeant said that “because of needs”
persons take advantage.
The health professional stated that young girls
usually get pregnant “for someone who assist
them”.
In the rural contexts, many interviewees referred to
the causal nature of youth relationships. It was
reported that there was a worrying trend among
girls to have multiple boyfriends (though not
necessarily to be sexually active). It was reported
that girls were increasingly promiscuous and
aggressive. And that the culture generally was to,
“see a thing and catch a fling,” meaning to have a
quick, random and casual sexual encounter.
Registered 248 persons 41 on ARVs
Actively attending 108 persons 80 on ARVs
Children HIV+ Ages 0-14 4 males,
3 females
Ages 15-24 2 males
Sexual Abuse
Sexual abuse was a key concern of several Duty
Bearers in both hinterland and urban contexts. The
Regional Chairman, Regional Health Officer, various
head teachers, Peace Corps Volunteers, School
Welfare Officers and the police all mentioned sexual
abuse as a problem in the hinterland context.
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The Probation Officer in one sub-district mentioned
many specific cases involving girls as young as age
six. The perpetrators were usually a member of
their immediate family including grandfathers and
uncles. However, several persons mentioned that
there had been a rise in “stepfather rape” since
changing social and family dynamics meant that
stepfathers were raising children. Mothers were in
some cases reported as abandoning their children
in the sense that they continued to live in the house
of the abuser.
Many persons said that they felt that the legal
support and facilities were not in place to deal with
the problem. It was also reported that in Mabaruma
there was no Probation Officer in the sub-region.
And several persons said that abusers were getting
off lightly as they were coming out on bail and
returning to the homes in which abuse was carried
out. The MoAA CDO stated that parents were left,
“looking for justice because the men still walking
free”. This was queried with the police and it was
stated that in the case of incest they could be held
for 72 hours and in the case of rape for 45 days.
However, the police were aware of the fact that it
was a problem and noted that “sexual abuse trips
the children out” and that “this is what is destroying
the children of today”.
Sexual abuse (including rape and incest) was
identified as a key issue by informants. Some
posited anecdotally, that there was a higher
prevalence of incest and suicide among Indo-
Guyanese families but this should also be seen
within the context of Indo-Guyanese having a
significantly higher population. As in other regions,
including the hinterland areas, it was reported that
there was sexual abuse perpetrated by step-fathers
on children in their care, in addition to typical
abusers like fathers, uncles and grandfathers.
As in other regions, there was mention of
discontent among persons who were involved in
reporting cases of sexual abuse. One NGO worker
stated that because these can involve powerful
persons and alluded to corruption, “bribery” among
officers charged with bringing perpetrators to
justice. The NGO worked credited having
established relations with the police as well as the
dedication of a senior police Inspector with
improving the chances of perpetrators being
brought to justice and homes being made safer. A
“Some parents who a drink
and get entangle with
them own lifestyle, they
gon get less time, or
sometime no time with
them children. Those
children now, end up doing
what they feel like”.
Indo-Guyanese mother,
Corentyne
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Pandit on the Corentyne also echoed this by saying
that people with responsibilities are not taking
them up, because “in Guyana if you have money you
are the leader…so I do what I want and I give money
to Tom, Dick and Harry and my case is closed”.
It was also a concern among Indo-Guyanese parents
on the Corentyne that teachers, including young
male teachers were having sex with students. They
stated that there were “many such cases” but that
the families were ashamed to raise it.
It was reported that Amerindians females tended to
be more prominent and in demand as sex workers.
However during the meetings held with FFSW
Amerindian females were not overly represented. It
was stated that young Amerindian girls were visible
when the large ships come in to port. This was not
observed in the field.
Within the Indo-Guyanese community, a Pandit
stated that, “we have some boys and girls living in
poverty, material wise, and so men and women,
young people of tender age once they are offered
money and they are in poverty…they will take the
money just to get something to eat, something to
drink, a nice piece of clothes and they will sell
themselves.”
Recreation & Entertainment
Most persons throughout the regions felt that there
were not enough recreational activities and
facilities for youth. In the Moruca area they were
successfully promoting cricket for girls, and boys
were involved in various activities including
football.
One Headmaster related that when a private person
had hosted a 5-day football match at Christmas
under floodlight, the place was packed. In total
eight teams participated. “You could see the
inquisitiveness, the vibe, young people want
something to do.”
In Region 6, as in other regions, and despite being
an urban area many persons referred to the fact
that there were inadequate facilities for youth, that
the private sector did not have youth friendly
recreational businesses and that there was a need
to have more facilities available for male and female
youth.
The Angoy’s Avenue Youth Friendly space for
example, attracts 30-35 persons a day. And it was
Photo: Bar in a hinterland location.
Alcohol consumption has been made
easier by the number of ‘liming spots’
that have sprouted up in recent years
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observed that there were a number of youth and
activities being conducted in this very well
managed space.
In many of the areas in which the research was
conducted there were several new entertainment
businesses that had sprouted up in recent years to
cater for the general increase in income in the
region.
In Mabaruma key informants referred to the several
well-known bars. In Moruca these included the
shops and bars around Kumaka. One proprietor of
an entertainment spot where several youth who
were interviewed said that they went to swim, does
not sell alcohol or cigarettes to youth and has a
strict policy of adult supervision for youth.
Key informants complained about the culture that
was being introduced in the region, for example one
woman referred to “some slack show from
[George]town” and lamented the fact that, “girls are
not focused on education, it is all about the road
and having fun.”
In Port Kaituma, the entire central area is populated
with multiple drinking places, discos and
entertainment areas. Alcohol (including high end,
expensive alcohol) is on sale in many locations and
consumed widely by both male and female youth.
There are comparatively higher numbers of hotels
and rooms available for rent. Commercial sex
workers are easily accessed in Port Kaituma and
these include female sex workers from riverain
Amerindian communities as well as girls from
Georgetown, Brazil and Venezuela. It was reported
that Amerindian girls are usually paid less, are quite
young and come in groups. Or tend to rent rooms
and stay there with more than one girl. The girls
were reported to use alcohol and engaged in casual
sex whilst inebriated for alcoholic drinks in some
cases.
This was also reflected on the maps of youth as well
as in the interviews. These include restaurants and
shopping centres, bars and pool halls.
Prostitution
This was raised as a key issue especially among
persons who interacted with youth from low-
income homes and inner-city youth. It was
highlighted by an NGO staff member, that “sex for
money,” was on the increase for male and females.
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The culture of sugar daddies and older men
providing favours for younger girls who have sex
with them is common. One person said that “girls
“friend” with men who give them thing”.
It was reported among several informants that
poverty was resulting in several girls engaging in
sex in return for “things”. Some of these girls tended
to have anal sex in order to leave their hymen
intact.
Employment
In hinterland and rural contexts, informants widely
reported that employment opportunities available
to youth who have finished school are limited.
As one hinterland interviewee stated, “they come
out of school and nothing happens”. Mabaruma
was described as a “stagnant community” with
limited opportunities for those children who had
invested in their education and staying in school. As
a result many of them leave home for other interior
locations, Venezuela and Georgetown to search for
opportunities.
The region has witnessed a gold boom in recent
years, which has attracted both male and female
youth who have been unable to find work and who
are seeking “fast money”. Working in the “bush” is
traditionally seen as a lesser profession to other
more coveted jobs like teaching but there is some
indication that that is changing. One headmaster
explained that the earning potential of mining far
outstrips those of other professions. He explained
that for the last two consecutive years the top
performing boys of the secondary school had given
up teaching for gold mining. One student had five
grade ones. The salary of an unqualified teacher is
approximately $45,000 per month and a youth
working in the mining sector can earn
approximately $150,000 to $200,000 per month.
Young people therefore have a disposable income
that his much higher than they could usually expect.
The gold boom has meant that a number of youth in
school, and out of school are fast flocking to mining
sites seeking employment. One informant said that
mothers also take their children out of school to
join fathers and other siblings in the “backdam” to
prospect for gold. The majority of these persons are
male, who engage directly in the extraction of gold
and to a lesser extent females who cook, work in
shops and work as sex workers.
Photo: Opportunities in the gold
mining areas have resulted in
several young men having the
resources to purchase cars, which
they use as taxis
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As a result of the mining boom, several changes
have occurred; an increase in the disposable
income of young people, an increase in the
purchase of vehicles for transportation (cars to be
used as taxis mainly) and a rise in entertainment
and other facilities to cater for the needs of youth
(see below).
“Gold Money Flowing”
Another factor, is a certain sub-culture notable in
areas like Port Kaituma where miners work a
“quarter” (six weeks) and then emerge to ‘the
landing ’ or neighbouring towns to let off steam and
enjoy themselves. This excess can involve the
consumption of copious amounts of alcohol/drugs,
partying and sex all of which are readily available. It
normally involves all night sessions and partying
that can go on for days. One group of young miners
who was interviewed stated that they deliberately
avoided the landing so as to not get sucked in to this
lifestyle and lose their money.
The miners usually have in their possession large
sums of money that they have recently been paid
and are known to spend excessively. Many
informants referred to this sub-culture and drink
and excess in the interviews, the Regional Health
Officer referred to it as “craziness time” and “a lot
happens” “gold money flowing” and, “lots of
partying and drinking”.
In the rural context, several persons made
reference to both the fact that secondary school
dropout was ‘high’ (actual levels were
undetermined) in the region, as well as the fact that
youth did not have many gainful employment
options. Female adolescents were felt to have a
more limited number of options and many of them
turned to supermarkets and other low paying jobs.
Among male adolescents it was reported that they
tended to be employed in area like mining, logging
and at the rice mills.
One person stated that because young men were
starting to work at a young age (15 years and up)
and were within an environment of predominantly
older men that they were adopting several of their
attitudes and behaviours including alcohol
consumption, unprotected sex, sex with multiple
partners and drug use.
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It was also mentioned that the presence of gold
mining and gold miners meant that there was a
culture at Charity and in other areas of partying
and revelry. Typically “bush men” would conduct
mining activities for a quarter (six weeks) and then
come to places like Charity and Anna Regina in
search of entertainment. The men would often
bring with them large sums of money and pursue
women including adolescents.
The School Welfare Officer felt that the dorms are
also a risky environment for young people. There
was a report of a suicide in the Charity dorms
apparently by a young boy who had been bullied.
Consumerism
The increase in disposable income in the Region is
demonstrated in many ways.
In Moruca it was mentioned several times that
cellular phones had only been introduced four
years ago, but since its introduction along with
Internet and DVDs, there has been an impact on
youth culture. One person said that “blackberry is
the first thing” that is purchased and the
researchers observed several youth who had cell
phones. The headmaster one secondary school
complained that cell phones were creating a greater
possibility for men and male youth to engage
female youth in the dorms. As a result a security
guard was placed in front of the door of the
dormitory.
Some persons spoke of young girls exposure to
“American style of dressing” meant that young girls
were increasingly dressing up and looking older
than their ages, and using make-up. In an interview
with young soldiers it was reported that young girls
were dressing and it was difficult to tell who was a
young girl. The research team also observed two 11
and 12 year olds dressed up who looked
considerably older, which may put girls at risk of
being treated as much older women.
Civil Society
It was found in all regions and contexts that NGOs
are central to the HIV/AIDS prevention and
awareness. In the rural context, Hope For All, the
leading NGO in Region 2 was engaged in several
activities including:
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Condom distribution on Monday’s at
Charity when there are a lot of parties
and entertainment
Working with In and Out of School
Youth
Providing care hampers to youth
Conducting HIV awareness session and
counseling
Running a mobile VCT that services the
riverain communities
Summer camps for youth.
Hope For All was the only organization engaged in
HIV/AIDS activities that had significant scope in
terms of the areas covered and the number of
persons who benefitted from the services provided.
Another local NGO, the Pamona Youth Group
reported as also working with youth but noted that
it was difficult to keep them engaged and their
membership has dropped from 30 to 15.
The Church
In all of the contexts, the church was present
though the perceived role of the church in
addressing adolescent HIV vulnerability varied.
The Arya Samaj [Hindu faith] said that they
promote “moral living” and that the Mandir has a
sizeable youth population (approximately 30-40%)
of the total members. The Pandit at the Arya Samaj
said he addresses what the scripture says about
moral living and how people are affected by
decisions and actions. Some of the Mandirs were
also found to have youth groups.
The Arya Samaj had developed some culturally
appropriate education kits in a national HIV/AIDS
project funded by UNICEF, which ended five years
ago and these activities were not sustained. The
Arya Samaj is not currently capable of addressing
HIV/AIDS education.
A vicar of the Catholic Church noted that it has a
Catholic Youth Centre (CYC) on Brickdam, which
has programs to support youth through various
stages of their lives and addresses issues such as
sex, marriage and HIV/AIDS. It was also mentioned
that the pastors are encouraged to talk to their
congregation about HIV/AIDS. However, like the
vicar, the Pandit said that he preferred to refer to
others on issues related to HIV/AIDS as he did not
have enough knowledge.
“Angoy’s Avenue want
praying out”
Nurse at New
Amsterdam family
centre
“At one PTA meeting
[Tagore Secondary]
the teachers say that
they surprised that the
cleaner report and tell
them how much
condom paper and
wrap they find. So
from then the PTA
advise, especially girls
that going to the party,
they must wear pants
and not dress.”
Indo-Guyanese parent
discussing school
parties
“Now I no longer
preach too much of
scriptures, I preach on
social issues. ”
Young Hindu Pandit,
Corentyne
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There were differing views captured of the role of
religious bodies within the region. One priest, active
in social work stated that, “pastors need to move
from the pulpit and into the lives of people and the
homes of people”. This was typical of churches in
urban areas where there was a strongly held view
that the church had a role to play in addressing HIV
issues.
In discussions with a group of Indo-Guyanese
parents, the general consensus was that HIV/AIDS
and sexual reproductive health issues should not be
discussed in the Mandir, but should be addressed in
the home and in school.
However, the Pandit at the Mandir was young and
echoed the views of the pastor, stating that it is
important to address the root issues of these
problems. He himself was active in the community
and, “if you want to understand something, dive in
the trench”.
The church was mentioned as a key and stabilizing
factor in hinterland communities. There are several
religious denominations including Jehovah Witness,
Catholic and Christian. Many youth confirmed that
they attend church and though the dominant
message seems to be of preaching abstinence, the
church also ran activities for young people.
One woman captured this by saying, “them girls
alright because them girls are church girls.”
In rural areas, the research team engaged two
religious representatives, one of the Anglican
church and the other an Imam at a local learning
institution. These two interviews captured two
opposing views of the role of religious institutions
in the fight against HIV/AIDS. The Muslim leader
was aware of the problem of HIV/AIDS, but it was
not felt that the disease had to be addressed
directly through awareness and education but
rather through the teaching of “God Consciousness”
which would help youth to control their desires.
The school promoted abstinence from sex, alcohol
and drugs.
The Anglican Church saw a greater and more direct
role and through its youth group which meets
regularly, it would invite persons to speak on
various subjects of concern to youth including
HIV/AIDS. However, senior members of the church
had never received training on HIV/AIDS and could
“Them girls alright
because them girls
are church girls.”
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not themselves support HIV/AIDS education and
awareness.
However, both the Muslim and Anglican religious
leaders reported a need to have more activities for
youth including outings and religious clubs in
schools.
Suicide
The research team was unable to visit one
recommended site, Black Bush Polder, a community
where suicides rates were said to be the highest in
Guyana. The remarks made by informants tend to
suggest that adolescents are a significant sub-
population among suicide cases and that these
often involve affairs of the heart/relationships. This
issue was felt to affect Indo-Guyanese youth more
than any other ethnic group.
Parents also stated that they were sometimes afraid
to correct or discipline their children for fear that
they would “drink poison” in retaliation, which was
described as a “bigger problem”.
A Pandit related that in the close knit Indo-
Guyanese communities that people were “talking
out [disclosing]” the private affairs of young people,
which was leading to suicide.
Counselling
One person stated that many youth had “rage pent
up in them” and this was because of various issues
including their relationships with their parents,
many had things that they “hold against their
parents”. Counselling was a means identified by a
few persons (especially HIV/AIDS NGO staff) as an
important service that should be available to youth.
The HIV/AIDS support group run by the Bricklayer
Association (NGO) in New Amsterdam has 195
members in 2011 and 220 in 2012. A Corentyne-
based Pandit stated that, “People have nobody to
tell their story to, they can’t trust people. I have a
set of things in my brain, I can’t eat, I can’t sleep, I
can’t talk. The thing is I have all of these problems
who am I going to tell, when I go and tell somebody
and that somebody go and blow me out in the open
air, then what do I become”.
The emotional state of young people was referred
to on a number of occasions and they were painted
as being vulnerable and having to deal with a
number of issues. The Headmistress at a secondary
school stated that, “young people have a lot of
Suicide in
Guyana
In 2012, a World Health
Organization report stated that
Guyana has the highest suicide rate
among countries in the Caribbean.
It also stated that, “suicide is
recognised as a serious public
health issue in Guyana with
between 150 and 200 deaths
annually.”
Statistics from 2003 to 2007
period show that there were 946
reported suicides in Guyana.
The statistics indicate that suicide
is the leading cause of death
among young people 15-24 and
the third leading cause of death
among persons aged 25-
44.
Suicide rates are consistently
highest in Region Six followed by
Region Two.
Source: Kaiteur News article,
Guyana towering in suicide rates
amongst Caribbean countries –
WHO, June 5, 2012
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baggage,” another said that they “keep these things
inside” and the police sergeant stated “nobody is
listening to them”.
Several persons identified the need and importance
of life skills and of having counselling available for
youth. It was recommended that each school should
have a School Welfare Officer and that teachers
should receive training on dealing with youth, at-
risk youth and on issues related to HIV and sexual
activity among youth. It was also highlighted that
the general policy of the public school system is to
promote abstinence.
However, private schools such as School of the
Nations had a Guidance Counsellor and the Vice
Principal is responsible for counselling females. An
NGO representative stated that girls often have low
self-esteem and are easily influenced.
The main source of information on this in Region 2
came from the Social Worker at the Family Health
Clinic in Suddie. It was reported that a monthly
support group meeting was being held and
provided information on various topics. The
attendance was affected by the discontinuation of
Public Assistance through the MHSSS, which was
seen as an incentive for several persons. It was
noted that food hampers were being distributed by
NAPS.
Parenting
Many persons blamed poor parenting and limited
parental skills as being the reason for children
being put at risk. It was felt that parents don’t speak
to their children and as such, “what they know is
what they find out for themselves”.
“As soon as they start to get
big, as soon as they get
menstruation and at high
school …from 14 or 15 [years
old]
Mother
To me it start from 12 and
13….”
Father
“Yeah, yeah”
Other mothers agreeing
Parents discussing age
when children start to
have sex
Photo: The School Welfare
Officers are viewed as vital
human resources in the
responding to adolescents in
schools
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Social and Probation services all stated that parents
were letting their children down by not reporting
abuse and by neglecting them.
As was common in other regions, in the capital,
parenting and in particular poor parenting skills
and parenting presence was identified as key
issues. Among youth in low income and
economically recessed areas it was reported that
there are numerous single parents and the single
parents tend to have multiple partners and neglect
their children. One sports leader stated that the,
“generation gap between parents is narrowing and
so parent dress like youth and party with their
kids”. This was cited as an example of conditions
that lead to at-risk behaviour among youth and a
reduced social control.
Georgetown was the only region in which parental
facilities were reported as being available in the
form of the Guyana Mother’s Union although it was
reported that it currently does not have the
capacity to integrate HIV/AIDS. The Mother’s Union
stated that theirs was a regional program with 92
active counsellors.
At one private school, with a school population of
mostly middle-income students, it was reported
that “parents are unaware of what’s going on with
their children” and that many of them are “too
busy”.
As in the capital (Region 4) Berbice also cited poor
parenting as a key issue in reducing the nurturing
and supportive nature of the home environment.
Several persons mentioned that such homes
provided limited parental guidance and support as
parents were neglecting their children. These
homes were often characterized as having other
social problems (drug and alcohol abuse, domestic
violence etc.) that affected the wider family, which
put children at risk. It was mentioned that children
from such families were often left unattended and
were in some instances found to be wandering on
the streets. One informant described this as the
“absence of a family setting”.
It was also mentioned especially among health and
social workers that in these households, children as
young as age 13 were having sex with their parents’
knowledge. In addition, changing dynamics in the
socio-economic environment meant that mothers
were often out working and not as present in the
“No!”
Parent in response to
question of whether
sexually active
daughter [already
interviewed] is
sexually active
…Explanation
“Because the latest she
comes home from
school is four o’clock,
from school she comes
home.”
“What they know
is what they
[youth] find out
for themselves”.
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home. Among middle class Indo-Guyanese parents
it was found that they are also changing the way
that they parent which is different from how they
were parented.
Mothers were widely viewed as the parent most
likely to be responsible for the behaviour of their
children. In some instances children were left in the
care of guardians, such as grandparents who could
not provide the level of parental guidance that was
required.
It was also reported in the Angoy’s Avenue area
that there was a high number of single parents
living in the area. And overall, a common remark
was that parents lacked the skills to talk to and
support adolescents in matters related to their
sexual and reproductive health.
In an interview with some Indo-Guyanese parents it
was mentioned that parents do talk to their
children, and felt that “some parents do not all”
some have an “open relationship,” which is not
typical in indo-Guyanese rural families. In one
family they said that as compared to their own
upbringing they “talk” more than “beat” their kids.
One middle-income mother said that she
approaches it by saying, “today we will talk as
friends” and uses storylines in movies to broach the
issue of sexual reproductive health. A lot of the
education centred on “girls getting fooled” by boys.
It was related that this was a reason why girls were
being taken out of secondary school, “because she
will get carried away with Tapir boy and will not
come home back”.
A pandit related that parents were not making time
for their children, nor were they spending quality
time together as a family. “I got to go to the rice
field, my wife got to go clean some body house, me
go send the pickney to school when they come back
pon an afternoon me didn’t check their book”. He
also mentioned that a sizeable number of parents
do not go to school to find out about how their
children are doing in school.
3.1.6 Peer Pressure
These two factors were identified as having a
significant impact on youth culture. It was felt that
Peer pressure was a key issue among youth.
Several persons also mentioned the influence of
media (television, internet, mobile phones), which
“Young girls are
fascinated by fancy
things.”
“This is their last year in
school, so them will do all
that them got of do. From
3rd, 4th and 5th form that is
when the problem start
with boy and them things.”
Father, discussing sexual
activity in school
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is readily accessible in these areas. According to one
informant, “what is learnt on television, or from
friends is what they [youth] go with”. In an
interview with Indo-Guyanese parents, one mother
lamented that they tried to monitor what her
children watched but they [the children] were one
step ahead. The children were not allowed to have
cell phones but they did have access to the Internet
and computers in the home.
Several persons also referred to Facebook and
texting as ways that adolescents were
communicating and engaging with each other in
spaces that were unregulated. As in other regions,
reference was made to the “Americanization” of the
society, which influenced a wide range of behaviour
and attitudes from type of dress, tattooing and
sexual practices.
It was also reported that music and the lyrics in
popular songs was also having an influence on
youth. This was reinforced by the presence of loud
music in various locations (streets, bars,
restaurants etc.) as well as the actual citing of songs
among youth, for example in articulating his disdain
for homosexuals, one Afro-Guyanese 14 year old
male sang the song, “don’t BB me” much to the
amusement of his peers.
As in other regions, parenting and in particular
poor parenting skills and parenting presence was
identified as key issues. Among youth in low income
and economically recessed areas it was reported
that there are numerous single parents and the
single parents tend to have multiple partners and
neglect their children. One sports leader stated that
the, “generation gap between parents is narrowing
and so parent dress like youth and party with their
kids”. This was cited as an example of conditions
that lead to at-risk behaviour among youth and a
reduced social control.
Georgetown was the only region in which parental
facilities were reported as being available in the
form of the Guyana Mother’s Union although it was
reported that it currently does not have the
capacity to integrate HIV/AIDS. The Mother’s Union
stated that theirs was a regional program with 92
active counsellors.
At one private school, with a school population of
mostly middle-income students, it was reported
that “parents are unaware of what’s going on with
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their children” and that many of them are “too
busy”.
3.1.7 Teenage Pregnancy
Teenage pregnancy was widely reported as being
unplanned and was viewed as an indicator of
condom use among adolescents.
At the New Amsterdam Family Health Centre it was
reported that there was “a lot of teenage
pregnancy” as an example the statistics of the two
previous years were cited.
2012 15-19 year old mothers – 54 of 210 births
(26%)
2011 15-19 year old mothers – 60 of 240 births
(25%)
In instances when the mother is less than 16 years
old, it was reported that these are reported to the
Social Worker. To a lesser extent teenage births
were attributed to sexual violence, the medical staff
reported two cases of rape by an uncle that had
resulted in pregnancy. It was approximated that
these early births affected Afro-Guyanese and Indo-
Guyanese adolescents equally.
In hinterland areas it was reported that the
pregnancies tend to be unplanned, in some
instances involves sex with other teenagers and to
be a significant number of the total number of
births each year.
As one HIV/AIDS trainer stated that “every time you
blink is another teenager pregnant. It seems that we
are wasting our time and money. Even the HIV
community facilitators are getting pregnant”.
In Moruca it was reported that of 73 births in 2012,
7 of them were less than the age of 19 (9%). When
probed further head teachers and REDOs did not
have specific data but said that it happen “one, one
time”. The CDO recalled that there were four such
cases in Barima. One School Welfare Officer said
that they tended to get pregnant from the age of 12
and 13. A health professional stated that “one of my
fears is the under-15s getting pregnant” and they
are getting pregnant for she also provided statistics
reflecting the fact that between the ages of 15-19
there were 189 cases of females requiring ante-
natal care. This is 25% of the total number of
pregnancies.
“Every time you blink
is another teenager
pregnant. It seems that
we are wasting our
time and money. Even
the HIV community
facilitators are getting
pregnant”.
Teenage
Pregnancy
A recent presentation on
“Knowledge, attitudes &
practices of reproductive
health, of teenagers attending
the Georgetown Public
Hospital (GPHC) Obstetric
Unit” found that at the GPHC
July 2009- June 2012, 3776
births to women <20yrs and an
average of 1265 per year (June
2009-June 2012)
20%
of live births were to mothers
who are <20 years old
The average age difference
between the mothers and the
fathers of the children was
father was 6 years the largest
was 32 years
64%
of the teenage mothers said
they regretted the first time
they had sex
22%
Disclosed that they had been
raped at some point in the past
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3.1.8 Transient Populations
In Region 1 [hinterland] the steamer boat was
mentioned within the context of bringing foreign
ways to the community as well as persons from
outside. In Port Kaituma there was a significant
sub-population that was mobile and that came and
went including both miners and sex workers.
There is also movement of youth, especially males
as they work on trucks that run between hinterland
locations.
In the rural context, several persons made specific
mention to indigenous youth in a number of areas.
It was mentioned that families were migrating from
the lower and upper Pomeroon and settling along
the Essequibo Coast. It was identified that the
riverain communities were generally seen as
vulnerable as children had to travel vast distances,
in some instances unaccompanied.
The Community Development Officer identified
Mashabo, Capoey and Mainstay as areas where
there were issues of alcohol consumption.
3.1.9 Adult Attitudes towards Youth
For example, a teacher recalled a conversation in
which a colleague had told her, “Miss you would be
surprised to hear that some of our students are HIV
positive.” To which she replied in horror, “no way”.
It was also suggested that there was a need to get
rid of the “bad apples”. And some teachers seemed
out of touch with the adolescent nature of the
school population and their needs.
There was also some indication that persons who
come in contact with adolescents needed greater
training in how to engage youth and cultural
sensitivity, and the development of inter-personal
skills.
Several persons including a taxi driver and former
mini-bus owner felt that girls were “hot” and were
aggressive in their pursuit of males.
3.1.10 Youth in Revolt
Overall, there was extensive mention of the limited
morals and values that youth possessed. This was
raised in various contexts, for example the teacher
of one school branded youth behaviour as being
“appalling” at both school and in public. Another
informant attributed the “decline in morals and
values” to the abolishment of flogging at schools.
“Parents are out of
touch with their
children. They have to
find family time. They
have to sit down and
talk with them [their
children].”
Grade 8 Coordinator,
Anna Regina
Secondary
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Another informant mentioned that young girls
regularly displayed “vulgar behaviour” as they
would “sit on bus conductors laps.” Persons also
expressed the view that youth were not, “serious
about life” and did not want to work even when
they were given the opportunity.
3.1.11 Condom Use
There were various views on the current situation
of youth and condom use in urban areas. It was
mentioned among persons in contact with inner-
city and impoverished youth that condoms were
not being used by 70% of youth. Another view was
that the habit of using a condom was catching on
though not among young married couples where a
partner may not be faithful.
The representative of the Guyana Football
Federation mentioned that condoms were being
distributed and that the HIV epidemic was being
controlled. However, it was evident that it was not
always being widely used. The coach stated that
two young people on the football team had died of
HIV/AIDS.
3.1.12 Communication
Several persons mentioned the influence of
communication instruments on adolescent
behaviour. They identified the television and
Internet as a negative source of influence, as one
commented “sex sells”. One informant
recommended that there should be greater
censorship of what adolescents were exposed to
and another lamented the influence of “Jamaican
and American” culture on youth.
It was recommended that awareness and
informational campaigns and products that target
youth should be graphic and shocking so that they
would get the message.
3.1.13 Indo-Guyanese Cultural Norms
In both interviews with youth and in discussions
with key informants it was revealed that the
predominantly Indo-Guyanese cultural practice of
“asking home” for girls was significant in
understanding the situation of young girls. It was
reported that in some instances parents viewed a
girl being “asked home for” as an indicator to take a
more lenient approach to parental control. “Asking
home” is one step before an actual engagement and
is more of a promise than a commitment.
“In me opinion, me feel
that as much as you talk to
them [children] and you
feel that everything is OK,
when they go to school,
me somehow feel that is a
different story when they
are among their friends
because friends can tell
them other stories and
influence them”.
Parent at #64 Village
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As such the betrothed was having sex at a young
age with the older male. In an interview with
parents, it was also mentioned that because of the
shame that girls might bring to the home when they
are caught having relations with “tapir conductors”
that it was better for them to marry them off. It was
also reported that this practice is less common now
but it does happen. They also acknowledged that
some parents allowed boys to sleep with girls once
they had asked home for them.
It was reported that some children get married at
the age of 14 and 15 years old. It was not
determined if these marriages were registered. This
was seen as a way to “avoid problems,” when they
are “going out with boys and then they gon get
involved and then they will get pregnant…then they
[the parents] gon end up with a kid home”. It was
felt that a girl getting pregnant out of wedlock was
an act that brought shame to the family.
3.1.14 Youth with Disabilities: The Deaf
Community
Efforts to interview deaf youth were not successful
because of restricted access to schools, however the
research team did meet with two teachers of deaf
youth one of which was a Peace Corps volunteer
with a strong background in HIV/AIDS.
It was reported that the deaf are “riddled with
knowledge gaps” and awareness on HIV/AIDS
because of the lack of materials and programs that
specifically target persons with disabilities. Among
the deaf are several deaf youth who have
intellectual and other challenges that result in them
even having a very basic understanding of their
bodies.
Many of the materials and programs that are
developed for HIV/AIDS do not take persons with
disabilities into consideration. For example
scenes/images are often culturally inappropriate,
“there’s never anyone in a wheelchair” and the fact
that because there are shut-ins and persons with
low education levels, it is often not easily
understood. Even in instances when sign language
is used, it is assumed that the deaf person is a
competent signer. The deaf often have problems
with colour blindness, which makes the use of the
colours red (for danger) and green ineffective.
Because several of them are also have physical
disabilities, it also places them at high risk for
“Since this TV with all
them fancy show, that get
a lot of young people
carried away…and them
series that they watch
every day.”
Parent
“HIV/AIDS is a hearing
disease”
Peace Corps Volunteer
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sexual abuse. The Peace Corps volunteer remarked
that she had not encountered a single deaf person
who had been tested despite the fact that the deaf
are considered to be promiscuous. The reliance of
care takers, and the strong influence of the church
position on abstinence, was felt to possibly hinder
their ability to get tested and to access condoms.
3.1.15 Hot Spots
For the purpose of this study, hot spots are defined
as places where it is perceived that high risk
activities take place.
In the urban context, Region 6, the most common
response to the question of where was an area or
place where youth were vulnerable was Angoy’
Avenue.
In addition “the streets” or “the road” were
mentioned as a hot spot since there was a culture of
liming and socializing on the main street. Several
persons mentioned a fast food location as an area
where youth were put at risk for this reason, as it
was popular with young persons. Similarly in
Village #64 it was mentioned that the road
provided open access to young girls by older men
and boys.
Based on observation it was noticed that, as is
common in Georgetown on the seawall at certain
days of the week, the main road is used as a place
for teens to hang out, drink and interact with their
peers. In addition to this there were a number of
bars, clubs and eating places that were identified.
Informants also viewed some schools as being “hot
spots” and a place where children were vulnerable,
and where children from low-income homes and
neighbourhoods attended. These included “Donkey
College”/Vryman’s Irving, Berbice Educational
College, Canje Secondary School and New
Amsterdam Multilateral School. However one Indo-
Guyanese father stated that it was not only limited
to low-income families as, “I think that a lot of the
wealthy off people their children are involved in a
lot of things…because they have the money, they
believe say that they can do what they want to do.”
On the Corentyne they also referred to the “back
street areas” which are poorer neighbourhoods.
One Pandit on the Corentyne who is also a
Counsellor gave the example of a young girl whose
parents were essentially having her prostitute in
order to bring money into the home.
“TV is a problem. I am
guaranteeing you any TV
station; you go and see
how many sexual activity
they put out there. Music –
listen to our songs, and I
really get angry when they
play these songs and
…there are certain TV
shows and songs that
when you hear them
you’re somebody
else…these songs and
shows they trigger you.”
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In the rural context, there were a number of places
that were cited as being where poverty and
vulnerability was high; overwhelmingly Charity
was singled out as being a key area where
adolescents were at risk. The Charity area on
Monday was largely seen as a time of the week
when there is partying and socializing. As a result
NGOs such as Hope For All would distribute
condoms at Charity on Mondays.
This was followed by another area Supenaam, these
two locations were generally described as hubs and
“points of entry”. Several persons mentioned that
there were a number of “short stop” hotels that had
sprung up in these areas. And one of the youth
informants also mentioned that she had been taken
to a hotel and had sex there with a young teacher
who was not from her school.
Other specific locations included:
Anna Regina
Dartmouth
Onderneeming
The Pomeroon area
Charity Housing Scheme
Lima Sands
NOC
It was mentioned by the Police at Charity that
youth in Charity used drugs and alcohol and that
they could openly be seen liming at nightspots in
the evening. This was also observed by the
research team and reinforced by interviews with
adolescents during the course of the study. It is
ironic that the Police station is yards away from
these locations.
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SECTION IV
4.1 Empirical Evidence on Most At
Risk Adolescents
This is a seminal section of the YKAP Study report
since it addresses several of the key aspects of the
study, and also because it reflects the views of
adolescents themselves who participated in the
study. The research required the design and
analysis of a participatory qualitative study on a
range of young people to understand the context in
relation to risk and vulnerability to infection, and to
understand their experiences with services for
adolescents at high risk for infection and young
people who were HIV positive. The sessions also
involved youth drawing and discussing “their
world”, both the narrative and images from these
sessions are used within this section of the report.
Specifically the study was required to determine:
Psycho-social and protection needs
Sexual and reproductive health and HIV-
related needs
Perceptions of the availability, accessibility,
and quality of reproductive and sexual
health and HIV-related services
Experiences of stigma and discrimination
and its effects on their practices and service
use
Challenges and aspirations.
In addition to the focused discussions with youth, In
Depth (one-on-one) Interviews (IDIs) were held
with youth to drill down to some of the key issues,
such as early sexual activity among 10-14 year old
girls, unprotected sex among MSMs, poverty as a
driver for sexual activity, and safe sex practices
among 15-19 males. In order to have a
comprehensive understanding, these findings were
triangulated with those presented in the final
analysis, Section 4.
The focus groups were held with youth within the
age ranges of 10-14, 15-19 and 20-24. The
adolescents were again divided by sex and the
groups ranged from between 6-12 persons. In total
56 FGDs were held and 352 adolescents were
engaged as follows:
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Region 1: 88 (48 Male; 40 Female)
Region 2: 124 (59 Male; 65 Female)
Region 4: 85 (41 Male; 44 Female)
Region 6: 55 (19 Male; 36 Female)
The findings are significant as a lone component,
but it also reinforces the legal and contextual
findings presented in Sections II and III. It is also an
important precursor to Section VI, which outlines
an action plan that is meant to capture the most
“appropriate forms of service delivery to identified
male and female YKAP and YPLHIV.
Key Findings
Psycho-Social and Protection Issues29
Many male and female YKAP were grappling
with various psychosocial issues (feelings of
abandonment, low self-esteem, trauma,
bullying etc.) that were bottled up, and for
which professional counselling was generally
not available, resulting in feelings of isolation.
In a few extreme cases cutting, overdose and
other suicide forms had been attempted. In-
school youth also stated that they wanted to
have confidential counselling services
available to them.
Changing socio-economic dynamics
(migration, absent mothers, single parents)
and poverty have a direct effect with the type
of support that young people have available to
them in homes.
Poverty was generally viewed as a significant
driver of adolescent vulnerability and several
schools, communities, areas “hot spots” and
family dynamics were cited as being a major
cause for early sexual debut and sexual
exploitation.
There was a comparatively higher reporting of
violence in urban schools than in rural and
hinterland.
Adolescents with disabilities and 10-14
adolescents who were out-of-school were
found to be especially vulnerable and spent a
significant period of their day unsupervised.
Similarly youth in contact with the law
(including YPLHIV) did not have adequate
29 UNICEF defines this as children who have “ exposure to violence, disaster, loss of, or separation from, family
members and friends, deterioration in living conditions, inability to provide for one’s self and family, and lack of
access to services can all have immediate and long-term consequences for children, families and communities and
impair their ability to function and be fulfilled.
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sexual and reproductive health services and
psycho-social support.
Alcohol and to significantly lesser extent
marijuana/cocaine is a significant risk
perceived by key informants as putting
adolescents at risk, but although some male
and female adolescents felt that consumption
did place them at risk, among others the
connection to increased risk was not realized,
“it spruces up the night”
Suicide (region 1,6), teenage pregnancy
(region 1,6) and teenage marriage (Region 6)
were pronounced in both urban and rural
contexts.
There were mixed feedback on teachers and
parents; some parents were adapting their
parenting style to meet the needs of their
adolescent children; some did not speak to
their children about reproductive health
issues. Parents were generally identified as
needing to have skills to support HIV/AIDS
prevention. This is a significant inhibitor of
providing a environment that is conducive to
being supportive for adolescents. This was
further exacerbated by the marked lack of
formal support networks for youth in all
categories including 10-14 and 15-19.
Sexual and Reproductive Health Issues;
Although the sexual debut of adolescents was
reported by several key informants as being at
a very young age (11 and 12 years old), the
study found that among in-school youth there
was not a significantly high level of early
sexual debut; of those who were sexually
active in hinterland areas the majority of
reported sexual activity started at 14 years old
for males and 15 years old for females, in rural
areas at 15 years old for both sexes and in
urban areas there were some reports of early
debut around 12 and 13 years old. Among
FSWs, MSMs and youth in contact with the law
this varied and responses were inconsistent
but tended to be sexually active from a young
age.
Although there was sexual activity reported
among the 10-14 age range, this tended to be
among males more so than female adolescents
and in the categories of youth in contact with
the law, hinterland males and out-of-school
(school aged youth).
In a few cases, both male and female
adolescents reported forced sex, and among
Amerindians girls there was a notably higher
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reporting of rape and sexual abuse (from as
young as 8 years old) than among other female
cohorts in the same age range of different
ethnicities, this was reinforced by interviews
with several key informants including the
police, School Welfare Officers and the
Regional Chairman who had concerns about
the rate of abuse.
FSWs and MSMs tended to have higher levels
of awareness of HIV/AIDS than other cohorts.
However, there are still knowledge gaps in
terms of awareness and understanding on
HIV/AIDS and awareness efforts are still
needed among various YKAP populations
including youth in contact with the law and in-
school youth.
HIV/AIDS education was generally reported
(teachers and students) to be taught in schools
starting from Grade 6 and schools are a central
source of information especially in hinterland
and to a lesser extent rural areas where access
to television, internet and cell phones is more
limited than in urban contexts.
HFLE and other programs that teach life skills
and provide practical examples for youth are
essential though their impact and effectiveness
needs to be determined as no evaluation has
been done of the program.
There are still no extensive facilities or
services available for adolescents (both male
and female) who have been abused. In the
hinterland areas, although there was a VCT
present it was used primarily for pregnant
mothers.
It was common among young girls and boys
who become sexually active for them to try to
induce the same type of behaviour in their
immediate circle and peer pressure was widely
cited as a general factor.
Perceptions of the availability, accessibility,
and quality of reproductive and sexual health
and HIV-related services
Guyana’s focus on youth specific services is
well founded, and suggestion that these need
to be expanded to widen the scope both of the
populations served and the range of services,
as well as providing targeted services for
specifically vulnerable youth populations.
The quantity, and variety of services (including
through communications media) that are
available to adolescents were much higher in
urban areas than in hinterland and rural areas.
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Key groups such as out-of-school youth, FSWs,
MSMs and youth in contact with law, have
special service needs and barriers that make
the accessing of services difficult including
their remote location, stigma and
discrimination especially in rural areas and in
the case of out-of-school youth, their limited
engagement with key services.
Several key services provided by key agencies
such as GGMC (Region 1) and various NGOs
have been discontinued because of a lack of
funding. Several initiatives for youth, Youth
Friendly Health Services (YFS) and Community
Care Points (MHSSS) were found to be critical
but HFLE is being stopped in school at a
critical age (Grade 9) when youth are
becoming sexual active, experimenting with
alcohol or under pressure to have sex.
There are several key points of vulnerability in
a adolescent’s life and one of the less obvious
ones, seems to be in the period just before they
exit school and immediately after, as they
adjust to having to a world without the social
reinforcement for positive behaviour of a
school environment.
Adolescents were more likely to use NGO-run
facilities and services than MoH facilities; this
is because of the perceived poor quality of
condoms and the heightened need for privacy
and confidentiality.
The use of condoms is not high among key
YKAP groups (especially MSM and youth in
contact with the law), 90% of male youth in
contact with the law (15-19 age range)
respondents have had sex but only 33% have
ever used a condom. Attitudes among YPLHIV
among youth in contact with the law ranged
from denial, fear to anger and in one instance a
desire to re-infect by not disclosing their
status.
Across all geographic locations there was a
perception that condoms have a high failure
rate (40% among urban males in Region 4),
especially those that are sourced from NGOs
and hospitals, which meant that adolescents
felt that they had to buy condoms but they did
not always have the finances to do so. In
hinterland areas, there was a perceived lack of
anonymous access to free condoms, and the
relatively high price of “good” condoms in the
shops (rough-rider: $500) was at time
prohibitive.
In rural areas, among sexually active 15-19
year old girls and boys, there was a significant
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reporting of unprotected sex. Even among
older 19-24 educated females whose sexual
partners were not monogamous, reports of
unprotected sex and unwanted pregnancies
was also reported especially in Region 1 and 6
(hinterland and urban). It was found that even
though adolescents were aware of the risk and
of means of protection, it did not always lead
to behavioural change.
Testing was generally found to be very low
(except among YKAP and FSWs), especially
among youth where services are largely
unavailable (hinterland, rural). Among
sexually active males there is a perception that
condoms are the most vital form of protection
and that testing was secondary, and as such,
they were less likely to be tested unless they
were targeted in school campaigns, or the
annual National Week of Testing, which was
generally ad hoc.
Sports and increased recreational facilities
were one of the most requested facilities
among youth, to provide alternatives to risky
behaviour and to promote awareness.
Stigma and Discrimination
The School Health, Nutrition and HIV&AIDS
policy makes no mention or provision for
YKAP and this may serve to both marginalize
LGBT, adolescents with disabilities, and impact
their ability to enjoy their right to an education
in a safe environment, that is not characterized
by discrimination, and in which services such
as counselling are available.
Several key Duty Bearers (including teachers,
schools, parents, Village Councils etc.) were
found to lack the personal capabilities and
organizational capacities to effectively support
HIV/AIDS prevention among YKAP.
Homophobia is strongest in urban and rural
areas and the quality of life of adolescent YKAP
is often affected.
There was significant reporting of
discrimination against female FSWs and male
MSMs.
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4.2 What do adolescents
know about HIV/AIDS?
A key aspect of the study was to determine the
sexual, reproductive and HIV needs of adolescents.
This was gathered from adolescents through a
series of participatory exercises that included a
pictorial display to gauge knowledge, a timeline
that gauged sexual practices and the timing of
knowledge and activity in the lives of adolescents.
One of the first steps was to determine their
knowledge levels. The study sought to go beyond
numbers in order to determine the factors that
accounted for the knowledge that they had.
The knowledge and awareness levels on HIV/AIDS
amongst youth generally, and male and female
YKAP specifically are generally considered to be a
significant measure by most international
institutions. An adolescent, who is knowledgeable,
is arguably better equipped to navigate risk, or to
understand the consequences of risky behaviour. As
outlined in the MDGs a key indicator is the
“proportion of population aged 15-24 years with
comprehensive correct knowledge of HIV/AIDS”.
The UNGASS list of indicators, that specifically
relate to “Knowledge and Behaviours” are:
Percentage of young people aged-15-24
who both correctly identify ways of
preventing the sexual transmission of HIV
and who reject major misconceptions about
HIV transmission
Percentage of young people most-at-risk
populations who both correctly identify
ways of preventing the sexual transmission
of HIV and who reject major
misconceptions about HIV transmission
Percentage of young women and men aged
15-24 who have had sexual intercourse
before the age of 15
Percentage of men reporting the use of a
condom the last time they had anal sex with
a male partner
For the YKAP Study timelines and focused
discussions were generally used to determine
98%
Of in-school-youth surveyed in the
2008/2009 BHSS had heard of HIV.
This compares with other cohorts
such as out-of-school youth (99%),
FSW (98%0 and MSM (100%)
52%
In-school youth Knew all three
methods of prevention
61%
Out-of-school youth had no
misconceptions about HIV
transmission
There have been several notable
studies on HIV/AIDS and youth.
According to the MICS (2006), the
Guyana Behavioral Surveillance
Survey (2008) and the NAPS (2012)
National Facts &
Stats
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typical behaviour and to build consensus among the
group (where possible) about what is common for a
particular group. This also helped to determine
between variance and a-typical occurrences.
Children tended to access HIV/AIDS awareness
from multiple sources throughout their lives, which
would tend to reinforce and sustain safe sex
information. As the timelines demonstrate, for a
number of children their initial awareness of
HIV/AIDS normally comes from an immediate
family member, or from an external source
(television, poster, pamphlet); the latter is
especially in urban and to a lesser extent rural
areas.
Several children also had experiences of persons in
their immediate family and communities dying of
AIDS, or having contracted HIV. This was especially
prevalent among youth in contact with the law, out
of school youth and indigenous youth. Suggesting a
correlation between poverty and HIV, but also
reinforcing the seriousness of the disease, as
several persons who were referred to were young.
Young girls tended to have accessed information
from their mothers, but with some probing this did
not seem to include much information and took the
form of general warnings about boys who would
“fool them…” These conversations did not
necessarily provide information on safe sex
Photo: Schools are a key source of accurate information for
adolescents
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practices. This is also consistent with meetings with
mothers, including mothers of children in contact
with the law who did not generally speak to their
children about reproductive health, or were
embarrassed to do so. However, respondents did
cite their parents as a source of information.
Several of the In-School Youth and other
populations (SMW, MSM), said that they were
taught about HIV/AIDS in school. The In-School
youth mentioned subjects such as Social Studies
and Integrated Science in which HIV/AIDS was
taught. However, several of these adolescents were
unable to dispel popular misconceptions about how
HIV/AIDS is spread. What this research highlights is
the importance of evaluating the quality and
consistency of how HIV/AIDS is taught in schools.
The majority of adolescents (including those who
had gotten exposure at home etc.) said that they
received exposure to HIV/AIDS education starting
from Grade 6, when youth are approximately 10
years old but have had some exposure before that.
In several cases HIV/AIDS education preceded
puberty and the forming of partnerships with the
opposite sex, kissing and sexual debut. The majority
of In-School youth practiced abstinence and saw the
ending of the secondary school as being a landmark
for commencing sexual activity. However, as that
period draws closer, older adolescents several of
whom (including teenage mothers) displayed weak
sexual maturity and decision-making skills were
receiving less support (HFLE ends in Form 3) and
had limited social reinforcement.
The awareness levels among Amerindian youth
were markedly lower than in other areas. And they
were more likely to have fewer exposure
opportunities than their counterparts in urban and
rural areas. Several persons, including Amerindian
females, mentioned youth camps as an experience
that they enjoyed and one from which they were
able to gain many practical skills that related to life
skills and sexual and reproductive health. These
included how to use a condom, body image and
dealing with unwanted male attention.
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The awareness levels among both 10-14 and 15-19
age ranges were found to be low and inconsistent.
They tended to have fewer awareness sessions
from parents. They also mentioned fewer practical
experiences of learning how to put on a condom
and to store it correctly. Although the 15-19 year
old males had slightly better awareness than the
girls, it was still lower when compared to other
regions.
The social networks of male youth tend to have a
positive role in influencing safe sex practices. For
example, many male youth mentioned that they had
heard of condom use from another male relative
(brother, cousin usually) and they tended to obtain
condoms from these sources rather than from
health centres. This was especially the case for the
youngest cohort (10-14 years old) and sexually
active. Almost all the Region 1 respondents said
that they got condoms from friends/relatives or
bought them at shops, they tended to rely almost
exclusively on these sources.
Several children who had been exposed to training
in schools (from Grade 6) and who had heard about
HIV from members of their family still believe that
it was possible to contract it from a mosquito.
MSMs and FSWs had a heavy reliance on NGOs both
for information on safe-sex practices and services.
Several persons, mentioned NGO services such as
Bricklayers Association, Hope for All, Merundoi and
Artistes in Direct Support.
Diagram showing most
frequent coded terms to
sources of information
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4.2.1 In-School Youth
Some girls, who discussed sexual health issues and
relationships with their parents (and more often
than not their mothers) tended to have general
discussions about relationships, for example 10-14
year old girls in Moruca discussing what their
mothers told them at 10 years old:
M: So what type of things your mom told you?
R: Must take boys who could take care of us
and so
R2: And don’t drink and beat us up and so
They also went on to mention the Be Safe program:
R: Bad touches. And put inside some box like
write if anybody touch you or so, write it
and put it in the box
For in school-youth the majority of persons tended
to identify condoms as a means of protection but in
both the 10-14 and 15-19 categories, there were
still unable to reject major misconceptions about
HIV, the most common of which was that it could be
contracted from a mosquito and secondly, to a
lesser extent, there was an unwillingness to share
food with someone who was known to be HIV+
because of the fear of contracting the disease. This
was especially the case among 10-14 youth of both
sexes. Persons also mentioned needles and kissing
as a means of becoming HIV positive, and the
majority of participants, both male and female, did
not feel that it was possible to look at a person and
tell whether s/he was HIV positive.
It was evident when the quality of exposure and
education in the school was strong because the
children seemed at ease discussing sex, and they
were generally quite knowledgeable about sexual
reproductive health. They could identify means of
preventing HIV and could dispel popular
misconceptions. For example, In-school females
aged 10-14 in a rural area:
M: Tell me about it
R: (laughing) Miss the male and female vagina
R: As soon as we go to that part, everybody
start laughing
M: And what was the thing about the zebra?
R: Is a man penis getting stiff and hard and the
woman vagina
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However, though many younger cohorts could
identify ways of prevention there were still a few
(and in some cases a larger number) who are still
unable to debunk popular misconceptions across all
age ranges.
Girls 10-14 (rural)
Cindy30: Like if someone that is HIV positive
and they inject themselves with the
needles and then someone else use
it, it is possible that person could be
infected
Moderator: OK, and Tifanie said that when you
get bite with a mosquito you can get
HIV
Tifanie: Yes, because sometimes like if
somebody it has bitten and then it
go and bite somebody else
Alicia: No, you don’t get it from
mosquitoes
Among older cohorts (especially females) the
uncertainty persisted. For example, among seven
15-19 University of Guyana (Berbice campus)
students there was still some confusion. This was
typical of females in this age range; they tended to
have a smaller sub-group who were unsure. These
misconceptions, though prevalent among 10-14
males, were less prevalent among 15-19 age range
as compared to females.
Moderator: And what about like, mosquitoes?
Participants: No, no
Moderator: Are you sure? You can’t get HIV
from a mosquito?
Participant: No, cause we woulda already get it.
Moderator: OK, anyone else think that you can’t
get it? Or anybody that’s unsure?
Fench: I’m unsure
(Another girl raises hand)
Moderator: You’re unsure. The two of you are
unsure.
Jazz: I was at first but then one teacher
explain how you cannot get infected
through a mosquito bite
Moderator: So now you’re?
Jazz: Pretty sure
In Region 2, five of ten 15-19 female respondents
concluded that you could become positive through
a mosquito, their male counterparts (consistent
with other regions) in the same age category, across
30 All the names used are pseudonyms adopted for the exercise.
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regions were much more aware. One explanation
for this could possibly lie in the life patterns across
the sexes, most in school youth said that they had
chores to do after school and spent more time in the
home, whereas boys reported less restriction and
had greater exposure. Males were more likely to
refer to information obtained from other males
(especially about condom use) than their female
counterparts.
Charity Secondary (Rural)
15-19 Girls
(10participa
nts)
15-19 Boys
(8
participants)
R: Actually it’s saying [referring
to photo] that you can’t get HIV
through um sharing food
mosquitoes and um holding the
person hand and socializing.
M: Anything else?
M: Who else think that you can
get it through sharing food and
a mosquito bite?
Um a mosquito, you cannot get
AIDS from a mosquito
R: Miss I think you can. You sure?
R: You can. Because like if like mosquito share
AIDS all of us would be having AIDS
because mosquito bites each one of
us
M: Anybody else? The 2 of you
3, Lisa you think so 4, anybody
else? What you think Maria
You agree, y’all agree? All of y’all
agree? You could get it from a
mosquito? How many of you think
you could get it from a mosquito?
OK show of hands? How many, 1,
ok one out of 8.
Miss yes
So 5 of you think yes
It was only in Region 4 that both boys and girls
could consistently and confidently dismiss major
misconceptions.
4.2.2 Out of School-Youth
There were several age ranges of out of school
youth that were engaged in the study. These
include, 10-14 males (rural), 15-19 males urban
and, 15-19 females (pregnant mothers).
Among the 10-14 male31, rural youth there was a
very basic knowledge of HIV, the six males who
31 The group “The Bling Bling Gang” was identified as a result
of meetings with various regional officials who identified
Riverstown (Essequibo Coast, Region 2) as being an area with
high truancy rates and one where young children were known
to be out of school. The meeting took several attempts to set up
since the Ministry of Social Services had recently been in the
area and there was a palpable fear among adults that the
research team was there to apprehend the youth and “take
them away”. The meeting was held in the home of one of the
youth who participated in the research and whose
grandmother consented to having the focus group at her home.
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participated in the study stated an array of
responses that showed both high levels of
understanding and also reflected major
misconceptions:
It was possible to contract HIV from a
mosquito (all)
If you kiss somebody or have a bad tooth
you could become HIV+
It was not possible to tell from looking at a
person if they were HIV+ or not
It has no cure and attacks your immune
system
Condoms protect you from HIV infection
There were also positive outcomes in instances
where out-of-school youth were involved in sport,
exposed to NGOs, and had parent(s) who educated
them on HIV and reinforced these messages and
practices.
For example 15-19 boys who were out of school
were quite knowledgeable:
R: Is a condom [referring to image] You got to
use a condom
M: Why?
R1: To protect yourself
R2: Injected needle could pass it on
R3: If you mouth burst….blood transfusion
M: What about the mosquito?
R2: Nah
R1: Nah, is a human transmitted infection
4.2.3 Female Sex Workers
In keeping with the national statistics, FSWs tended
to have both a good knowledge of the disease and
were knowledgeable of how to protect themselves.
Most of them mentioned having learnt about HIV in
school. This group (urban) in Region 6 was attached
to a local NGO and had frequent exposure to
HIV/AIDS related awareness through the peer-to-
peer education program run by the NGO.
Several of the women were mothers, and had long
term partners.
As in other low-income groups, the women also had
personal experiences of relatives and close family
The children were all out of school youth who were not
working. All of the children who participated in the study had
consent forms signed by their parents and guardians.
“First when I hear
about AIDS is when me
uncle died. I ask
mommy what he dead
from and she said that
how, is AIDS.”
FSW, Region 6
“I was like 15 but
I never forgot
what I see…how
it [HIV] eat out
your immune
system”
[Sic]
The quotes used in this
report were all
transcribed exactly
from the spoken word,
creole. Where local
terms were used, these
are explained.
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members who were positive or had died from the
disease.
“The first time I heard about HIV is at my secondary
school. They had, a ammm, organization, come into
the school and was like show us on a TV, a video
about HIV and how you can contract the virus.
[mumbling] and that was like, I was like, fifteen years
old but I never forgot what I see...how it eat out your
immune system, that is the first time I heard about
HIV and that was in school …That [video] stay with
me forever, since I heard about HIV, gonorrhea,
syphilis... because we turn young lady and they say
that once you have it, once you gonna become young
lady and like you see your menstruation, in case you
to have sex, you know how to protect yourself.”
Like other cohorts their education came from
multiple sources throughout their lives, for
example:
Nurses on mother-to-child transmission:
“One of the most, amm, part you could get HIV is
from mother to child...transmission. Like if a
mother, when the baby is in her, the baby, if she is
HIV positive – and I learn from a nurse – the baby
would not be HIV positive. But when the baby do
born, you cannot nurse the baby and if you do nurse
the baby. That is the most important part that could
infect the child.”
Other Sex Workers:
“Me ain know about them, so I used to live with
whores them right? So me whores them, i know
they always get a condom. So certain things...
From NGOs
“Yes, you got to tell the boy don't break it 'cause you
could get it. They explain to you so properly that,
you know, even if the man ain breaking you could
still get it. And then we never used to get them
information. When you push in, before you come,
sometimes they break, they break in you.”
Tattoos
Tattoos were also popular among FSWs and they
identified it as being a practice that put them at
risk.
“The other day, I nearly like, because I like tattoo
and I went to put on a tattoo on my breast. I get
another two tattoo, I just see a tattoo and I like it,
but when I go to put on this tattoo, I did not carry
“The other
day,…I went to
put on a tattoo
on my breast. I
get another two
tattoo, I just see
a tattoo and I
like it, but when
I go to put on
this tattoo, I did
not carry my
own needle. I
was too anxious
to put on this
tattoo, so I
not...when this
boy go to put on
this tattoo I say
'Oh Christ', then
I realize that I
playing with my
life.”
FSW, Region 6
Tattoos are an increasingly visible
part of youth culture in Guyana and
many ad hoc tattoo parlors were
observed during the research
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my own needle. I was too anxious to put on this
tattoo, so I not...when this boy go to put on this
tattoo I say 'oh Christ', then I realize that I playing
with my life.”
4.2.4 Men who have Sex with Men (MSM)
The MSM populations who were interviewed for
the study fell between the 15-19 or 20-24 category
and all demonstrated good levels of knowledge. The
MSMs who were sourced for the study were done
using “gatekeepers”, local NGOs that had a history
with the participants and had in most cases already
exposed them to training and education
opportunities related to HIV/AIDS.
However, they also said that among some young
males there were still knowledge gaps.
R: Yes, yes, is a prevalence that the younger
generation still is at risk.
M: And why is that
R: Ignorant of the fact. They still is ignorant.
I would still say ignorant of the fact
because…the NGOs doing an excellent job
The younger generation of MSMs (teenagers) were
described by a peer educator as having a
complacent attitude.
“We look out for our little sister [other MSM]
them...some of them are so much rude, they are
very rude. They arrogant. When I say rude...not you
lil girl...some of them are so rude. 'What the
[expletive] ya'll telling me, ya'll done had ya'll time,
is we go round, leave we alone', you understand
me?
I does call them 'cliffhanger', that's like when you
playing the game on the ‘Price Is Right’ [yodels] go
till you drop, go.”
4.2.5 Young People Living with HIV
At the NOC in Region 2, an FGD was conducted with
three YPLHIV. The three individuals (2 males and
one female) ages 15-19 had started to have sex at
ages 12, 13 and 15. Based on their responses all of
the youth came from inner city Georgetown and
one specifically reference being from Albouystown.
M: So, before you had sex, when was the first
time you heard about HIV?
R: My father does work at Georgetown Public
Hospital
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M: Do you remember what age you were when
you heard?
R: The first time I know me father, I was
round the age of like 10
M: So ten is when you heard about HIV? What
about when you were in school?
R: Miss they never tell me about HIV in school.
M: So they never told you about safe sex, about
your body and that type of thing?
R: Miss I was like 10 when I heard about HIV?
Among urban YPLHIV interviewed in Georgetown
(8 persons, mixed sex group) similar sentiments
were shared in that they did have some knowledge
of HIV from school (Form 1) and from the
television.
4.2.6 Youth in Contact with the Law
As stated in this FGD with young females (10-14) at
New Opportunity Corps displayed the same levels
of knowledge about HIV as other cohorts with some
believing that it was possible to get infected by
sharing food and by a mosquito:
Ema: Like you could get it from food miss
Moderator: You could get it from food?
All: Yes miss
They all agreed that it was not possible to look at
someone and tell if they were HIV+
Roshnie: Don’t matter what you could have
HIV and you could be big and
strong, fat normal fine
The 10-14 females also demonstrated a much more
worldly and practical knowledge of HIV/AIDS. For
example they referred to the use of pills (ARVs).
They knew of the dangers of condoms bursting and
putting partners at risk of contracting the disease,
and referred to mother to child transmission which
few other females in the same age range did. The
older males 15-19 had knowledge en par with boys
in other age ranges but touched on other
information that other groups did not mention:
Ziggy:
Orin: I know bout all like if you kiss
somebody and they lip buss you can
get it
Moderator: Huh, if you had anal sex
Orin: Two man and one of them got AIDS
Ziggy: Running is healthy [referring to
image of athlete]
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4.2.7 In Depth Interview
‘Girls, Girls, Girls’
One of the typical behaviour patterns among
adolescents who were out-of-school, and
significantly either truant or not working was a
higher likelihood of being sexual active, with
numerous partners as compared with their peers
who were of the same age. This case study sheds
light on a number of key factors both positive and
negative and cuts across several key themes; such
as the occurrence of a traumatic event (parents’
divorce, forced sex etc.) and the impact on sexual
activity, the importance of social networks and
peers etc.. There were a small amount of young men
in the age categories of 10-14 and 15-19 who
described their first sexual encounter as being
forced and one described it as being rape.
Martin, is a nineteen (19) year old afro-Guyanese
male living in a rural area on the Essequibo Coast
(Region 2). He is handsome, popular and has a well-
honed physique because of his love of football and
other sports. He parties fairly regularly and
considers himself to be a moderate drinker. He also
uses marijuana occasionally (about once a month).
He was born in Guyana but spent a lot of his life
living in a neighbouring country.
His sexual initiation was unwanted and forced. He
was nine years old and encountered a friend of his
parents who owned a small bakery. The woman
was thirty-nine (39) years old at the time and got
permission from his mother for him to stay
overnight and help her to bake bread. She then
forced him to have sex with her, which he described
and which clearly left emotional scars:
“Whole night the woman buss up me thing like when
I watch this women here like I want murder she boy I
hate she like you know ‘cause is bare pain”. I
[expletive] then but she put on condom on me and so
that’s the first time I use a condom cite put on
condom and so.”
When he went home he told his father, because he
was bleeding and had burst a vein. His father then
relayed this to his mother, “somebody buss up he
virgin”. He did not relay any action being taken
against the woman, but did have support from his
parents.
In
Depth
Interview
“Whole night the
woman buss up me
thing [penis], like
when I watch this
woman here, like I
want murder she,
boy I hate she like…
you know ‘cause is
bare pain”.
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“You see me old lady and me old man is they say the
best friend you suppose to have is your mother and
your father cite you does don’t hide nothing from
them two so if you got something to like, you know,
like you getting a problem with your girl or some
[expletive] call your mother or your father cite you
talk to them.”
His mother “forced” him to have an HIV/AIDS test
shortly after he would never have another test. His
mother was raised in Venezuela and there is
exposure regularly “every minute” to HIV/AIDS
related programs. Martin also got exposed in a
“Sexologia” class dedicated to sex education.
HIV/AIDS was integrated into other subject classes.
A few years after the incident, at age 11, he started
to have girlfriends. Several of the girls that he had
causal sex with were with women who were having
sex with his cousins and his friends. He has since
had sex with multiple girls, including young girls
(who get away from home when their parents are
sleeping) that he meets on Monday night at
Charity’s night scene. He has a main girlfriend who
he is sexually active with along with other girls who
he is also sexually active with.
‘cause he [his cousin] went deh with the girl first, and
I go and deh with the girl, the girl tell me come
[ejaculate] just so because [name] is come just so. I
say what, no man I can’t go just so, hold on it aint
gonna tek me long to put on a condom. So I say you
can’t catch me so easy man, I got to deh real, real,
real, real, pissing drunk, I could deh with a woman
without condom. “
“Yea I get more than one girl man cite, but certain
girls not … dehing with you alone, that what more
you really don’t do [expletive] with cite, like what is
done you wife.”
Martin has two key practices. He is aware of the
dangers of alcohol and is open to the use of
marijuana, which his mother endorses because of
its benefits to the body. He reported that even when
he was under age he was able to buy alcohol at
clubs in Charity except for one bar [name of bar
withheld] “because …you is got to show ID card to
go up deh”.
“First thing when you over drink alcohol you does
always want go bare back, if you ain’t got you focus
up, gone you gone…so I don’t drink to the extent.
“First thing when
you over drink
alcohol you does
always want go
bare back
[without a
condom], if you
ain’t got you
focus up, gone
you gone.”
In
Depth
Interview
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“Weed is nah really ”drugs” you know. Weed is a good
thing for a man body, but you is can’t do it too steady
cite if you smoke a joint of weed every month it good
for you body cite.”
“I know nuff people who does smoke weed by we side
deh and them man is big and fat cite, like up to me
big sister is smoke weed.”
Martin understood the importance of condom use,
this is largely because of the influence of his mother
and his deep distrust of women.
“No boy you don’t trust yourself now a days boy
because sometime you aint know what she got man,
you can’t see in she body and say, you know, that she
got AIDS, you got to always go protected.”
“Even me mother is tell me that mommy say watch
certain girl (name) you don’t trust cite because a
woman could just now deh with a man ‘round the
corner deh and she could come home by you and she
dry, dry, dry again cite but you see we man now when
we kick two water by the turn deh and we pull up by
we wife we can’t really kick three more water you
understand me.”
Martin did not have much faith for the quality of
condoms that are distributed freely and at the
hospital so he prefers to buy them in the store. His
mother also gives him condoms whenever she goes
to the hospital. His relationship with his mother is
such that she is aware of his sexual practices.
“Because mommy know me and this girl is friend and
mommy catch me and this girl sexing. Mommy don’t
tell me nothing cite, all she’s tell me, (name) when
you going and do something make sure you get on a
condom. To mommy that is a must don’t take them
bluff with condom at all.”
When he was seventeen, he returned to a VCT to
support a pregnant girlfriend. He feels that if the
girlfriend is not HIV positive then he is not positive
and there is no need to be tested.
“I went deh with one of me friends girl and she get
pregnant and you know them is got to test
themselves all like when them test themselves like
when them get pregnant to get baby and them
[expletive], so that means if she aint got me aint
got.”
“No boy you
don’t trust
yourself now a
days boy, because
sometime you
ain’t know what
she got man, you
can’t see in she
body and say, you
know, that she
got AIDS, you got
to always go
protected.”
In
Depth
Interview
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4.3 What are the
relationship and sexual
practices of adolescents?
In the chapter, the sexual and relationship practices
of adolescents cover a wide range of areas including
age of first boyfriend/girlfriend, sexual debut,
nature and number of relationships etc.. Because of
the importance of condoms and testing, this is dealt
with in the proceeding chapter.
The majority of children in school were not found
to be sexually active. The majority of in-school
youth generally said that they wanted to delay
sexual debut until they had completed school or
until they were older mainly placed at around 18
years old. The school and social environment
tended to have positive role in reinforcing such
behaviours and choices among both male and
female adolescents. Girls, especially in rural and
hinterland areas also mentioned the number of
after-school chores that they had which kept them
preoccupied.
This finding ran counter to the view of Key
Informants in decision-making and service delivery
roles that believed that many adolescents both male
and female were having sex. However, it was quite
common for males to become sexually active at a
slightly younger age than girls, but this was
generally around the age of 14 and 15. In instances
where young women were found to be sexually
active at a pre-teen age, it was usually because of a
violent act such as rape, or as the result of peer
pressure.
A common characteristic of a relationship network
of some male adolescents who were sexually active,
was to have one dominant partner, referred to as a
“wife,” “wifie” or “girlfriend” and numerous other
partners, “spare wheel” “playmate” “plaything” that
were more casual. This was also the case with girls
but to a lesser extent, and their secondary partners
were usually not males that they had sex with.
Some girls mentioned that their boyfriends possibly
had other girlfriends, or that they were unsure or
how monogamous their relationship was. Among
MSM respondents this was a lot more prevalent and
the “main/dominant” relationship was with one or
more males (up to three reported), supported by a
range of other causal relationships.
According to the
2009 Demographic
and Health Survey
The median age at first
sexual intercourse is 18.5
years for women and 17.8
years for men.
6 in 10
Among young adults, age
15-19, about six in ten (62
percent of women and 59
percent of men) have never
had intercourse.
8%
Eight percent of women age
20-49 had sex before age 15,
while almost half (43
percent) had first sexual
intercourse by their 18th
birthday.
16%
Twice as many men as
women age 20-49 (16
percent versus 8 percent)
had sexual inter- course
before age 15
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There was reporting among both male and female
adolescents of being raped, or having been forced to
have sex, one male adolescent described his sexual
debut as being “like a rape”. Like their female
counterparts they tended to carry the emotional
scars of these experiences with them but with
fewer opportunities to discuss their experiences
since this did not reconcile with male stereotypes
or macho behaviour that young men are expected
to display.
Many young men who had sex at a young age
tended to have an unplanned and unprotected
sexual debut.
It is important to understand what the term
“boyfriend” connotes among female youth. Most of
the male and female adolescents that we
interviewed had a boyfriend or girlfriend. They
tended to be a person who they liked, and in whom
they could confide, do homework, text and meet
socially. For others it connoted a sexual
relationship. In the 10-14 age range in hinterland
areas, there were few boyfriend relationships
reported. This was to some extent borne out by the
fact that the sexually active girls said that they
made their debut at circa 15 years old. Similarly, in
rural and urban contexts having a
boyfriend/girlfriend described either a platonic or a
sexual relationship.
For example among 15-19 in-schools, Indo-
Guyanese females:
Diagram: The frequency of
codes under the theme of
sexuality, reflects a high
reference to pre-sexual
activity experiences such as
boyfriends, kissing and
petting.
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M: So when you say, like a boyfriend, right?
Are you kissing your boyfriend, or…?
R: No
R: Well I don’t really have one right now, but
when I was in form four … it was just a
friend, like just for a two week or so…
M: So what would you do, like talking on the
phone?
R: No, in school…just talk
M: So what makes him special that you call
him a boyfriend? Cause you talk to many
boys, or you like him a lot?
R: Yeah, it used to be like, you know any time,
like school work and stuff he’s normally
help me.
Among Indo-Guyanese in rural areas, there was also
mentioned of arranged marriages, but this was not
commonly reported. There was a strong sense of
social control and stigma related to a loss of
virginity, or having a relationship and being
unmarried as this would bring “shame” on the
family. Having sex meant having to be married, with
very few other options in between.
R: I was engaged at sixteen
M: And how old was the boy?
R The boy, was um, twenty, twenty-one….
R …I got away one time…
R …confusion, problem, peer pressure,
everything and he just come, collect me
from school and I go, unexpected. I didn’t
know he was going to carry me away. We
went, we went over the river, spend the
night…not gonna le. We spend the night
without doing anything, because I was just
confuse.. and now I came back home,
Mommy bring the police everything…and I
still didn’t go home because I was already
engaged. They say if I go back home, leaving
this guy [mumbling
M: They [parents] think you’re “finished” if
you sleep with a boy?
R: Yes, it means you lost your virginity
already, no man would ever want you. Who
gon want somebody that…already finish?
A common trend among adolescents, across all
categories (MSM, out-of-school youth, in-school-
youth) was the prevalence of opportune,
spontaneous sex; at school sports, in the toilet, on
the grass etc.. where neither partner expected to
have sex, and as a result, did not come prepared to
have protected sex.
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In addition, although many girls referred to peer
pressure as a contributing factor to sexual initiation
many young males, especially those who came from
troubled backgrounds or had emotional issues
tended to mimic the sexual patterns of their peers,
i.e there seemed to be a higher probability that they
would also be sexually active. This speaks to the
role of social networks and peers in informing
relationship and safe sex practices.
A critical period in a young person’s sexual life
seems to be the period just before they depart
school (3rd, 4th and 5th form) and when they leave
school. Many youth then would more likely begin to
party and have sexual encounters. This includes
after they have left school and this was reflected in
comments with both male and female respondents
including teenage mothers.
Because of the prevalence of new means of
communication (such as cell phones and internet)
in all of the sites (cell phones more so in hinterland
areas) these devices were being used to connect
youth and to place both female and male youth in
contact with older adolescents and more mature
adults with whom they may not ordinarily have
access. In Region 1, a female respondent reported
being offered money for her cell phone number and
at some schools the use of cell phones had been
banned.
There was a general distrust on both sides (male
and female), as reflected in this quote:
‘Cause she could just now deh with a man and pull
up, “ ow baby” remember you ain’t gonna know.
Cause women is a thing you don’t really trust at all
you know.”
4.3.1 In-School Youth
Most female, in-school youth did not report sexual
activity and in general, those who were sexual
active were a small percentage of the group
(possibly 10-30%). Most girls said that they felt that
they would be ready to initiate sex when they,
“were older [usually late teens, or early 20s] or
when they had left schools.
In instances where girls were sexually active, a few
of them mentioned peer pressure as being the
cause, usually in combination with alcohol or being
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at a place or event where there was minimal or no
supervision.
For example one Afro-Guyanese female [15-19] in
an urban setting recounting how her female friend
was instrumental in her having sex for the first time
at thirteen:
R: She [her friend] was like 12 when she lose
hers. She said "I went and do this thing this
thing feel good" and "If you nah gon do it
you can't be in our crew anymore." I didn’t
tell my mother it was like rape, cuz I was
like sleeping. When I wake up I see the guy
on top of me and I just wash off and never
come back.
…That’s what I thought, I thought he would
always be there for me. But he listens to he
mother and he felt bad about what he did.
He sister call he and tell he "She don’t like
you she got another man etc." At the age of
15 I started having sex again.”
4.3.2 Out of School-Youth
Generally the male 10-14 years old were aware of
condoms though their sexual practices, which were
usually opportune and hurried, meant that they
were usually not protected.
M: So when the girl is there…like where you
would be?
R: Like if you hurry to do it, you don’t have
time to put on condom
M: So normally you does be in a hurry to do
it, because you would be doing it where?
R: A fowl pen
R: A bush
R: A old house
R: A hut, in the water, on a tree
[Boys laughing]
Emotionally the boys expressed a variety of
responses including humour, fear and
apprehension at having had un-protected sex with
one suggesting that he was too young (“too small”)
to become infected. Pregnancy seemed to be the
most worrisome issue for females, but both
pregnancy and HIV/AIDS was spoken of among
male even it was first referred to among males.
Generally, youth revealed some of their confusion
and worry after they had had sexual intercourse.
A fowl pen
A bush
A old house
A hut
Places where 10-
14 rural youth
are having
spontaneous sex
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M: How do you feel – you get scared?
R1: Me does feel like wha if she come
back and tell me she pregnant.
M You worry about that, you don’t
worry about her saying I got HIV?
R1: Yeah, I does frighten like if she got
AIDS
M: So how you feel, you nervous you
worried?
R1: Heart beating
M: After, or, all the time?
R1: All the time
M: Or maybe yall not thinking about
HIV and getting girls pregnant? You
think about it or you don’t?
R2: No
R3: Don’t think about it…I small
Their sexual partners were multiple and involved
girls who were not significantly older than they
were.
M: You think that they are? That they have
other boyfriends?
R: They got other boys
R: You would think they don’t have, and is
you alone, but they is got nuff [many]
boyfriends!
M: Your girlfriend is the same Ramesh?
R: She deh all bout [laughing]
M: What about you Ethan, you think your
girlfriend is going with other boys?
R: Yeah
The respondents demonstrated earlier engagement
with the opposite sex as compared with other youth
in the same category who were in school. Half of
them described having had a first girlfriend from an
early age and that this involved kissing. One boy
who was not involved in sexual activity had started
groping girls, which he described as “lash and run”
(quick sex).
4.3.3 Young Gold Miners [20-24]
32
32 A 2002 study by Carol Palmer et al, HIV Prevalence in a Gold
Mining Camp in the Amazon Region, Guyana, found that 6.5%
of 218 were HIV positive. The report noted that the “high
percentage of HIV infection provides a reservoir for the virus in
this region, warranting immediate public health intervention to
curb its spread.
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Most of the young men who were interviewed in
Region 1, got involved in mining at a young age
(between 14-17). Several of them had dropped out
of school, and a few of them had completed school.
One boy was the top student for his year.
Miners described the lifestyle in their trade.
Generally, they worked for several weeks,
approximately six weeks (a quarter) and would
then come out to the landing. Because of the known
temptation some miners said that they avoided the
area in order to abstain from risky behaviour and to
save their money:
“All gold mining port is like that, you know. If you go
to Port Kaituma, when you coming out the mines, you
come down to the landing, just like Bartica, you go up
into the mine to come down the piece of landing.
When you come down now, you get temptation to
start spending your money. Got a lot of woman, got a
lot of beers...”
It was not definite that they would have sex, it
would depend. But some said that they would tend
to trust the women (FSW) they usually have sex
with, and others said they did not. Alcohol was
generally mentioned and this tended to impair
decision-making.
R: Normally you going and look for a piece of
money, women [FSWs] going too. She got a
family so anybody come and want have sex
with she...might be two pennyweight
M: Whats the value of two pennyweight?
R: Gold selling for twenty thousand a
pennyweight
M: That's about $40,000?
R: Yea. Is just like for an hour...five minute or a
hour. All depends...
M: It means you could spend a lot of money on
stuff like that...on women
R: Every individual I see, don’t spend all that
[money] on a woman...maybe one and two
time [not often]. Mostly any one of we is
just go and buy thing [alcohol, food], but it
got people [who do buy sex regularly].
4.3.4 Teenage Mothers [15-19]
Within Region 1 it was frequently cited that teenage
pregnancy was a key social issue. Teenage
“Some of us are
[monogamous], but
on a scale from one
to a hundred, you
gon get 99.9% who
is very much
promiscuous and
the other one
percent who is
monogamous”.
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pregnancy along with sexual abuse and incest were
the most often cited issues in the region that affect
women. It was found that 25% of the recorded
births from January to October 2012 were to
women less than 18 years old. Pregnancy among
young people was used as a gauge of use of
protection, especially since both pregnant mothers
and care givers at health centres and hospitals
stated that these pregnancies were largely
unplanned.
In Region 1, three young mothers were interviewed,
two of whom had become pregnant as teenagers.
What is evident is the low emotional intelligence
displayed and despite the age range (i.e. being over
18) limited of respondents who became pregnant
because she thought she was infertile, she never
used protection, which suggests that the primary
deterrent for using protection is family planning.
And another simply did not use protection. Both
became pregnant after the left secondary school
and one was a teacher. Both girls are, one year later,
still in relationships with their partners but neither
is certain if they are in exclusive relationships.
4.3.5 Men who have Sex with Men (MSM)
The MSMs who were interviewed were confined to
urban centres. As in other studies, it was difficult to
get MSMs who were willing to participate in
rural/hinterland because of the stigma and
discrimination. In Region 2, it was reported that
most of the MSMs had moved to Georgetown and
several persons made homophobic remarks.
In Region 6, the MSMs were sourced through a local
NGO and was a mixed group [male respondents
who were over the 24 year ceiling] which allowed
for an inter-generational discussion.
The majority of MSM respondents who were
interviewed described themselves as “female” and
as “bottoms”. Overall the MSMs painted a picture of
a very close knit and vibrant social life that was
characterized by multiple partners and lots of
sexual activity. They described themselves and
their community as being “promiscuous” which
they knew put them at risk. They would have
multiple partners and the partners would not be
knowledgeable about the other partners. The
relationships were also to some extent
“I had an affair with a
guy for thirteen years
and a wife, a
beautiful wife and
two beautiful kids
and we're still
together. The wife,
people does complain
to her and she stop
me a day on the road
and she ask me, but I
could not have say
'yes' you deny the
fact.”
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transactional since one MSM was living with an
older MSM though not in an exclusive relationship.
It was reported that:
“In a homosexual setting is very rare...very, very rare,
because, amm, I would want to say we always crave
for more. Something better, something flashy.”
For example, in one case, one MSM was having
primary relations with three main partners, but
also having sex with other men, who were referred
to as “playmates” and “sex mates”. Some of the
partners were also married or bisexual. The group
also referred to men who were married and kept
their homosexual relations on the “down low”.
Tops and Bottoms
Everyone in the group considered themselves to be
females “bottoms,” or receivers, which places them
at greater risk.
The MSMs stated that there was a new practice of
being “flexible” i.e. being both a top and a bottom
although this was looked down on by older men.
Under Age Partners
Interestingly, older males (above the age of 24)
stated that their preference was for much younger
boys, including ages that were below the age of
consent.
“And the craving is getting deeper and always a
yearning for more, and younger bloods.”
Another said that:
“By the time you reach twenty, you expire”.
“I love young boys!”
Most of the MSMs became active in the early teens
14 and 15, but felt that among the younger
generation they were becoming sexually active at a
much young age ten, eleven and thirteen. They also
described younger boys as being aggressive.
One MSM who was in his late forties described
being pursued by a younger male (aged 10) from
who and his anxiety about it:
“Every day this lil child coming for this ice [to buy],
me getting cold sweat, fever...why this guy looking at
me, smiling, smiling...but nine, ten, always with a
broad smile and when he watch you underneath.”
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Sexual Enhancers
The respondents also referred to products that
allowed for longer gratification, which they also
saw as putting them at risk as it potentially resulted
in more sporadic unplanned sex as described
below.
“Now you have a particular product selling at the
drugstore called Last Long, is for the male partner to
use, I wouldn't call the drugstore name, but one is
being sold for the sum of GY$500, the other $1000.
One is for 4 hour, one is for 8 hour...the longevity...for
the penis, ok.
So is a lot of sexual enhancement out there. Now he
might go to his girlfriend when he already use this
product, but due to the agony the girlfriend get rid of
him. Remember, he did not ejaculate to get that
fusion out, so the only way now 'oh, [expletive], I
living through the same street with Antiman [name
given].'”
Sporadic Sex
The group stated that one of the sexual practices
that put them at risk was an unplanned, and
sporadic sexual encounters. This was consistent
with what was reported among other male cohorts.
They said that they may meet someone in the toilet,
or end up having sex in a burial ground or on the
grass. So they were not prepared and did not have
protection.
Money
Respondents said that younger MSM were attracted
to them because of their wealth, but dismissed the
notion that it gave them power over young males.
“Working as a public servant, they watch you, they
know is your pay day, you leave to go to the
washroom...these are some of the advantages and the
challenges that the MSM face in the field or in the air
or in the community. Especially, for the men who are
not working, young out of school men and those drop
out of school, because remember they have their
needs to be met, ok. Now they approach you, you go
to the back washroom to urinate...please for $500.
Sometimes he ain even want you to urine, he will take
out his penis and he would show it to you, you
understand?”
Another said that amongst MSM, money was not
always the motivation, but pleasure was:
“We gay
people
always have
money.
Antimen
never
broke!”
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“If I may, they have a lot of them that does not
approach you for money, they approach you 'cause
they wanna feel nice...I want you give me a lash off
[oral sex] or...or...I want to have sex with you.”
4.3.6 Young People in Contact with the
Law
There was a higher incidence of sexually active
males and females among this cohort. This was also
the case for girls across age ranges 10-14 and 15-19
years old.
Girls 10-14 FGD, New Opportunity Corps
R: 12 years [sexual debut], the person was
older
M How old was he?
R: 17
M He was 17, ok, anybody else want share?
R2: Miss well me the person was older than me
and he was 18
M: And how old were you?
R2: 13
Forced Sex
The incidences of rape that were discovered during
the research were mainly among girls and less
among boys, however a few boys recalled being
raped as children or forced into having sex.
This emerged during the ‘timeline’ exercised in
which respondents were asked to identify what age
they were when they had their first sexual
experience.
Boys 10-14, Scouts Group, New Amsterdam
Police Station
M: And where do these things [men
approaching boys for sex] happen? Where
would they be?
R: In a old house...
M: So they would be in the old house and the
people would call you in? And they would
call you in?
R: Miss, on the road they take you in [to the
house] and they rape you.
Youth in Contact with the law, Males 15-19
“Miss 9 [first had sex], miss, is not really sex miss like
I de miss to me like I de get rape, miss.“
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Another said:
“I remember I didn’t want kiss the girl, but she
forcing me to kiss she and I didn’t want kiss she and I
still end up kissing she because she force me.”
Female 15-19, In-School Youth
Felicia: So, um, two things, how about if you’ve
been abused in your early age um is that
sexually active?
M: Yes, rape is sorta [sort of] means that you
had a trauma in your life like something
that was very traumatic. So you wanna put
like say roughly when, or anything like that,
or you don’t want to talk about it? ‘Cause if
it’s something that makes you
uncomfortable, you don’t have to talk about
it.
Kelly: 13
M: 13 good. Anybody else?
Felicia: 15
M: If like anybody want say, like something
that was traumatic, where you didn’t want
to do it and you want to include it, you just
say trauma and we put it as an age you
don’t have to say that it was like boyfriend
and girlfriend. Alright.
Tia33: 17
M: 17 [repeating]
Brea: Abused at 5
M: Ok, we’ll put trauma down here.
Maria: Miss, age 9
M: OK, so that’s a trauma. Anybody else?
Brea: Sex at 15
Persons were given the option not to reveal
anything that made them uncomfortable and at the
end of the session were invited to discuss it further
if they so wished. In one such case, Crystal, now
aged 15 and being educated on the coast, recounted
in private, that she was raped in her village
(hinterland) at age 8 and again at age 9. She has
brothers and sisters and later said that her sister
had told her mother that she was molested by her
cousin.
She remembers that the first incident occurred
during Amerindian Heritage Month because her
33 All the names used are pseudonyms adopted for the
exercise.
“But all of them
tell me that I
have to “forget
about it [being
raped] and
move on”, but I
can’t forget.
They don’t
understand my
feelings.”
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father was drinking excessive amounts of alcohol.
Up until she started Charity Secondary
When she was age 11, during a class in which STIs
were being discussed, she realized that it was not
normal for your uncle to sleep with you, up until ten
she had thought that it was. She was so
overwhelmed and felt so bad that she had to get up
and leave the class, which is when her teacher
realized that something was not right. She then
wrote a letter to her teacher explaining what had
happened to her. She said that two days later, the
teacher invited her over to dinner and would
eventually tell her she’s not the only person it
happened to. She would eventually tell two teachers
that she had been raped and one in particular has
continued to take an interest in her and would give
her treats. “But all of them tell me that I have to
“forget about it and move on”, but I can’t forget.
They don’t understand my feelings.”
Healing
Crystal loves to write and documents her life in
stories. She wrote a essay about her experience
called, “The Most Momentous Incident in My Life”.
At the time she had showed it to her mother, telling
her that it was something she made up, but she
dismissed her. “I showed it to Mum but she said,
“you don’t have anything good to write.”
When she was 15, she had a vaginal infection and
her teacher who told her “you can tell me
everything,” took her to the doctor. She was
confused about whether she was a virgin or not and
she asked her teacher, “if I could still be a virgin”.
When her mum came out from the river she was
vexed that she didn’t know about the hospital visit.
She responded to her mum by saying, “see how I
does feel because when I tell you things you don’t
take interest in me, so I have to tell someone who
takes an interest in me.” She has never been tested
for HIV/AIDS.
She said that she hated boys after the incident and
does not want to have a boyfriend until she is ready.
“I feel like I will never do it! “Her uncle has moved
and now lives in Bartica, her plan is to buy a gun
and take revenge when she leaves school. She plans
to graduate as the best student in the school and
has topped the region in the past. Her school
performance is what gives her the courage to move
on. She feels suicidal “nuff time” especially when
she has problems with her mother, she feels that
her mother does not give her the support she needs.
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4.3.7 Young People in Contact with
the Law
In Depth Interview
Girls with Early Sexual Debut
“Every Best Friend, has A Best Friend”
Through a senior Social Worker in Region 2, three
teenage Amerindian adolescents (Angel, Kelly and
Madonna34) who had run away from home and had
been briefly trafficked, were identified and
interviewed individually (in one case Angel and
Madonna together) to understand what were some
of the drivers behind young girls in this age range.
The interview provided insight into the social
networks of teenagers - the reasons for low levels
of protection, self-esteem and peer pressure. It also
speaks to the psychosocial and protection needs of
young girls. One of the common recommendations
among young girls, including Kelly whose story is
presented here, was to have counselling available to
guide them through difficult and confusing periods
of their lives.
The sexual debut in all three cases was before the
age of 15 and unprotected.
In one case, Angel was pressured by her friend
Kelly (same age range) to have sex, “she had it and
she used to tell me, it’s good and I should
experience it”. She felt pressured to have sex. Angel
described sex like an initiation, she said that “Kelly
had done it already and I feel stupid. She [Kelly]
used to say that she big already and I is small”.
Angel then had unprotected sex at her 14th birthday
at a party even though her boyfriend (16 years old
at the time) was willing to wait. She said she would
not have had sex at 14 years old if she had not been
pressured. After she had sex with her boyfriend
who had other sexual partners she never had sex
with him again even though they remained in a
relationship for a year. She would think about it
often and regretted having sex, it affected her
school performance and she dropped back in
school, she went from scoring between 50-60% in
class to 40%. She then went on to another
boyfriend with whom she has sex, he is out of
34 All the names used are pseudonyms adopted for the
exercise.
“Kelly had done it
already [had sex]
and I feel stupid.
She [Kelly] used to
say that she big
already and I is
small. It wasn’t
something that I
wanted”.
Angel
15 years
“I don’t like telling
mummy certain
things…because
case we get into an
argument she will
throw in me face.”
Kelly
15 years
In
Depth
Interview
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school and she was attracted to him because he was
cute and dressed nicely. She regularly has sex with
her current boyfriend who is 18 and they always
use a condom.
Madonna (15 years old), her friend, ran away from
home because she was “bored at home and wanted
to go to Georgetown”. She also had sex at the age of
14 at a “wedding house” [place where a wedding is
held usually a private house, or hotel], she had been
drinking at the time. If she had not been drinking,
she said she would not have had sex. She meets
with him after school and at the weekend. She also
has another boyfriend who she met at a club. Her
main incentive for using a condom is that she does
not want to get pregnant. Madonna fights regularly
with her parents and feels that the teachers at the
school ignore them, and brand them as “bad girls”
Kelly, who initiated Angel into having sex with boys
said that she started to have sex with her boyfriend
when she was 11 and he was 16 years old and out
of school. They dated for one year and he told her
that he was going to marry her. When he left her
she decided to “bruk wild”.
Kelly generally distrusts adults and her friends with
sharing her feelings. She is convinced that the social
worker has been spreading rumours about her, that
she has slept with “a whole set of boys” when she
was in Bartica (the location to which they girls were
trafficked). She only tells some things to her
girlfriends because, “every best friend has a best
friend”.
Kelly feels that the males that she has had sex with
don’t care about her, she now feel suicidal because
she thinks constantly about the things that she has
done with boys from the age of 11 to now. She feels
“ashamed” and that she “doesn’t have much worth”.
She has tried to mix up sleeping pills (that she
bought at the pharmacy) and to take her life. She
feels the trigger for her behaviour stems from her
father leaving the home and her parents’ divorce.
She found dealing with this difficult and having to
deal with her boyfriend abandoning her at around
the same time. ““Everything is difficult…just being a
teenager is difficult.”
She does not have a good relationship with her
mother. She related that her mother heard on the
street about some of the things that she was
involved in and came home and slapped her in the
face. She feels that her mother embarrasses her by
In
Depth
Interview
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saying “plenty hurtful things…I don’t know why she
make me, I just bring disgrace on the family.”
Her sexual and social activities include:
Sex with two teachers at a hotel when
she was fourteen, their ages were about
23/24
She has sex at hotels with guys
Having slept with approximately 20
boys
Usually slept with the majority of them
one time
Started drinking alcohol at 12, drinks in
the clubs at Charity, consuming about
17 beers in one night paid for by gold
mining male friends
She has been tested once – last year
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4.4 Are adolescents using
condoms and getting tested?
There were mixed and inconsistent responses as it
relates to adolescents and HIV prevention. In
general, condoms were identified and were used as
the first line of defence against infection. As such,
many people equated using a condom with not
having to be tested regularly, which opened them
up to exposure.
Among Female Sex Workers and MSMs there was a
higher tendency to get tested, especially if they
were able to access services that they trusted.
However, this was by no means uniform. Condom
use among MSMs was also not uniform, and even
though men were aware of the dangers, the
spontaneous situations meant that they were often
unprepared and unprotected. Among male youth in
contact with the law there was the highest
incidence of practicing unsafe sex. Males between
the ages of 15-18 provided reasons such as
discomfort and lack of knowledge for being the
reason for not using a condom.
In hinterland areas, where testing facilities were
not available youth tended to be conscious of
wearing condoms and even among young cohorts
(10-14) claimed to always use condoms when they
had sex. Among young 10-14 out-of-school youth in
rural areas, condom use was not widely practiced,
however among older age ranges they were much
more likely to use condoms largely because they
were sharing partners and did not trust their
female sex partners or, were afraid of getting
HIV/AIDS or getting a girl pregnant. Among older
girls, the fear of becoming pregnant seemed to be
greater motivation for safe sex than the risk of
contracting HIV.
Civil society organizations (CSOs) were more likely
to be mentioned as a source of condoms and testing
that any other institution. Several persons felt that
the quality of free condoms were poor, which
exposed them to risk.
In order to ensure confidentiality, some adolescents
(mainly older adolescents 20-24) who are mobile
tend to get tested in other regions (when mobile)
such as Georgetown, rather than close to where the
Diagram: Several studies, including
the 2007 Guyana Epidemiological
Profile found high levels of condom
use among MSMs
75%
of MSM in the BSS 2008/2009
reported that they always used a
condom
49%
in school youth reported using a
condom in the last six months
60%
of out-of-school youth said they used
a condom the first time they had sex
80%
Commercial Sex Workers reported
that they always used a condom
when having sex with clients in the
past month
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lived. However the generally knew where to go to
get tested if they wanted to. Many reported “shame
shyness” as a reason that keeps them away from
both public and possibly even NGO facilities. This is
the same for accessing free condoms.
4.4.1 In-School Youth
With the exception of girls who reported being
raped or sexually molested, there was, in general
limited reporting of sexual activity among girls in
the 10-14 category across the regions.
In Region 1, boys in the 15-19 age range said that
they started to have sex usually around the age of
14 years old. And some boys in that age range said
that they were sexually active. One 14 year old said
that condoms, “Is a must”. They were motivated to
use condoms for fear of contracting HIV, STDs and
getting girls pregnant. They could obtain condoms
from the Red Cross. One boy said he had had sex
with five girls and had used condoms but had never
gotten tested. When asked, the boys also produced
condoms. Parties, sports meets and other events
that led to chance encounters among boys meant
that in some instances (including the first sexual
encounter) protection was not used.
In older males (15-19) in Region 2 (rural) there was
not much reporting of sex but in some instances it
was reported as being unprotected. Males tended to
become sexually active at age 15. This was mirrored
in the same female category and was also mainly
unprotected.
4.4.2 Female Sex Workers
Female Sex Workers, generally understood that
they were at risk. Some of them demonstrated
extreme discipline and protocols for ensuring that
they were protected in both their private and
personal lives.
“If I want a baby, I go to Comforting Hearts or I come
to brickwall [Bricklayers Association] or whatsoever
and me and he gon come in the room and we gon do
the test together and then when the test come back
we gon have unprotected sex, but we make sure the
test run for six months, that's how I do it in my
relationship, but how long no rubber….no ride...”
HIV prevention was not the only motivation for
protection:
“Now okay, nobody
buys sickness, okay,
you go with
somebody we all
know that you
condomize, but we
all know that even if
you use a condom,
they are not 100%
safe, it can burst
right? And we can
contract it like that,
so I want to know
the reason why
people still
discriminating
others and all of us
in one circle and we
are entitled to get
any STIs, STDs, or
HIV and AIDS”.
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“I don't want children that's why I don't sex with a
condom and I don’t like doing abortion so that's how
I protect myself and my relationship.”
“A sex worker tell me, she normally use a condom
and this condom burst and she ain realise this
condom burst, right now she's pregnant.
Another said:
R: All of that too. Another thing how I does do
is, I go at Comforting Heart, I have my card,
every three months, I repeat my test and I
carry he [partner] along with me, every
three months.
[Laughter]
R: I ain shame to say, every three months we
go to Comforting Heart and we sit down and
we do it. Sometimes the girl might watch
me, so watch me. I say ' I come to know me
status, what going on? This young man here
too'. Every three months I do my HIV test, I
have my white card...”
The FSWs were also conscious about the quality of
the condoms they received. They felt that the local
NGO’s “durex” condoms were of good quality. Some
said they preferred to buy them. They did not use
female condoms:
“The female one [condom] ain make it, it ain
make it.”
4.4.3 Men who have Sex with Men (MSM)
MSM’s generally displayed a strong awareness on
the role of condoms as a means of protecting
themselves from contracting HIV. They also were
more likely than other groups to be tested along
with sex workers and miners.
Dialogue with Urban (Region 4) MSM FGD
M: So what is the relationship [of a condom] to
HIV?
R: That is one of the safest thing right now, the
only safest thing we have right now is
condom
R1: But that is not the condom for we
R2: You should abstain
R3: How many of us is abstain, you is abstain?
“Everything for me is for
woman. And they have a
lot of them who is also
open out and no matter
how you try to educate
them, I know that they will,
they does go without
condom. Right now there's
a MSM who is living in my
community who is HIV
positive and I try my best, I
try all my best, because
she's HIV positive and she
will go with young men
without a condom.”
Peer Educator/MSM
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M: Some people say it is not safe, why do you
say it is not safe?
R: It could burst
R2: If you put water in the condoms, you is see
holes inside
R: Sometime in penetration it could burst if
you don’t properly lubricate yourself
Several persons openly admitted to not using a
condom consistently i.e. every time they had sex
because of the sporadic nature of the event. A
fleeting opportunity that had to be grasped:
“I was attending UG, there was this guy up Corentyne,
we were in the same class and he was like, he always
wanted, always wanted me. I left to go to the
washroom and he followed me...and I had it in the
washroom without a condom.”
Another incident:
“I on the road, I see this driver and I’m like 'Oh my
God', I would [not] get this opportunity again. You
don't care if you don't have anything [condoms], you
just go and put yourself at risk.”
Another said that he does not worry about using
condoms because he knows the people he goes
with, even though he has multiple sex partners and
engages in threesomes with a married man and
another girl.
Another common pattern was to have unprotected
sex in the teenage years, or the “wild years” as one
referred to it, when they first became sexually
active and then to start to use condoms and get
tested later on. For example, one MSM had been
sexually active for 5 years before he started using a
condom.
“Well even though you were informed of it you still
ain’t use to use it. In reality, it ain kick in. it now
filtering in. remember we are a young generation
and the learning process takes time to adapt to
certain changes.”
There was also dual reporting on the use of
condoms among young MSM in that it was also
reported:
R: The men now, or the young boys, they are
so health conscious that even if you don't
have...they have
“First she ask me if I
find out I am HIV
positive what I
would do? I tell she
I won’t want my
family to know
cause they gon hate
me.”
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M: They have a condom? So you think sex now
is really safe among MSMs?
R: Yes
R: To a degree
The reporting on testing was also mixed; some said
that they tested regularly, for example in one case
for the last five years he got tested everything three
months. Another said that in the last five years he
had been tested twice.
The preference was to be tested at an NGO, because
“I trust and rely on the people that works here.”
There was also some trepidation at the idea of
being tested based on fear of being exposed but
others were not afraid to be tested:
“Most persons are scared to be tested. They have
friends, relatives working there and they talking.”
R: I talk to most guys, they are afraid to have the
test
M: So you never got tested?
R: I got tested, I am not afraid. And I telling my
friend them, don't be afraid.
4.4.4 Young People Living with HIV
One male 15-19, who was interviewed at NOC said
that they became aware of their status when they
arrived there as it was compulsory to have a test.
Some persons said that they were not expecting to
have sex and did not have a condom.
One female YPLHIV reflected:
“They say carry a condom with you all the time but if
a person says they not planning to be sexually active
any time soon, they wouldn’t carry a condom with
them. But being in the time and place and the
opportunity presents itself and they don’t have a
condom, what would happen? So I think whether
you want to or not, you should carry a condom.”
Most of the youth interviewed at NOC (15-19 male
and female) said that they were surprised and got
tested because of having been required to do so by
social services. One male (Peter) seemed to be in
denial about his condition.
National Testing
Statistics
The Guyana Behaviour
Surveillance Survey 2008/2009
found that…
79%
of Commercial Sex Workers ever
been tested
78%
of MSMs reported that they had
ever been tested
42%
of Out-of-School youth reported
that they had ever been tested
19%
of In-School-youth reported that
they had ever been tested
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Shenise35: First she ask me if I find out I am
HIV positive what I would do? I tell
she I won’t want my family to know
cause they gon hate me. Then she
tell me that I HIV positive but that
won’t change anything.
M: So you remember how you felt that
day?
Shenise: Yeah, I cried at the clinic, I didn’t
want to go home back.
M: And when you heard Akeem, you
were surprised?
Akeem: I was surprised
Peter: I came here (NOC) and I found out
M: How did you feel about it?
Peter: Well it wasn’t the end of the world
M: Were you sad?
Peter: Well, is life.
Shenise said that she contracted HIV from a tattoo
that she had gotten. Akeem, said that he was not
knowledgeable about HIV/AIDs. Peter did not like
wearing condoms:
M: Peter, you ever used [a condom]?
Peter36: No
M: So why is it that you never used?
Peter: I did not want to …I did not feel
comfortable using them
4.4.5 Out of School Youth
The boys were aware of where to obtain condoms
and mentioned that they could be obtained from
the health centre or purchased in stores for $100.
They knew where to get them but unlike most other
boys in that age category they relied on friends and
male relatives to supply but were not typically
wearing a condom when they had sex.
M: So tell me this is really important, when you
had sex with girls were you wearing a
condom?
R: No
R: The girl wears a condom
M And she gave it to you to wear?
R: No she had a condom
35 All the names used are pseudonyms adopted for the
exercise.
36 All the names used are pseudonyms adopted for the
exercise.
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M: Female condom?
R: Yeah, it got da!
M: I know. Ethan, Ramesh you?
R: No
M: You don’t wear one?
R: Never
Because of social stigma, the boys tended to
generally hide their sexual activity from their
parents and the parents of their sexual partners.
This fear prevented them from safe sex and being
tested for HIV.
M: And Bob why you didn’t go and get tested?
R: He frighten his mommy
M: Alright where do you have to go?
R: Health centre
R: You’s want drink gramazone and poison
yourself [Ethan to Bob] you frighten the girl
father
M: What are you afraid of? That people hear?
R: No, I frighten the doctor tell me I got AIDS.
4.4.6 Youth in Contact with the Law
At the NOC, the majority of male respondents have
had sex. Only approximately one-third have ever
used a condom. One male responded that he didn't
use it, because I didn't have one” another said that
it was uncomfortable to wear one. As in other
groups (MSM) similar behaviour was
demonstrated, in which adolescents were aware of
the dangers but willing to take the chance.
Males 15-19, New Opportunity Corps
R: I never had sex with one
M: You never did?
R: Never had it with condom
M: Ok. So you know where to go like how, Ziggy
[other participant] since you would be free to
talk like why you didn’t use the condom?
R: Miss ‘cause me ain’t had none.
Male youth also said that condoms cost around
$100 to $300 dollars:
M: Ok, so you could go and get the money, it’s easy
to get the money to buy condoms?
R: No miss, only if you working, or you getting
money from your mother.
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Males 15-19, New Opportunity Corps:
M: And when you decided to have sex with her
right you already knew lots of things about
HIV and so
R: Yes miss
M: Ok, so you felt like you know enough?
When you had sex with the girls, were you
using a condom?
R: No miss
M: You weren’t using a condom, none of you?
R1: No
R2: No
Females 10-14 New Opportunity Corps:
M: All of y’all using a condom?
R: Except the time [when she was raped].
M: Right, of course, everybody else would be
using it [condom]? And your boyfriends
know how to put it on when they want to
use it, or you ask them to use it?
All: Both
M: Both, and why would you use it?
R1: Protection
R2: Because you don’t know what they will be
doing on the road
M: Right ok, and do you know like all of you
know where to go and get one? Selena you
know where to go and get one?
R: A test miss?
M: No a condom
R: They always got [available]
R1: Always got
In terms of health concerns - older male cohorts
(20-24) those who were in contact with the law,
were [despite being unprotected], primarily
worried about contracting HIV/AIDS after the fact,
more so than impregnating a female.
R: Yes miss, worried if she got AIDS or if she
get pregnant
M: So but you didn’t go and get tested or
anything like that but you ask her if she’s
pregnant or so?
R: Yeah, I ask she.
M: And what she said?
R: Me aint ask she if she pregnant, I ask she if
she get AIDS
M: Before or after [sex]?
R: After
M: And what she said?
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R: She said no.
M: And you were with her for a long time like
she was your girlfriend for a long time?
R: Yeah miss
M: Like how long?
R: Miss, since primary school
M: And she’s still your girlfriend now?
R: No
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4.4.7 In Depth Interview
Condom Use Practices and Testing
The empirical evidence suggests that behavioral
change among at risk groups is complex. For
example, there is evidence among both out-of-
school youth and YPLHIV that they did have some
knowledge of HIV/AIDS prevention strategies but
still engage in risky behaviour. A report on the
subject states that, “HIV prevention is neither
simple nor simplistic. We must achieve radical
behavioural changes—both between individuals
and across large groups of at-risk people—to
reduce incidence. Once achieved, it is essential that
such changes are sustained. Although cognitive-
behavioural, persuasive communications, peer
education, and diffusion of innovation approaches
to change are beneficial within a combination
prevention framework, behavioural science can and
must do better.”
Similarly in the NAC 2004 report, Bulkan draws on
lessons that address this phenomenon, “…mass
media campaigns flooded many of these countries,
but failed to result in behaviour … people do not
change deeply-entrenched behaviour, such as
sexual practices, simply on the basis of intellectual
awareness that the behaviour may be dangerous to
them.” One of the key questions that this research
generated was why, given the risks were
adolescents not consistently wearing condoms.
Before we sat down with Dharshanie (male MSM 34
years), we knew that he was positive and was
having unprotected sex with other men. We knew
this because one of the peer educators had
mentioned him in the discussions and we requested
a meeting. We then found out that he was outside of
the age range, but we decided to use the
opportunity of someone who was willing to talk, to
explore his life experiences when he was younger.
When Dharshanie37 was 12-years old his mother
died, which worsened the bad relationship that he
had with his father. In the same year he started to
have sex for the first time with a neighbour who
was male and 16 years old. They had unprotected
sex and Dharshanie had no understanding then of
37 All the names used are pseudonyms adopted for the
interview.
In
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Interview
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HIV/AIDS or the dangers. At 14 he left home and
went to live at his grandmother’s house. At the time,
“me tell me I can do what me feel to do, you know. I
don’t have nobody like to tell me anything.”
He described that as being the time that he “bruk
out” and started to drink, party and have sex with
multiple men. Most of these relationships were
casual and Dharshanie would usually go out three
times socially during the week and would pick up a
male partner for the night to have sex with. He
never had a constant partner and considered
himself to be unlucky in love.
“It got men who move hand to hand you know.
Sometime they come they see she [MSM], they like
she, sometime they can go with you too. Actually, abi
[MSMs] is a different type of people… you know, you
want to feel good, that's why you do that [sex] and
sometimes you see another one, you gone again...”
One of the constants in Dharshanie’s life was
alcohol and sex and alcohol went together.
Dharshanie loved music and loved to dance and to
“display” himself.
“I drink and I get high, you know sometime when
you over drink and you get high, if you not know
what you doing. Sometime you see one guy you fall
in love with him…you pick him up from the bar, you
gone you do you thing.”
He worked as a casual worker doing odd jobs for
people and also occasionally had transactional sex.
They payment was sometimes in money [“if they
got”] or in alcohol at the bar. During this time, due
largely to the influence of friends he would use
condoms but not consistently, “in and out”. He
would especially not use a condom if he had been
drinking.
“Actually I spend time with guy like they is come
and visit me at me home, do what they gotta do and
just, you know...hit the road after that.
When he developed a problem with his eyes he
went to the New Amsterdam hospital and as part of
the treatment he did a test. At 25 years old he
discovered that he was HIV positive. He estimates
that before then he slept with, “Oh Lord, extremely
nuff” men.
He was surprised to be HIV positive, but received
counselling which he was satisfied with. What he
“I never had love,
trust me, never,
never, never!
That is the
reason I put
myself like this.
Me never get
luck like with a
person who love
you and who can
tell you them
things. So
anything you
catch you gone
with.”
In
Depth
Interview
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was not happy about was that it took 2.5 weeks
before he was able to start his free course of
treatment because the drugs were not available. He
claims that the doctor at the hospital [name given]
told members of his family that he was positive.
During that time he joined the support group at
FACT and got support from members of the group
every month [third Monday]. He attended once a
month, except for bouts when he was ill but was
less interested to attend because the NGO no longer
distributed free items, and the cost to travel was
quite high. He relies heavily on hand outs and from
money he receives from family who live abroad.
He does have sex, his preference is for younger men
and he is able to find lovers who are about 20 years
old, but sometimes he get males that are 16 years
old. He collects condoms from the health centre,
usually a month’s supply. He believes that it is
possible to “catch out” [detect] young males who
are positive if they do not insist on wearing a
condom.
“Actually if they come to me and them hussle me, and
we deh pon something and if they go bare back with
you - watch them. If you is a careful man, you want to
wear a condom, that mean you is a safe man. You
know? Don't make no body fool you, any man go like
that, done know what they deh got”.
In
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Interview
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4.5 Are adolescents using
alcohol and other
psychoactive drugs?
The prevalence of alcohol was quite notable among
all age ranges, sexes, and across all settlement types
(urban, rural, hinterland). This was a consistent
thread throughout multiple discourses with
adolescents.
Whereas younger cohorts (10-14) may clearly
distinguish undesirable behaviours (sex, drugs etc.)
as bad or risky, they generally did not view alcohol
in the same way. The significant number of
respondents (including those in the 10-14
categories) had triedalcohol at a young age, and in
some cases, had done so with the consent or
knowledge of their parents. In most cases they had
been introduced to it in a semi-controlled
environment and drank various amounts ranging
from a sip, to a glass or a bottle of beer. They tended
to drink around occasions such as Christmas,
weddings, sports meets, Heritage celebrations, and
parties for the first time. This was also around the
time and at the same events, when they would have
sex for the first time.
Among males (MSMs, older cohorts 15-19, 20-24)
alcohol in large quantities was a common
characteristic of their social lives. Equally among
girls who were sexually active or were promiscuous
they tended to use alcohol and some directly
attributed alcohol to unprotected sex. Many
reported that they were likely to go “bare back” i.e.
without a condom when they were intoxicated.
Alcohol was observed to be readily available and
generally inexpensive (approximately $500 for a
quarter bottle of vodka).
Some youth referred to bars and clubs where
alcohol was sold and generally, there were no
barriers to obtaining alcohol – either through
friends, stealing from the home, or buying it in
shops even though they were underage.
There were no reports of drug use that involved a
needle. Most adolescents who were exposed to
needles outside of a hospital, tended to be within
“First thing, when you
over drink alcohol you
does always want go
bare back, if you ain’t
got you focus up, gone
you gone.”
Spanish, 19 years old
Afro-Guyanese, out-of-
school youth
“I think if they really
want to get people
they should state a
really effective point,
like
it doesn't make you
look cool to have
unprotected sex and
smoke”
Female, Region 4
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the context of having a tattoo, which was popular
among young people. There was not a lot of
reported drug use but drugs, and in particular
marijuana was mentioned more in urban settings.
The price was reported by both youth and adults to
be cheaper (starting at $200/300) in urban areas
than in rural and hinterland areas where the cost
was more prohibitive ($1,000).
4.5.1 In School Youth
Similar to out-of-school youth and other cohorts,
alcohol consumption was generally seen as
acceptable whilst other behaviors such as having
kissing, having a girlfriend, smoking marijuana was
seen as unacceptable behaviour. Most young male
and female adolescents and pre-adolescents (10-
14) have some sort of initiation with alcohol use
during this age range. In some instances it is a one
off or occasional drink, and inevitably it occurs at a
function or in the home with the consent of parents.
An example from a rural area, male 10-14 (Suddie
Primary)
M: What about alcohol like have you ever
had alcohol. How many of you had
alcohol by hands 1, 2, 3, 4 , 5, 6, 7. [seven
persons]
M: Often or one time?
R1: One time
R2: Miss a couple of time
M: OK, like what would you drink, cool aid?
R: No Ivanoff vodka
M: What do you drink Kevin?
R: Banks [beer], shandy
M: And where are you getting it from?
“Miss I don’t steal, I
does ask them first.
Miss, when I go to
the lake with my
uncle, before I go I
ask my mommy and
daddy if we can
drink alcohol, then
they say “tek a
drink”.
Diagram: Frequency
of coding
occurrence of the
word ‘alcohol’ in all
of the discussions
with adolescents
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R: At the liquor shop
R: Miss, I would drink like when it’s a
holiday, or my father or me mother
birthday
M: You would steal some, or they would give
it to you?
R: Miss I don’t steal I does ask them first, miss
when I go to the lake with my uncle and
so, before I go I ask my mommy and daddy
they if we can drink alcohol, then they say
“tek a drink”.
M: How many of you got parents that you think
drink too much.
Six children indicated that a parent(s) drank
too much.
4.5.2 Out of school Youth 10-14
Similar to youth in other age categories the FGD
respondents had tried alcohol but not in large
quantities and mainly on special occasions, and in
particular at Christmas time when they would
spend long periods of time on the streets.
M: Anybody else? Anybody here drinks
alcohol? What age yall started
drinking…no you won’t get in trouble
R: Eight and nine and so
R: But we don’t drink to get drunk, like
Christmas time and so
R: Beer one-one time
Apart from alcohol the respondents did not claim to
have tried any other substances such as marijuana.
Some also mentioned cigarette smoking but this
was not excessive or common.
“Well one time when we de small after we see big
people trying it, this time we have 70 dollars and we
send he [pointing at Ramesh] to buy two, and we try
it, and then we choke, cough up and so we throw it
away”
4.5.3 Young Adults 20-24
There was some indication that sports often served
as a deterrent for teenage drinking.
M: How old were you when you first start
drinking?
R: Me aint even know…twenty
M: So how come you start drinking late?
R: I was the sportsman for the town
Alcohol Consumption
among Youth in Guyana
According to BSS 2008/2009 Report
91%
of MSM reported that they use alcohol and
50% were identified as problem drinkers
61%
in school youth reported ever using alcohol
68%
of out-of-school youth said they used ever
used alcohol
46%
Commercial Sex Workers reported using
alcohol weekly
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M: What type of sport?
R: Anything, volleyball, football
Young gold miners described the drinking scene at
the landing:
“If you go to Bartica … all of a sudden you dont know
what happen, you get drunk, money done. A dog
better than you right now, in Bartica. People would
know you, so you got to got a head fuh now pick
up...nuff young man come to Bartica from this area
[Region 1] and had to turn back...with no money. A
man I know come down with $500,000...next morning
he ain got no money.”
4.5.4 Youth In Contact With The Law
Among 10-14 female youth at the New Opportunity
Corps, drinking was not reported to be excessive; it
was used to deal with stress and was usually taken
in small amounts with the knowledge of adults.
R: Miss, I don’t drink
R1: Once I had um I don’t know what it’s call
but I had friends and she tell me was lovely
and I go and drink and since that day, the
only time I ever drink alcohol is when I
leave home and I see the alcohol bottle, and
I take a little.
M: But any of you drink regularly?
All: No
R2: One time time I drink alcohol and
[inaudible] and it was my stepfather
birthday and I just pick it up ‘cause I de
thirsty and I throw it down my throat and I
walk down the step and fall down.
R3: When we get like birthday and easter and
so the my family does buy like [inaudible]
and sometimes I does go and hide and take
the Malibu.
M: OK, but ya’ll don’t generally drink a lot
All: No
R4: Miss, when I’m stressed out when people
say things behind my back which is not true
[drinks]
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4.6 What are their views of
self, and their world?
This section encapsulates those views that youth
shared that speak to their emotional well-being,
their dreams and concerns.
Adolescents generally, including those in contact
with the law, had aspirations to work in a various
professions including being doctors, cashiers, pilots,
lawyers and teachers.
Feelings
There were both observations and reporting of low
self-esteem and sadness. Some youth in the
hinterland areas reported feeling sad when they
were away from home and in the dormitories.
Others also reported having unsupportive
caregivers. Some boys in the 15-18 categories in
rural areas placed their self-esteem at “medium” or
neither high nor low, girls in the same category
reported as being “medium to high”. The
adolescents often painted a picture of being isolated
and having no one to talk to about their problems,
especially as girls in particular distrusted their girl
friends (every best friend has a best friend) on
matters related to their sexuality.
They also presented their views of the outside
world both positive and negative, including places
where they like to go and places where they felt
were a danger to them “hot spots”. These were
often in synch with what the adults said. In
addition, they talked of people who were
supportive of them and cited instances in which
they felt unsupported. Boys generally tended to say
mother, friends, cousins etc. and girls to a lesser
extent. The youth who were in contact with the law
at NOC, said that they could speak to the Welfare
Officer, Pastor and one mentioned a guard. Many
persons, girls especially, said that they wanted a
counsellor or someone who they could discuss what
they were experiencing confidentially.
Several youth across all age categories stated that
there were times when they felt stressed out and
overwhelmed. Some youth, including those in
contact with the law said that they had had suicidal
feelings. Among younger in-school cohorts feeling
of depression and sadness usually centred on when
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there were problems in the home with their parents
and “parents fighting” was a common response.
9
Discussion with ten (10) 10-14 In-school males
(rural):
M: Never had any feeling like that, like what
would make you feel sad or depressed?
R: Miss when my parents quarrel.
R1: Miss, when they [parents] have fights
M: How many of your parents fight a lot,
1,2,3,4 [persons raising hands] and then
you feel sad?
All: Yes miss
There was also a lot of indication among youth in
contact with the law that they had generally been
living in an environment that was not supportive.
4.6.1 Young People Living with HIV/AIDS, New
Opportunity Corps
M: If you think back, what were you doing at this
time of your life? Were you living home with
your family?
R: Yes miss
M: How old were you when you started having a
boyfriend or girlfriend?
Mumble....
R: Miss is only because of my family certain things
happen to me, if my mother didn’t move out, I
won’t a deh whey I deh
4.6.2 In school youth 15-19 years old (Male)
Several adolescents including in-school youth and
sex workers mentioned, or explored the issue of
discrimination as a key characteristic of the outside
world of young people who are considered as
‘different’ because of their sexuality.
R: Everyday we hearing something ‘cause all the
young boys them talking ‘bout it.
M: So you would hear about it regularly people
talking about it, like what kind of things they
would be saying
R: How that person got AIDS and something
discriminating.
In conversations with MSM and FSWs this hostility
was quite pronounced, and was by far much more
frequent, and more violent that among other
cohorts.
“Because some of
the teachers in the
school believe that
once you hit 14 or
15 then you want to
have a boyfriend. So
whenever they see
you talking to a guy,
any guy, they would
just assume well
that’s her boyfriend
and they would just
go and think
otherwise.”
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FSW, Region 4:
“Like what bother me really is the discrimination and
the stigma about my work. Now okay, nobody buys
sickness, okay, you go with somebody we all know
that you condomize, but we all know that even if you
use a condom, they are not 100% safe, it can burst
right? And we can contract it like that, so I want to
know the reason why people still discriminating
others and all of us in one circle and we are entitled
to get any STIs, STDs, or HIV and AIDS. In South
Central we are having a lot of that and that is what
getting me perturbed. The discrimination. That is all
we not having any other problem but the
discrimination.”
MSMs also cited violence and discrimination and a
few cited their homes as a place that they had a
strong attachment to because it was the only place
where they felt safe:
R: It shorten, it limit the things you could do, is like
if you want to work in this place and it is
homophobic, and you really want to work here,
they got people outside there….
M: Anything else that makes you unhappy? Apart
from the way people treat you, like anything
else in society that affects you life?
R2: Sometimes I am very skilled but due to my
sexuality I am being prohibit from doing what I
want to do. So I think job discrimination due to
my sexuality is annoying with me but with a lot
of others.
In another example among MSM:
“They gat this new thing now when you passing they
call out whores! whores! whores!”
It was also common for them to refer to the limited
amount of support (emotional, financial etc.) that
they received from family, often from a young age:
M: So what makes you happy?
R: Persons who accept us for who we are, who do
not criticize our sexuality
R2: Friends and family
R3: Friends and family who don’t reject you,
especially in this community you find it hard to
continue living your life.
Urban and rural adolescents who were interviewed
also showed hostility towards homosexuals and in
some cases they held extreme views.
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4.6.3 Male 15-19, Youth In Contact with the Law,
NOC
M: So what y’all think about men who have sex
with men?
R: You could buss up them head miss
R1: Can kill some of them
M: You think it’s wrong?
All Yeah, miss.
R A’int worth living, miss
R1: They ain’t worth living
R They ain’t supposed to get rights
Among girls especially there was a prevalent sense
of isolation when they had to deal with issues
related to boys and sex, this was because they often
did not trust their girlfriends, “every best friend has
a best friend”. And in some instances they had
difficulties relating to their mothers. Apart from
typical “teenage issues” these examples also
highlighted fracture homes, mothers who were
economic migrants, parents who were alcoholics in
the home and poverty, all of which had an impact
on adolescents.
4.6.4 Youth in Contact with the Law, Female 10-
14
“Well for me, I fed up hear my mother ballin’ one
thing in me ears, and I just get fed up and on a
morning I tell them I want go NOC. I can’t live with it
no more because me cousin me and she was in like, I
went in a higher class than she and she use to behave
more better than me, but my situation use to be why I
behave so, but mother fail to realize that me cousin
use to get mo better treatment that me because me
mother de hardly deh in the country.”
4.6.5 Youth in Contact with the Law, Female 15-
19
R: Miss when I tell me mother she don’t believe me
M: She don’t believe you?
R: If tell me grandmother something she will say I
lie. You lie or you bad or something like that. So
I don’t tell she nothing I just deal with matters
in my own hand
Girls generally were concerned about how their
teachers viewed them and felt that teachers often
attributed behaviours to them that were inaccurate.
So he ask me if I
ever sex and he go fo
hold my hand and
he carry me ‘til to
canje so I say wha’
you going the side
now, he say going
and get a lil’ discuss
and I just get scared
and I just seh open
the door just stop
the car I just come
out and he didn’t
want me to so I just
holla, scream out
and people was
walking and like he
get scared and I just
open the door and
run out ”
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4.6.6 Females 15-10, In-school Youth (rural)
M: So give some examples. What bothers you,
for example?
R: Because some of the teachers in the school
believe that once you hit 14 or 15 then you
want to have a boyfriend. So whenever they
see you talking to a guy, any guy, they
would just assume well that’s her boyfriend
and they would just go and think otherwise.
R2: Or the rest of teachers hear that this child
has a boyfriend, or that boy has a girlfriend
M: So in your school the teachers look down
on you and talk about you if they see you
have a boyfriend?
All: Yeah.
Many of the groups who were most-at-risk, FSWs,
MSMs, out-of-school youth and youth in contact
with the law, had ambitions to do something
differently and find a profession. They seemed to
want to have a means to contribute productively
and to be seen beyond the stigma of the labels that
society had given to them: thief, prostitute etc..
4.6.7 Self Harm
Apart from suicide cases that were reported among
key informants, adolescent responses to stress and
depression varied from being angry to self-harm.
This included cutting, suicidal feelings and drinking
tablets and lethal substances.
Youth in Contact with the Law 10-14 Female
R: Anything happen to me like when I have
confusion with my step father he drink and
start cussing and I just cuss he and I just
drink tablets and kerosene
M: You drink kerosene?
R: Yea
4.6.8 Relationships with Men
Female adolescents, especially among in-school
youth and youth in contact with the law, recalled
experiences of being groomed by older men for sex.
One girl said that a taxi driver at Charity offered her
several thousand dollars if she would give him her
number. Other girls spoke of relationships or
encounters, prior to which men (ranging from a few
years to several years older) had approached them
continuously. It was often a difficult experience to
Suicide in Guyana
In 2012 it was reported in the
local media that “Guyana has
by far the highest suicide rate
among countries in the
Caribbean, according to the
World Health Organisation
(WHO.)
Guyana has also been
listed in the top ten most
suicidal countries, earning the
ninth position which statistics
reveal 45 suicides per 100,000
people. However, statistics
show that of the more than 45
people who kill themselves,
about one-fourth are women.
Suicide is recognized as a
serious public health issue in
Guyana with between 150 and
200 deaths annually. Statistics
from 2003 to 2007 period
show that there were 946
reported suicides in Guyana.
The statistics indicate that
suicide is the leading cause of
death among young people 15-
24 and the third leading cause
of death among persons aged
25-44.
Suicide rates are
consistently highest in Region
Six followed by Region Two.
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navigate in terms of being able to judge the
sincerity of what they [the female adolescents]
were being told. In most cases they were being
approached on the road.
Another source of confusion for girls was in their
interaction with the opposite sex
“Yea you’re confused. You just want to know if he
likes you or he just wanna use you like all the rest.”
One female recounted an abduction, NOC 10-14
female:
“Well me went to send some food for my lil cousin
because he was in jail and I give my aunty to send it.
So a day I come home and was going in a car and this
man, I tell he I like to go in the back seat, I don’t like
to go in the front seat especially when me alone with
the driver, so I go in the back seat and he said no
come in front, I said no I gon go at the back and he
said come in front so I go in front and he started to
drive and he wind up all of the glasses and you know
he press down the locks and he just ask me if I have a
boyfriend [inaudible] and he ask, “would you like to
have a boyfriend” and I said no…So he ask me if I ever
sex and he go fo hold my hand and he carry me ‘til to
canje so I say wha’ you going the side now, he say
going and get a lil’ discuss and I just get scared and I
just seh open the door just stop the car I just come
out and he didn’t want me to so I just holla, scream
out and people was walking and like he get scared
and I just open the door and run out ”
Girls also relayed strategies that they adopted to get
rid of unwanted attention including saying that they
had a boyfriend and in one instance responding
with, “ok Uncle” to make the adult aware of his
seniority to her (14 years old).
Among out-of-school youth (school aged) the males
that were interviewed say themselves as being
under attack by the Probation Officers who they
considered to be hostile, so they developed whistle
signals to communicate with each other and protect
themselves.
They did not have much trust in Social Services and
there was a palpable fear and distrust of this
Ministry in particular. Because of this the boys had
developed an early warning system to allow them
to escape detection.
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M: So what about the call signs
[making noise]
M: What does that mean?
R: Come
M What else?
Ling, ling
M: What’s that
R: Means people deh round or people coming
R1: Trouble
M: Ok, what else
R: Monkey whistle
M: How does that go?
[Whistling]
M: What da means?
R: Place clear
It was not only females who were being approached
by older males. Young male adolescents [10-14]
also referred to similar situations.
R: Miss, I gon break it down in syllables, right?
Good. Don't laugh, cause that's not
something to laugh about. Miss, he mean,
that you go, like, Brandon..
R1: Hey, hey, don't call me name!
R: All right, John go…No, hold on, hold on, hold
on. I gon find a name. Say [name] leave
here, and he walking down the road and he
want $500, he gon go by Harry Paul...
[Laughter]
R: Man, ya'll laughing this thing…
[Laughter]
R: ...and he said "I gon give you the bamzy
[anus] for $500"
[Laughter]
R: [Singing] Don't bb me...[referring to a
popular song]
Apart from being of a sexual nature youth in contact
with the law also referred to persons who
encouraged them to do drugs.
“All like them man that’s sell drugs, cocaine they
don’t really care ‘bout you. As long as them get
money just buy and collect they don’t care they like
destroy you.”
4.6.9 Truancy
“Don’t BB
me!”
““All like them
man that’s
sell drugs,
cocaine they
don’t really
care ‘bout
you. As long
as them get
money just
buy and
collect they
don’t care
they like
destroy you.”
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As can be seen from the map, the boys spend a lot of
time staying away from the roads and roaming in
areas away from the main road (afraid of being
detected by the authorities), covering a wide area
without adult supervision. Key areas for them
included an abandoned house, the park, the
backdam and the pools hall.
They did not spend much time at home, with one of
the aging guardians complaining that sometimes
she did not see him for the entire day. In all cases it
was never reported that the boys would sleep
outside of the home but they would generally
return late or for meals. In all instances, it was not
the case that the parents were not aware of the
children being out of school. One child stated that
his mother had told him that he could stay at home
but that he had to avoid the road to avoid being
detected by social services.
Some of the circumstances for not attending school
were not solely financial but alsobecause they were
being yelled at and ill-treated in the school, for
example, being lashed by teachers. In one instance,
one child did not have a birth certificate and cited
this as being the reason for not being in school.
They did not see teachers or other community
leaders as persons that they turned to …and relied
more on the filial ties that they had developed
among themselves.
M Yall want to spend a few minutes talking
about why you don’t like to go to school,
when we interview other kids they say
they don’t like to talk to the teachers.
The teacher does holler on we
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All Yeah
R The teacher does want to holler up
M They like to holler at you?
All Hmmmm
Yeah
Bob They like shame you up
R Embarrassing you
R So yall remember yall decide no I don’t
want to go back to school?
He lazy
Ethan Me don’t have birth paper
M: If you had birth paper you could go?
Bob Me don’t want to go to school because
when them teacher embarrass me I feel
bad …got to wait till my passion cool.
Anna Regina boys 15-19 sketch map showing
key areas of importance to them – religious
centre, their homes, school and recreational
areas.
4.6.10 Hot Spots
Most of the areas identified by youth as hotspots
were largely consistent with what were provided
by adults – these included bars, clubs, buses, car
parks/central points and the streets. The latter
(thoroughfares) were referred to quirt a bit across
groups. Youth, including both boys and girls were
acutely aware from a young age [10-14 age range]
Girls 10-14, In school, Region 2 (rural)
Discussion as the girls (ten of them) are drawing
their maps:
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M: Is there any place in your community, or
where you go a lot where you think is not a
good place or that you don’t like at all or
who you think the person hurt me, or
something like that considered a bad
person, or a bad places not good for
children or girls your age.
R: Clubs
R1: The bus shed
Several: The beach
M: Do you think the beaches are bad?
R: Yeah, because when you cross the road …
the liquor restaurant
M: So why did you say the bus shed
R: Because they have men smoking
R2: Miss the places that are deserted
R3: The bus park
Boys 10-14, Scouts Group, New Amsterdam
Police Station
M: And where do these things [men
approaching boys for sex] happen? Where
would they be?
R: In a old house...
M: So they would be in the old house and the
people would call you in? and they would
call you in?
R: Miss, on the road they take you in [to the
house] and they rape you.
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4.6.11 In Depth Interview
The Tale of Three Sisters
One of the key issues that the HIV/AIDS prevalence
highlights is the vulnerability of females to
infection. There are a number of causal factors that
have been explored in this report that may explain
why, poverty, low self-esteem, peer pressure,
alcohol etc.. As this report highlights there are
many opportunities to negatively influence
behaviour but there are also positive ones. This
case study reflects the story of how cultural factory,
poverty and attitudes are not only putting girls at
risk but limiting their socio-economic options from
a young age.
Ashanti (not real name) is a 12-year-old Indo-
Guyanese and lives in Charity. During our research,
several pointed out the small wooden house as the
home of two sisters who have transactional sex.
She agreed to meet and got consent from her father
to be interviewed. She says that she goes to school
but has not been for the past two days because she
bought a shoe and it got destroyed. She has an
interesting perspective of school attendance, which
is largely driven by her own desire to attend, “when
I stop go I don’t want go no more, and when I start go
I don’t want stop.” She says the girls in the school
dorms have told her that the place is “boring”.
Her sisters are not at home.
She is the youngest of three sisters, one of her
sisters is fourteen and lives home with a man. She
has a baby that is three months old. She moved out
of the home last year, and moved in with the father
of the child who now speaks to his daughter over
the phone as he is in jail for piracy. Ashanti knows
other teenage mothers at her school who had a
baby and went back to school but her sister didn’t.
It’s not that no one is trying:
“She get baby in town and two social worker trying
to put she in intensive care...but me father tell she
he ain want she go back to school”.
Her other sister is nineteen years old. She also has a
child that is about to turn four, with a man who is a
fisherman and came to the region from time to
time. She doesn’t quite live with him as he already
has a wife and family of his own. When they split up
she got another boyfriend, a miner from Port
In
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Interview
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Kaituma. She also had another boyfriend. Ashanti
says that her sister is now pregnant again and she is
certain that the child is for one of the two boys.
Meanwhile, Ashanti doesn’t mind being alone at
home, “Yeah, I does deh being around me father. I
does enjoy that.” Her mother died seven years ago
and they are close, he can tell her anything and she
can tell him anything. Her father is a contractor and
she gets up early in the morning when he is
working and prepares breakfast. They also have a
little shack in front of the property, which was used
as a shop but which is no longer used.
What she doesn’t like is her older sisters discipline:
“Me big sister tell me don’t go to school, how I got to
clean up the house, wash clothes and I just go and
cry in the shop 'cause I ain suppose to be washing
clothes.”
Ashanti doesn’t have a boyfriend but she has
friends who do and three of her female class mates
are sexually active.
“They don’t care what people talk or so. They just
living according to themself. You ain got to be a bad
girl...as long as you lime with bad company you
getting bad name. People just talk about you...”
She also doesn’t drink, much.
“In 2011 I drink Christmas eve night. I had money
and I tell me [younger] brother, let we buy a
quarter vodka and a one litre Pepsi. They drink
almost all the drink and like half of the quarter leff,
and I throw all together and drink…and me sister
come home and she get a brown pants and I tell she
that's a nice purple pants...”
Now she takes “one one” shot when her sister is at
home. As she starts to loosen up, Ashanti shares
that she did have a boyfriend when she was 11. He
was nineteen years old.
Where did she meet her boyfriend?
“Kumaka...I used to lime and so. We was friends
before and he tell me he like me. But i didnt know if
I like he. He say let he be me boyfriend, I say no
problem.”
Question: What boyfriend mean at eleven though?
In
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“I didnt thinking how far he was thinking, he
thinking about sex, but I been thinking just normal
talking.
Question: How you know that's what he thinking?
“He tell me”
Question: How long after?
“Couple months after and I tell he no, I ain ready,
me friend is tell me she boyfriend is ask she for sex
and they is fight about it.”
Did she learn anything from her sisters?
“Them never tell me nothing about boyfriends! In
school them is get teachings, social
studies...whatever is happen to me friend I is glad it
don’t happen to me.”
In
Depth
Interview
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SECTION V
5. Analysis and Recommendations
This section of the report will synthesize some of
the key findings based on various sources of
information contained in the previous sections,
desk review, policy and legislation framework as
well as the findings of the empirical research.
Adolescents in Guyana are a key demographic; the
sheer size of the youth population, the importance
of youth to national development outcomes, and
youth susceptibility to HIV/AIDS has ensured their
visibility. The latter has resulted in a national
response in Guyana that has been characterized by
an increase in the services available to adolescents
including key facilities and programs such as the
Adolescent Unit within the Ministry of Health, the
Health and Family Life Education (HFLE) program
within schools, and the establishment of Youth
Friendly Health Centres and spaces throughout the
country. The vulnerable adolescent that this study
describes is one that is characterized as being
multidimensional, for example early sexual debut
was often linked to other social ills such as teenage
alcohol consumption, low levels of education,
poverty and sexual abuse. As such, an integrated
response is the most appropriate and essential.
It is evident from the government policies reviewed
in Section II of this report, that combating HIV/AIDS
is a national priority and that youth are a priority.
What is also evident, from both the legal review and
the field research, is that there are critical gaps in
areas such as the legal provisions for HIV/AIDS in
the Health Ordinance (1834), the criminalization of
the sexual acts which affects key YKAP
demographic – young MSMs, and the Sexual
Offences Act, which has not been fully implemented.
Policies such as the National Workplace Policy
which could potentially be a key measure in
reducing discriminations against YKAP is largely
voluntary and its implementation was not visible in
rural and remote areas where many vulnerable
adolescents work. The School Health, Nutrition and
HIV&AIDS policy makes no mention or provision for
YKAP and this may serve to both marginalize LGBT
adolescents, and impact their ability to enjoy their
right to an education in a safe environment, that is
not characterized by discrimination, and in which
services such as counselling are available.
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What the research has found is that there should be
a common consensus on who the at-risk or key
adolescent populations are, in order for them to be
effectively targeted for programs and services.
There were hidden populations such as sexually
active adolescents with disabilities who were
perceived to be at-risk and who were not featured
in the literature. “Adolescent” is often used
synonymously in the literature as referring to
someone who is in school, however some of the
most vulnerable groups were found in institutional
centres and out-of-school. As both examples
highlight, there is a need to focus specifically on
adolescents, which will inform the strategies,
approaches and messages used. For example, a FSW
or MSM who is in his/her fifties cannot be
compared with a 15 year old and neither can all of
their needs.
The DHS has highlighted, “widespread stigma and
discrimination in a population can adversely affect
people’s willingness to be tested for HIV as well as
their adherence to antiretroviral therapy. Reduction
of stigma and discrimination in a population is, thus,
an important impetus to the success of programs
targeting HIV/AIDS prevention and control.”
The 2007 research study of Brian O’Toole et al,
highlights the high prevalence of discrimination
that exists in the country, 68% of adolescents who
were interviewed felt that it was not ‘ok’ to have a
homosexual relationship.
This research has further reinforced the central role
that schools play in the lives of adolescents, but it
has also shown that several planned services and
programs outlined in the School Health, Nutrition
and HIV&AIDS policy have not been widely
implemented – namely the provision of counselling
services, the distribution of condoms, and the
capacity development of teachers and parents on
HIV/AIDS. The research highlighted that even
though parents and teachers are a key stakeholder
in the eco-social context, they are often ill equipped
to deal with the changing needs of their adolescent
children, including children who become sexually
active at a young age, sexually active children with
disabilities and those who may be in same sex
relationships.
The plan to equip every in-school youth with life
skills highlights the lack of life skills among the
adolescents, including those who are especially
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vulnerable, who may not be in school and are
already in the workplace (at goldmines, in brothels
etc.) or have dropped out of school. These
adolescents, i.e those who are out of school, were
found to more likely to be sexually active and at-
risk that those who were in schools. However, one
opportunity can be found in the presence of civil
society bodies who traditionally are closer to these
sup-populations and whose services adolescents
seemed much more comfortable in accessing.
Recent research suggests that adolescents are
sexually active at young ages (the BSS 2008/2009
placed the age of first sex at 14 years old) and that
among 15-19 years old adolescents there has been
an increase in infection (from 3.66% in 2006, to
2.5% in 2007, and by 2009 accounting for 6.04% of
the infected population). The presence of early
sexual debut and the lifestyle choices of adolescents
are a challenge to more traditional and
conservative views held by key Duty Bearers such
as teachers and parents which will has had a direct
impact on how YKAP are treated. A good example of
this is the lack of debate on condoms in schools, or
the presence of same through school counsellors.
As the DHS has highlighted, “social acceptance of
condom use among young people is a key factor
determining use of condoms to prevent the sexual
transmission of HIV and other STIs, as well as to
prevent early pregnancy. However, educating youth
about condoms is sometimes controversial, with
some saying it promotes early sexual
experimentation.”
The DHS found that only 49% of in school youth
who were sexually active were using a condom, and
only 19% of them had been tested. These findings
all have significant implication for the achievement
of related MDG indicators: (i) HIV prevalence
among population aged 15-24 years, (ii) condom
use at last high-risk sex, and (III) the proportion of
population aged 15-24 years with comprehensive
correct knowledge of HIV/AIDS
This research project found that testing was
generally low among sexually active adolescents
except for MSMs and FSWs and this can be partly
attributed especially in hinterland areas to the lack
of facilities and in other areas of the importance of
privacy and confidentiality to adolescents.
A critical strata in the delivery of social services is
at the micro and meso levels i.e. community and
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regional administrative level, which was found in
both human resources and organizational
capacities to be deficient in their ability to support
YKAP. Many regional level officials in key and
strategic positions lacked basic data on important
social issues in their region such as HIV prevalence,
sexual abuse rates, teenage pregnancies etc.. and so
their ability to guide programs, plan or respond to
issues was limited and unstructured. Even though
vital data often flows upward from within various
agencies within the region to the national level the
processed data is not always fed back down.
Stakeholders at the micro and meso levels also did
not demonstrate an awareness of key laws, acts and
policies that related to adolescents and at-risk
adolescents. This study also revealed the lack of
uniformity in the availability and quality of health
services such as VCTs and condom distribution
since these were increasingly sparse as one moved
from urban to rural contexts and from rural to
hinterland.
Another critical aspect linked to the scope and
reach of programs is the importance of
coordination and the maximization of resources
and efforts through collaboration and integrated
planning. This would require both national and
regional bodies to work together to plan who does
what and where with all stakeholders including
NGOs, INGOs, CBOs and government agencies.
The 10-14 adolescent populations were a key
cohort in the research, especially with the intention
of both understanding behaviour and practices but
also to putting the vulnerable 15-18 cohort into
perspective. Among 10-14s the research found low
and inconsistent awareness of HIV in hinterland
areas and limited information being obtained from
teachers and parents when compared to other
regions. One adolescent stated that they, “learn how
to put on a condom by watching movie”. In rural
areas parents and teachers are a key source of
information for children, though the confusion of
whether HIV could be contracted by a mosquito
suggests that the accuracy of information is
questionable, but also it reinforces the need for
sustained and multiple sources of information to
reduce the risk of misinformation.
Among out of school youth and those in contact
with the law, sexual debut tended to be at an early
age and most importantly, it was usually not safe
sex. A key factor in the vulnerability of this cohort is
the context, and factors such as, older-male
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predators, unsupervised settings (especially for out
of school youth, parties), alcohol availability and
peer pressure all contributed to sexual debut,
although the majority of 10-14 year olds were not
sexually active. The study did reveal that a small
population of both male and female adolescents
who experienced traumatic events by the age of 14,
such as forced sex and sexual abuse, for which they
generally did not disclose until they were older
because of the lack of persons to confide in, or
places to seek services. In some instances
pregnancy was the only reason why abuse was
brought to fore. Even in instances in which children
did disclose being abused teachers, parents and
communities were ill equipped to provide adequate
support. Many children who are abused and live in
rural or remote areas have limited possibilities to
receive professional counselling. For this cohort of
YKAP the national implementation of the Sexual
Offences Act is critical.
The 15-19-age range is one that is critical in terms
of the key changes that adolescents experience. The
study found that some of the knowledge gaps found
among some 10-14 adolescents persisted among
this age range especially in hinterland areas and to
a lesser extent in rural and urban contexts. What
becomes more critical for these age ranges are the
social networks which both positively (teachers, the
church, sports) and negatively (peer pressure,
sexual predators) influences their behavior. Gender
roles also play an important role, for example
teenage girls often said that school and the fact that
they were expected to do chores in the home meant
that they didn’t have as much opportunity to be in
‘hot spots’ and which preoccupied them.
The majority of school aged girls and boys were not
sexual active. The 2007 youth study by Brian
O’Toole et al also found that these 48.6% of youth
surveyed wanted the person to be a virgin and 46%
felt that a woman should remain a virgin until she is
married and 37.2% for men. In the same study it
was found that, “one-third of the respondents
reported having had sexual intercourse, but this
figure was highest for males aged 15–20 years (48%)
and lowest for females aged 12–14 years (15%).
Moreover, those who knew and followed their
religion’s teaching were much less likely to have
engaged in sexual intercourse (18%) than those who
did not (45%). This held true irrespective of gender
and age group.”
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For men socially constructed views of their
masculinity is also a key factor and many male
adolescents demonstrated that this included having
more than one girlfriend and keeping traumatic
sexual experiences such as rape a secret. However,
the majority of male adolescents viewed the use of
a condom as being socially acceptable and many
younger men said older brothers and relatives had
told them that they should use condoms.
What the study did highlight, especially among the
15-19 and 20-24 age range, is the challenges of
behavior change even though many adolescents
could state the different forms of prevention and
were aware of the importance of condoms or the
risks of unprotected sex they would still have
unprotected sex. The reasons given for this tended
to be that they did not have a condom at the time,
that they didn’t have money to buy one if they did
not want to use those distributed freely and the fact
that the sex was spontaneous. Even when
adolescents had had risky sex and were worried of
having contracted HIV (more so than getting a girl
pregnant for some males) it was not enough to
compel them to get tested. Adolescents were
generally receptive to life skills and many said that
they had obtained practical from youth camps held
in the summer. However, within the schools many
of these vital lessons were being discontinued at
Grade 9 when most adolescents are starting to have
sexual relationships.
The YKAP study generated a wide range of
information on adolescent vulnerability and the
factors and conditions that lead them to adopt
most-at-risk behaviours including:
Economic poverty and unemployment
Alcohol use predominantly
Peer pressure
Sexual abuse
Prevalence of spontaneous sex and a,
Lack of awareness, or awareness
combined with a decision to not apply
safe sex practices
It has also highlighted a need to change and
reframe the way that certain behaviours of sub-
populations are understood. For example,
Commercial Sex Workers are often targeted in bars,
in kaimoos [makeshift brothels] etc.. However, the
research highlighted that transactional sex involves
a wide spectrum of activity that makes it even more
difficult to target adolescent at-risk populations.
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Among older and younger women, transactional sex
tends to take the form of commercial sex a group
defined as being professionals who depend on sex
work for their income.
However, there are a range of new behaviors
among adolescents specifically opportunistic sex
work, where female and male YKAP “occasionally
and opportunistically engage in sex in exchange for
gifts money etc.” and, there is also a third category
of survival sex workers, characterized as sex work
practiced in situations of “dire need either for the
person or their dependents”, this can include items
such as food, clothing etc..
In the latter two instances, both male and female
YKAP tended to be equally characterized by.
The current “gold rush” in hinterland areas, lack of
alternative livelihoods and poverty means that both
sex workers, opportunistic and survival sex will
continue and may even increase. Because of the
high rate of mobility and migration among persons
who get employment from mining areas it poses a
direct risk to other partners and potentially to
efforts of reducing new cases of infection.
As funds for HIV/AIDS dwindle, numerous critical
programs that target at-risk-populations may be
affected and as such, creative and low-budget, high
impact initiatives should be utilized especially
those that are community based and driven, or that
address multiple issues and involve multiple actors.
The study has shown that whomever youth come in
contact with can have a strong influence on their
well-being and their development. As such, several
key persons including field level government
officers, teachers, storekeepers and parents should
Which sex worker are we
targeting?
Commercial
Sex Worker
Opportunistic
Sex Worker
Survival Sex
Worker?
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have a greater awareness of issues specific to
adolescents (including male and female YKAP) and
should be supported to develop skills to provide the
correct response and adequate support.
Several of the “hot spots” identified in the study
were at business establishments (bars, clubs etc.).
Or are in areas where other members of society,
parents, adults etc. are present (tapirs, buses, car
parks) and who can contribute to reducing risk in
these areas. Of equal importance, peer pressure has
emerged as a key issue that needs to be addressed.
Recommendations
Advocacy
There should be advocacy at the both the national
and international level on the importance of making
provisions for YKAP, including funding for
expanded services (government and non-
government), and for the rights of key populations
such as MSM, CSWs, and adolescents with
disabilities in urban, rural and hinterland areas.
Key laws such as the implementation of the Sexual
Offences Act, the development and implementation
of the National Youth Policy and ending of punitive
laws, which negatively impact YKAP populations,
should be central to advocacy strategies.
Policies and Guidelines for YKAP
In order for key adolescent populations to be
effectively targeted there should be specific
policies/guidelines that firstly clearly outline who
they are and what approaches and programmes are
being developed for them. These could include a
broad range of provisions such as legal advice,
counselling, alternative livelihoods opportunities
and day care facilities.
Knowledge & Skills for key Duty Bearers
The research identified many gaps in the
understanding of both the laws of Guyana that are
relevant to youth as well as key policies38.
Community and regional level agencies and
individuals who come in contact with adolescents
38 The School Health, Nutrition and HIV&AIDS policy of the
Ministry of Education is a key policy document. There are
several provisions including providing counseling services in
collaboration with CSOs, opportunities for youth to participate
in determining implementaion for example condom
distribution in schools, and parent and community education
programmes which are especially relevant.
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or at risk adolescents, should have the skills,
capabilities and capacity to plan for and manage
integrated social development initiatives. Relevant
up-to date data relevant for demographics,
presence of facilities and programs, adolescent
health, education and economic development
should be provided to relevant authorities
including village councils, CBOs, CDOs, SWOs and
regional authorities.
Key laws and policies that relate to adolescents
should be summarized and provided to all official
offices as a single source document and regularly
updated. Guidelines on how to plan for or deal with
issues like reported teenage drinking; sexual abuse,
drug abuse etc.. should also be disseminated with
consideration to socio-cultural contexts.
HIV/AIDS Awareness
Knowledge gaps, and under-served areas (where
information and programs are limited) among
adolescents should be addressed through
investments in HIV/AIDS awareness campaigns
especially among adolescents in remote hinterland
locations where mining is prevalent.
Communications methods should also reflect the
changing use of social media and communication
tools in Guyana especially cell phones, the internet,
television and Facebook.
Youth camps (including those offered by
government, private and NGO groups) across the
country should have one streamlined approach to
HIV/AIDS awareness and skills development, which
should be practical, professionally done and
accurate.
HIV/AIDS Materials
Education materials should reflect the broad range
of Guyana’s adolescent population including the
adolescents with disabilities, and adolescents who
have different sexual preferences such as
adolescent LGBT.
Program and Policy Development
Existing programs that target youth should be
reviewed to determine the extent to which at-risk
populations and YKAP are adequately targeted. Key
populations such as 10-14 and 15-19 adolescents
should be targeted with tailored information.
In the instance when new policies and programs
are being developed such as the National Youth
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Policy and the Guyana HIVision 20/20 these should
integrate the views, and reflect both the needs and
rights of YKAP.
Improved Information and Skills for PTFAs
PTAs and PTFAs provide an opportunity to engage
parents and develop their skills and capabilities to
support adolescents generally and YKAP
specifically. PTAs can play a key role in
implementing the MoE’s health and HIV policy.
Improved Monitoring and Data Collection
Key offices, such as the School Welfare Officers,
should be provided with skills to conduct basic
data collection and collation to monitor trends and
to plan programs based on an analysis of issues.
Inter-Agency Coordination
It is critical for key institutions both at the national,
and especially the regional levels, to coordinate
their response and to be aware of how their efforts
contribute to HIV/AIDS reduction among
vulnerable adolescents and some of these
partnerships should be formalized and coded.
Evaluation and Expansion of HFLE
HFLE is an innovative initiative that many potential
at-risk adolescents can benefit from, however HFLE
currently stops at a critical juncture (Grade 9/Form
3) in an in-school adolescent’s life and should be
continued. Given the knowledge gaps in in-school
youth it would be useful for the program to be
evaluated and its impact determined.
Opportunities should also be sought of providing
life skills to out-of-school populations including the
those with disabilities, truant youth and young
workers, MSMs and FSWs.
Improved Services
There is a need for improved and expanded
services and facilities for youth, the study revealed
that youth do not have much confidence in free
condoms distributed by the MoH, and many said
they preferred to purchase them, when they could
be afforded. They also had reservations in using
facilities where their privacy might be
compromised.
Hinterland VCT Services
VCT Services should be expanded within hinterland
areas with a strong investment in mobile clinics and
possibly through partnerships with CBOs/NGOs in
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establishing permanent testing facilities in key hot
spots such as mining areas.
Alcohol and Drug Abuse Prevention
Underage drinking, and alcohol and drug addiction
programmes should be developed for adolescents,
including those that are out of school and young
adults 17-24 who have joined the workforce.
Peer Pressure
Peer pressure should be addressed in schools along
with other related issues such as bullying and
alcohol consumption in schools. Female adolescents
and to a lesser extent male adolescents said that
peer pressure played a significant role in shaping
their decision to engage in risky practices.
Recreational Facilities
Recreational facilities and sports are of critical
importance to youth and these should be
introduced with the intention of providing
alternatives sources of entertainment and
especially those that directly integrate HIV/AIDS
awareness and life skills. Private-public
partnerships could be used to support the increase
in safe and commercially viable, youth-friendly
spaces.
Civil Society
Civil society organizations (NGOs, FBOs, CBOs) are
well placed to provide services to YKAP, and their
presence should be encouraged in hot-spot zones
such as Port Kaituma, CBOs can be especially
effective and similarly specialized organizations
such as the Women Miners Association can play a
key role in targeting YKAP and in ending
discrimination.
Counselling Services
The School Health, Nutrition and HIV&AIDS policy
provides for counsellors in schools and this should
be viewed as a critical service for adolescents.
Schools where counselling services are needed
should be piloted in schools with high incidences of
teenage pregnancy and those that have high
reporting of other social issues (truancy, violence,
alcohol abuse etc.).
Role of the Private Sector
Private businesses should be monitored to ensure
that premises are safe and secure for adolescents,
which includes observing the laws of Guyana and
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especially not condoning the sale of alcohol to
under aged children.
Bars, clubs, transport providers and hotels should
all be part of a local compact to protect children and
ensure that adolescents produce identification
before entering, and that their staff does not target
young males and females.
Businessmen, and other powerful persons have
been identified, as occasionally grooming young
girls and boys for sex and this practice should be
addressed by the social committees of the
Chambers of Commerce and the Private Sector
Commission.
The timing of the broadcasting of music and
television programmes that have mature content,
or that are considered lewd or suggestive, should
also be reviewed by private companies and they
should be encouraged to support more ‘family
friendly’ broadcasting.
School and Context
The school should be seen as a wider part of the
community and their responsibility for children
should extend beyond the school gates. Schools
should be proactive in addressing problems that
affect adolescents outside of the classroom. In
Region 1, the REDO and Educational Department
has been proactive in addressing a common issue of
public transport operators (taxis, buses etc.)
conducting themselves in a proper manner and
making public transport safe for adolescents.
Youth Participation
New programs, policies and services that are being
developed for youth should be designed and
implemented where possible with their
participation and their insights and perspectives
should be valued. Youth should be involved in
critical decisions that affect them such as the age of
testing at VCTs (parental consent is currently
required for adolescents under 16) and the
distribution of condoms in schools.
There is some evidence that policies and programs
that are developed are done in consultation with
youth. However consultation is on the lower rungs
of the ‘participation ladder’ and agencies should
aspire to stronger partnerships that empower
youth such as their participation on committees
and the joint implementation of programs.
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Youth Organizations
Youth groups, sports groups should be encouraged
and should with knowledge that supports a better
understanding of HIV/AIDS policy and practice.
Youth groups should be resourced and supported to
strengthen their advocacy on health related issues
and YKAP youth should be supported to form
representative bodies especially in areas or regions
where the HIV/AIDS prevalence is high or there is
risk of an increase such as in mining areas.
Youth organizations could potentially be
instrumental in disseminating information to
adolescents to raise awareness on adolescent
sexual and reproductive health, and on the exercise
of their sexual and reproductive rights.
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ANNEX 1
REPORT ON THE WORKING SESSION ON HIV VULNERABILITY
AMONG YOUNG KEY AFFECTED POPULATIONS IN GUYANA
UNICEF/MINISTRY OF EDUCATION
Grand Coastal Inn, East Coast Demerara
May 14, 2013
Rapporteur: Andrea Bryan-Garner
PURPOSE/OBJECTIVES
To present the findings of the Qualitative Research Study on HIV Vulnerability
among Young Key Affected Populations (Most At Risk Adolescents) in Guyana
To provide a platform to discuss issues arising from the report by sectors, and to
plan the way forward
Welcome and Opening Remarks
Chief Education Officer – Mr. Olato Sam opened the session by highlighting the
importance of such a gathering, taking into consideration what drives stakeholders
to commit to the task at hand on a daily basis. He re-emphasized the ultimate goal
of shaping the course for the adolescent population in Guyana, and congratulated
UNICEF, and the lead researcher and her team for their efforts and hard work in
capturing the voices of Guyana’s young population through the study.
In examining the situation of adolescents in Guyana, he opined that gaps needed to
be filled regarding this group of individuals, in an effort to provide the necessary
safety nets for those without strong domestic environments to guide and support
them. He noted that with some of the weaknesses that exist in the school system,
the necessary support mechanisms for adolescents were lacking. He spoke of the
role of stakeholders to legitimise the voices of adolescents and their experiences,
and the need to respond in a way that can consistently target this particular group
and provide the support services that they will need to help them cope.
All present were welcomed and asked that they recognise those who are slipping
through the cracks on a daily basis, as the ones who are going to be the
beneficiaries of all the hard work and efforts today, thereby sending a clear
message that they do exist as an at-risk population and need our help and support
as the duty bearers in our society.
The proceedings were then handed over to the lead consultant on the research
project, Ms. Esther McIntosh for the Presentation of Findings.
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KEY POINTS FROM PRESENTATION by Esther McIntosh – Lead Researcher
Target Group of study - 10 – 24 years (in school youth, out of
school youth, MSMs, female sex workers) Note: Out of school
youth are not necessarily going to the institutions that we
normally target. They are extremely vulnerable and recent
findings show males are at risk as well.
At a very young age, those in the study said they started kissing,
using cigarettes and alcohol. They have heard about HIV and
some had girlfriends before hearing about condom use.
It was found generally that institutions exist but there are gaps
A National youth policy is critical, since everything else depends
that
They do not want their parents to know they are sexually active,
but parental permission is necessary for adolescents to get
tested at VCTs
Many of the successes are at risk because funds are running out
to sustain them
Alcohol consumption is prevalent and alcohol is accessible
Poverty is a huge driver
There is a lack of recreational facilities across the board.
Recommendation is to get businesses to provide safe spaces
Communication – presence of cell phones/internet. Parents are
unable to regulate what young people are exposed to. There are
some suggestions for censorship or the creation of educational
games/apps
Peer pressure/teen pregnancy – schools in other countries are
very proactive in dealing with teen pregnancy, however with
sexual abuse sometimes it is not preventable
‘Asking home’ – if a boy asks a family for their daughter’s hand
in marriage, they would allow a relationship. But shame forces
young people to hide what they are doing, which forces them to
get married sooner and can result in a higher incidence of
suicide.
Many young persons said they had suicidal thoughts as a result
of parents arguing at home, not relationships. Some take
substances and engage in cutting themselves
Sexual abuse – ‘step daddy’ rape and incest came out very
strongly amongst youth and duty bearers. Services and facilities
were very poor. Victims are as young as 6 years old and there is
no way of dealing with the trauma. Schools in particular are
critical; school life is an anchor for them. In school youth were
not as sexually active.
There was also a strong sense of anger, especially if sexually
abused, and no outlet for that anger. It is recommended that
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counselling be provided to deal with their issues. HFLE allows
them to talk about these sensitive issues.
There is a prevalence of single parent headed homes, blended
families, and a lot of absent mothers e.g. guards
The majority of young men were having unprotected sex
Hotspots: Where are young people vulnerable? – one girl said
‘Everywhere’. In some instances – ‘the road’ is the hotspot,
where people hang out, and places such as car parks, bars and
hotels. A lot of businesses allow girls who look very young to
enter hotels to have sex.
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DISCUSSION ARISING FROM PRESENTATION
Alistair Sonaram – SASOD
Mr. Sonaram asked if there were plans by the Ministry of Education to review the
sex and sexuality theme in the Health & Family Life Education (HFLE) Programme
with the objective of making it about sexual orientation and gender identity. The
aim of which would be preventing violence against persons of different sexual
orientation in the school system.
The question was referred to the HFLE Coordinator, Mrs. Colleen King-Cameron,
who noted that there are no plans at the moment to review that aspect of the
curriculum. However, it was noted that if there is a position in relation to that issue,
the Ministry is willing to welcome input, since like any curriculum, it is under
constant review and the content is always being reshaped and redefined.
Esther McIntosh mentioned that it was a significant point which is reflected in the
report as a weakness. It is not only youth of a different sexual orientation in the
schools and how they see themselves reflected, there are other marginalised
populations e.g. persons with disabilities. In one of the quotes it was mentioned
that HIV is a ‘hearing’ disease. One person interviewed for the study said that some
persons with disabilities tend to be colour blind and red is used as a colour for
prevention. Persons with disabilities are rarely represented in HIV material. If you
are looking at vulnerable youth and at risk adolescents, their needs and rights
should also be reflected. She mentioned that the school policy which exists is
somewhat flexible and leaves room for the PTA and the schools to make decisions
about those issues.
Karen Roberts – PAHO/WHO asked if there is any projection/recommendation
that addresses strengthening or enhancing the curriculum of the teachers’ training
programme to empower them to be able to deal with these sensitive sexual and
reproductive health issues.
Based on her past experience, teachers would make requests regarding some
aspects of the curriculum that they were not comfortable teaching. She referred to
the presentation which highlighted that the school played a very central role in
some of the communities, and felt that teachers needed to be equipped with special
skills to be able to provide the support in the various roles they play within the
school.
Esther McIntosh responded by saying that when she read the School Health and
Nutrition HIV/AIDS Policy which is available online, there are three (3) key aspects
that are very relevant to this target group – one of them is strengthening the
capacity of both the teachers and the parents, and if the policy was implemented,
many issues would be addressed. She also highlighted the importance of good
relationships between the teacher and the students, and the need to change the
perception of intimidating authority figures.
DCEO Doodmattie Singh - agreed with training for teachers to improve their level
of comfort teaching sensitive issues, but stressed the need for training of parents
also. She mentioned that even if equipped with life skills and information about sex
and sexuality, when living in an abusive home, those skills may not be fully utilized.
She also spoke about the influence of Peer Pressure and lack of parental
supervision.
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Malcolm Marcus - Secondary Head teacher, Region 1 addressed HFLE in the
school setting as a good idea if there is a specific teacher who specialises in
teaching HFLE, and maybe another pure subject area. He gave an example from his
school of one teacher - Patrick Ashley, who had received extensive prior training
via NGOs, and was very helpful when it came to issues of that nature.
Paula Sampson – GRPA - spoke of the burdens carried by teachers themselves,
especially those who may have been affected by Gender Based Violence. Those in
difficult circumstances may need special attention before being able to deal with
the sensitive issues of the children
Esther McIntosh – Stated that another thing to note is that some of the key people
in the school system are the school welfare officers, and they should also be
acknowledged for the job they do.
Secondly, she said that the report is not suggesting that the teacher should be
counselling children. Counselling should come from someone who is trained to do
so, but the teacher should have the skills to recognize the needs of the child and
take the necessary follow up action.
Representative from NGO, United Brick Layers
She raised the fact that NGOs are thefoot soldiers who carry the burden. Children
need the HFLE programme from nursery onwards, not just about HIV but other
topics. She spoke of the need to work together to make a better brighter future for
our children.
DCEO agreed and noted that HFLE is in the curriculum from nursery through
secondary. In nursery school it is not taught as a separate subject but integrated.
She applauded teachers for their hard work with children, who have a range of
abilities, attitudes and behaviours, that are often moulded from different home
environments which is difficult.
WORKING SESSION:
Inter-sectoral working groups comprised education, health, and civil society
groups. Each group looked at the key issues of the report presented, priority areas
and recommendations
GROUP PRESENTATIONS:
(Health including MOE, NGOs, MOLHSSS) Strengths, Gaps and Recommendations
for the Ministry of Health
Ministry of Health Group: Presented by Ms. Vyfhuis
Key issues:
Suicide
Disabilities
Alcohol (substance abuse)
Teenage Pregnancy (sexual and reproductive health)
Sexuality Issues
Sexual Abuse
HIV/STIs
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The group felt all their key issues were interrelated. e.g. some clients might
attempt suicide because of HIV/AIDS. People with disabilities in our society are
often rejected, and they are also abused in some ways. Persons affected by
HIV/AIDS might also turn to alcohol or substance abuse.
The study also highlighted that these were some of the key issues that
contributed to some of the behavioural challenges that made these groups
vulnerable and at risk for HIV, so in both ways that is how they can be grouped
with Health issues.
Priority Areas:
1. Sexual abuse
2. Suicide (which deals with Mental Health)
3. Alcoholism
Recommendations:
- Review health policies (eg. Ref. Pg 4 of report about the 1834
health ordinance, youth policy is also in draft) to address
existing gaps with reference to adolescents and HIV. (Age of
consent is 16, but to have an HIV test you must be accompanied
by an adult if you are 16, yet an abortion can be done at 13
without the consent of an adult. With a good youth policy, it
should be able to cover all of this to make it more
comprehensive for adolescents)
- Strengthened health education and life skills for health care
providers and communities accessing health services. (to
address information given to adolescents and treatment of teen
mothers)
- Integration of specific services to address alcoholism, suicide
prevention and sexual abuse at the primary health care facilities.
- Strengthened youth friendly health services. (where youths can
go to access information/counselling etc.)
Questions/comments:
Questions were raised regarding realistically achieving the integration of services
at the Primary Health Care level, and whether the Youth Friendly Health Centres
should be restarted. The response given by the group spoke of the need to have a
broader range of services, since just a few services are available and even fewer, if
any, are tailored to adolescents.
The MoH responded to the issue of youth friendly centres and highlighted their
push for HIVision 2020, which is the new strategy for HIV. This includes training
the existing healthcare workers at the Health Centres to be more youth friendly.
Before, it was a funded position paid by a separate department, and now since that
department has closed the aim is to integrate this service into the normal
healthcare service.
It was noted that there are other components that make a service ‘youth friendly’
and the MoH was encouraged to ensure that those other components are in place,
including opening late on Fridays and on Saturdays. It was unfortunate that after a
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lot of thought, support and effort, the youth friendly centres could not have been
sustained without additional funding.
One suggestion was that there could be one room in the schools that does not look
like a classroom where a counsellor (possibly provided by an NGO) can play a role,
and young people can access services and address their issues. Caution about the
NGOs and their selection criteria was recommended.
The Ministry of Human Services had expressed some concern regarding the quality
of persons who apply for counselling positions, and currently, the UG curriculum is
being revised so that students spend a longer period of time in the
classroom/counselling sessions before they can be certified as a counsellor. NGO
personnel would have to fulfil that criteria in order to provide the highest possible
standard of service.
It was suggested that UNICEF can fund 20 counsellors from each region to attend
UG, and give them the highest possible training. UNICEF is currently supporting the
University to complete the revision of the curriculum which is Phase 1, and has also
funded ECD training for NGOs
The MoE expressed the need to have counsellors, at least in each school cluster, if
not in each school.
Group work - (NGOs including MOE, MOH)- Strengths, gaps and
recommendations
NGO Group presentation – Alistair Sonaram
Group members from MoE, RC Church, Artistes In Direct Support, United
Bricklayers, Ministry of Home Affairs & SASOD
Key issues
Most NGOs that are here did not see the report beforehand
Most NGOs were not involved in the information gathering process
(much information is available from NGOs as their reach is wide)
The limitation of not finding enough MSM’s could have been avoided
had NGOs been contacted
No mention was made of the NGO contribution in the implementation
of the HFLE Program
It is felt that the issues highlighted are not new but have been
repackaged in a new way
No mention of the need to strengthen the services that must be put in
place to deal with the issues that arise from the implementation of
HFLE
Limited mention of Trafficking in Persons (TIP) and Commercial Sex
Workers (CSW’s)
Priority Issues
- How to deal with persons of different sexual orientations – new approaches
are needed and new thinking is required (especially within the school
system.)
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- Education of adults who can be part of the solution. (Ignorance is still part
of the discrimination that a lot of persons face. Parents should be invited to
workshops on how to counsel their children)
Recommendations
- If underlying views are not addressed, no change can be realised
- Civil society inclusion is needed throughout the processes and not just at
the end, to avoid biased reports
- Follow up and feedback are necessary as many reports are done and no
further action is taken
- Strengths of youths must be highlighted as NGOs have seen that many
youths are not as vulnerable as we may think. Parental interference and the
lack of channels of expression give way to vulnerability
- Schools must find other ways to engage parents e.g. PTA meetings which
are integral in understanding what is happening with a child within the
school setting, but often suffer from poor scheduling. Meetings normally
occur at 3:00pm, or 11:00am on Saturdays and Sundays
- Parenting classes are needed for both teachers and the parents of their
pupils.
Questions/comments:
The researcher indicated that SASOD was included in the information gathering
process, and a transcript and recording are available. She said they were quite
comfortable with the number of NGOs that they spoke with, and used the UN action
plan which speaks to youth participation. One of the recommendations was to look
at forming CBOs at the local level e.g. in mining areas where young people are
vulnerable if not much is being done. If they are organised they can have a voice
and speak on their own behalf. She agreed that there are a lot of issues which are
resurfacing, and that it is time for action, but the research team’s job was to say
what was found.
Group work (Education including MOH, NGO, MOHA, MOLHSSS) Strengths,
gaps and recommendations for the Ministry of Education
Education Group Presentation - Presenters: Ms. Persaud & Ms. Moses
Group members – Guidance officers, School welfare officers, child care and
protection officers, teachers and personnel from GRA.
The group felt that there is a moral decline, and in order to address these issues
there are a number of things that need to be taken into consideration. They
preferred not to prioritize the issues since they are all important to move our
nation forward. Key issues and recommendations were dealt with simultaneously
in their presentation.
Key issues and Recommendations:
High reports of violence in urban schools as opposed to rural
and hinterland areas
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Recommendation - Extensive facilities and institutions to
mold/correct behaviour: youth groups etc.
Adolescents with disabilities and age 10-14 out of school youth
are unsupervised a lot of the time
Recommendation - Structured programmes organised/designed:
Community Based Rehabilitation (CBR) Programmes
Social ills – suicide, teen pregnancy, abuses of all types etc.
(pronounced)
Recommendation - Trained and confidential personnel who are
morally inclined
Drug use and abuse contributes to risk
Recommendation - Massive campaigns with adequate staffing and
resources, increase collaboration of social services: police, health,
child care etc.
Lack of poor parenting skills
Recommendation - Effective use of the PTA Programmes e.g.
Mentoring Programmes, greater involvement of NGOs: Peer
education and peer counselling, other governmental
organisations/agencies
Priority Areas:
Staff (qualified, certified and professional)
Ensure the policies to address youths are revised and enforced
Collaboration/network systems should be strengthened
o Ministry of Health e.g. if there is a malaria problem in Region
1, do not just go and take care of the health issue, tell MoE
which can help via Education’s health sector, and share
ideas. Instead of being reactive, there is a need to become
more proactive
Involvement of the community (business/corporate)
o Businesses are not often involved in what is being done e.g.
A small football group can keep young people from being
idle - healthy body, healthy minds. Footballs and gear might
be needed which can be sourced from the store. Other
aspects of sportsmanship can be taught – leadership, speech
making.
Understand/monitor youth culture: music, dress code (style &
fashions, sex tools/toys, tattoos, piercings etc.) Help youth
through the messages and get into their psyche in order to
understand them and ourselves.
Review of HFLE and its methodology. (In some cases both
methods of inclusion and timetabled sessions could work
together to cater for different learning styles.)
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Inclusion of sporting activities
Questions/Comments:
There is a need to come out of a classroom setting; instead of ‘chalk and talk’,
perhaps chat with children in the yard, take walks which may encourage young
people to listen to you more. They tend not to relax when they see a figure of
authority in front of the classroom but may open up if having fun.
It was also felt that LGBT views and issues should have been reflected in the report.
Another question raised was the group’s position on morality. The response given
was that people look at you by how you live your life e.g. your decorum as a school
welfare officer and the importance of setting good examples.
There was also mention of incestuous relationships, but it did not come out
strongly in the report; however case studies were highlighted.
It was noted that the PTAs were again mentioned and as the NGO group highlighted
in their presentation, creative ways should be sought to get parents involved and if
the parents don’t come to the schools, agencies have to go to them. The parents of
children with the most challenges rarely attend PTA meetings, since between 3 –
5pm on weekdays most parents are at work; however having those meetings on
another day would mean a sacrifice for the teachers.
One suggestion addressed the many parents who are security guards, and
proposed that parenting sessions can be conducted at the guard service instead.
MoCYS shared their best practice, where they have parenting bodies in
communities and conduct home visits along with the MoE, since poverty is a factor
and many parents cannot afford to travel frequently.
Utilizing FBOs more was another suggestion since they are usually located in
almost every community and frequented by community members. It was also felt
that FBOs can be approached to assist with counselling, but in a structured way so
it is not strictly religious but more of an open dialogue.
Internship after high school: when adolescents exit the school system, they should
be able to cater for themselves. Employers would often work persons to the bone
for a meagre wage, however if properly regulated, internships can provide valuable
working experience at the end of high school or university. Many vacancies call for
years of experience which young people do not possess.
HFLE came into focus once again and it was noted that it encompasses more than
the topics discussed; it is about developing life skills. Young people need to be
equipped with these life skills, so when they go into the world of work or are with
their peers, they will know what they believe and know how to say no or how to
respond appropriately to situations. The curriculum can be examined in relation to
developing adequate life skills for young people to deal with situations as they
arise.
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NEXT STEPS
Inter-sectoral collaboration
MoE was charged with taking the lead through an inter-sectoral response to the
study which is now available. Stakeholders can be brought in since the MoE is well
placed to take the lead and spearhead collaborative efforts with the other agencies,
so that children can have the support they need to grow up to be productive
citizens. The focus should now be on how this will be accomplished.
The DCEO noted that they must work with the recommendations to look at what
can be done now and within a timeline, and develop a strategic plan so each child
can be the best adult he/she can be.
There was a call for UNICEF to bring participants or representatives from the
organisations together within a year’s time, to share success stories and to follow
up. The way forward is to take the recommendations back to the respective
organisations, share them and, work with them to develop a strategic plan. The
starting point would be to look at what can be done in the short term with few
resources.
Often, things can be done with conscious effort, e.g. following up on whether the
HFLE skills curriculum is being implemented (send out a few persons to check, sit
in the classroom.) Some initiatives however will require financial resources, which
were not budgeted for in the current year, and these will have to wait until the end
of the year or next year.
Participants noted that the current interaction between all sectors is limited, and
that work is often done in isolation, which speaks to the need for better planning
and integration, even with NGOs. The need for early strategic planning was
stressed.
Conclusion
UNICEF’s Regional office held a regional workshop in Jamaica, to assess the
situation of at risk adolescents. With this report, Guyana has documented what is
occurring, and now has the evidence based knowledge, to begin to address the
needs of adolescents, in an effort to provide them the best environment in which to
become productive adults.
It was also suggested that the MoE convene a smaller meeting to decide on a plan of
action, based on the recommendations from this workshop. The Ministry indicated
that this workshop was a priority and from this study a plan of action will be
developed.
Those present were thanked and the inter-sectoral approach was highly praised as
a key strategy towards the development of the adolescents, and addressing their
many needs.
i Kibombo, Richard; Neema Stella, Fatima Ahmed (2007) “Perceptions of Risk to
HIV Infection among Adolescents in Uganda: Are they Related to Sexual
Behaviour?” African Journal of Reproductive Health Vol. 11 No.3 December
169
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ii UNICEF, UNAIDS, WHO (2000) “Young People and HIV/AIDS Opportunity in Crisis.”
New York: UNICEF
iii Ibid
iv O’Toole, Brian; Roy McConkey, Karen Casson, Debbie Goetz-Golbery (2007)
Knowledge and Attitudes of young people in Guyana to HIV/AIDS, International
Journal of STD & AIDS 2007; 18: 193–197
v USAID Guyana HIV/AIDS Health Profile, 2010
vi Ministry of Health (2006) – Guyana National AIDS Strategic Plan 2006-2011
vii O’Toole et al
____ WHO (2006) “Preventing HIV/AIDS in Young People: A Systematic Review of the
Evidence from Developing Countries.” UNAIDs Inter-agency task team on Young
People. UNAIDs/UNFPA/UNICeF/WHo. WHO technical Report series #938. Geneva
____ WHO Statistics on Guyana, December 2005
Jenkins, Molly (2010) Qualitative Assessment of MSM in Guyana Overview and
Preliminary Findings, GHARP II Publication
Wills, Magda Fiona (2005) Qualitative Assessment of Barriers and Motivational
Factors towards HIV Risk Reduction Practices among MARPS: Youths, FFSWs and
their Clients in Guyana. GHARP Internal Publication
____ UNGASS Guyana Country Progress Report, January 2008, Presidential
Commission on HIV and AIDS – December 2009
____ Guyana Behavioural Surveillance Survey 2008/2009 and Comparative
Analysis of 2003/2004 BSS and 2008/2009 BSS
____ Ministry of Health, STI Baseline Study Report: “Prevalence of STI pathogens
and the susceptibility of Neisseria gonorrhoea to antimicrobial agents in Guyana.”
November 2004 and November 2006
____ Guyana Epidemiological Profile (2007) “Epidemiologic Profile – Guyana
Integrated Epidemiologic Profile for HIV/AIDS Prevention, Care and Treatment,
and Strategic Information”.
Guyana | Situation Analysis of Children and Women
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Guyana
Situation Analysis of Children and Women
2016
Guyana | Situation Analysis of Children and Women
2
Published by United Nations Children’s Fund, Guyana
72 Brickdam,
Georgetown
Guyana.
© United Nations Children’s Fund (UNICEF)
July 2016
Guyana | Situation Analysis of Children and Women
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Acronyms 5
Acknowledgements 8
Foreword 9
Executive Summary 10
Part I: Introduction to the SitAn Document 17
Chapter 1: Introduction 18
1.1) Methodology 20
Part II: Country’s Context 23
Chapter 2. Guyana’s Socio-Economic Situation 24
2.1) Demographics 25
2.2) Migration 29
2.3) Economy 30
2.4) Poverty 33
2.5) Disaster Risk Management 37
Chapter 3: Systems for Children 39
3.1) Educational System 39
3.2) Health System 40
3.3) Child Protection System 42
Child/Juvenile Justice 42
3.4) Budget Allocation 43
3.5) General Legislation for Children 46
Part III: The early years: a healthy start (from conception to 5 years) 49
Chapter 4: The Right to Health 51
4.1) Maternal Mortality 51
4.2) Child Mortality 51
4.3) Main causes related to maternal and child mortality 54
A) Obstetric Risks and Inadequate Health Care 56
Antenatal Care 57
Delivery 59
Post Natal care 62
B) Diseases and Infections 63
Diarrhoea 63
Acute Respiratory Infection (ARI) 65
Malaria 65
C) Nutrition 67
D) Access to Immunization 75
E) Access to Proper Water and Sanitation 77
4.4) Bottlenecks and Barriers 80
Chapter 5: Preventing maternal to child HIV transmission 84
5.1) Bottlenecks and Determinants 86
Chapter 6: Birth Registration 89
6.1) Main causes related to low birth registration 91
6.2) Bottlenecks and Determinants 91
Chapter 7: The Right to Education: Early Childhood Education 93
7.1) Early Child Development Index 96
7.2) Main Causes relate to low ECE enrolment 98
7.3) Bottlenecks and Determinants 99
Table of Contents
Guyana | Situation Analysis of Children and Women
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Part IV: The formative years: Childhood (from 6 to 11 years) 101
Chapter 8: The Right to Education 103
8.1) Primary Education 103
A) Bottlenecks and Determinants in Primary Education 109
8.2) Children with Special Needs 110
A) Bottlenecks and Determinants related to education for children with special needs 110
Chapter 9: The Right to be Protected 112
9.1 Corporal Punishment 112
A) Causes related to corporal punishment 113
B) Bottlenecks and Determinants 114
9.2 Child Involved in Economic Activities and Household chores 115
Part V: The emergent years: Adolescents (from 12 to 17 years) 117
Chapter 10: The Right to Education: Secondary Education 119
10.1) Enrolment Numbers 119
10.2) Gender Parity at Secondary Education 120
10.3) School Attendance, Out of school children and School Dropouts 121
A) Causes for school absence and dropouts 126
B) Bottlenecks and Determinants of school dropouts 126
10.4) Quality of Secondary Education 129
Chapter 11: Teenage Pregnancy 133
11.1) Causes and Bottlenecks related to Teenage Pregnancy 133
Chapter 12: Adolescents and HIV/AIDS 138
12.1) Causes, Bottlenecks and Barriers related to HIV/AIDS among Adolescents 139
Chapter 13: The Right to be protected 143
13.1) Domestic Violence 143
Causes, bottlenecks and determinants of domestic violence 144
13.2) Sexual, psychological and physical abuse 146
Causes, bottlenecks and determinants of abuse against children 147
Children in Need of Alternative Care 149
13.3) Child Trafficking and Child Labour 150
Child Trafficking 150
Causes and bottlenecks related to child trafficking 151
Child Labour 152
Causes and Bottlenecks on Child Labour 157
13.4) Adolescent’s Behavioural Health 157
13.5) Children in Contact with the Law and Juvenile Justice 158
Causes and bottlenecks related to children in contact with the law 160
13.6) Participation in Decision Making 161
Part VI: Conclusions and Recommendations 163
Conclusions 164
Recommendations 169
Annex 1: International Conventions ratified by Guyana 173
Annex 2: Child Budget Methodology 174
Annex 3: The Sustainable Development Goals 178
Annex 4: Equity and Equality in the scope of the Situation Analysis. 179
Bibliography 180
Guyana | Situation Analysis of Children and Women
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Acronyms
Acronym Definition
ACTO Amazonian Cooperation Treaty Organization
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Care
ARI Acute Respiratory Infection
ART Antiretroviral Therapy
ARV Antiretroviral
BBSS Biological and Behavioral Surveillance Survey
CARICOM Caribbean Community
CDC Center for Diseases Control
CEDAW Convention on the Elimination of All Forms of Discrimination against
Women
CHW Community Health Worker
CPA Childcare and Protection Agency
CRC Convention on the Rights of the Child
CSEC Caribbean Secondary Education Certificate Examination
CSO Crime and Social Observatory
DESA United Nations Department of Economic and Social Affairs
DHS Demographic Health Survey
DNA Deoxyribonucleic acid
ECD Early Childhood Development
ECDI Early Childhood Development Index
ECE Early Childhood Education
ESL English as Second Language
ESP Education Strategic Plan
EVM Effective Vaccine Management
GARPR Guyana AIDS Response Progress Report
GBV Gender Based Violence
GDP Growth Domestic Product
GGMC Guyana Geology and Mines Commission
GII Gender Inequality Index
GPHC Georgetown Public Hospital Corporation
GRO General Register Office
HDI Human Development Index
HFLE Health and Family Life Education
HIV Human Immunodeficiency Virus
HPV Human Papilloma Virus
IDB International Development Bank
IGME United Nations Inter-agency Group for Child Mortality Estimation
IMCI Integrated Management of Childhood Illnesses
IMR Infant Mortality Rate
IPV Inactivated polio vaccine
Guyana | Situation Analysis of Children and Women
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Acronym Definition
ISAGS Instituto Sul-Americano de Governo de Saúde (South American
Institute for Government Health)
ITN Insecticide treated net
LBW Low Birth Weight
LGBT Lesbian, gay, bisexual and transgender
MAF MDG Acceleration Framework
MCYS Ministry of Culture, Youth and Sport
MDD Minimum dietary diversity
MDG Millennium Development Goals
MICS Multi Indicator Cluster Survey
MLHSSS Ministry of Labour, Human Services & Social Security
MMR Maternal Mortality Rate
MoPH Ministry of Public Health
MOPS Ministry Public Security
MPI Male partner involvement
MSM Men who have sex with men
NAR Net Attendance Ratio
NCD National Commission on Disability
NER Net Enrolment Rate
NGSE National Grade Six Examinations
NOC New Opportunity Corps
NPHRL National Public Health Reference Laboratory
OHCHR Office of the United Nations High Commissioner for Human Rights
ORS Oral rehydration salts
PAHO Pan American Health Organization
PCR Polymerase chain reaction
PHC Primary Health Care
PMTCT Prevention of Mother-to-Child Transmission
PNC Prenatal Care
PNM Post-neonatal mortality
PPP People’s Progressive Party
PRSP Poverty Reduction Strategy Paper
PSSD Probation and Social Services Department
PSSO Probation and Social Services Officer
RCC Rights of the Child Commission
RHA Regional Health Authority
RHF Recommended home fluid
SDG Sustainable Development Goals
SDPS Secondary Departments of Primary Schools
SEN Special Education Needs
SHN School health and nutrition
SIDS Small Island Developing States
SRH Sexual and Reproductive Health
TVET Technical Vocational Skills Program
TVPA Trafficking Victims Protection Act
UCLA University of California Los Angeles
UNASUR Union of South American Nations
UNDP United Nations Development Programme
Guyana | Situation Analysis of Children and Women
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Acronym Definition
UNESCO United Nations Educational, Scientific and Cultural Organization
UNFPA United Nations Population Fund
UNICEF United Nations Children's Fund
UNODC United Nations Office on Drugs and Crime
UNV United Nations Volunteers
USAID United States Agency for International Development
USD United States Dollars
VSO Volunteers Service Overseas
WASH Water and Sanitation
WHO World Health Organization
Guyana | Situation Analysis of Children and Women
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Acknowledgement
The Guyana Situation Analysis of Children and Women was carried out in 2015/2016 by the Government of Guyana,
through the Ministry of Social Protection, with support from a number of partners. Technical support was provided by
the United Nations Children’s Fund (UNICEF). It is important to acknowledge the technical support provided during
this SitAn process by UNICEF staff from the Regional Office for Latin America and the Caribbean, in Panama and the
Guyana and Suriname Country Office.
The collaboration of multiple Government Ministries and Departments in Guyana is also deeply appreciated.
Furthermore the invaluable assistance of consultants on this project is noted. The decisive role in the review of the
reports by the members of the Technical Committees as well as the overall management of the SitAn by the steering
committee is also noteworthy. It is expected that this SitAn will pave the way for the systematic monitoring of the
situation of children and women living in Guyana.
Guyana | Situation Analysis of Children and Women
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Foreword
Children are at the heart of everything we do, and the issues that affect them shape our priorities. This 2016 Situation
Analysis of Children and Women in Guyana (SitAn) will inform planning, programming and decision making for the
benefit of children in all 10 Regions of Guyana.
We are pleased with the partnership between Government of Guyana, through the Ministry of Social Protection, and
UNICEF, which has contributed to the completion of this document.
Making use of the most recent available data and analysis on children in Guyana from both national and international
sources, this SitAn reveals a compelling story about the issues that impact children’s lives and wellbeing in the areas
of health, education and protection among others, and allows us to effectively focus resources on programmes which
respond to their needs and make a difference for them.
One of the distinctive characteristics of this situation analysis is that it adopts a life cycle approach, with connections
to the achievement of the Sustainable Development Goals (SDGs). By making the whole child the centre of the
analysis, it provides a holistic and integrated approach that connects and reinforces policy and support measures in
a coherent manner.
The process also utilised an equity-based approach. For the purpose of this analysis, equity means that all children
have an equal opportunity to survive, be protected, develop, participate, and reach their full potential, without
discrimination, bias, or favouritism.
This SitAn will be extremely important in informing UNICEF’s Programme of Cooperation with the Government of
Guyana for 2017-2021, which has three priority areas; Safety and justice; Life long learning; and Social inclusion and
child rights monitoring. This will support the Government in the development and implementation of National Strategic
Plans and Programmes, with a view to advancing the realization of the rights of children with emphasis on equity, and
on reaching the most vulnerable children and their families.
_______________________ _____________________
Hon. Volda Lawrence Marianne Flach
Minister of Social Protection UNICEF Representative,
Guyana Guyana and Suriname
Guyana | Situation Analysis of Children and Women
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Executive Summary
The 2016 Guyana Situation Analysis of Children and
Women (SitAn) is a cooperation between the Government
of Guyana and UNICEF, and it has as its main objective
to support the new Government in the development and
implementation of National Strategic Development Plans
and Programmes so as to advance the realization of the
rights and development of Guyanese children, with a
strong equity focus on the most vulnerable children and
their families.
The SitAn document adopts a life cycle approach, with
connections to the SDGs. In this line, the document is
divided into three main parts: Early Child Development
(ECD), comprising children from conception to 5 years
of age; childhood, children from 6 to 11 years; and
adolescents, boys and girls between 12 and 17 years of
age.
Worldwide, inequalities are reflected in many different
dimensions. In Guyana, the main dimensions of
inequalities used in the analysis were (i) geographical,
subdivided into Coastal and Hinterland regions, rural
and urban, and among the 10 administrative regions;
(ii) gender; (iii) poverty; and (iv) household ethnicity.
Whenever possible, these characteristics were used to
show the differences in the realization of rights in the child
population in the country, and were used to frame the
analysis of the situation of children. In reality, despite the
fact that the dimensions are analysed separately in the
document, they usually overlap within the same social
group, and that can either serve to magnify inequalities
and inequities, or concentrate privileges.
Socio-Economic context
Guyana is considered to be a medium human
development country. In UNDP’s Human Development
Report of 2014 (UNDP, 2014), the country’s value for
HDI was 0.638, ranking Guyana in position 121 among
187 countries. Despite the fact that the latest value
shows and improvement of 0.87% when compared to
the value in 2000, the country has been stagnated in the
same ranking position since 2008. In terms of Gender
Inequality Index (GII), Guyana is in position 113 (among
the 187 countries), with value 0.524.
Among the almost 759 thousand inhabitants of the country,
children represent 36% of the population. The majority
of the population (89%) lives in the coastland region,
which represents 7.5% of the country’s landmass. The
remaining 11% of the population lives in the Hinterland
region, responsible for 92.5% of the country’s landmass;
a region that is characterized by dense forestlands and
mountain ranges and marked also by a series of hills and
rivers, contributing to the region’s low-density population
and difficulty of access.
One important characteristic of the population is the
elevated number of Guyanese nationals living abroad. It
is estimated that around 422 thousand Guyanese live in
other countries. On one hand, the influx of remittances
is an important factor for the country’s economy and
represents an informal safety net for many families. On
the other hand, high emigration is influenced by lack of
internal economic opportunities, indicating failures in the
job market. On the economic side, this brain drain creates
losses around 8% of the country’s GDP. On the social
side, emigration breaks families and forces children to
live far from one or both parents.
Guyana is considered an upper middle-income country.
Despite its good GDP performance, in taking into
consideration the GDP per capita, Guyana is the third
poorest country in the Western Hemisphere, after
Haiti and Nicaragua. Unemployment is high, and it is
particularly concerning for the young population, which
represents more than 60% of Guyana’s population. Since
2002, youth unemployment has been consistently higher
than 30% and is currently estimated to be about 40%.
Guyana’s latest official poverty measurement was done in
2006, prior to the economic crisis that hit the world in 2008.
According to that measure, 36.1% of the population in the
country was living in poverty, including 18.6% that were
living in extreme poverty. Poverty is higher in the interior
of the country, and for those families living in the rural
areas (including rural in the coast). Poverty in Guyana
has a child’s face. Similar to previous measurements,
the poverty number from 2006 shows that younger age
cohorts have a significantly higher poverty headcount
than older ones. 33.7% of young people aged 16-25 lived
in poverty in 2006. Almost half of all children aged 16 and
below were poor (47.5%) in 2006.
Guyana is susceptible to a variety of hazards including
flooding, landslides, drought, fires, and severe weather
systems, among others. Between 1990 and 2014, floods
were the main natural disaster that happened in the
Guyana | Situation Analysis of Children and Women
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country and primarily responsible for deaths. Flooding is
common in the coastal areas and in the interior of the
country. In the coastal area, an extensive sea defence
system of sea walls and dams is the main defence against
inundation of the coastal plain due to heavy rainfall,
overtopping of the river networks, and breaches in the
conservancies or seawall. In the interior, heavy rains and
the abundance of rivers create the conditions for constant
increases in the water levels. Natural disasters create an
extra stress on public finances and significant impact on
homes, businesses and human life. In this sense, almost
94% of the negative impact in the country’s economy
resulted from past floods.
The country has a body of legislation that protects
the rights of children, women and other vulnerable
populations. Some of the legislation is considered to
be updated and in line with international standards.
Nevertheless, the implementation of the legislation was
identified as one of the major bottlenecks in the country
for the three main sectors related to children (health,
education and child protection).
The early years: a healthy start
(from conception to 5 years)
Maternal mortality estimates for 2015 stand at
229/100,000 live births, a number that has not shown
significant progress since the year 2000 (210/100,000).
Child mortality numbers have shown small reductions
since the year 2000, but that also does not indicate major
changes in the situation. Neonatal mortality continues
to be the major component of Under-5 mortality in the
country.
Maternal and Child mortalities share similar causes: (i)
congenital factors; (ii) elevated obstetric risks reinforced
by low levels of prenatal care, delivery and postnatal
care; (iii) the incidence of diseases and infections such
as respiratory infections, malaria and diarrhoea; and (iv)
the poor nutritional status of mothers – high incidence
of anaemia – and children – high incidence of stunting –
all, were the identified as immediate causes. These are
influenced by the following underlying causes: inadequate
health care, lack of full immunization, the unhealthy
situation of household environment in relation to water
and sanitation, and by household food insecurity. Poverty,
social norms, regional disparities and gender norms
were identified as the structural causes. All these causes
are exacerbated for some specific populations such as
mothers-to-be and children under the age of 5 living in
the Hinterland, in the rural areas, living in poor families,
and from Amerindian families. These do not have access
to good quality health services, and, consequently, higher
chances of mortality or in the development of cognitive
and/or physical impairment.
These causes are supported by a series of bottlenecks
and barriers. In terms of enabling environment, the
country presents opportunities for the improvement of the
coordination among the different actors involved in the
health of mothers and children. Stakeholders identified
issues related to the management of the system, including
lack of communication among the health facilities in the
regions and the central management in the capital. On
the supply side, the availability of essential commodities
and the access to adequately staffed services are both
contributing factors to the current situation. Qualitative
information shows that not all regions have the adequate
number of trained health workers and community health
workers. One of the direct factors that hinders access
is the country’s geography, that negatively impacts the
propensity of families to search for help, but also in health
– and educational – professionals to work in the most
remote places.
On the demand side, despite being free, difficulty of
access creates some implicit financial barriers to some
groups. There are also social and cultural practices
and beliefs that influence the personal decision of some
mothers to access the obstetric services provided by
the government. In some areas of the country, cultural
barriers are considered as one of the major obstacles
impeding women from getting adequate and timely
care. Cultural practices also influence the use of home
remedies, and the elevated number of home-births that
happen in the interior of the country.
HIV prevalence among pregnant women in 2014 was
1.9%, the same as 2013, consolidating an upward
trend since 2010. The HIV Prevention of Mother-to-
Child Transmission (PMTCT) program is available
countrywide. HIV testing of all pregnant women is a
requirement during prenatal care. In 2014, 94.4% of the
pregnant women accessed PMTCT services and were
tested for HIV. Among those identified as HIV positive,
97% of them had received ART in 2014. There were 37
new cases of HIV reported among children (ages 0 to
19) in 2014, number that represents a reduction when
compared to 2010, but an increase when compared to
2013 (32 new cases). Most of the new cases among
children are found between 15 and 19 year old boys and
girls. The fact that almost 25% of the new cases of HIV in
the child population in 2014 had happened between the
ages of 1 and 14 demands extra attention on prenatal
procedures, delivery and postnatal care of mothers
and children. These cases represent the failures in the
system, i.e., the cases that were not identified, monitored
Guyana | Situation Analysis of Children and Women
12
and/or properly threated during pregnancy, delivery and
the initial months of life of the child.
The efficiency of the PMTCT programme in Guyana is
affected by the same bottlenecks related to maternal and
child health: shortage of essential commodities, difficulty
of access to health facilities, financial constraints, and
social and cultural practices and beliefs. Deficiencies in
the prenatal care, delivery and postnatal care affect not
only the detection of the virus in mothers and babies,
but also in the follow up that identified patients should
have. Interviewees mentioned that it is known that some
pregnant women would perform the rapid testing, and
even with a positive result, would not come back for
further testing, for getting advice and/or for collecting
their ARV medication. Knowledge on mother-to-child
HIV transmission is also low in the country (53% among
women, and 35% among men), increasing the risk of HIV
transmission among those babies born to women who
did not have proper prenatal care.
Birth Registration still has room for improvement.
11.3% of the births in Guyana are not registered, with
no differences between boys and girls. The number of
unregistered births is 3 times higher in Region 1 than
the average for the country. Similarly, a child living in the
interior of the country (Hinterland), has twice the chance
of not having a birth certificate in comparison to a child
living in the urban areas (19% and 9.5%, respectively).
Two other factors that increase the chances of a child
not having a birth certificate are poverty and ethnicity.
Areas with high incidence of babies delivered at home
also present an elevated number of babies not being
registered.
Qualitative assessment done in Guyana indicates two
immediate causes and two underlying causes that
influence the low levels of birth registration for some
groups and some regions. In terms of immediate causes,
on one hand, while knowledge of the importance of
having children registered is important; on the other
hand, parents and caregivers have to have the means
to register their children. Both immediate causes are
influenced by the cultural aspects and by the efficiency of
the system. Poverty, social norms and regional disparities
will work as structural causes for the low registration of
some populations.
The 2014 Early Child Development Index (ECDI)
identified that around 86% of children aged 36-59
months in Guyana are developmentally on track in terms
of physical growth, literacy and numeracy skills, socio-
emotional development and readiness to learn, with few
differences based on socio-economic characteristics
and Regions. For example, children (i) from Amerindian
families; (ii) from the poorest families; and (iii) living in the
interior of the country have the smallest ECDI (73.2%, 78%
and 78.5%, respectively). In terms of regions, children
living in Regions 1, 7, 8 and 9 are far beyond the average
for the country. The results also show the importance of
children to attend ECE institutions: the ECDI for children
attending ECE was 91.4% in comparison to 76.5% of
those children not enrolled in early childhood education
programmes.
Early childhood education can be divided into
two segments: Day Care Centres and Play Groups
for children between the ages of 0 and 3 years old,
these under the responsibility of the Ministry of Social
Protection; and Nursery schools for children between 3
years and 6 months, and 5 years of age who did not start
primary education, which are under the responsibility of
the Ministry of Education. Data for day care centres is not
available. In 2014, on average, 61% of the children aged
36-59 months in Guyana were attending nursery school
(59.0% of the girls and 63.0% of the boys. Attendance
of ECE programmes varies by area, wealth quintile and
ethnicity. Rural and interior parts of the country are the
ones with lower attendance. Similarly, despite the fact
that public nursery schools are available, the poorer
the family, the smaller are the chances that the child is
going to attend these programmes. In terms of ethnicity,
only four in each ten Amerindian children were attending
nursery schools in 2014. Regarding regional disparities,
Regions 5, 4, 10 and 6 present the highest attendance
rates in the country. Meanwhile, in Region 1, only one
child out of five is attending nursery school.
Access to formal ECE services is affected by the direct
cost involved in enrolling children in day-care centres (the
free public ones are few) and indirect cost associated to
transport these children to and from school. Evidence
also points to the fact that lack of parental knowledge on
the importance of starting formal education at early ages,
and the difficulty of access to young children, especially
in the most remote areas, as immediate causes.
The formative years: Childhood
(from 6 to 11 years)
Primary education is mandatory in Guyana, covering
children between the ages of 6 and 11. Due to delays
in analysing the 2012 Census, the country does not
have available an official net enrolment rate (NER) for
children in primary education. The lack of official rates
does not allow for a proper discussion on the efficiency
of the system. In the school year 2011/2012, 94,843
boys and girls were enrolled in the six grades of primary
Guyana | Situation Analysis of Children and Women
13
education, 49% of them were girls. The vast majority of
pupils (93%) were enrolled in free public government
schools. On average, 85% of the children attending the
first class of primary school in 2014 attended preschool
in the previous year, an increase when compared to 2006
when only 65% of the children had attended preschool.
Among those enrolled at school, 97% of them were
attending the classes regularly. Also, around 96% of the
children who start grade 1 in the past reached grade 6
(last grade of primary education in Guyana), showing an
improvement when compared to 2006, when 71% of the
children reached grade 6.
While access to primary education is important, access
to quality education is fundamental for the sustainable
development of the country. Using the National Grade
Six Assessment as proxy of quality of the primary
education, grades between 2009 and 2013 for students
from the Hinterland and Coastal areas have improved for
Mathematics, English and Science. Nonetheless, the gap
in grades between students has increased. For example,
while the gap in Mathematics between Hinterland and
Coastal areas students was 15 percentage points in 2009,
in 2013 that difference was enlarged to 24 percentage
points. This indicates that instead of having the inequality
reduced, it has in fact increased.
The causes and bottlenecks that influence the difference
in quality between the two regions are driven by lack
of qualified teachers and poor infrastructure found in
the hinterland region. Moreover, most of the students
in the Hinterland do not have access to early childhood
education, only starting their formal educational career
at ages 6 or 7, in comparison to some students in the
coast that will start at age 3 or younger. The SitAn also
identified that language – some students are raised in
their native language that is different from the official
English language that is taught in school – and implicit
financial barriers will also contribute to the low quality of
school achievement of some students.
Guyana does not have an account of how many children
with special needs there are in the country, or how many
are in need of formal education. Small-scale surveys have
identified that 15% of all persons with special needs have
never attended school, and the proportion increases to
42% among those children younger than 16 years of
age. The country has a limited number of institutions that
provide special education, and access to them is difficult
due to their location – most are in Georgetown – and
due the associated cost related to transport children to
and from the schools. There are also social and cultural
practices and beliefs that hamper a more inclusive
education in Guyana. For some parents, the fact that
they have a child who requires special attention is seen
as a burden and considered to be shameful. Adding to
that, bullying is normal, with children presenting negative
attitudes towards those who need special education.
Therefore, inclusive education and training of teachers
for its provision remain severely limited, particularly
for children with sensory, cognitive, and/or mental
impairments, which leads to the majority of children
with disabilities staying at home, resulting in isolation,
stigmatization and compromised access to employment
opportunities and social services. The reality is that
children with disabilities have difficulties in accessing
not only schools, but also health services, employment
and even social and recreational opportunities. The
country’s infrastructures are not accessible for children
and adults with motor impairments; and even in the
country’s capital, sidewalks, buildings and roads are not
completely accessible.
In Guyana, corporal punishment is still legal – with the
exception of the courts and the juvenile justice system,
where it has been repealed from the laws. In 2014, 70% of
children were identified as suffering some sort of corporal
punishment. Boys are more likely to receive violent
discipline than girls. Violent discipline is widespread in
society, and it is independent of the household’ socio-
economic characteristics, and the region where the child
lives.
Immediate causes of corporal punishment are the
excessive use of alcohol and drugs, family conflict, and
lack of parents’ knowledge on other forms of discipline.
As underlying causes are the fact that the legal system
allows for that practice, the lack of parenting skills, and
the cycle of abuse that still happens in some families, i.e.,
the feeling that if the parent suffered corporal punishment
when he/she was a child, they can use it to discipline
their child today.
The emergent years: Adolescents
(from 12 to 17 years)
There were 82 thousand boys and girls enrolled in private
and public secondary schools in the country for the
school year 2011/2012. Similar to primary education,
an official secondary net enrolment rate (NER) is not
available, jeopardizing any analysis of the efficiency of
the system. There were two main problems seen related
to secondary education in Guyana. First, while students
might be enrolled at school, their attendance is not
guaranteed. Second, the quality of the education that
students receive is not homogeneous.
Guyana | Situation Analysis of Children and Women
14
Boys and girls are dropping out of school – or not attending
– (i) due to the country’s economic situation that pushes
some of them to start working without the necessary
qualification and in low skills – and consequently low
pay – jobs; (ii) due to the fact that some do not see the
benefits of continuing their academic studies – quality of
education, including appropriateness of the curriculum;
and (iii) specially in the case of girls, due to teenage
pregnancy.
Quality of secondary education has the same problems
as primary education. Not all the schools have qualified
teachers – in some cases, parents have to pay for private
tutors in more specialized subjects; and the learning
infrastructure is not the same – while in some schools
in the coastal area students have access to education
through technology, in others, especially those in the
interior and in the rural areas, schools do not have
electricity or proper sanitation. As a consequence, the
difference in CSEC scores between Hinterland and
Coastal areas has not improved between 2008 and 2013.
Teenage pregnancy is still a problem in the country.
About 15% of the girls between ages 15 and 19 in Guyana
had begun child bearing, with different rates depending
on the area that the girl lives, her poverty status, and her
ethnicity. For example, one in every five Amerindian girls
between ages of 15 and 19 was a mother at the time
of the survey, and one in every four girls who lived in
poor households in Guyana have started childbearing,
in comparison to 1 in every 10 girls living in richer
households.
Teenage pregnancy has been associated with three
factors: (i) early sexual debut, on average, 5% of
the women had their first sexual relationship before
the age of 15. That rate is much higher for women in
poor families (12.5%), women living in the interior of
the country (10%), and for those who are Amerindians
(11%). It is important to mention that it is not known if
early sexual debut is associated with consensual sex or
forced. (ii) Low levels of use of contraceptives. Around
13% of sexually active adolescents (young women
aged 15-19 years) mentioned using contraceptives in
their sexual relationships. (iii) Early marriages are not
a common practice in the country; nonetheless, among
girls between 15 and 19 years of age, 13.3% of them
were married or in union (cohabiting) in 2014. All these
factors are also associated with individual behaviour, i.e.,
with the boy and the girls’ knowledge on how to practice
safe sex, their use of alcohol and drugs, and their level of
empowerment in society.
Elevated rates of teenage pregnancy indicate that
adolescents are in risk of contracting HIV and/or other
sexual transmitted diseases. Following Haiti, Guyana
at that time had the second highest incidence of HIV/
AIDS in the Caribbean, and AIDS was considered the
second leading cause of death in the country. Knowledge
is one of the most important components in avoiding HIV
transmission. Less than half of the adolescent population
between 15 and 19 years of age (47.7% for women, and
33.2% for men) have comprehensive knowledge on HIV
and AIDS. Small comprehensive knowledge on HIV, high
levels of unprotected sex and elevated levels of sexual
violence against adolescent girls create extra risks for
teenage boys and girls.
Boys and girls in Guyana are exposed to elevated levels
of sexual, psychological and physical abuse at home
and in their communities, as well as child trafficking and
child labour. Gender based violence contributes to the
aggravated situation of violence against children. Neglect
is the main type of abuse suffered by children, followed
by sexual abuse.
A mix of social norms and social and cultural practices
have been identified as the main factors that influence
violence against children and women. In this sense,
using a sociological perspective, gender-based violence,
different forms of abuse, and attitudes toward them,
could be subdivided into two sets of causes: those at
the individual level and those at the social level. For the
individual, violence is largely driven by factors related
to gender inequality, childhood experiences and the
enactment of harmful forms of masculinity. Abuse and
violence against women and children are related to the
power control that men try to exercise over the women,
which is also extended to the children. While legislation
to prevent abuse and punish perpetrators exists, the
consensus among stakeholders in the country is that
the implementation of the different legal norms is still
lagging behind. Impunity is seen as a major bottleneck
in the system, caused by victims and witnesses that are
afraid of reporting abuses – sometimes due to personal
or financial connection to the perpetrator.
Child trafficking and child labour are considered two
major issues in Guyana. They are interrelated and usually
reinforce each other. Among all the cases of human
trafficking identified between 2013 and 2015 (totalling
170 cases), 50% of them involved children. 91% of the
cases have women as survivors.
Around 18% of the children in the country were involved
in child labour. The number is much higher when boys
and girls involved in economic activities are taken into
consideration: around 35% of adolescents between 15
Guyana | Situation Analysis of Children and Women
15
and 17 years of age were working in 2014. Both child
trafficking and child labour are triggered by the economic
situation in which families live. There are also social
norms that influence the propensity of families to allow
adolescents to work, i.e., work is seen as character
building and it should be emphasized from early ages.
Stakeholders in Guyana believe that the situation of
children in contact with the law is worse today than it
was in the past. There are two institutions that formally
work with children in contact with the law. Out of the
831 children and adolescents admitted into the Juvenile
Holding Centre between 2011 and 2014, 70% were boys.
Most of the boys were admitted accused of theft (break,
enter and larceny). For girls, wandering was the main
cause of admission. In September 2015, 84 children
and adolescents were residents in the New Opportunity
Corps (NOC), 55% of them boys.
Poverty is identified as the major cause that influences
children to break the law. Adding to that, alcohol and drug
consumption, and the influence of peers are also factors
that add to the problem. Some stakeholders mentioned
the fact that elevated cases of wandering is an indication
that the relationship between adolescents and parents
is broken. While there are calls to remove wandering
from the statute books, many see it as a precursor to
committing various crimes, and for some families, it
becomes a solution to fix a problem that parents do not
know how to solve.
Conclusions
Despite improvements in the socio-economic situation,
inequity is a major factor in Guyana, i.e., boys and girls do
not have access to the same quality of education, health
and child protection due to structural problems described
in this document. The country’s averages hinder serious
differences, and create different vulnerable groups that
demand special attention.
The Situation Analysis points to different groups of
vulnerable children and women in Guyana. These
vulnerabilities are created and/or emphasized by the four
dimensions of inequality utilized throughout the report:
geographical, gender, household economic status, and
ethnicity. The first group of vulnerable children and
women are those who live in the Hinterland. As shown,
for almost all indicators used to describe the situation of
children, those living in the hinterland are in a worse off
situation than those in the coastal areas.
The second group of vulnerable children and women are
the Amerindians. Historically they live in the interior of
Guyana (hinterland) and share the same problems as
other ethnicities that inhabit those areas; nonetheless, if
the Amerindians are analysed isolated from other groups,
maybe with the exception of nutrition, they do present the
worst indicators among all the population in Guyana. A
third group identified as vulnerable are those children
with disabilities and special needs. The lack of data on
this population is worrisome, and signals that the country
does not properly address their needs. Without knowing
how many boys and girls have special needs, it is not
possible to know if they have access to school and health
facilities, and if they have their rights realized.
Children living in single-parents households,
especially those headed by women were identified as
a fourth group of vulnerable children. Recent information
on the correct number of households’ arrangements like
these is not known, and available data does not present
that disaggregation; however, different interviewees have
mentioned that these types of families are common in
Guyana. These family arrangements are driven by the
harsh economic situation that pushes parents – mainly
men – to search for jobs abroad and/or in the most
remote areas of the country (mining and logging). In
single-parent households, when a mother – of father – is
not home, children are affected in different ways. One
direct danger for children is that in being alone, they are
susceptible to being abused by older children and/or
adults. Besides, as mentioned, the lack of a male figure
at home was identified as correlated to school dropouts,
and to behavioural problems, especially with boys.
The fifth group represents a stand-alone group, but
it was also identified as the major cause of all other
vulnerabilities: poverty. Not all poor families are going
to have their children out-of-school, or will have cases
of domestic violence. However, statistically, poor families
in Guyana have higher chances of living in a worse-off
situation. Children living in poor families have smaller
chances of having access to computers and books; they
are more susceptible to domestic violence and other
types of abuses; they have higher chances of being
stunted and have higher chances of being out of school;
among other problems.
Despite the fact that the SitAn identified five main
vulnerable groups, these are not insulated, i.e., children
in one group might also be exposed to the situation
described in a second or third group. For example, a child
who lives in a female-headed single-parent household
might also live in the hinterland, and in a poor family. One
point that all these vulnerable groups have in common
is that they are exacerbated by the poverty status of
the family. Poverty is at the core of most, if not all, the
Guyana | Situation Analysis of Children and Women
16
problems that affect children and adolescents.
The situation of children and women in Guyana is influenced by different immediate, underlying and structural
causes, which are then reinforced by many bottlenecks that prevent boys and girls from fully accessing their rights.
The importance of identifying the causes and bottlenecks is related to helping government and different stakeholders
to construct public policies that target the most vulnerable populations based on an assessment of the reasons that
influence that situation. The SitAn document acted as the first stage in this process: it identified broad bottlenecks that
explain the situation. The second stage would be to intensify the analysis, so for each problem acknowledged in the
document a thorough map of causes, bottlenecks and determinants can be constructed.
Guyana | Situation Analysis of Children and Women
17
Part I:
Introduction to the SitAn Document
Guyana | Situation Analysis of Children and Women
18
Chapter 1: Introduction
The 2016 Situation Analysis of Children and Women (SitAn) document is the result of a cooperation process between
UNICEF and the Government of Guyana. The process of developing the SitAn was informed by three very important
facts: firstly, the 2015 general elections that resulted in a new Government from an opposition coalition; secondly,
the end of the period where the Millennium Development Goals (MDGs) set the agenda of international cooperation;
and thirdly, the approval of the Sustainable Development Goals (SDGs) and, consequently, the appearance of a new
framework for international development and cooperation among countries. Despite the fact that during the time
the SitAn was being developed the indicators for monitoring the SDGs were still being debated by the international
community, the 2016 Guyana SitAn was developed taken the SDGs and its targets in context. In this sense, the SitAn
is not a SDG document, but it carries their principles and ideas, and it will further support the government to reporting
against them.
Within this context, the 2016 SitAn has as its main objective to support the new Government in the development
and implementation of National Strategic Development Plans and Programmes so as to advance the realization of
the rights of development of Guyanese children with a strong equity focus on the most vulnerable children and their
families.
One of the distinctive characteristics of this situation analysis is that it adopts a life cycle approach, with some
connections to the SDGs. This is a whole-child oriented approach by making the child the centre of analysis, instead
of the social sectors and the services. This approach avoids compartmentalizing the rights of children, and provides
a holistic and integrated methodology that connects and reinforces the various policy support measures in a coherent
manner1. The idea behind the document is quite simple: the realization of one right often depends, wholly or in part,
upon the realization of others. For instance, realization of the right to health may depend, in certain circumstances,
on realization of the right to water and sanitation, education and information. Hence, it is impossible to disassociate
the problems, and try to improve the current situation of children if not by a coordinated approach.
Still, even though all children have the same rights, at any time, everywhere, children have different needs during
different stages of their lives. Hence, certain rights may have more relevance or urgency at one age over the other.
For example, while the needs for early childhood are mainly relate to health and nutrition, children at primary
schools age are mostly concerned with education and access to information. Adolescents face additional needs
and challenges with respect to reproductive health and protection from violence and abuse. Hence, the life cycle
approach acknowledges the heterogeneity within the children’s needs during the first 17 years of their lives.
For this report, three main life stages are considered: Early Child Development (ECD), comprising children from
conception to 5 years of age2; childhood, children from 6 to 11 years; and adolescents, boys and girls between
12 and 17 years of age. These age groups were selected based on the available data for the country. For instance,
primary education in Guyana should cover ages 6 to 11, so, despite UNICEF considers ECD to cover up to the age
of 8, to comply with available data, ECD was limited to ages 0 to 5, and childhood to ages 6 to 11. Similarly with
adolescents: despite the fact that the United Nations defines adolescence as the period between 10 and 19 years of
age, the SitAn has limited that group to those ages where boys and girls should be in secondary education, moving
into tertiary education, i.e., between 12 and 17. The reader must have in mind that groups – and the problems
children face – are not narrowly defined, and a sharp separation between the different stages is not real.
While the advantage of using the life cycle approach is undeniable, one of the disadvantages is that some topics
were deliberately placed in one life cycle group. For example, domestic violence was presented and analysed in the
part related to adolescents, but it is clear that this violence also affects children younger than 12 years of age. Similar
situation with child trafficking that is also placed in the adolescent part, but violates the rights of children of all ages.
Those divisions do not jeopardize the overall objective of the document and frequently the text of the document tries
to do the links among the different parts, chapters and sections.
1 http://www.unicef.org/adolescence/index_73650.html
2 UNICEF considers ECD as the period between 0 and 8 years of life; nonetheless, different literature will consider that period as being
between 0 and 5 years. In order to facilitate the analysis – and specially due to how data is disaggregated – in this situation analysis ECD will be
considered as 0 to 5, having in mind that the longer the care with the early stages of the child, bigger are the returns in the future.
Guyana | Situation Analysis of Children and Women
19
The SitAn process also followed an equity-based approach. For the purpose of this situation analysis, equity means
that all children have an equal opportunity to survive, be protected, develop, participate and reach their full potential,
without discrimination, bias, or favouritism. This definition is consistent with the Convention on the Rights of the Child
(CRC), which guarantees the fundamental rights of every child, regardless of gender, race, religious beliefs, income,
physical attributes, geographical location, or other status. Inequities (lack of equity) generally arise when certain
population groups are unfairly deprived of basic resources that are available to other groups (UNICEF, Sept 2010).
For an equity-based situation analysis, inequalities have to be mapped; i.e., the differences between groups have
to be identified. Once this process happens, inequities can be flagged so they can be addressed in coherent public
policies. For more on the difference between inequity and inequality, please refer to Annex 4.
The reduction of inequalities was recognized as one of the major pillars of the Sustainable Development Goals
(SDGs). Among the different targets related to this Goal, the empowerment of the most vulnerable populations; the
actions to ensure equal opportunities; the promotion of social, economic and political inclusion independently of age,
sex, disability, race, ethnicity, origin, religion and other statuses; and the elimination of discriminatory laws, policies
and practices are the ones that directly impact on the realization of the rights of the children in Guyana, and are the
ones that guide much of the debate raised by this Situation Analysis3.
Worldwide, inequalities are reflected in many different dimensions. In Guyana, the main dimensions of inequalities
used in the analysis are presented in Table 1. Whenever possible, these characteristics were used to show the
differences in the realization of rights in the child population in Guyana, and were used to frame the analysis of
the situation of children in the country. In reality, despite the fact that the dimensions are analysed separated in the
document, they usually overlap within the same social group, and that can either serve to magnify inequalities and
inequities, or concentrate privileges.
Table 1: Inequality Dimensions, Guyana
Dimension Identified Characteristics
Geographical
Three geographical subdivisions were identified as presenting the major
inequalities:
First, the difference between:
• Coastal
• Hinterland Region
Second, the difference between
• Rural
• Urban
Third, the difference among the 10 administrative regions.
Gender
Not for all indicators, but very important in some:
• Male
• Female
Household socio-
economic status
Quintiles identified in MICS, especially the comparison between the first
(representing the richest population) and the last quintile (representing the
poorest population).
3 Targets 10.1, 10.2 and 10.3 of the Sustainable Development Goals.
Guyana | Situation Analysis of Children and Women
20
Dimension Identified Characteristics
Ethnicity
The ethnicity of the household head identified in the MICS was used as a
proxy of the ethnicity of mothers and/or children. In this sense, the following
groups were used in the equity analysis:
• East Indian
• African
• Amerindian
• Mixed Race
The analysis has showed that among the four ethnic backgrounds, the
Amerindian population is the one with worst off indicators.
The SitAn document is divided into six parts. The first part has the introduction to the document and its methodology.
The second part presents the country context. It summarizes important socio-economic aspects that influence the
realization of child rights, and it describes some of the systems that are directly related to the development of policies
and provision of services for boys and girls. Part III debates Early Childhood development, including topics related
to health of the mother and child, water and sanitation, education and child protection. Part IV concentrates on the
formative years – between 6 and 11 years old. It mainly focuses on education, but also starts the debate on child
protection. Part V presents the situation of adolescents in different aspects related to health, education and child
protection. Part VI has the conclusions and recommendations.
Different boxes are presented throughout the document. Their main objective is to complement the text with
information, to flag some SDGs, to present some of the stories that were heard during the data collection process,
and to make aloud the opinions of adolescents and other stakeholders who were part of the process. The proper
Situation Analysis tries, as much as possible, to involve different stakeholders, including children and mothers. The
2016 Guyana SitAn did that, and to use their full extension of thoughts, some were transcribed in the boxes.
1.1) Methodology
The SitAn used, as its main methodological support the Guidance on Conducting a Situation Analysis of Children’s
and Women’s Rights – Taking a rights-based, equity-focused approach to Situation Analysis (UNICEF, Dec 2012),
as well as insights from the UNICEF Global Assessment on Situation Analysis of Children’s and Women’s Rights
(UNICEF, June 2012), among other key documents developed by UNICEF in the past years.
The following were the main methodological choices used during the SitAn process:
1. Desk Review of key documents from research, studies, publications, governmental plans, and other materials
that are identified as important for the work to be conducted. The objective was to first conduct a mapping of
the problems related to children and their possible causes, the assessment of availability of data, the input for
questions to be used during the interviews and focus groups, and the identification of causalities that could
explain the situation and the bottlenecks. The list of documents used in this Situation Analysis is presented
at the end of the document.
2. Quantitative Data Review of national and international surveys, demographic and health surveys, census,
and income and expenditure survey, among others, as well as administrative records from health, education
and child protection sectors. The objective was to identify trends in the indicators, and to map the disparities
presented in the country, trying to link with possible sources of inequalities.
In 2014 UNICEF Guyana in partnership with the Bureau of Statistics conducted a Multiple Indicator Cluster
Survey (MICS). The SitAn extensively used the MICS’ results as the main data source.
3. Interviews with key stakeholders, including UN Staff, governmental officials, representatives of NGOs, civil
society and adolescents, among others. The objective was to explore the problems identified in the literature
Guyana | Situation Analysis of Children and Women
21
review, to map the main problems related to children, and to determine their possible causes and bottlenecks.
Also, the interviews were used to capture different perspectives that were not found – or were not evident
enough – in the literature review.
4. Focus Groups / Group interviews with stakeholders in the country, including representatives of indigenous
populations, civil organizations, NGOs, mothers and/or adolescents groups. The objective was to go beyond
the formal interviews (described in item 3) and to capture the interaction between those that were participating
in the discussion.
5. Field Observation: Some of the interviews and focus groups happened during work visits to Region 1, 4 and
6. The visits were used to observe the environment where children lived, and also used as an opportunity to
generate human-interest stories that are presented in the boxes.
The overall process of developing the Situation Analysis followed UNICEF’s three steps in conducting a situation
analysis (Figure 1).
Figure 1: UNICEF’ suggested steps to conduct a Situation Analysis
The process of identifying the major causes of child rights shortfall (step 2) overlapped with the process of assessing
the main shortfalls and inequities (step 1). Causal analysis was the major tool used in step 2. The causal analysis
is based on three levels: (i) immediate causes, i.e., events or circumstances that can, by themselves, produce an
effect; (ii) underlying causes, which are conditions that by themselves will not produce an effect, but must be present
for the effect to occur; and (iii) the structural causes that are the factors or events that are further back in the chain
but deeply influence the effect – they are social relations, socio-economic situations and social norms that influence
all other causes4.
Once the causes are recognized, bottlenecks and barriers, i.e., specific issues and/or situations that are preventing
children to access their rights, are identified and framed within the determinant framework also adopted by UNICEF
to help in identifying bottlenecks in the realization of children’s rights (Figure 2).
4 For more on causal analysis please refer to (UNICEF Regional Office for Latin America and the Caribbean, 2006), (UNICEF, Dec 2012)
Guyana | Situation Analysis of Children and Women
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Figure 2: Key determinants for barriers and bottlenecks
Source: UNICEF Guidance on Situation Analysis (UNICEF, Dec 2012)
The text for each of the chapters is deliberately divided into two sections: (i) the description of the situation, i.e., a
narrative on how the situation of children and women is for the country and for the different inequality dimensions, and
(ii) an analysis of causes and possible bottlenecks/barriers related to the described problem.
The validation process (step 3) happened in two presentations that took place in Georgetown in April of 2016. In the
presentation were invited representatives of all the stakeholders groups that were part of the process.
Guyana | Situation Analysis of Children and Women
23
Part II:
Country’s Context
Guyana | Situation Analysis of Children and Women
24
Chapter 2. Guyana’s Socio-Economic Situation
Guyana lies in the north part of South America, and it is bordered by the Atlantic Ocean to the north, Brazil to the south
and southwest, Suriname to the east and Venezuela to the west (Figure 3). With 215,000 square kilometres (83,000
sq. mi), Guyana is the third-smallest country on mainland South America after Uruguay and Suriname. The fact that
around 80% of the territory is covered by rainforest creates a distinction that is going to be further explored in this
report: the difference between the interior area of the country (i.e. the Hinterland Region) and its Coastal area. Much
of the inequalities described in this report are based on these two regions.
Figure 3: Guyana geographical location
Source: Google maps
Due to its coastal vulnerability, Guyana is also considered a Small Island Developing State (SIDS), and it is a
member of the Alliance of Small Island States. In common with other SIDS, Guyana also faces special disadvantages
associated with small size, insularity, remoteness and susceptibility to natural disasters. These factors render the
economies of these states very vulnerable to forces outside their control – a condition that sometimes threatens their
economic viability (Smirnov, April 2014).
Out of 18 human rights treaties, Guyana has ratified 11 of them, including the Convention on the Rights of the
Child (CRC), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), and the
Convention on the Rights of Persons with Disabilities (Please refer to Annex 1 for a complete list of human rights
conventions ratified by the country).
Guyana is considered to be a medium human development country. In UNDP’s Human Development Report of 2014
(UNDP, 2014), the country’s value for HDI was 0.638, ranking Guyana in position 121 among 187 countries. Despite
the fact that the latest value shows and improvement of 0.87% when compared to the value in 2000, the country
has been stagnated in the same ranking position since 2008. In terms of Gender Inequality Index (GII), Guyana is in
position 113 (among the 187 countries), with value 0.524.
Guyana | Situation Analysis of Children and Women
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2.1) Demographics
According to the latest census (Bureau of Statistics Guyana, June 2014), the population of Guyana in 2012 was
747,884 inhabitants, slightly smaller than the 2002 population (751,223 people). The largest age group is the one
between ages of 15 and 19 (Figure 4). Children ages 0 to 195 represent around 36% of the country’s population (Table
2).
Figure 4: Population pyramid, % of the population, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Table 2: Population estimation by age groups, Guyana, 2012
Boys Boys % Total Pop Girls
Girls % Total
Pop Total
% Total
Pop
0-4 37,864 10.2% 33,910 9.0% 71,774 9.6%
5-9 38,345 10.3% 33,703 9.0% 72,048 9.6%
10-14 38,350 10.3% 36,454 9.7% 74,804 10.0%
15-19 42,796 11.5% 40,258 10.7% 83,054 11.1%
20-24 32,380 8.7% 32,539 8.7% 64,919 8.7%
Child Population 157,355 42.2% 144,325 38.5% 301,680 40.3%
Adolescent
Population (10-19)
81,146 21.8% 76,712 20.4% 157,858 21.1%
Youth Population (15-
24)
75,176 20.2% 72,797 19.4% 147,973 19.8%
Adult Population
(18+)
214,274 57.5% 229,898 61.3% 444,171 59.4%
5 According to the Convention on the Rights of the Child, a “child” is a person below the age of 18. Due to data constraints, some of the
indicators will include the population under the age of 19 as being part of the child population.
Guyana | Situation Analysis of Children and Women
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Boys Boys % Total Pop Girls
Girls % Total
Pop Total
% Total
Pop
Total Population 372,547 100.0% 375,337 100.0% 747,884 100.0%
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)6
Among the child population, 55.3% of the children live with both parents, 27.7 live with their mothers, 10% do not live
with their parents, and 4% live with their fathers only (Figure 5).
Figure 5: Children’s living arrangements, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
In terms of gender, at country level, females slightly outnumbered males (Figure 4), with some variations in terms
of regions (Table 3). According to the 2014 MICS, 66% of the household heads were male, and the remaining 34%
were female7. Women’s role in Guyana’s decision-making processes is on the rise; women represent 61% of the work
force, 31% of judges, 75% of magistrates, 31% of parliamentarians, and 29% of government ministers (PAHO, 2012).
Despite this progress, as it is going to be discussed in this Situation Analysis, women are still lagging behind men in
realizing their rights – and they are still the ones who are subject of different types of abuse, and the most vulnerable
in terms of trafficking.
6 Until December 2015 the country’s Bureau of Statistics did not release the final analysis of the 2012 Census. Some numbers for the situation
analysis are calculated based on percentages presented in diverse surveys (including the 2014 MICS and 2009 DHS).
7 This number does not account for the number of single households headed by women and by men.
Guyana | Situation Analysis of Children and Women
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Table 3: Male/Female percept distribution at country and region levels, Guyana, 2012
Region Name Male Female
Region 1 Barima-Waini 52.5 47.5
Region 2 Pomeroon-Supenaam 50.4 49.6
Region 3 Essequibo Islands-West Demerara 49.9 50.1
Region 4 Demerara-Mahaica 48.9 51.1
Region 5 Mahaica-Berbice 49.8 50.2
Region 6 East Berbice-Corentyne 50.2 49.8
Region 7 Cuyuni-Mazaruni 52.8 47.2
Region 8 Potaro-Siparuni 54.1 45.9
Region 9 Upper Takutu-Upper Essequibo 51.3 48.7
Region 10 Upper Demerara-Berbice 49.6 50.4
Coastal 49.5 50.5
Hinterland 52.4 47.6
Guyana 49.8 50.2
Source: 2012 Census (Bureau of Statistics Guyana, June 2014)
There are 10 administrative regions (Table 3) in the country that are located in two meso regions: Coastland and
Hinterland regions. The Coastal plain, which include the capital city, represents the smallest physical geographic area
of Guyana, but at the same time comprise the higher percentage of the population (89.1%). The heavy concentration
of population is due to the fact that the majority of the commercial activities in the country are carried out in the
Coastland regions.
The Hinterland region comprises more than two-thirds of the land area. Despite the fact that its population continues
to grow, it only represents 10.9% of the total population (Figure 6). The region is characterized by dense forestlands
and mountain ranges and marked also by series of hills and rivers, contributing to the region’s low-density population.
Figure 6: Characteristics of Coastland and Hinterland Regions, Guyana
Source: (Bureau of Statistics Guyana, June 2014)
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Table 4: Summary of Guyana’s Administrative Regions, Area, Population and Region, 2012
# Administrative Region Area km2 Population Population per km2 Region
Urban /
Rural
1 Barima-Waini 20,339 26,941 1.32 Hinterland Rural
2 Pomeroon-Supenaam 6,195 46,810 7.56 Coastland Urban
3
Essequibo Islands-West
Demerara
3,755 107,416 28.61 Coastland Rural
4 Demerara-Mahaica 2,232 313,429 140.43 Coastland Urban
5 Mahaica-Berbice 4,190 49,723 11.87 Coastland Rural
6 East Berbice-Corentyne 36,234 109,431 3.02 Coastland Urban
7 Cuyuni-Mazaruni 47,213 20,280 0.43 Hinterland Rural
8 Potaro-Siparuni 20,051 10,190 0.51 Hinterland Rural
9
Upper Takutu-Upper
Essequibo
57,750 24,212 0.42 Hinterland Rural
10
Upper Demerara-
Berbice
17,040 39,452 2.32 Coastland Urban
Guyana 214,999 747,884 3.48
Source: 2012 Census (Bureau of Statistics Guyana, June 2014)
Guyana is essentially a rural country. 73.6% of the population lived in rural areas in 2012, an increase when compared
to 2002 (Figure 7). At the same time, according to the 2014 MICS, almost three-quarters of households (72%) were
found in rural areas and just over a quarter are found in the urban areas. Four out of ten administrative regions are
considered to have urban townships and cities (Table 4). There are more women living in the cities than men (around
100 thousand women in comparison to 92 thousand men). About two-thirds (61.7%) of the urban population is
clustered in Georgetown, the capital city of Guyana and its suburbs. As a matter of fact, Region 4, where the capital
city Georgetown is located, is the most densely populated, with 42% of the population.
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Figure 7: Urban and Rural Population, Guyana, 2012
Source: 2012 Census (Bureau of Statistics Guyana, June 2014)
The present population of Guyana is racially and ethnically heterogeneous, with ethnic groups originating from India,
Africa, Europe, and China, as well as indigenous or aboriginal peoples. Despite their diverse ethnic backgrounds,
these groups share two common languages: English and Creole.
There are nine indigenous tribes residing in Guyana: the Wai, Machushi, Patamona, Arawak, Carib, Wapishana,
Arecuna, Akawaio, and Warrau. The 2006 Amerindian Act (Government of Guyana, March 2006) protects indigenous
peoples’ rights and sets forth benefits, including land titling, intellectual property rights, environmental protection and
mining and forestry. The act also empowers the village councils to establish rules for their communities and set fines
within the legal confines of the law.
Despite being a multicultural country, evidence points to discrimination against some groups. The UN Committee on
the Rights of the Child expressed concerned at the prevalence of discrimination against Amerindian children, and
children with disabilities. Furthermore, the Committee was showed concerned about discrimination against children
on the basis of sexual orientation and/or gender identity (UN Committee on the Rights of the Child, 2013).
In terms of religion, data from a 2002 census on religious affiliation indicates that approximately 57% of the population
is Christian, 28% are Hindu and 7% are Muslims. An estimated 4% of the population does not profess any religion.
2.2) Migration
According to the United Nations, the country had a little bit more than 11 thousand legal migrants in 2013 (United
Nations, DESA-Population Division and UNICEF, 2014), mainly from Suriname, Brazil and Venezuela (Table 5).
This number might hinder a significant population that moves to and around the country attracted by the mining and
logging operations, especially near the borders of Venezuela and Brazil. Qualitative data shows that the number of
citizens from these two countries is seen as elevated by many Guyanese.
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Table 5: Stock of legal migrants by top five countries, Guyana, 2013
Country of origin Total
Suriname 4,662
Brazil 2,166
Venezuela (Bolivarian Republic of) 2,132
United States of America 1,273
China 1,166
Total 11,399
Source: United Nations Population Division (United Nations, DESA-Population Division and UNICEF, 2014)
A significant number of Guyanese professionals and skilled personnel migrate to Europe, North America, and other
Caribbean countries (PAHO, 2012). Data from the United Nations Population Division shows that in 2013 (United
Nations, DESA-Population Division and UNICEF, 2014), more than 422 thousand Guyanese lived abroad, most of
them in the United States and Canada (Table 6). The high levels of emigration in Guyana are related to difficulties in
finding employment, and the inability of local economies to absorb young graduates. One clear consequence of the
elevated number of people living abroad is the brain drain that happens in the country. Those who are qualified by
the educational system in Guyana do not see immediate opportunities in the country and are forced to move abroad
to continue their education, and/or to use the skills that they learned.
Table 6: Total number of Guyanese living abroad, top 5 countries, Guyana, 2013
Country of destination Total
United States of America 281,371
Canada 101,004
United Kingdom of Great Britain and Northern Ireland 21,073
Suriname 11,530
Venezuela (Bolivarian Republic of) 7,401
Total 422,379
Source: United Nations Population Division (United Nations, DESA-Population Division and UNICEF, 2014)
Around 6% of the children 0 to 17 have at least one parent living abroad. Fathers being abroad are more common
than mothers. The highest percentages of children with at least one parent living abroad are in Region 10 (13%),
in urban areas (9%), among children in the richest households (10%), and among those living in households with
an African (9%) or mixed race (8%) household head (Bureau of Statistics, Ministry of Public Health and UNICEF
Guyana, April 2015).
Apart from the social loss that the country has – children living far from their parents – from an economic perspective,
this brain drain produces gaps in knowledge and skill that are not easily replaced. The Caribbean Development Bank
reports that Guyana’s emigration has produced a loss of 7.8% of the country’s GDP (Caribbean Development Bank,
2015). Estimates from the World Bank show that around 80% of those who were born in Guyana and had graduated
at university level live abroad, mostly in the United States (The World Bank, 2008).
2.3) Economy
Guyana is considered an upper middle-income country. Guyana’s GDP has been stabilized after the fall in 2006, with
a performance better than the average for the region (Figure 8). Real GDP growth slowed in 2014 (3.8%) reflecting
the softening in global commodity prices including gold and bauxite.
Guyana | Situation Analysis of Children and Women
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Figure 8: GDP Growth, Guyana and Latin America & Caribbean, 2000-2014
Source: (The World Bank, 2015)
Despite its good GDP performance, in taking into consideration the GDP per capita, Guyana is the third poorest
country in the Western Hemisphere, after Haiti and Nicaragua. The country’s GDP per capita reached around US$
4,000 in 2014, a number that is one and a half times smaller than the average for the Latin America and Caribbean
region in 2014 (Figure 9). According to the World Bank8, real GDP growth is projected to fluctuate within the range
of 3% to 5% during 2015-2018. Economic activities will be driven by continued investments in primary industries.
Potential offshore and hydro-energy projects may also attract foreign investment and further boost growth. Inflation is
expected to remain relatively subdued. Nonetheless, volatile commodity prices represent a significant risk.
Figure 9: GDP Per capita, comparison Guyana and Latin America & Caribbean, 2000-2014
Source: (The World Bank, 2015)
8 http://www.worldbank.org/en/country/guyana/overview Accessed on December 11, 2015.
Guyana | Situation Analysis of Children and Women
32
The service sector, including banking and construction, is responsible for about 59% of the GDP in 2014. Other main
economic activities in Guyana are agriculture (production of rice and Demerara sugar), bauxite mining, gold mining,
timber, shrimp fishing and other minerals (Figure 10). In May 2015 Exxon Mobil announced Guyana’s first significant
oil find9, creating a possible new source of resources for the country.
There is a concern by the UN Committee on the Rights of the Child that the fact that the economy is heavily dependent
on extractive and timber industries might generate violations of children’s rights (UN Committee on the Rights of the
Child, 2013). The Committee is especially concerned at the impact of these businesses on the living conditions of
children and their families in the regions directly affected, on the health hazards and environmental degradation
arising therefrom as well as on issues related to child protection such as child abuse, child labour, and child trafficking,
among others.
Figure 10: GDP Composition, Guyana, 2014
Source: (Bureau of Statistics, 2014)
Unemployment has remained high. With youth making up more than 60% of Guyana’s population, the youth
unemployment issue is of particular importance. Since 2002, youth unemployment has been consistently higher than
30% and is currently estimated to be about 40% (Caribbean Development Bank, 2015). As mentioned, unemployment
is one of the causes for high levels of emigration to other countries. Chronic problems related to the labour market
include a shortage of skilled labour – as mentioned before the country has a process of brain drain due to the
migration of qualified labour to other countries – and a deficient infrastructure.
Remittances are a very important component of the country’s economy, making it comparable to direct foreign
investments in the country. In 2005, remittances represented about 25% of the country’s GDP (The World Bank,
2008). Around US$ 438 million in remittances entered the country in 2014, representing 16% of the country’s GDP
(Maldonado, R., Hayem, M., 2015). In 2013, direct foreign investment represented less than 7% of the GDP.
On a positive side, remittances are used by many families as a constant source of income, and are considered by
many as a safety net for many families; consequently, it is an important factor to reduce poverty and inequalities.
Remittances allow poor recipient households to increase their savings, spend more on consumer durables and
human capital, and improve children’s health and educational outcomes (The World Bank, 2008).
On a negative side, as evaluated by the World Bank (The World Bank, 2008), remittances not always reach the
poorest segments of the country; instead, they reach the better-off households. In this line, government cannot see
the inflow of remittances as a substitution to programmes to alleviate and fight poverty among the most vulnerable
populations. On the contrary, the large inflow of remittances indicates that (i) wages in the country are not enough to
provide for the wellbeing of families; and (ii) poverty is considerable in the country and policies to reduce it are not
9 http://news.exxonmobil.com/press-release/exxonmobil-announces-significant-oil-discovery-offshore-guyana Accessed on October 14, 2015.
Guyana | Situation Analysis of Children and Women
33
being efficient. In both cases, families have to depend on external money to improve their situation.
2.4) Poverty
Guyana’s latest official poverty measurement was done in 2006, prior to the economic crisis that hit the world in 2008.
According to that measure, 36.1% of the population in the country was living in poverty, including 18.6% that
were living in extreme poverty (see definitions in the box below). Poverty rates in 2006 were almost the same as
the ones calculated in 1999 (Figure 11).
Box: Measuring Poverty in Guyana
The poverty line is obtained by specifying a consumption bundle considered adequate for basic
consumption needs and then by estimating the costs of these basic needs. In other words, the poverty
line defines the level of consumption (on income) needed for a household to escape poverty. Absolute
poverty lines were defined from the consumption data in order to be able to distinguish the poor from the
non-poor and to quantify the level of poverty.
For those who are considered poor, two poverty lines were used to measure the extent of their poverty
as extreme or moderate poverty. The extreme poverty line is based on the normative food basket (2400
calories per male adult) provided by the Caribbean Food and Nutrition Institute. Total calorie intake is
identical to the food basket used in 1992 and 1999, allowing for the comparability of the poverty rates
derived. The average cost of the food basket across the ten regions for 2006 was G$7,550 per month
per male adult (approximately US$1.25 per day).
Moderate poverty lines were constructed to include an allowance for non-food items. This allowance
was estimated by observing the share of total consumption devoted to food and non-food items of the
40% poorest households. The average moderate poverty line across regions for 2006 was G$10,494
per month per male (or US$1.75 per day).
Source: (Government of Guyana, July 2011)
Figure 11: Poverty Rates, Guyana, 1992-2006
Source: 2011-2015 Poverty Reduction Strategy Paper - PRSP (Government of Guyana, July 2011)
Guyana | Situation Analysis of Children and Women
34
The 2006 measurements confirmed that poverty and extreme poverty were stronger in the interior areas of the
country (Table 7), and were uneven if regions were taken into consideration (Table 8).
Table 7: Poverty rates for different areas, Guyana, 2006
Moderate Poverty Extreme Poverty
National 36.1 18.6
Urban Coastal 18.7 7.3
Rural Coastal 37 17.1
Rural Interior 73.5 54
Source: 2011-2015 Poverty Reduction Strategy Paper (Government of Guyana, July 2011)
Out of all poor people in the country, most of them were living in areas categorized as rural coastal, followed by urban
areas and rural interior (Figure 12). Due to the population distribution in the country, most of the poor people would
be living in Region 4, nonetheless, in percentage terms; poverty is massive in Regions 8, 1 and 9, where more than
70% of the population living in those areas were considered poor (Table 8).
Figure 12: Distribution of poor population by areas, Guyana, 2006
Source: 2011-2015 Poverty Reduction Strategy Paper - PRSP (Government of Guyana, July 2011)
Guyana | Situation Analysis of Children and Women
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Table 8: Poverty distribution by Regions, Guyana, 2006
Regions
% of population
living in poverty
National share of
the poor population
(%)
Barima-Waini 80.06 3.18
Pomeroon- Supenaam 51.94 6.25
Essequibo Island West
Demerara
40.09 14.08
Demerara- Mahaica 24.56 42.43
Mahaica- Berbice 42.58 6.11
East Berbice Corentyne 28.45 15.76
Cuyuni Mazaruni 61.42 2.48
Potaro- Siparuni 94.28 1.48
Upper Takatu Upper Essequibo 74.38 2.96
Upper Demerara Berbice 39.36 5.26
National 36.1 100
Source: 2011-2015 Poverty Reduction Strategy Paper - PRSP (Government of Guyana, July 2011)
One challenge in calculating poverty in Guyana is to find a measurement
that can encompass different cultures and lifestyles that are present in the
country. As emphasized in the 2011-2015 Poverty Reduction Strategy Paper
(PRSP) (Government of Guyana, July 2011), due to the Amerindians’ lifestyle
characteristics, this group is particularly prone to measurement error when
using the same consumption basket to calculate poverty lines, and that
expenditure patterns for this group may be quite different from those of other
ethnicities.
As mentioned in the 2015 World Development Report (The World Bank,
2015), children living in poverty experience greater levels of environmental
and psychosocial stressors than their higher-income counterparts and
that stress and adversity in the first years of life can permanently constrict
the development of physical and mental capacities throughout adulthood.
Furthermore, children from disadvantaged families are less likely to receive
consistent support and guidance
from responsive caregivers. They are also likely to have had less opportunity
to develop the critical skills—including skills in controlling their impulses,
understanding the perspectives of other people, and focusing attention—that
are important for engaging effectively with teachers and other children, paying
attention in class, completing assignments, and behaving appropriately.
The Sustainable Development Goals (SDGs) advance on the Millennium
Development Goals call to end poverty. This time the SDGs on its Target 1.2
openly indicates that poverty must be reduced among women and children.
Poverty in Guyana has a child’s face. Similar to previous measurements, the
poverty number from 2006 shows that younger age cohorts have a significantly
higher poverty headcount than older ones. 33.7% of young people aged 16-
25 lived in poverty in 2006. Almost half of all children aged 16 and below
were poor (47.5%) in 2006. Data on child poverty was not disaggregated for
different ethnicities, regions and/or areas of the country.
The 2014 Multiple Indicator Cluster Survey (MICS) did not calculate poverty rates for the country, but used a quintile
wealth index to differentiate wealth across households, from poorest to richest10. Data from MICS 2014 has confirmed
10 The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using
The Voice of Adolescents:
Who are the poor people in
Guyana? Are there many poor
people in the Guyana?
“The people living in poverty - no
homes, can’t afford to take care
of their children; children being
forced to drop out of school and
being required to work in the
mining industry to help make
ends meet.”
“ Poverty exists all over Guyana”
Guyana | Situation Analysis of Children and Women
36
two main disparities in Guyana: the difference between rural and urban, and the difference between coastal and
interior regions. While 13% of the population living in the urban areas could be considered poor, the number is raised
to 22.5% in the rural areas. As a matter of fact, almost 44% of the population in rural areas would be living in the two
smaller wealth quintiles, in comparison to 30% in the urban areas (Figure 13). That difference is higher when coastal
and interior regions are compared: 62% of the population in the interior areas of Guyana were considered to be living
in poverty in 2014, in comparison to 12.8% in the coastal areas (Figure 14).
Figure 13: Percentage distribution of the household population by wealth index quintiles, according to area
of residence (Rural and Urban), Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 14: Percentage distribution of the household population by wealth index quintiles, according to area
of residence (Interior and Coastal Areas), Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the
household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample.
Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on
the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth
index values.
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37
2.5) Disaster Risk Management
According to the Emergency Response Preparedness Plan (Ministry of Social Protection and UNICEF in Guyana,
Oct 2015), Guyana is susceptible to a variety of hazards including flooding, landslides, drought, fires, and severe
weather systems, among others. Between 1990 and 2014, floods were the main natural disaster that happened in the
country (Figure 15) and the main responsible for deaths (Figure 16).
Guyana is abundant in water, but, at the same time, drainage throughout most of the country is poor and river flow
sluggish. Swamps and areas of periodic flooding are found in all but the mountainous regions, and all new land
projects require extensive drainage networks before they are suitable for housing and agricultural use (Ministry of
Social Protection and UNICEF in Guyana, Oct 2015). Flooding is common in the coastal areas and in the interior
of the country. In the coastal area, an extensive sea defense system of sea walls and dams is the main defense
against inundation of the coastal plain due to heavy rainfall, overtopping of the river networks, and breaches in the
conservancies or seawall. In the interior, heavy rains and the abundance of rivers create the conditions to constant
increases in the water levels.
Figure 15: Frequency of reported natural disasters, 1990-2014, Guyana
Source: Prevention Web (Prevention Web, 2015)
Figure 16: % of total deaths related to natural disasters by type of disaster, 1990-2014, Guyana
Source: Prevention Web (Prevention Web, 2015)
Natural disasters create and extra stress to public finances and significant impact on homes, businesses and human
life. In this sense, almost 94% of the negative impact in the country’s economy was resulted from past floods (Figure
17). For example, in 2005, severe floods resulted in the loss of economic activity and damage to buildings, crops and
other national assets totaling approximately 59.49% of 2004 GDP. This economic impact put considerable pressure
Guyana | Situation Analysis of Children and Women
38
on government expenditure, necessitating the redistribution of resources away from development endeavors to
meet emergency response and recovery needs. Additionally, approximately 34 persons died, essential services
(schooling, transportation and safe water distribution) and basic economic activity (primarily agricultural production)
were disrupted, and thousands were displaced from their homes for months.
Figure 17: % of total natural disaster economic impact, 1990-2014
Source: Prevention Web (Prevention Web, 2015)
Apart from regular localized cases of flooding, Guyana’s other main disaster threats are droughts and fires. Homes
in Guyana have traditionally been constructed with wood and situated closely together, providing the conditions for
large urban fires. The country is also prone to severe forest fires, especially in the dry seasons and during El Nino
conditions.
The extent of the vulnerability of communities to Guyana’s disaster risks is determined by a number of social,
economic, cultural, political, and environmental factors. Groups particularly vulnerable to disasters include children,
pregnant women, the elderly, the differently-abled, single parents (especially mothers), farmers (crops and livestock),
the homeless, and the poor (Ministry of Social Protection and UNICEF in Guyana, Oct 2015).
After the floods in 2005 Guyana has intensified its institutional response to disasters. The country has solidified its
commitment to addressing its vulnerabilities and decreasing its disaster risk. This was first officially highlighted in
the 2007 Declaration of Turkeyen, which recognized the need to strengthen the capacity of signing members to
prevent and respond to disasters through international cooperation and policy development and implementation.
This commitment also resulted in the consideration of disaster risk in development strategies, including the National
Competitiveness and Low Carbon Development Strategies, and sector plans and programmes including the draft
National Health Sector Plan, the Hinterland Water Strategy, and the joint International Development Bank (IDB)/
Government of Guyana (GoG) Water and Sanitation Initiative. The country is also a member of the Caribbean Disaster
Emergency Management Agency, the apex disaster risk management body in the Caribbean, and it works to ensure
its disaster management policies and strategies align with those adopted at a regional level.
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39
Chapter 3: Systems for Children
3.1) Educational System
Guyana’s education system through its school curricula, funding, standards and other policies are set by the central
government and implemented through the Ministry of Education and eleven education departments. Ten of these
education departments correspond with the administrative and geographical regions of the country, while the capital,
Georgetown, is treated as a separate education department. The Principal Education Officer (Georgetown) and
Regional Education Officers are responsible for monitoring and supervising all educational activities within their
respective regional education departments (Ministry of Education, 2015c).
The educational system is composed of Nursery, Primary Education and Secondary Education. Despite the fact that
the government of Guyana considers children between the ages of 0 and 8 to be in Early Childhood Education (ECE),
for the purposes of this Situation Analysis, ECE is going to encompass those children who did not start Primary
Education. Day Care Centres and Play Groups are not considered to be part of the formal educational system (the
MoE is not responsible for it), but they contribute to the cognitive and physical development of the child (Figure 18).
Children enter primary school at age six and should start secondary from the age of 12. At the end of the primary
education cycle, students are requested to do a placement exam. Those who perform well are placed in the school
of their choice, which general speaking is a Senior Secondary school. Secondary schools are further subdivided
depending on the grades achieved namely list A, B, C and D schools. The children with the lowest grades are placed
in the secondary departments of the primary schools referred to as Primary Tops (Figure 19).
Figure 18: Summary of Educational System in Guyana
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Figure 19: Detailed Educational System in Guyana
School is mandatory for children between the ages of 6 and 16 years of age (covering primary and secondary
educations). Private and public schools are available in the country. There are no tuition fees for public Nursery,
Primary and Secondary schools; nonetheless, as it is going to be discussed later, families still have to afford for some
indirect costs such as transportation, specialized books and food.
National budgetary allocations determine the level of expenditure in each education district. The amount is disbursed
to the ten Regional Democratic Councils, which run the affairs at regional level and which in turn disburses funds to
the regional education departments. The funds for the Georgetown Education Department are disbursed through the
Central Ministry of Education (Ministry of Education, 2015c).
The 2014-2018 Education Sector Plan frames the educational sector in Guyana (Ministry of Education, 2014).
According to the plan, the priority for the 5 years is to increase the learning achievements at all levels of education
and for all sub-groups, and to decrease the differences in learning outcomes between sub-groups, especially between
students in coastal and hinterland schools.
For Early Childhood Education (still under the supervision of the Ministry of Education), the country has developed an
action plan that sets the targets between 2014 and 2018 (Ministry of Education, 2014b). The targets cover important
areas in terms of guaranteeing access, improve monitoring and evaluation processes, increase the participation of
parents, and improve quality of teaching.
3.2) Health System
In Guyana, the Ministry of Public Health (MoPH) is responsible for setting national policy, regulation, and standards;
for building and initial furbishing of facilities; and for initial financing of 100% of the employment of doctors, nurses, and
Medex’s11 (Government of Guyana, 2014). At regional level, the Regional Health Authority (RHA) has the autonomy to
assess, plan and implement health services and manage the facilities for a defined population in a defined geographic
area, including day-to-day management of the facilities and employment of all other staff working in the health sector
(ISAGS and UNASUR, June 2014). The country’s main framework for health is the Health Vision 2020 (Ministry of
Public Health, Dec 2013) that sets the strategy and overall planning for the health sector. The document has as one
of its priority areas to focus on the reduction of maternal and child mortalities, and the improvement of health for
adolescents.
11 A Medex is a medical extension worker with prescription and diagnostic rights.
Guyana | Situation Analysis of Children and Women
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There are five levels of health care in Guyana as depicted in Figure 20. Each provides a specific spectrum of services
to patients. The system prescribes that referrals should go from one level to the next level and that counter referral
should take place accompanied by the necessary information on diagnosis and treatment.
Figure 20: Guyana Health Structure and number of facilities
Source: (ISAGS and UNASUR, June 2014)
Although the Hinterland population has numerous facilities compared to the small proportion of the total population,
these guarantee only local access to limited health services. For access to a broader range of diagnostic and treatment
services individuals of the Hinterland will need to overcome large distances and travel frequently over rivers, by road
and sometimes by air (ISAGS and UNASUR, June 2014).
Budgetary flows and lines of responsibility have been agreed on between the Ministry of Finance, the Ministry of
Local Government and Regional Development, the Ministry of Public Health, and the Regional Democratic Councils
(PAHO, 2012). The right to healthcare free of charge is guaranteed in the country’s constitution.
Maternal health care services – as well as other primary health consultations – are provided free of cost in public
facilities. Overall, in 2014 there were 364 antenatal care sites, along with 43 regular delivery sites in the 10 regions
of Guyana. Occasionally, deliveries also occur at home or in the community. The only referral institution for high-
risk pregnancy and emergency cases is Georgetown Public Hospital Corporation (GPHC) (Government of Guyana,
2014).
Maternal and Child Health services are provided by a multi-disciplinary team as part of the Ministry of Public Health’s
Family Health Programme, in hospitals, health departments and health posts and in homes through the introduction
of Integrated Management of Childhood Illnesses (IMCI) and Community-Integrated Management of Childhood
Illnesses and Community Health Workers (CHWs). The CHWs are front-line workers, mainly situated in the hinterland
regions where the indigenous population live.
According to analysis from the Pan American Health Organization (PAHO), the country’s health system performance
and health outcomes have improved over the years, but challenges remain, especially related to data management
and quality of care. Formal data needed for monitoring and evaluating health system performance at the regional
level are limited, and information flows among central, regional, and facility levels are fragmented and not fully
integrated. In addition, data from the private sector are not systematically collected, analysed, and integrated. With
respect to quality of care, while protocols and guidelines exist, and training is conducted, inadequate monitoring and
enforcement of standards and loss of trained health human resources present barriers to sustained improvement
(PAHO, 2012).
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3.3) Child Protection System
Different actors contribute the the child protection system in Guyana12. The Ministry of Social Protection (MoSP) –
through the Childcare and Protection Agency (CPA) (agency created by law and linked to the Ministry) – has central
role in terms of child protection. The CPA functions as the oversight and management body for the protection of
children in Guyana and has the power to implement policies and decisions in relation to the laws governing children,
monitoring of child care facilities, intervene in cases where a child is abused or neglected and to protect vulnerable
children (Ministry of Social Protection and UNICEF Guyana, June 2014). Another important stakeholders is the
Probation and Family Welfare Department (under the Ministry of Social Protection), which is largely responsible for
prevention services through access to social protection mechanisms, and reintegration and rehabilitation of children
in contact with the law. Further, the Labour Department also in the MoSP is responsible for issues on child labour.
Note that the MoSP is also responsible for some amount of social protection programmes and as such, play as critical
role in the other sectors. Therefore, in order to fulfil its mandate the CPA must work with other government and non-
government institutions such as the Ministry of Education and Ministry of Public Health – a discussion on the agency
capacity is done in Chapter 13.
The Ministries of Education and Public Health are two other key ministries with significant child protection
responsibilities. Besides being responsible for the New Opportunity Corps – next subsection – the Ministry of
Education has Welfare Officers placed regionally to provide support to the students and parents. Further the Ministry
of Education has responsibility for the provision of prevention and response services to all children, in cooperation
with other agencies such as the Guyana Police Force and the Ministry of Public Health. The Ministry of Public
Health plays a critical role in services such as those related to school health (e.g. school screening for visual and
hearing impairments, personal hygiene and enviornmental health care and drug education), nutrition and HIV/AIDS
preventions; and in monitoring of health standards of facilities – including treatment services for survivors of abuse.
The Ministry of Public Health also interacts with the Department of Citizenship to guarantee birth registration to the
children born in the country.
The current staff, financial capacity and management of the system are seen as insufficient to guarantee the rights
of the children in terms of protection against abuse and violence. For instance, the country has less than 100 social
workers – some of them working at schools as welfare officers –, and, based on the review of the national budget
(section 3.4), the allocations for the sector are not as significant as health and education. Moreover, unlikely to those
two sectors, the child protection system is still highly centralised.
Outside the government, the Rights of the Child Commission (RCC) is a non-governmental and non-partisan
organization that is the primary agent for holding the government and people of Guyana accountable to child rights.
Besides, different NGOs and international organizations such as UNICEF are present in the country to support
national capacity to achieve results for children and realize their rights.
The Juvenile Branch is the unit within the Guyana’s Police to deal with all matters that concern juveniles – where they
are the perpetrators as well as victims. They handle cases involving different types of abuse such as rape, neglect
and abuse. The Juvenile Branch is response for the investigation and police part of the case. The support to victims,
including counselling, is done by the Childcare and Protection Agency.
The country has about 100 Social workers - minus school welfare officers, a number that is considered by many
stakeholders as insufficient to cover the whole territory. Also, based on the review of the national budget (next
subsection) the allocations for the sector are not as significant as those for health and education. Moreover, unlike
those sectors, the system is still highly centralised.
Child/Juvenile Justice
Child/juvenile justice in Guyana includes different Ministries and branches of government: the CPA, the Ministry of
Public Health, the Ministry Public Security (MOPS), the representative for the police, the judiciary, the Ministry of
12 A child protection system may be described as a set of laws, policies, regulations and services, capacities, monitoring, and oversight needed
across all social sectors – especially social welfare, education, health, security, and justice – to prevent and respond to protection related risks
(UNICEF, 2010).
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43
Social Protection (MoSP) and the Department of Culture, Youth and Sports, among others.
According to the country’s legislation, the age of criminal responsibility is 10 and at age 17 a child can be tried as an
adult. The national juvenile justice system provides for both custodial and protective forms of guardianship or custody
for children in contact with the law. A juvenile who has been apprehended by the Police is kept in the police precinct
separate from the adults prior to being taken before a Magistrate – where available, such as in Georgetown, the child
is kept in a separated facility; when that is not possible youth are reportedly kept in a separate room in the police
facility. It is the policy that juveniles who are arrested are brought before the courts at the earliest date or released
into the custody of their parents or guardian, who enter into a recognizance until the hearing of the case. The Court
would determine sentencing of the child following a probation report. The Court system allows for child matters to be
separately addressed and/or in camera hearings to be conducted (Ministry of Social Protection and UNICEF Guyana,
June 2014).
Pre-sentence procedures are conducted when the child first comes into contact with the law and is held at the
holding facility or at a police station as the matter is investigated. Based on the outcome of the investigation an officer
of the Probation and Social Services Department (PSSD)/Ministry of Labour, Human Services & Social Security
(MLHSSS) is requested to prepare a probation report. Two options may be determined by the court, that the child be
placed on probation or be put in detention. Should the child be placed on Probation, s/he falls under the supervision
of a Probation and Social Services Officer (PSSO) whereas, if the child is placed in detention, the child is sent to
New Opportunity Corps (NOC) and falls under the guardianship of the Ministry of Culture, Youth and Sport (MCYS)
(Ministry of Social Protection and UNICEF Guyana, June 2014). Hence, there are two major institutions that host
children in contact with the law: the Juvenile Holding Centre and the New Opportunity Corps (NOC) (Figure 21)13.
Figure 21: Institutions related to children in contact with the law, Guyana
The Juvenile Holding Centre should be used for the reception, care and custody of Juveniles awaiting their court
appearance; Juveniles who have been committed by the courts but not escorted to the New Opportunity Corps;
and Juveniles who have completed the period of their sentence and awaiting rehabilitation to their families or to the
community. Meanwhile, the New Opportunity Corps (NOC) is the only juvenile correctional facility in the country. It
serves to provide social rehabilitation of juveniles (males and females) between the ages 10 and 17.
3.4) Budget Allocation
The total national budget estimated for 2015 was G$163.7 billion, around US$810 million, an increase of 12% when
compared to the revised 2014 budget (Government of Guyana, 2015). The expenses in the country’s national budget
are divided into two categories: those conducted by the central government, and those expenses carried by the
regional governments. Figure 22 depicts the monetary allocation for 2015 for those Ministries more related to children.
13 The number of children in contact with the law and the discussion on the topic is presented in chapter 13.
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Figure 22: Government Expenses divided by selected Ministries, Guyana, 2015
Source: (Government of Guyana, 2015)
Despite the fact that Guyana does not have a budgetary system that allows for monitoring social services to children,
nor to monitor how services targeting boys and girls are being delivered at subnational levels (UN Committee on the
Rights of the Child, 2013), using the 2015 Budget estimations it is possible to make a rough calculation that around
35% of the 2015 budget is related to expenses that could influence the situation of children14. Among those
expenses, 46% of them were allocated for projects related to education (Figure 23), which are implemented by
national and regional governments.
Figure 23: Categorization of expenses directly related to children, Guyana, 2015
Source: (Government of Guyana, 2015)
Considering all the values allocated for the educational sector in Guyana, around 36% is destined to “education
delivery”, followed by expenses in “post-secondary education” and “secondary education” (Figure 24). Allocations
for secondary, primary and nursery schools correspond to 14%, 11% and 7% of the national budget for education,
respectively.
Figure 24: National Budgetary Allocation for Education, Guyana, 2015
14 The methodology identifies those areas related to children and adds their budgetary allocation. Please refer to Annex 2 for a more detailed
description of the methodology used to calculate this number, the sub-projects that were used to estimate this number, and the limitations of the
estimation.
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Source: (Government of Guyana, 2015)
OBS: Data includes all the expenses for the Ministry of Education (budget lines 40 and 41). Data does not include
the values to be implemented by regional governments.
The second highest allocation for children is health. The biggest allocation happens in regional and clinical services
managed by the national government (48% of the national budget) – this value does not consider those funds
allocated directly to the regions for their own expense with health. The second highest expense is Georgetown Public
Hospital, which consumes 24% of the national budget. It is important to mention that only 2% of the national budget is
allocated for disability and rehabilitation projects, and around 1% to family healthcare. As it is going to be discussed
through this report, both areas were considered to be vulnerable in terms of policies for children and women.
Figure 25: National Budgetary Allocation for Health, Guyana, 2015
Source: (Government of Guyana, 2015)
OBS: Data includes all the expenses for the Georgetown Public Hospital Corporation, Ministry of Health and
Ministry of Public Health (budget lines 46, 47 and 43). Data does not include the values to be implemented by
regional governments.
Around 16% of the budget dedicated to children is allocated to child protection services, a value that does not
correspond to the importance of this topic to the stakeholders in the country. As it is going to be discussed later in this
document, child protection – involving child abuse, domestic violence, corporal punishment, child trafficking and child
labour, among other topics – is considered to be one of the child related areas in Guyana where many child rights are
being violated, and where massive investments in capacity building for prevention and support must be done.
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Almost 89% of the budget related to child protection goes to “Social Services” (Figure 26), which is defined in
the 2015 budget as follows: to work in partnership with all Guyanese toward the empowerment of individuals and
families through the elimination of poverty and inter-personal violence.” Less than 5% of the budget allocated for child
protection goes to “child care and protection”15.
Figure 26: National Budgetary Allocation for Child Protection, Guyana, 2015
Source: (Government of Guyana, 2015)
OBS: Data includes all the expenses for the Ministry of Labour, Human Services and Social Sec.; and Ministry
of Social Protection (budget lines 48, and 49). Data does not include the values to be implemented by regional
governments.
3.5) General Legislation for Children
Despite the fact that the provisions for child rights are guaranteed in different articles of the Country’s constitution,
assessment from the Ministry of Social Protection (Ministry of Social Protection and UNICEF Guyana, June 2014)
reports that the country has no consolidated law that embraces all topics related to children, rather legislation of
relevance to children can be found in a number of Acts such as:
• The Status of Children Act No. 19 of 2009
• The Childcare and Protection Agency Act No. 2 of 2009
• The Protection of Children Act No. 17 of 2009
• The Criminal Law Offences Act No. 16 of 2005
• The Adoption of Children Act No. 18 of 2009
• The Prevention of Crimes (Amendment) Act No. 11 of 2008
• The Occupational Safety and Health Act No. 32 of 1997
• The Sexual Offence Act No. 7 of 2010
• The Marriage Act 2005
• The Amerindian Act 2006
• The Persons with Disabilities Act 2010
• Childcare & Development Services Act 2011
• Custody, Contact, Guardianship & Maintenance Act 2011
• Training Schools Act
15 Childcare and protection is defined in the budget document as: To prevent, reduce and alleviate abuse and neglect of children by effective
interventions, procedures and programmes.
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• Juvenile Offenders Act
• Employment of Young Persons Act
• Probation of Offenders Act
• Education Act
• Registration of Births and Deaths Act, 1973
Similar situation happens in terms of public policies. Public policies exist for health, education and social welfare, but
the country lacks a coordination policy that is able to connect all the policies under the umbrella of child rights. The
lack of one public policy translates into lack of coordination in the system. The CPA does not have the autonomy,
the capacity and the means to coordinate all the actions related to children. Similar situation faces the Rights of the
Child Commission. Despite the fact that its mandate clearly defines the promotion of programmes, policies and other
actions aimed at the wellbeing of the child, the RCC does not have the internal capacity to coordinate the system, nor
it is its mandate to coordinate government’s actions related to children.
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Part III:
The early years: a healthy start
(from conception to 5 years)
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The early years of life are crucial not only for individual health and physical development, but also for cognitive
and social-emotional development. Events in the first few years of life are formative and play a vital role in building
human capital, breaking the cycle of poverty, promoting economic productivity, and eliminating social disparities and
inequities. Early Childhood Development (ECD) refers to a comprehensive approach to policies and programmes
that should include attention to health, nutrition, education, and water and environmental sanitation in homes and
communities (UNICEF, 2002).
Evidence suggests that investing in the initial years of the child brings the optimum return in terms of socio-economic
benefits. For instance, for every $1 invested in the physical and cognitive development of babies and toddlers, there
is a $7 return, mainly from cost savings in the future (UNICEF, 2001). For every dollar spent on immunization, studies
show savings of US$6.30 in direct medical costs, and US$ 18 in indirect medical costs – losses due to missed work,
death and disabilities (Zhou, et al., 2003). Besides, investments in ECD increase the chances of performing well at
school, improve child’s attention, increase the child’s capacity to be resilient, and increase his/her ability to cope with
stress and difficult situations (The World Bank, 2015).
The concept of investment in ECD should be seen as systemic, and it involves the areas of health, education and
child and social protection. A proper environment for the development of the child should guarantee proper (i) care of
the mother and the baby; (ii) access of quality water and sanitation; (iii) access to institutions that are safe and parents
who are knowledgeable to help developing the initial cognitive aspects of the child; (iv) nutrition to the mother and
child; and (v) registration at birth; all combined to an overall scheme where the rights of the child can be fully realized,
independently of his/her socio-economic status, ethnicity or place of living.
In order to address this dynamic system, this part has four chapters that should be seen as interconnected. Chapter 4
deals with the health of the mother and the child, focusing on the main causes and determinants of maternal and child
mortalities. Chapter 5 starts the discussion on HIV, presenting what is the situation in terms of prevention of mother-
to-child transmission. Chapter 6 describes the situation in terms of birth registration. Chapter 7 depicts the situation
of Early Childhood Education (ECE).
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Chapter 4: The Right to Health
This chapter explores the connections between maternal and child health. It starts presenting the numbers related to
maternal and child mortality, and then explores the main causes and bottlenecks associated with them. The reduction
of Maternal and Child mortalities, and the improvements in health and decline of diseases that have to be associated
with them, are the core of the third SDG Goal (Ensure healthy lives and promote well-being for all at all ages).
4.1) Maternal Mortality
A healthy start for a child’s life has to take into consideration the care that the mother receives during pregnancy,
delivery and post-delivery. Maternal mortality and child mortality are interconnected. Babies whose mothers have
died during childbirth have a much greater chance of dying in their first year than those whose mothers remain alive.
Guyana has identified the health of its mothers – present and potential – as the most crucial area to be addressed
within the MDG Acceleration Framework (MAF) (Government of Guyana, 2014). According to the most recent
estimates, Maternal Mortality in Guyana for 2015 was 229/100,000 live births, a number that has been showing
signs of decrease in the past 5 years, but still higher than the 2000 value (Figure 27).
Figure 27: Maternal Mortality Ratio estimation, Guyana, 2000-2015
Source: (WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division, 2015)
4.2) Child Mortality
Based on the 2014 MICS data, the infant mortality rate (IMR) is 32 per 1,000 live births, showing a small reduction
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52
when compared to 2000. Under-five mortality (U5MR) has also been reduced over the years, reaching 39/1,000 live
births in 2015 (Figure 28), compared to 47/1,000 in 2000 (Figure 28).
Figure 28: Trends in Mortality Rates, Guyana, 2000-2015
Source: Estimates generated by the UN Inter-agency Group for Child Mortality Estimation (IGME) in 2015, available
at http://data.unicef.org
Most of the deaths related to children younger than 5 years (around 59% of them) occur in the neonatal period,
i.e., between birth and the first month of life (Table 9). There are some differences in the probability of dying among
children up to age five years based on certain background characteristics, such as place of residence, mother’s
education, and ethnicity (Table 10).
Table 9: Early childhood mortality rates, per 1,000 live births, Guyana, 2014
Mortality Rate Definition Value (/1000 live births)
Neonatal mortality
(NN):
Probability of dying within the first month of life
23
Post-neonatal mortality
(PNM):
Difference between infant and neonatal mortality
rates
9
Infant mortality: Probability of dying between birth and the first
birthday
32
Child mortality: Probability of dying between the first and the fifth
birthdays
8
Under-five mortality: The probability of dying between birth and the fifth
birthday
39
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
In looking at the data (Table 10), the difference between coastal and interior areas has to be seen carefully. At first
sight, U5MR was 41/1000 for coastal areas, and 33/1000 for the interior (Bureau of Statistics, Ministry of Public Health
and UNICEF Guyana, April 2015), generating a discrepancy with other socio-economic indicators that would suggest
that the situation in the interior was worse than the situation in the coast. Nevertheless, in disaggregating the data by
urban and rural coastal, the rural part is responsible for the majority of the child mortality deaths. Another important
observation to be further investigated is the fact that in the interior areas of Guyana, the post-neonatal deaths are
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53
higher than the neonatal deaths. In other words, children are surviving birth, but are dying before completing their first
birthday. The same situation is seen mainly with the Amerindian population. While in general the U5MR for this group
is below the country’s average, most of the child deaths for the Amerindians will occur after the first month of life16.
Table 10: Early Childhood mortality rates, per 1,000 live births, by different geographical areas, Guyana,
2014
Neonatal mortality
rate
Post-neonatal
mortality rate
Infant mortality
rate
Child mortality
rate
Under-five
mortality rate
Guyana 23 9 32 8 39
Area
Urban 6 1 7 4 11
Rural 28 11 39 9 48
Coastal 27 8 35 6 41
Urban Coastal 7 0 7 0 7
Rural Coastal 34 10 45 9 53
Interior 7 13 20 13 33
Ethnicity
East Indian 43 5 48 6 55
African 15 9 24 4 29
Amerindian 3 15 18 12 30
Mixed Race 15 9 24 4 29
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
There is no difference in terms of neonatal mortality between the poorest 40% population, and the richest 60%.
Nonetheless, mother’s education level appears to play a major role in limiting childhood mortality. All the indicators of
childhood mortality are much higher among children whose mothers only have primary education compared to those
whose mothers have secondary or higher education (Figure 29). For example, neonatal mortality, infant mortality and
under-five mortality rates among children with mothers with primary education are over three times higher than those
with mothers with secondary or higher education.
16 Despite all the methodological robustness of the method, disaggregated mortality estimations are subjected to large confidence intervals and
conclusions must be taken cautiously.
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Figure 29: Early Childhood mortality rates by mother’s education, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
4.3) Main causes related to maternal and child mortality
Figure 30 summarizes different causes that combined could be associated with maternal and child deaths in Guyana.
These causes are then arranged in a causal tree in Figure 31, where the immediate, underlying and structural causes
are then identified.
Figure 30: Group of possible causes for maternal and child deaths
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55
Figure 31: Causality Analysis for Maternal and Child Mortalities in Guyana
Source: based on (UNICEF, 2009)
In terms of maternal mortality, these causes could be divided into two groups: first, those that are directly related
to obstetric complications during pregnancy. Around 73% of the maternal deaths in 2012 were direct maternal
deaths17, i.e., those resulting from obstetric difficulties of the pregnant state (pregnancy, delivery, and postpartum),
interventions, omissions, incorrect treatment, or a chain of events resulting from any of these (Government of Guyana,
2014).
The second group is related to indirect obstetric deaths that occur due to either previously existing conditions or
from complications arising in pregnancy, which are not related to direct obstetric causes but may be aggravated
by the physiological effects of pregnancy. These include such conditions as HIV and AIDS, malaria, anaemia and
cardiovascular diseases (UNICEF, 2009). Indirect causes were responsible for 27% of the deaths in 2012 (Figure 32).
Figure 32: Direct and Indirect number of maternal deaths, 2010-2012
Source: 2014 MDG Report (Government of Guyana, 2014)
17 Estimates available for 2015 do not allow for this disaggregation.
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56
Both direct and indirect causes could be seen under two lenses. First, in terms of services, many deaths could
be avoided if quality services for pregnant women were available. In reality, taking congenital factors outside the
equation, most of the deaths could have been avoided if appropriate care of pregnant women, attention at birth and
care post-partum and in the initial stages of life of the new-born were available for all pregnant women in the country.
Moreover, the fact that 59% of the under five mortality deaths happens in the first month after delivery indicates that
the poor quality of prenatal, delivery and postnatal care is also connected to high levels of neonatal mortality in the
country. For instance, neonatal sepsis, congenital anomalies, birth asphyxia and prematurity could all be reduced
with appropriate access to quality maternal health services (antenatal and delivery care, including a clean delivery
environment).
Second, some of the causes are directly and/or indirectly associated to personal characteristics of the mother, i.e.,
to their nutritional status; their health situation; to the quality of the environment of where they live (including access
to proper water and sanitation); and to the access to government supplies, among others. These are influenced
by the structural and underlying causes depicted in Figure 31, but also directly influence the chances of morbidity
(immediate causes).
For child mortality, when looking at the direct causes of death between birth and 12 months (Figure 33), respiratory
infections, nutrition and other factors that are independent – but maybe consequence – of the ANC, delivery and
PNC periods start showing up as important immediate and underlying causes of child mortality. In this sense, the
same service and personal characteristics lenses that were seen related to maternal mortality also apply to child
mortality. Similar socio and economic structural conditions that will negatively impact in the chances of mothers to
die during delivery and postnatal periods will influence the child’s propensity of dying before the age of five. The next
subsections explore the different causes in more details.
Figure 33: Leading causes of infant mortality, Guyana, 2005-2008
Source: (PAHO, 2012)
A) Obstetric Risks and Inadequate Health Care
While obstetric risks are considered to be immediate causes of Maternal and Child mortalities, these risks are caused
by inadequate access to good quality health care, especially prenatal care, delivery and post natal care.
Guyana | Situation Analysis of Children and Women
57
Antenatal Care
The antenatal period is essential to prevent complications during pregnancy and at births, to prevent HIV transmission
from the mother to the child, and to monitor the health and nutritional status of the mother and the baby. Antenatal
care is available in Guyana at different levels of the health care system. Although differences still exist between the
coastal and hinterland regions in Guyana, the national antenatal coverage rate has been above 90% since the year
2000 (Government of Guyana, 2014). According to the 2014 MICS, nine in ten mothers (91%) received antenatal care
more than once and a vast majority of these had at least four visits (87%).
As other indicators, antenatal care oscillates depending on the region where the mother lives, her economic status,
and her ethnicity. As depicted in Figure 34, in two out of the ten regions, 9% of the pregnant women did not have any
prenatal care. On Region 1, only 67% of the women had the recommended four or more antenatal care visits.
Figure 34: Percentage of pregnant women without any prenatal care, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Also, as shown in Figure 35, those mothers who live in the interior part of the country have three more times the
chance of not having access to prenatal care than those women who live in the coastal part of Guyana. Almost 4% of
the poor women did not have access to prenatal care in comparison to the women in the richest quintile, and almost
6% of the Amerindian women did not see a doctor before delivering their babies. In reality, only 77% of the Amerindian
women had four or more prenatal visits, in comparison to 90% of the East Indian mothers.
Guyana | Situation Analysis of Children and Women
58
Figure 35: % of women with no prenatal care by different characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Table 11 shows a much stronger disparity that affects the most vulnerable populations, the percentage of mothers who
attend antenatal care provided by a skilled provider. Common with the other indicators, those mothers in the interior
of the country, in the poorest households and from the Amerindian families are not seen by medical doctors, nurse/
midwifes, single midwifes or Medex – all considered to be skilled providers – at the same rate as other populations.
Table 11: Access to prenatal care, Guyana, 2014
% antenatal care
provided by skilled
provider
% antenatal care
provided by non skilled
provider
% with no prenatal
care
Urban 98.1 0.7 1.1
Rural 88.4 8.8 2.8
Coastal 97.2 1.2 1.7
Urban Coastal 98.7 0.8 0.6
Rural Coastal 96.6 1.4 2
Interior 66.7 28.1 5.3
Poorest 75.7 20.5 3.9
Second 94.9 2.2 3
Middle 96.8 0.9 2.3
Fourth 98.9 0.5 0.6
Richest 99.1 0.5 0.4
East Indian 97.3 1.4 1.3
African 98.5 0.1 1.3
Amerindian 58.5 35.5 5.9
Guyana | Situation Analysis of Children and Women
59
% antenatal care
provided by skilled
provider
% antenatal care
provided by non skilled
provider
% with no prenatal
care
Mixed Race 91.3 5.3 3.3
Country 90.8 6.9 2.4
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
While rates of prenatal care are high, access at the correct period of pregnancy – first trimester – is not being
achieved. Almost 45% of the pregnant women have their first doctor visit after the initial three months of pregnancy
(Figure 36), opening a window for problems to occur during pregnancy.
Figure 36: Time of first antenatal care visit, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Delivery
Overall, skilled personnel delivered almost 92% of births that occurred in the two years preceding the 2014 MICS
survey. Historically, that number was around 80% in the year 2000, and has been higher than 90% since 2005
(Government of Guyana, 2014).
Despite the elevated proportion of births being delivered by skilled health personnel, the Government of Guyana admits
that addressing insufficient obstetric and gynaecological capacity in the public health sector remains a bottleneck - for
instance, in 2011, only six obstetricians were present in the entire public health system in Guyana (Government of
Guyana, 2014). Besides, in 4 out of the 10 regions in the country, the presence of skilled health professionals during
birth have values below the national average of 92.4% (Figure 37). The presence of skilled birth attendants is low
for those populations living in the interior of the country, those from the poorest families, and those mothers coming
from an Amerindian background.
Guyana | Situation Analysis of Children and Women
60
Figure 37: Percentage of births delivered by skilled providers, Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 38: Percentage of births delivered by skilled providers, socio-economic characteristics, Guyana,
2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Most of the assistance at delivery is provided by nurses/midwives, followed by doctors (Figure 39).
Guyana | Situation Analysis of Children and Women
61
Figure 39: Person assisting at delivery (%), Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Regarding place of delivery, in Guyana, in the two years preceding the 2014 MICS, 93% of births were delivered in
a health facility – 79% of deliveries occurred in public sector facilities and 14% in private sector facilities. 6% of the
births happened at home. As with the other indicators, deliveries at home are higher in Regions 1 (15.2% of the births)
and 7 and 8 (31.6% of the births). Deliveries at home are quite high in the interior area of the country (around 25%),
and among the Amerindian mothers (34% of the deliveries). In terms of wealth, while no birth among the mothers
in the richest families happened at home, almost 19% of the births in the poorest populations happened at their
residence (Figure 40).
As it is going to be discussed later in this chapter, delivery at home are influenced by cultural factors, but also by the
distance that mothers have to travel to access health facilities, the lack of access to these facilities (mothers have to
travel by boat or in poor road conditions), and, consequently, by the direct and indirect costs that are associated with
the delivery.
Figure 40: Percentage of births that happened at home, socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
In 2011, the Georgetown Public Hospital Corporation (GPHC), which is the national referral hospital for obstetric
cases, accounted for 41% of all deliveries nationally, with a total of 5,497 live births. Due to the high number of
Guyana | Situation Analysis of Children and Women
62
deliveries, most of the maternal deaths also occurred in the same hospital – around 74% of the maternal deaths in
2011, and 59% in 2012.
Despite the elevated number of births that take place in health facilities, the statistics do not take into account the
standard of care available at the delivery facilities. As reported by the Ministry of Public Health, all high-risk and
emergency cases have to be referred to GPHC due to the lack of adequate resources at regional level institutions.
An assessment carried out by the Ministry of Public Health in collaboration with UNFPA established for the first time
the national baseline data on availability, use, and quality of emergency obstetric and new-born care (EmONC)
services as recommended by the WHO, UNICEF, and UNFPA. The report suggested that the number of facilities
providing EmONC in Guyana is inadequate and that this is compounded by issues regarding competence and skills
of health personnel, and provision of equipment, which undermine the quality of emergency care provided nationwide
(Government of Guyana, 2014).
Post Natal care
Postnatal care usually involves 3 visits to the doctor within six weeks of delivery. Increased emphasis on the
importance of post-natal care, recommending that all women and new-borns receive a health check within two days
of delivery. Post-natal care visits (PNC) refer to a separate visit by any health provider to check on the health of the
new-born and provide preventive care services. PNC visits do not include health checks following birth while in
facility or at home.
Despite the fact that health checks following birth were conducted for nearly all deliveries taking place in health
facilities in Guyana (93% of the babies and 92% of the mothers receive a health check after delivery), the level
of postnatal care (PNC) visits for children and mothers is quite low: on average 52% of the babies did not have
a postnatal care visit following their birth, and most likely they saw a health provider once it was time for their first
vaccine. For the mothers, the situation is actually worse: almost 68% of the mothers who delivered in health
institutions did not come back for a follow up visit with a health provider.
On the contrary of other health indicators, as depicted in Figure 41, there is no much oscillation in terms of postnatal
visit when socio-economic characteristics are taken into consideration. Four regions are above the national average
in terms of babies not coming back for postnatal visits, and three of them have rates higher than 65%: Regions 10,
3 and 6 (Figure 42).
Figure 41: Percentage of babies with no postnatal visit, socio-economic characteristics, Guyana, 2015
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Guyana | Situation Analysis of Children and Women
63
Figure 42: Percentage of babies with no postnatal visit, regions, Guyana, 2015
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
B) Diseases and Infections
Diseases and infections can directly and indirectly contribute to the death of mothers-to-be and children before
the age of five. The main diseases and infections identified in Guyana are related to diarrhoea, acute respiratory
infections (ARI) and malaria. HIV is also a major disease that jeopardizes the health of children and mothers. HIV
related to prenatal and delivery is discussed in chapter 5.
Diarrhoea
Diarrhoea is a leading cause of death among children under five worldwide, and it also relates to child and maternal
deaths in Guyana. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of
water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts
(ORS) or a recommended home fluid (RHF) – can prevent many of these deaths.
On average, 8% of the mothers interviewed for the MICS survey mentioned that children between 0 and 60 months
had episodes of diarrhoea in the two weeks preceding the interview18, a number that does not show much improvement
if compared to 2006, when around 9% of the mothers have reported their children presenting diarrhoea (Bureau of
Statistics and UNICEF Guyana, 2008). The 2014 rate varies considerably depending on the area where the child
lives, the poverty status of the family and his/her ethnicity. For instance, children living in the interior of the country
have three times more chance of having diarrhoea than those living in urban areas. Similarly, 21% of the children
living in Amerindian communities had diarrhoea (Figure 43). Episodes of diarrhoea are also more frequent in Regions
7, 8 and 9 (Figure 44).
18 As warned by the MICS report: These results are not measures of true prevalence, and should not be used as such, but rather the period-
prevalence of those illnesses over a two-week time window (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015).
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64
Figure 43: Percentage of children who in the last two weeks had an episode of diarrhoea, by area and
socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 44: Percentage of children who in the last two weeks had an episode of diarrhoea, by region,
Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Cases of diarrhoea are directly related to access to proper water and sanitation, and to hygienic habits in the family.
As explored previously, access to improved sources of drinking water and improved sanitation are smaller for those
families living in the interior of the country, for the poorest families, and the Amerindians: the same three characteristics
that surround those families whose children under 5 present the higher episodes of diarrhoea. According to the 2014
MICS results, 61% of the mothers who reported their children had diarrhoea looked for advice from a health facility.
Number can be low since mothers might not see the need to look for medical advice as the condition might happens
Guyana | Situation Analysis of Children and Women
65
frequently, and, consequently, be considered normal. Overall, 43% of children with diarrhoea during the two weeks
prior to the survey received ORS: 27% received fluids from ORS packets and 25% from pre-packaged ORS fluids.
Children in interior areas (52%) are more likely to have received ORS than those in coastal areas (36%). Treatment
with ORS was similar regardless of sex of the child and socio-economic status of the household (Bureau of Statistics,
Ministry of Public Health and UNICEF Guyana, April 2015).
Acute Respiratory Infection (ARI)
Globally acute respiratory infection (ARI) is one of the leading causes of death in children under five. In Guyana, 31%
of the children dying below the age of 1 are related to respiratory infections, and 5% were identified as ARI (Figure
33 on page 40). Among different acute respiratory diseases, pneumonia is the most serious for young children.
Identification of cases of pneumonia and other respiratory infections are limited since suspected cases might not
be real cases. In the two weeks preceding the 2014 MICS survey, 2.2% of children between 0 and 59 months were
identified as having symptoms related to ARI19. Suspected cases of ARI were four times higher in the interior of the
country (4.1% of the children) then the urban areas (0.8%). Also, children in the poorest quintiles have three times
more chance of having symptoms of ARI than those children in the richest quintiles (3.3% and 0.7%, respectively).
In terms of ethnicity, 4.5% of the children living in Amerindian families presented ARI symptoms, the highest number
among all ethnicities identified in the country.
Eighty-four per cent (84%) of children aged 0-59 months with symptoms of ARI were taken to a qualified provider.
The great majority of these children were taken to a public health facility (77%), while much smaller proportions
were taken to a private health facility (12%) or a community health provider (10%). Overall, 31% of children with ARI
symptoms were given antibiotics (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
ARIs are caused by viruses and bacteria, which are almost impossible to avoid. Nonetheless, certain risk factors
increase the chances of young children to develop the infection. Poor water and sanitation in the households, and
the lack of hygiene at home can increase the chances that children are affected by respiratory infections. Also, the
fact that some children are not fully vaccinated can weakness the immune system, increasing the chances that
common respiratory infections can develop into more severe diseases. The nutritional status of the child (subject
to be explored later) also determines the chances of developing a more serious respiratory infection: malnourished
children have higher chances of developing serious ARI (Cunha, 2000).
All these factors are somehow present in Guyana. Those children living in poor families, in the interior of the
country, and/or coming from Amerindian families have higher chances to be susceptible to stronger infections and,
consequently, have their health affected to the point where they are in danger of dying.
Malaria
In Guyana, the coastal areas are considered to be malaria-free, while the interior is considered to be a high-risk
malaria area, affecting mainly the indigenous and mining populations. According to the World Malaria Report (WHO,
2014), the number of cases in Guyana has increased between 2000 and 2013 (Figure 45). As a matter of fact, among
all the countries in the Americas, Guyana and Venezuela were the only two that registered an increase in incidence
in the period. The country has registered 31,478 presumed and confirmed cases of malaria in 2013.
19 According to the MICS report: A child was considered to have had an episode of ARI if the mother or caretaker reported that the child had,
over the specified period, an illness with a cough with rapid or difficult breathing, and whose symptoms were perceived to be due to a problem in
the chest or a problem in both the chest and a blocked nose. While this approach is reasonable in the context of a MICS survey, these basically
simple case definitions must be kept in mind when interpreting the results, as well as the potential for reporting and recall biases. (Bureau of
Statistics, Ministry of Health and UNICEF Guyana, April 2015)
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66
Figure 45: Number of presumed and confirmed malaria cases, Guyana, 2000-2013
Source: (WHO, 2014)
In terms of prevention, the 2014 MICS results indicate that 5% of households have at least one insecticide treated
net (ITN), a decrease of 20 percentage points when compared to 2009 – the 2009 DHS had indicated that 25.6% of
the households had at least one ITN (Ministry of Health, Bureau of Statistics and USAID, Oct 2010). Other important
indicators also show decline in use of ITNs; for instance the percentage of children under age of 5 who slept under
and ITN in the previous night was reduced from 32% in 200620, to 24% in 200921, and finally to 7.4% in 201422; and the
percentage of pregnant women who had slept under an ITN was reduced from 32% to 7% between 2009 and 201423.
These declines need to be further investigated. One possible reason for the decline in the use of ITNs might be the
impression that as malaria cases have been reduced, the use of ITNs was not necessary anymore. In fact, the pick of
use of ITNs coincide with the low number of malaria cases reported in the country (Figure 45), giving the impression
that malaria was under control. After that, as fewer people were sleeping under ITNs, cases have increased reaching
a new peak in 2013 when.
The 2014 MICS results also indicate that 30% of households in the interior areas have at least one ITN and 16% have
at least one ITN for every two household members. Availability of ITNs at the household level is most prevalent in
Regions 1, 7, 8 and 9, with more than one-half of households with at least one ITN (53%), and just over one-quarter
of households with at least one ITN for every two persons (27%). The high percentages of ITN availability in the
poorest households and households with an Amerindian household head are indicative of the concentration of these
households in the high-risk interior areas.
Similar to ARI, identification of malaria is not straight forward, and many times it is confused with fever. Around 14%
of children 0 to 3 years of age had episodes of fever during the two weeks preceding the 2014 MICS survey. Advice
was sought from a health facility or a qualified health care provider for 71% of children with fever. In high-risk interior
areas, advice or treatment was sought from a health facility or provider for 81% of children with fever, a much higher
figure than that in coastal areas (66%), possibly reflecting the risk of malaria in case of fever. In interior areas, advice
or treatment was sought from a community health provider for a large percentage of children (21%), after public
health facilities (78%).
Children living in the poorest households and those whose mother have only primary education are more likely to
20 2006 MICS
21 2009 DHS
22 2014 MICS
23 Numbers for 2006 were not available.
Guyana | Situation Analysis of Children and Women
67
seek advice or treatment than those in wealthier households and those whose mother have secondary or higher
education.
Overall, 12% of children with a fever in the previous two weeks had blood taken from a finger or heel for testing. As
expected, the proportion of children tested for malaria is higher in interior areas (23%) than in coastal areas (6%), and
in the rural areas (13%) than in the urban areas (8%). Nearly one-third of children in the high-risk Regions 1, 7, 8 and
9 were tested for malaria (31%), a much higher figure compared to other regions. It is noteworthy, however, that one
in ten children with a fever in Region 4 were tested for malaria.
Malaria is not the only mosquito transmitted disease that can affect children in the country. Due to the constant
migration that happens in the borders of the country, vector-transmitted diseases that are present in other territory are
easily carried to Guyana. Also, the country is vulnerable to a range of natural and human-caused disasters that can
be exacerbated by climate change. These factors contribute to increases in vector-borne diseases that are endemic
in some areas of the country. For instance, dengue fever has been on the increase. There were 1,468 cases recorded
in 2010, up from 258 in 2006; there was one recorded death in the period, due to dengue haemorrhagic fever (PAHO,
2012). Additionally, the most recent threat in terms of vector-borne diseases is the Zika virus. The outbreak that took
place in Brazil in 2015 has reached Guyana, with some cases of the diseases officially confirmed early 201624.
C) Nutrition
The nutritional status of pregnant women and children is an immediate cause of maternal and child deaths, and also
aggravates the health status indirectly contributing to the precarious health status of some mothers and children.
Inadequate nutrition before birth and in the first years of life can seriously interfere with brain development and lead
to neurological and behavioural disorders (UNICEF, 2002). Even when nutrition is not directly responsible for deaths,
a deficient nutritional status negatively influences other diseases, aggravating the physical and cognitive condition of
boys and girls.
Guyana has met the MDG target of halving the proportion of people suffering from hunger (Government of Guyana,
2014), nonetheless, a considerable percentage of children still suffer nutritional problems in the country. The challenge
now is to reach the new targets set by the Sustainable Development Goals, which claims for ensuring access to
safe, nutritious and sufficient food (SDG Target 2.1) and to end all forms of malnutrition, including stunting, while
addressing the needs of adolescent girls, pregnant and lactating women (SDG Target 2.2). In order to reach those
targets, the government has been revising the 2002 Food Based dietary Guidelines, focusing on reducing the impact
of iron deficiency anaemia, emphasizing the importance of breastfeeding, and addressing the emerging treat of non-
communicable diseases, among others.
Around 9% of children under age of five in Guyana are moderately or severely underweight and 2% are classified as
severely underweight (definitions in the box below). 12% of the children are stunted (too short for their age), and 3.4%
are severely stunted. 6.4% are considered to be wasted, or too thin for their height, being 1.7% considered severely
wasted. 5.3% of children are considered to be overweight for their age (Table 12).
24 Source: http://www.who.int/csr/don/20-january-2016-zika-guyana-barbados-ecuador/en/ Accessed on January 25, 2016.
Guyana | Situation Analysis of Children and Women
68
BOX: Nutrition measures
Weight-for-age (underweight) is a measure of both acute and chronic malnutrition. Children whose weight-
for-age is more than two standard deviations below the median of the reference population are considered
moderately or severely underweight while those whose weight-for-age is more than three standard deviations
below the median are classified as severely underweight.
Height-for-age (stunted) is a measure of linear growth. Children whose height-for-age is more than two standard
deviations below the median of the reference population are considered short for their age and are classified as
moderately or severely stunted. Children whose height-for-age is more than three standard deviations below
the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure
to receive adequate nutrition over a long period and recurrent or chronic illness.
Weight-for-height (wasted) can be used to assess wasting and overweight status. Children whose weight-
for-height is more than two standard deviations below the median of the reference population are classified
as moderately or severely wasted, while those who fall more than three standard deviations below the median
are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator
of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease
prevalence.
Table 12: Percentage of children under age 5 by nutritional status, Guyana, 2014
Moderately Severely
Underweight 8.5 2.2
Stunted 12 3.4
Wasted 6.4 1.7
Overweight 5.3 -
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Stunting should be seen as a major concern for the country. A child who is stunted often appears to be normally
proportioned but is actually shorter than normal for his/her age. Stunting starts before birth and is caused by poor
maternal nutrition, poor feeding practices, poor food quality and frequent infections that can slow down growth.
Stunting is not reversible after a certain age; hence, to have an impact on stunting levels, nutrition interventions need
to be targeted to women during pregnancy and to children from birth to 18 months of age.
At short term, stunting increases the chances of death among children between the ages of 0 and 5; and decreases his/
her cognitive, motor and language developments. At long term, stunting is related to obesity, low school performance
and low learning capacity, and, consequently, low work skills and productivity (Stewart, CP; et al , 2013).
As depicted in Table 13, compared to other regions, greater proportions of children in Regions 7 & 8 and 9 are found
to be moderately or severely underweight (12%) and moderately or severely stunted (27-28%). Regions 7 & 8 also
have the highest proportions of children who are severely underweight, with 5%, as well as severely stunted, with
11%. In contrast, the percentage wasted is highest in Regions 3 and 6 (9%). While the differences are relatively small
for underweight and wasting prevalence between the areas of residence for both urban-rural and interior-coastal
disaggregation, as it relates to stunting, children in interior areas (20%) are twice as likely as those in coastal areas
(10%).
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69
Box: Feeding Programmes
Guyana has a National School Feeding Programme that seeks to address the issues of nutrition and stunting,
specifically in the hinterland region. The National School Feeding Programme supplies biscuits and fruit
drinks (for Region 9 it also supplies Peanut butter and cassava bread), and targets all Nursery and Primary
Level Schools (up to Grade 2). As of April of 2016, more than 45,000 boys and girls were beneficiaries of the
programme. In 2016 government has also started a pilot community based school feeding (hot meal programme)
with selected Nursery and Primary schools within the Buxton/Friendship and Enmore communities.
Table 13: Nutritional status by Region, Guyana, 2015
Region Underweight Stunted Wasted Overweight
Barima-Waini 6.2 18.4 3.3 7.1
Pomeroon-Supenaam 4.3 15.2 3.6 8.6
Essequibo Islands-West
Demerara
9.3 11.8 8.7
5.5
Demerara-Mahaica 7.8 9.4 5.8 5.4
Mahaica Berbice 9.4 11.3 6.2 3.8
East Berbice-Corentyne 10.1 8.4 9.1 4.2
Cuyuni-Mazaruni & Potaro-
Siparuni
11.6 28 5.3
7.3
Upper Takutu-Upper
Essequibo
11.6 26.6 6.5
4.1
Upper Demerara-Berbice 5.8 9.5 4.2 3.4
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Household wealth is clearly associated with the nutritional status of children relative to underweight, stunting, and
wasting: as household wealth and mother’s education increase, the likelihood of the children to be moderately or
severely underweight, stunted, and wasted decreases. As depicted in Figure 46, those children living in poor families
and those living in the interior of the country have double the chances of being stunted than the national average.
Besides, one in every four Amerindian children could be considered as suffering of stunting. A higher percentage
of children aged 0-5 months are severely undernourished according to all three indices in comparison with older
children.
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70
Figure 46: % of children moderately stunted by socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
The nutritional status of children and women are determined by immediate, underlying and structural causes that
involve, among others: (i) Low Birth Weight; (ii) inadequate dietary intake – which should start from breastfeeding;
(iii) constant diseases that weakness the children; and (iv) household food insecurity – determined by the economic
conditions that family has, among others (Figure 47).
Figure 47: UNICEF’s conceptual framework for nutrition
Source: Based on (UNICEF, 1998)
(i) Low Birth Weight (LBW). Weight at birth is a good indicator not only of a mother’s health and nutritional status but
also the new-born’s chances for survival, growth, long-term health and psychosocial development. Low birth weight
(defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished
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71
in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may
have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced
muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life.
Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school
and their job opportunities as adults (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
On average, according to the 2014 MICS, 14% of the infants who were weighted after birth were born with low
weight, a number that is smaller than 2006 figures – recorded as 19% by the 2006 MICS (Bureau of Statistics and
UNICEF Guyana, 2008) –, but slightly higher than the rate collected by the DHS survey in 2009 (13.2%). In 2014, low
birth weight does not oscillate much in terms of economic status – for instance, LBW for those children born in poor
families was 15.4% in comparison to 11.2% in the richer families; and ethnicity – LBW for Amerindian children was
16.4% in comparison to 14% in the East Indian populations. The same holds true when the region where the child is
born is taken into consideration: the highest incidence of LBW happens in Region 9 with 18% of the children being
born with this condition, and the lowest incidence happens in Region 2 and 10, with 11.2% of the children being born
with less than 2,500 grams.
While the low oscillation seems to indicate some structural problems in the country related to poverty and social norms
interfering with access to food and quality of health, underreporting might also interfere with the numbers, indicating
possible issues related to measurement and quality of data. Proper measurement of weight at birth is an issue that
should be taken into consideration when LBW is analysed. According to MICS, while only 6% of the births in Guyana
were not weighted at birth, that average hinders some important regional and socio-economic disparities. In Region
1, almost 20% of the boys and girls who were born did not have their weight measured, and for those children born in
the interior of the country the number reaches 11.4% of the births. For those boys and girls born in poor families, 10%
were not weighted when they were born. The number for those born in Amerindian families is much higher: 16%. All
these numbers point to the fact that the numbers related to LBW might actually be higher than the ones registered,
especially among the most vulnerable socio-economic situations.
The main direct causes of low birth weight are primarily connected with the mother’s poor health and nutrition. In
this sense, three factors have most impact: the mother’s poor nutritional status before conception, short stature (due
mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy.
(ii) Inadequate dietary intake. Proper feeding of infants and young children can increase their chances of survival;
it can also promote optimal growth and development, especially in the critical window from birth to two years of age.
For the 0 to 5 age group, proper feeding includes breastfeeding and, later, proper access to balanced and nutritional
meals. Exclusive breastfeeding for the first six months of life and sustained breastfeeding up to two years of age
protect children from infection, provides an ideal source of nutrients, and is economical and safe. However, many
mothers don’t start to breastfeed early enough, do not breastfeed exclusively for the recommended six months or
stop breastfeeding too soon (UNICEF, 2013a). UNICEF and WHO recommend that infants be breastfed within one
hour of birth, breastfeed exclusively for the first six months of life and continue to be breastfed up to two years of age
and beyond (WHO, 2003).
On average, 89% of the children born in Guyana between 2012 and 2014 were breastfed (Figure 48). Among the
children who were breastfed, only 23% of the children between 0 and 5 months of age were exclusively breastfed –
for infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding.
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Figure 48: Percentage of children who were ever breastfed by socio-economic characteristics, Guyana,
2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Another component that influences malnutrition is related to proper feeding of children and adults through
diverse feeding. According to the 2014 MICS, 65% of the children between 6 and 23 months of age had received
the minimum dietary diversity (67% among boys and 64% among girls)25. The minimum dietary diversity (MDD)
will vary depending on (i) the region – Region 9 has the smaller number of boys and girls with proper MDD (40%),
in comparison to Region 2 (83%); (ii) the area where the children live – children in the interior have 60% of MDD
compared to 71% in urban areas; (iii) mother’s education – 38% of the children from non-educated mothers will have
a minimum dietary diversity in comparison to 87% from mothers who have higher education; (iv) the poverty status –
55% of children from the poorest families will have the minimum diet in comparison to 77% of the children living in the
richest families; and (v) the household ethnicity – 54% of the children from Amerindian families will have the minimum
dietary diversity in comparison to 66% of other ethnicities.
Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired
psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also
increases the risks of stillbirth and miscarriage in pregnant women. Among those households in which salt was tested
in 2014, in almost 52% of them salt was not iodized. Use of iodized salt was lowest in Region 9 (3%) and highest in
Regions 3 and 7 & 8 (27% in each case). There are no notable urban-rural and coastal-interior differences in terms of
iodized salt consumption. The richest households are twice as likely as the poorest households to consume iodized
salt (26% and 13%, respectively) (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
Inadequate food intake also results in high levels of anaemia in the population. Although there are other causes,
anaemia is most often a reflection of micronutrient deficiencies. Micronutrient deficiencies pose a serious public
health problem in developing countries such as Guyana (Ministry of Public Health and the Pan American Health
Organization, Dec 2013). Even subclinical deficiencies of these micronutrients can impair health as well as intellectual
development of individuals. Hence, there is a wider impact of micronutrient deficiency on a nation’s economy, as
communities and entire countries become trapped in a cycle of poor health, poor education, poor productivity and
persistent poverty.
25 According to the MICS, minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) grains, roots and tubers,
2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich
fruits and vegetables, and 7) other fruits and vegetables.
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Anaemia is a direct and indirect cause of maternal mortality. In general, 41% of the pregnant women surveyed in 2014
were considered anaemic (Table 14). The high levels in the coastal and in urban areas might be associated with the
life style and the eating habits that women have in these areas.
Table 14: % Anaemia among pregnant women, Guyana, 2012
Area Normal Anemic
Urban 59.1 40.9
Coastal rural 54.9 45.1
Hinterland 65.9 34.1
All 58.7 41.3
Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)
Anaemia during pregnancy can also be avoided by the intake of vitamins and supplements. In 2012, iron supplements
were being used by 54.6% of antenatal women. When asked the main reasons for not being taking iron, the majority of
pregnant women answered that they did not think it was necessary (17%). 16% of the interviewed women mentioned
they did not start since they did not get it at the clinic yet. It is not known if the lack of access was due to lack of interest
in getting the supplements, lack of knowledge that they would benefit from it, or lack of supplies to be distributed to
those that needed it. All health facilities provide free supplements to pregnant women. However, pregnant women in
hinterland areas appear to utilise the free supplements received while those from coastal rural and urban areas have
a tendency to purchase the supplements, such as Feroglobin/Pre-natal supplements at a pharmacy (Figure 49).
Figure 49: Source of Iron Supplements for pregnant women taking Iron Supplements, Guyana, 2012
Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)
In terms of children, 24% of boys and girl between 0 and 5 years-old were considered anaemic in 2014. Despite the
fact that the gap between the urban, coastal rural and hinterland are not so distant from the country’s average (Table
15); the hinterland is the area that presents the higher levels of anaemia among children. It is important to flag the
difference between children and pregnant women in terms of anaemia prevalence in the hinterland. As depicted in
Table 14, pregnant women in the hinterland presented the smaller levels of anaemia.
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Table 15: % Anaemia among children 0 to 5 years of age, Guyana, 2012
Area Normal Anemic
Urban 78.2 21.8
Coastal rural 74.1 25.9
Hinterland 73.4 26.6
All 76.0 24.0
Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)
The difference in anaemia levels between children and mothers-to-be could be explained by the fact that lower
percentages of children are taking extra iron in the hinterlands than in the other two areas (urban and coastal rural)
(Figure 50). One of the possible causes for that is the financial barrier that families might have in accessing iron
supplements. 90% of the families that provide supplements for their children had to buy them in pharmacies (Ministry
of Public Health and the Pan American Health Organization, Dec 2013).
Figure 50: Percentage of Children 0-5 taking extra iron, by selected area, Guyana, 2012
Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)
Despite the fact that for the three groups investigated in the 2012 Anaemia Survey, anaemia is smaller than 1997
(Figure 51), the rate of reduction between children and pregnant women is quite different. While the reduction for
children between 0 and 5 was 50% and for the primary school group was 62%, for pregnant women anaemia was
reduced by 21%. This difference indicates that changes in the prenatal scheme in the country are necessary in order
for the proper nutrition of mothers and new-born babies to be fulfilled.
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Figure 51: Percentage of selected population with anaemia, Guyana, 1997 and 2012
Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)
In terms of eating habits, survey conducted in 2013 (Ministry of Public Health and the Pan American Health
Organization, Dec 2013) showed that the group of foods which young children were consuming most frequently
was Foods Made with Flour (85.7%), which included bread and roti. Chicken was eaten frequently by 67.6%, Egg
by 43.3% and Fish by 42.7%. Green leafy vegetables such as spinach and pak choi were consumed frequently by
33.1%. 27.2% of the children between 0 and 5 years old were having Beans, Peas and Lentils frequently and 20.0%
had nuts at least three times per week.
Box: Eating habits at the indigenous communities
In terms of Nutrition, many Indigenous Communities have their own staple diet. They would eat fish, which
is rich in protein, cassava bread and fruits from their farms. Hence the Hinterland communities have a pretty
healthy diet as against persons living in the Coastal Regions. However, many young children lack calcium in
their diet, as much emphasis is not placed on milk because it is expensive. Thus, many children are prone to
fractures because of the lack of calcium.
D) Access to Immunization
Most common vaccine-preventable diseases remain under control in Guyana (PAHO, 2012); nonetheless, around
22% of children aged 24-35 months were not fully vaccinated against vaccine preventable childhood disease in the
country. This percentage varies across background characteristics except for the sex of the child, where approximately
the same proportion was vaccinated. Children from the urban areas and those on the coast are more likely than their
rural and interior counterparts to be fully vaccinated. It is noteworthy that the likelihood of children in the coastal
areas to be fully vaccinated is 29 percentage points greater than those in the interior areas, with 85% and 56%
respectively. In terms of regions, less than 50% of the boys and girls in Regions 1 and 5 were fully vaccinated (Figure
52). According to PAHO, these facts indicate the need to scale up efforts to reach these populations and improve the
quality of vaccination services overall, including recording and monitoring systems (PAHO, 2012).
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Figure 52: % of children aged 24-35 months fully vaccinated, by Region, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Amerindian children are less likely to be vaccinated than other ethnic backgrounds (Figure 53). Almost half of the
children from the Amerindian communities were not vaccinated fully, creating a constant risk of outbreaks. One fact
to be further explored is that the percentage of children fully vaccinated is higher in those families in the mid-quintiles
than poor and richer families (Figure 53).
Figure 53: % of children aged 24-35 months fully vaccinated, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
In terms of other vaccines, Guyana incorporated rotavirus and pneumococcal vaccines into its immunization schedule
in April 2010 and January 2011 (PAHO, 2012). Similarly, the country has introduced the human papillomavirus (HPV)
vaccine in late 2011, targeting 11-year-old girls. It is estimated that every year 161 women are diagnosed with cervical
cancer and 71 die from the disease in Guyana. Cervical cancer ranks as the 2nd most frequent cancer among women
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in Guyana and the 1st most frequent cancer among women between 15 and 44 years of age (ICO Information Centre
on HPV and Cancer, Dec 2015). The HPV vaccine was supposed to help diminishing those rates; nonetheless,
according to the interviews for this Situation Analysis, the HPV vaccine was not fully introduced.
E) Access to Proper Water and Sanitation
Goal 6 of the Sustainable Development Goals focuses on ensuring availability and sustainable management of
water and sanitation for all, with special attention to the needs of the most vulnerable populations, including girls and
women. Precarious water and sanitation – WASH (including garbage management) are one of the main contributors
to under-five, infant and maternal mortalities worldwide. Inadequate access to and use of safe drinking water, sanitary
facilities and unhealthy hygiene behaviours are likely to contribute to high rates of infectious and waterborne diseases
and stunting adversely impacting on the mortality of children and mothers, nutrition, school achievement, learning
outcomes and future employability for boys and girls. It has been estimated that 50% of malnutrition is attributable
to improper water, sanitation and hygiene (Fewtrell L. et al, 2007). Different types of diarrhoea, measles and even
pneumonia could easily be avoided if families, mothers and children had access to clean, safe water and appropriate
sanitation facilities at home and in the health facilities where babies are delivered. Hand washing with soap is one
of the most effective and inexpensive ways to prevent pneumonia, as it reduces the risk of lower acute respiratory
infections by 25% (Global Public-Private Partnership for Handwashing with Soap, 2008).
Overall, 94% of the population in Guyana use an improved source of drinking water
– 99% in urban areas, 93% in rural areas, 98% in coastal areas and 71% in interior areas (Bureau of Statistics,
Ministry of Public Health and UNICEF Guyana, April 2015). Among the regions, the situation in Region 9 (Upper
Takutu-Upper Essequibo) is considerably worse than in other regions; only 42% of the population in this region get its
drinking water from an improved source. Access to improved source of water is also dependent on the family’s wealth
(Figure 56). Around 21% of the poor population in Guyana does not have access to any source of improved water.
Figure 54: Access to improved source of drinking water, regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
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Figure 55: Access to water by wealth quintile, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Among those households with improved access to water, almost half of them use bottled water (47%) as source of
water for cooking and/or drinking (Figure 56).
Figure 56: Source of improved water, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
The quality of the water in some regions of the country is a problem that affects the health of children. Gold mining,
which is one of the main drivers of Guyana’s economy, mainly occurs in the hinterland regions through public-
private partnerships. Studies in the gold mining areas of Region 1 in 2006 showed that all water samples contained
mercury above the WHO drinking water quality guideline of 1 mg/l, and sediment samples showed levels of mercury
that exceeded the Canadian Environmental Quality Guidelines of 0.486 ppm. About one-third of all fish caught had
mercury levels higher than those recommended by the United States Environmental Protection Agency of 0.5 ppm,
and results from a survey of the human environment showed a significant level of mercury contamination in the
northwest area of the country (PAHO, 2012).
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In terms of sanitation, overall, 95% of the population are living in households using improved sanitation facilities
: 98% in urban areas, 94% in rural areas, 97% in coastal areas and 86% in interior areas. The main difference being
the greater use of pit latrine with slab in rural and interior areas compared to urban and coastal areas, where the use
of flush toilets with piped sewer system or septic tank is more common (Bureau of Statistics, Ministry of Health and
UNICEF Guyana, April 2015).
Although 85% of the poorest households use improved sanitation facilities – 69.3% not shared and 15.4% shared
(Figure 57) – the type of improved sanitation facilities is strongly correlated with wealth, the poorest households
primarily using pit latrine with slab (60%), while the richest households have flush toilets with a piped sewer system
or septic tank (100%). Open defecation is practiced for less than 1% of the population in Guyana, but its practice is
higher among those living in Regions 7 and 8 (11% of the population). The 2014 MICS also shows a decline in the
percentage of children ages 0 and 2 whose last stools were disposed of safely. The 2014 rate was 43% in comparison
to 72% from 2006 (2006 MICS) and 77% in 2009 (2009 DHS).
Figure 57: Access to sanitation by wealth quintile, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
A proper household environment for children would combine the use of improved drinking water sources and improved
sanitation facilities by household; 83% of the people in Guyana would be living in households that match the two
characteristics. That number is much smaller for people living in the interior of the country (54.7% had access to
both), for the poorest population (57.7%), and for the Amerindian population (39%) (Figure 58).
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Figure 58: Percentage of people living in houses with improved drinking water sources and improved
sanitation, socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Sanitation and water availability should be complemented with good hygiene habits. Hand washing spaces were
observed in 75% of the households. In 9% of households the MICS data collector could not indicate a specific place
where people would usually wash their hands, and the remaining 16% did not give permission to see the place used
for hand washing.
As it is going to be presented next, challenges still exist with regard to the quality of water, sanitation and hygiene,
as reflected in the high rates of diarrhoea in children aged 1–5 years old in Region 3 (24.6%) and Region 4 (30.8%);
other regions report rates between 2.4% and 7.5%. The fact that in 47% of the houses that have access to improved
water use bottle water for cooking is a signal that piped water might not reach the desired quality in a large part of
the country.
4.4) Bottlenecks and Barriers
As depicted in the previous sub-sections, access to quality ANC, delivery and postnatal care; access to immunization;
access to water and sanitation; cases of diarrhoea, ARI and malaria; and the nutritional status of mothers, boys and
girls are going to vary by region, socio-economic status and ethnicity. These inequalities are sustained by different
bottlenecks and barriers that work together reinforcing the current situation, affecting not only the health of the
mothers, but also the health of children and future adolescents. In order to facilitate the analysis, these bottlenecks
are framed within the 10 determinants used by UNICEF (Figure 2 on page 5).
In terms of enabling environment, the country’s main policy framework for health is the Health Vision 2020 (Ministry
of Public Health, Dec 2013) that sets the strategy and overall planning for the health sector. The document has as
one of its priority areas to focus on the reduction of maternal and child mortalities, and the improvement of health for
adolescents. As depicted in section 3.2, Child and maternal health are delivered through a referral system with five
levels, from basic care (health posts that cover the entire country) up to two National Referral Hospital (both in the
coastal area). As mentioned before, analysis from the Pan American Health Organization (PAHO, 2012) shows that
the country’s health system performance and health outcomes have improved over the years, but challenges remain,
especially related to data management and quality of care. Formal data needed for monitoring and evaluating health
system performance at the regional level are limited, and information flows among central, regional, and facility levels
are fragmented and not fully integrated. In addition, data from the private sector are not systematically collected,
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analysed, and integrated to national statistics. Lack of data translates into problems with planning and management
of resources. As a matter of fact, inadequate coordination and collaboration at sectorial and inter-sectorial levels
and unclear definition of roles and responsibilities between central and regional authorities were identified as major
bottlenecks to reduce maternal mortality in the country (Government of Guyana, 2014).
The management and the coordination of the health system might not directly influence the parents’ decision to
search for a health facility, but both influence how the system works and how it addresses the needs of the population
in general. The Government of Guyana (Government of Guyana, 2014) has identified bottlenecks and barriers in how
management, supervisory, and monitoring tools are used in the health system. According to the 2014 assessment,
protocols and guidelines are not adequately disseminated and used; consequently, administrative processes are not
enforced. Also, communication and coordination between health facilities were considered to be inadequate, with
weak feedback mechanisms, and poor documentation. These, coupled with lack of accountability for physicians as
well as for staff at all levels of health care, translate into insufficient systems to prevent the recurrence of errors and
spurious referrals. The lack of some materials, medicines, rapid HIV testing kits, vaccines and other supplies were
identified as gaps in managerial capacity, including problems with procurement and stock management.
In terms of vaccines, as mentioned, a relatively large group of children are not fully vaccinated in the country. A
common issue that hinders the full access to vaccines in many countries is related to problems in the management
of the vaccines supply chain. Assessment conducted by the Pan American Health Organization and World Health
Organization on Effective Vaccine Management (EVM) (Pan American Health Organization and World Health
Organization, July 2014) showed that overall, the country’s management of the vaccine supply chain has reported
high scores related to vaccine arrival procedures; capacity to store the vaccines at decentralized levels; building
infrastructure; equipment availability; preventive maintenance of cold chain equipment, and stock management;
among others. Nonetheless, the assessment also indicated two major challenges related to (i) keeping the ideal
temperature for the vaccines – in some facilities there were oscillations in temperature that could jeopardize the
quality of the vaccines; and (ii) improving the distribution of freeze-sensitive vaccines. In this sense, while there
are still some challenges in management, the reasons why some groups of children do not access the vaccines is
not solely on the government responsibility to provide the vaccines, and should be further investigated. Probably,
difficulties of access and hidden financial costs – discussed in the paragraphs below – might influence the parents’
propensity to vaccinate their children.
On the supply side, the availability of essential commodities and the access to adequately staffed services are both
contributing factors to the current situation. Qualitative information shows that not all regions have the adequate
number of trained health workers and community health workers. In this line, according to the assessment
done by PAHO (PAHO, 2012), the low availability of qualified and skilled personnel is a major challenge for Guyana’s
public health system. More than 90% of the specialist medical staff in the public sector in 2012 was foreign nationals.
Vacancies ranged between 25% and 50% for most categories of workers, and in rural areas, specialties such
Box: Access to health in Region 1
Some economists believe that people are moved by incentives, i.e., people are motivated by different factors that
influence their decision of performing an action. That type of analysis could be used to understand the decision
of a woman to access or not a health facility in some of the most remote areas of Guyana. The following is part
of an interview and summarizes the situation that a woman would face and that will determine her incentives to
access health care in Region 1:
Region one is very vast area and health facilities are twenty miles apart. Most of the areas are swamps and
riverain. So for a mother to leave her home to go to a health post where a community health worker is stationed
would be difficult, time consuming and costly. The problem is compounded where that health worker is not
equipped to do a delivery or do a referral. For a health worker to reach some communities, the difficulty is the
same. In many instances, the health worker has to pay for the boat and the fuel since the government does
not have the money. A cost is attached to each visit and most times it is an expense that the community health
worker will have to bear.
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as pharmacy, laboratory technology, radiography, and environmental health had even higher vacancy rates. The
health sector in the hinterland has difficulty in attracting and retaining skilled staff due to low wages, challenging
working conditions, limited opportunities for training, inadequate career development systems, and the absence of
a comprehensive human resources development plan. Most of the staff from outside the hinterland does not see
the incentive to stay in the region. Residency in the hinterland goes together with unfavourable influences of other
social determinants such as poverty, lower educational levels, lack of job opportunities, and health risks arising from
environmental factors such as malaria, for example (ISAGS and UNASUR, June 2014).
Guyana’s geography poses further obstacles to mothers and children’s access to health care in hinterland regions
(see box below). Mountainous and riverine villages are sparsely populated. Besides, the conditions of roads to
these villages are usually extremely challenging, for some populations, the only access to government facilities –
health, school and police – is done by boat or by 4 by 4 trucks being driven in non-paved roads. The 2014 MDG
Acceleration Framework (Government of Guyana, 2014) noted that relatively few specialist and facilities serve fairly
large geographic areas with very challenging terrains. Besides, the weather in some areas might be brutal, with heavy
rains and gusty winds.
The difficulty of access and lack of adequate facilities also impacts on the referral system to emergency cases.
Access to obstetric emergency care is limited to Georgetown. If a woman living in one of the most remote areas of
the country needs surgery to deliver the baby, she has to be flown to the capital. The issue is that, depending on her
geographical location; this woman has to be transported in a regular car to the airport, wait for the plane to arrive
(Medi-Evac), has to fly to the capital, and has to be seen by an obstetrician. Between the identification of the need for
the surgery, and the surgery starts, more than 4 hours might easily pass by, decreasing the changes that the mother
and the baby have to survive.
The difficulties of access in the interior areas of the country are going to influence not only the low levels of prenatal
care, delivery and postnatal care, but also the propensity that mothers are going to have to transport their children
to be vaccinated or to visit a health facility. As identified by different stakeholders in the hinterland, most visits to the
doctors will only happen if the mother identifies an eminent threat to the life of the child. Cases of fever or diarrhoea
will be most of the time ignored and considered as normal. Sometimes, due to lack of access to medicines, and/or
cultural practices and beliefs, home-based medicines are going to be used instead of pharmaceutical drugs.
On the demand side, despite the fact that access to ANC, delivery, PNC and all the primary health scheme are free
of charge, and community health workers are available to provide the support for the families, the overall access to
the health facilities in the interior regions of the country is difficult and expensive, creating a financial barrier to some
families.
Financial barriers are not exclusive in the interior of Guyana, but also quite evident in the coastal and urban areas.
The country does not have a measure of how many people live in poverty in the urban areas (intra-city poverty), but
it is clear that cities such as Georgetown have pockets of poverty. In this sense, families might live in the cities, and
not have the same geographical difficulties in accessing public services such as health facilities, but their economic
situation influences on their decision of accessing those institutions. Pregnant women have to pay for transportation,
and, if they work, a day in the doctor represents a day without payment. Financial barriers also influence the food
intake of families in the country, as well as their propensity to provide vitamins and supplements to the children. Those
with more money have access to better quality food and have access to all the vitamins that children and pregnant
women might need.
Poverty is a serious determinant to all the issues that influence child and maternal deaths in Guyana. It is clear that
those pregnant women and children from richer families have higher chances to access good quality health, live in
households with improved water and sanitation, have access to proper food, and, consequently, have better chances
of having the appropriate physical and cognitive development between the ages of 0 and 5.
There are also social and cultural practices and beliefs that influence the personal decision of some mothers to
access the obstetric services provided by the government. Cultural barriers were highlighted in the MDG Acceleration
Framework as one of the major obstacles impeding women from getting adequate and timely care. These are
compounded by the fact that women (i) do not always know about the potential consequences of not seeking early
antenatal care; (ii) are denied access to information; and/or (iii) do not have the ability to seek services even if they
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are aware these are needed; all resulting in late enrolment. According to the 2009 Demographic and Health Survey
– DHS (Ministry of Health, Bureau of Statistics and USAID, Oct 2010), women’s use of antenatal, delivery, and
postnatal care services from health professionals vary by level of empowerment. In societies where health care is
widespread, women’s empowerment may not affect their access to reproductive health services; in other societies,
however, as it is the case of Guyana, increased empowerment of women is likely to increase their ability to seek out
and use health services to better meet their own reproductive health goals, including the goal of safe motherhood.
Data from 2009 DHS show that mothers who participate in one to four household decisions have better access to
maternal health services than mothers who participate in no household decisions. If cultural barriers continue to
hinder women’s acceptance of maternal health care services, any planned intervention will not have the desired
effects since it would not reach the target population (Government of Guyana, 2014).
Cultural practices were also identified as a bottleneck that influences the health seeking behaviour related to young
children. Anecdotal evidence shows that some parents prefer to offer new-borns their home remedies instead of
taking their babies to the hospitals. In the same line, qualitative reports mention that some communities have the
belief that fever is a component of the child’s development, and only seek for help when the health situation of the
child is unstable.
Some cases of babies being delivered at home are also influenced by cultural practices (and by social norms).
Qualitative information shows that while mothers from indigenous communities might do some prenatal visits, there
are also an elevated number that would decline to deliver in the hospital, and would opt for delivering their babies at
home, even when some risk is detected. Home deliveries in Guyana are relatively low. As mentioned, data from the
2014 MICS shows that on average, 6% of the births would happen at home, with considerable differences among
regions, ethnicity and socio-economic status. These disparities should be further investigated in order for a plan
that takes into consideration intercultural health services that allow women choice and quality services according
to cultural preference to be developed. While the large number of home deliveries for the Amerindian population
(34.1%) could indicate social and cultural aspects that guide their decision, the elevated number of home deliveries
for the poor population (19%) indicates that financial aspects might also influence in the decision to deliver at home.
Home deliveries are connected to two types of underreporting. First, babies delivered at home have a higher chance
of not being registered and not having a birth certificate. Second, in a worst case scenario when the mother or the
baby dies, there is also a high chance that their death is not notified to the authorities.
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Chapter 5: Preventing maternal to child HIV transmission
The HIV Prevention of Mother-to-Child Transmission (PMTCT) program is available countrywide (PAHO, 2012). HIV
testing of all pregnant women is a requirement during prenatal care. In 2014, 94.4% of the pregnant women accessed
PMTCT services and were tested for HIV. Despite elevated, the number represents a decrease when compared to
other years (Figure 59). According to the government, the main cause for that reduction was the shortages of test kits
at some regional sites during 2014 (Government of Guyana, 2015b)26.
Figure 59: % of women who performed volunteering HIV testing during pregnancy, 2010-2014
Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).
Despite being the same as 2013 (1.9%), HIV prevalence among pregnant women in 2014 consolidates an upward
trend since 2010 (Figure 60). This increase should be further investigated. It is not known if it represents an actual
increase in the number of women being infected, or the number is due to better detection of cases. For instance, the
number of sites that provide PMTCT services has doubled since 2006, from 92 sites to 188 in 2014, indicating that
more women are having access to testing, and, consequently, more cases are being detected.
Figure 60: Prevalence of HIV in ANC population, Guyana, 2010-2014
Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).
26 For a discussion on general cases of HIV, please refer to chapter 12
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All HIV-positive pregnant women are offered antiretroviral treatment (ART) as part of the PMTCT programme. The
number of HIV care and treatment sites increased from 8 in 2005 to 19 by the end of 2010, and the number of
voluntary counselling and testing sites increased from 27 to 75 over the same period (PAHO, 2012). According to data
from the Ministry of Public Health, 97% of the HIV positive pregnant women had received ART in 2014 (Government
of Guyana, 2015b). In the same year, 2.6% (5/193) of babies born to HIV-positive mothers were infected with HIV, a
slightly increase when compared to 2.1% (4/191) in 2013.
There were 37 new cases of HIV reported among children (ages 0 to 19) in 2014, number that represents a reduction
when compared to 2010, but an increase when compared to 2013 (Figure 61). Most of the new cases among children
are found between 15 and 19 year old boys and girls (Figure 62).
Figure 61: New HIV cases registered for children (ages 0 to 19), Guyana, 2010-2014
Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).
Figure 62: Distribution of new HIV cases for the children population, Guyana, 2010-2014
Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).
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The fact that almost 25% of the new cases of HIV in the child population in 2014 had happened between the ages
of 1 and 14 (Figure 62) demands extra attention on prenatal procedures, delivery and postnatal care of mothers and
children. These cases represent the failures in the system, i.e., the cases that were not identified, monitored and/or
properly threated during pregnancy, delivery and the initial months of life of the child.
5.1) Bottlenecks and Determinants
The efficiency of the PMTCT programme in Guyana is affected by the same bottlenecks explored in the sections
related to maternal and child health: shortage of essential commodities, difficulty of access to health facilities, financial
constraints, and social and cultural practices and beliefs. Deficiencies in the prenatal care, delivery and postnatal
care affect not only the detection of the virus in mothers and babies, but also in the follow up that identified patients
should have. Interviewees mentioned that it is known that some pregnant women would perform the rapid testing,
and even with a positive result, would not come back for further testing, for getting advice and/or for collecting their
ARV medication.
Regarding the enabling environment, access to quality data remains a challenge, and as such impacts on research,
policy development, and budgetary allocations to support service delivery in un-served/underserved populations.
Poor and/or limited supervision was another factor that contributed to poor quality data and affects quality assurance
of data too (UNICEF Guyana, June 2015). On the supply side, there were also reports of limited human resources
and shortages of HIV testing in some regions.
On the demand side, knowledge on HIV and how it is transmitted is an important tool to prevent mother to child
transmission during pregnancy. Overall, 92% of women and 84% of men know that HIV can be transmitted from mother
to child. However, only 53% of women and 35% men know all three ways of mother-to-child transmission (during
pregnancy, delivery and by breast-feeding) (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April
2015). Besides, male partner involvement (MPI) in counselling and testing at ANC and PMTCT services is especially
low in the country; for example data from Regions 1, 7 and 9 shows that MPI stranded at 8.9% in 2011; 10.4% in
2012; and 9.20% for 2013 and 2014 (UNICEF Guyana, June 2015). These results indicate the need to bring fathers to
the prenatal consultations, and the need to strength the HIV information being communicated to mothers. Knowledge
on mother-to-child transmission is low for all regions and socio-economic characteristics (Table 16). On the contrary
of other indicators, even if wealth is taken into consideration knowledge on mother-to-child transmission does not
vary much between rich and poor families.
Table 16: % of women and men with knowledge on mother-to-child HIV transmission by socio-economic
characteristics and region, Guyana, 2014
Women Men
Total 52.5 34.6
Region
Region 1 34.9 33.7
Region 2 54.4 62
Region 3 42.5 29.9
Region 4 54.9 29
Region 5 48.8 27.5
Region 6 63.4 44.5
Regions 7 & 8 58.6 41.7
Region 9 42.6 51
Region 10 42.1 40.7
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Women Men
Urban 50 32.2
Rural 53.4 35.5
Coastal 53.3 33.4
Urban Coastal 51.4 30.1
Rural Coastal 54.1 34.5
Interior 46.4 43.4
Poorest 53.2 39.7
Second 55.6 36.7
Middle 55.1 34.1
Fourth 47.7 29.2
Richest 51.7 32.9
East Indian 54.7 35.9
African 51.5 33.3
Amerindian 46.3 38.1
Mixed Race 50.9 31.5
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Knowledge on HIV is also acquired through HIV counselling during prenatal care. The numbers on HIV counselling
collected by the 2014 MICS survey show a different picture from the numbers reported by the Government of Guyana.
Among women who had given birth within the two years preceding the 2014 MICS survey, 67% had received HIV
counselling during antenatal care and 85% were tested for HIV during antenatal care and received the results
(Figure 63). Around 64% of the women in the country had received the “complete care” related to HIV (received HIV
counselling, were offered an HIV test, accepted and received the results).
Figure 63: HIV counselling and testing during antenatal care, averages, Guyana, 2014
Received antenatal
care from a health
care professional
for last pregnancy
Received HIV
c o u n s e l l i n g
d u r i n g
antenatal care
Were offered an
HIV test and were
tested for HIV
during antenatal
care
Were offered an HIV
test and were tested for
HIV during antenatal
care, and received the
results
Received HIV
counselling, were
offered an HIV
test, accepted
and received the
results
85.0 66.7 85.5 84.8 63.8
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Less than half of the pregnant women in Amerindian households and in the interior of the country had received the
complete HIV package during prenatal care (Figure 64). Much of this could be associated with the difficulties in
accessing prenatal care. It is also worrisome that less than 30% of pregnant women in Region 1 had access to the
complete preventive care in terms of HIV (Figure 65). Other regions with low access were Regions 7, 8 and 9.
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Figure 64: % of pregnant women who had received HIV counselling, were offered an HIV test, accepted and
received the results by socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 65: % of pregnant women who had received HIV counselling, were offered an HIV test, accepted and
received the results by Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
The 2014 MICS numbers show that while HIV prevention might be part of the prenatal care that takes place in the
country, its efficiency is not fully achieved. The fact that some women were not informed about HIV during their
pregnancy or do not remember having information on HIV, plus the low knowledge on HIV and the low rate of
mothers-to-be receiving the complete HIV package shows that despite the extended coverage, the content and the
reach of the PMTCT should be further evaluated and possibly improved. The PNC, delivery and PNC periods are
opportunities for HIV to be detected, and children to be prevented to contracting it. If this window is not used, and HIV
is transmitted from mothers to children without being detected, chances are high that the children will only find out
being HIV positive when they are adolescents or young adults.
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Chapter 6: Birth Registration
According to UNICEF, the birth registration is more than an administrative record of the existence of a child. It is the
foundation for safeguarding many of the child’s civil, political, economic, social and cultural rights. Article 7 of the Convention
on the Rights of the Child specifies that every child have the right to be registered at birth without any discrimination. Birth
registration is central to ensuring that children are counted and have quality access to basic services such as health,
social security and education. Knowing the age of a child is central to protecting them from child labour, being arrested
and treated as adults in the justice system, forcible conscription in armed forces, child marriage, trafficking and sexual
exploitation. A birth certificate as proof of birth can support the traceability of unaccompanied and separated children
and promote safe migration. In effect, birth registration is their ‘passport to protection.’ Universal birth registration is
one of the most powerful instruments to ensuring equity over a broad scope of services and interventions for children
, and its importance is recognize when Target 16.9 of the SDGs mentions that governments must provide legal
identity for all, including birth registration.
In Guyana, the law provides for registration of children within 12 months of birth. There is a nominal fee of G$ 30.
While the General Register Office (GRO) is responsible for recording births, deaths and marriages, and issuing
relevant certificates, the Ministry of Public Health also has some amount of responsibility for the registration of births
through their community health workers who also need to register births.
Registration centres are available in all 10 regions of the country. For children born out of marriage, the name of the
father is not stated except at the joint request of the mother and of the person who acknowledges being the father. In
that case, both are required to sign the required form.
Since 2013, Guyana has in place a bedside registration, i.e., birth registration is done at the institution where the birth
took place. However, qualitative assessment in the hinterlands shows that few are the children who were registered
at the hospital, and who have a birth certificate.
As a matter of fact, according to the 2014 MICS survey, 11.3% of the births in Guyana are not registered, with any
differences between boys and girls. The number of unregistered births is 3 times higher in Region 1 than the average
for the country (Figure 66). Similarly, a child living in the interior of the country (Hinterland), have twice the chance of
not having a birth certificate in comparison to a child living in the urban areas (19% and 9.5%, respectively) (Figure
67). Two other factors that increase the chances of a child not having a birth certificate are poverty, and ethnicity.
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Figure 66: Percentage of unregistered births by Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 67: Percentage of unregistered births by Socio-Economic Status, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
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6.1) Main causes related to low birth registration
Qualitative assessment done in Guyana indicates two immediate causes and two underlying causes that influence
the low levels of birth registration for some groups and some regions. In terms of immediate causes, on one hand,
while knowledge on the importance of having the children registered is important; on the other hand, parents and
caregivers have to have the means to register their children. Both immediate causes are influenced by the cultural
aspects and by the efficiency of the system (Figure 68).
Figure 68: Causal Tree on low levels of birth registration
6.2) Bottlenecks and Determinants
On the demand side, rooted in social and cultural practices, the lack of adequate knowledge of how to register a
child’s birth is one major bottleneck to the fulfilment of a child’s right to identity. Data show that only 16% of mothers
or caretakers of unregistered children report knowing how to register a child’s birth (Bureau of Statistics, Ministry
of Public Health and UNICEF Guyana, April 2015). Also connected to the social practices is the lack of knowledge
among parents and caregivers on the importance in having a birth certificate (side box). While some children might
be registered after birth, they do not have the official birth certificate document, and many parents of young children
do not see that as a problem.
Anchored on the enabling environment and supply side are two bottlenecks for the system: the lack of coordination
among the different stakeholders involved in the process of birth registration, and the inefficiency of the registration
system. The registration system is almost totally manual and highly centralized, resulting in delays due to loss of
application and original documents, errors, invalidity of certificates, multiple applications for one child and increased
transaction costs (Ministry of Social Protection and UNICEF Guyana, June 2014). There is also the deficiency of
effective methods to track and accurately assess the status of applications is process from their entry to completion.
As reported by the Rights of the Child Commission (Rights of the Child Commission and UNICEF, Oct 2011),
there are cases of unprepared and unskilled staff working with birth registration, resulting in errors in the process.
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For instance, some birth certificates are not being stamped by
government officials, making the document invalid. In the same
line, as appointed by the 2014 MICS, gaps in registration could
be a result of people reporting partial/incomplete registration as
not being registered. Until 2015, the partial/incomplete registration
would occur when, based on information from the child’s mother,
the father of the child was expected to present himself to affix his
signature to the form acknowledging being the father. This practice
has changed in 2015, and it is expected that the number of partial/
incomplete registrations to be reduced in the coming years. From
2015 on, birth registration forms pending fathers’ signature are
going to be processed and birth certificates will be issued by the
GRO after a specific length of time has elapsed. The process
allows for the name of the child’s father to be added to the birth
certificate at a later stage.
Box: Birth Certificate
In focus groups with indigenous mothers
in Region 1 we asked if their children had
a birth certificate. None of the children,
young or old, had a birth certificate. They
had their vaccination cards, but not the
birth certificates.
When we asked if the mothers had a birth
certificate, the answer was the same: no.
Asked why they (mothers and children) did
not have a birth certificate, they asked us
back: why do we need a birth certificate?
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Chapter 7: The Right to Education: Early Childhood
Education
Target 4.2 of the Sustainable Development Goals (SDGs), emphasizes the importance of investing in Early Childhood
Education when mentions that by 2030, countries should ensure that all girls and boys have access to quality early
childhood development, care and pre-primary education so that they are ready for primary education.
The government of Guyana recognizes the early childhood development years as birth to age and is in tune with
global trends as the Early Childhood Education (ECE) years as the period age 3 to 8. In a broader sense, ECE
could be subdivided into Day Care Centres and Play Groups for children between the ages of 0 and 3 years old,
and Nursery schools27 for children between 3 years and 6 months, and 5 years of age who did not start primary
education. Most of the day care centres are privately owned – the country has two municipal centres in Georgetown;
while Nursery institutions are made available free of charge for parents. The Ministry of Social Protection regulates
Day Care centres, while the Nursery, primary and secondary schools are under the responsibility of the Ministry of
Education.
Government has no data on the number of children in Day Care Centres. In terms of Nursery Schools, according to
the latest data available (Ministry of Education, 2012), in the school year 2011-2012, around 26 thousand boys and
girls ages 3 and 6 months to 5 were enrolled in nursery schools in the country. Out of that number, 93% of the children
were attending public nursery schools. There were 442 public and 58 private institutions offering nursery education
in the 2011-2012 academic year.
In 2014, on average, 61% of the children aged 36-59 months in Guyana were attending nursery school (59.0% of
the girls and 63.0% of the boys) (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
Attendance of ECE programmes varies by area, wealth quintile and ethnicity (Figure 69). Rural and interior parts of
the country are the ones with lower attendance. Similarly, despite the fact that public nursery schools are available,
the poorest the family, smaller are the chances that the child is going to attend ECE programmes. In terms of ethnicity,
only four in each 10 Amerindian children were attending nursery schools in 2014 (Bureau of Statistics, Ministry of
Public Health and UNICEF Guyana, April 2015). Regarding regional disparities, Regions 5, 4, 10 and 6 present the
highest attendance rates in the country. Meanwhile, in Region 1, only one child out of 5 is attending nursery school
(Figure 70).
27 Early childhood education programmes include programmes for children that have organised learning components as opposed to baby-
sitting and day-care, which do not typically have organised education and learning components.
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Figure 69: Percentage of children between 3 and 5 years of age who are attending ECE programmes,
Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 70: Percentage of children between 3 and 5 years of age who are attending ECE programmes by
Administrative Region, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Regarding quality, despite the fact that Day Care centres have to follow guidance from the Ministry of Social Protection,
there is no monitoring of quality of those institutions. The number of qualified staff and the conditions of the Day Care
institutions is practically unknown.
For nursery schools, out of the 1601 teachers at public nursery schools, 65% of them were considered to be qualified,
25% were untrained, and 10% unqualified. Out of all the teachers, 12% of them had a graduation related to early
childhood education (Ministry of Education, 2012). The Ministry of Education has pointed out in its Education Strategic
Plan (ESP) that in addition to an increase in the proportion of trained teachers, there has been improved monitoring
and greater support to schools through 40 Infant Field Officers from all education districts who have been trained to
support colleagues in a cluster of schools. The idea is that these Officers should visit schools in the cluster periodically
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to assess their instructional programmes, their internal and external environments and to offer advice as necessary
(Ministry of Education, 2015c).
Quality of care at the household environment complements the learning process that happens in educational
institutions. Different measures can be used to monitor the quality of care at home. The first one is parent engagement
with the child. Interaction with parents is crucial in supporting the development of children’s capacities for learning
(The World Bank, 2015), it helps children to build their vocabulary, shapes their behaviour, and learn motor skills.
According to the 2014 MICS survey, for almost nine out of ten (87%) children aged 36-59 months, an adult household
member engaged in four or more activities that promoted learning and school readiness during the three days
preceding that survey. In the same line, the survey indicates that the father’s involvement in four or more activities
was limited (16%), with a mean number of 1.3 activities, compared to that of the mother (55%), with a mean number
of 3.4 activities (Figure 71).
Figure 71: Fathers and mothers engagement in activities with children, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Father’s presence in playtime with children does not vary much in terms of area, ethnicity and poverty status. The
major differences in time of interaction with children is seen when the regions are taken into consideration (Figure
72). With the exceptions of Regions 2, 9 and 4, all other regions of the country had father engagement in activities
smaller than the national average.
Figure 72: Percentage of children with whom biological fathers have engaged in four or more activities by
Region, Guyana, 2014
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Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Exposure to books in early years not only provides the child with greater understanding of the nature of print, but
may also give the child opportunities to see others reading, such as older siblings doing school work. Research has
shown a strong correlation between exposure to books at home and the achievement of higher academic grades for
students (Evans, Kelley, & Sikora, 2014), as well as the importance of children from the most disadvantaged home to
have access to books to improve their academic scores (Allington, Richard L. et al, 2010).
According to 2014 MICS, 47% of the children below the age of 5 live in households that have 3 or more children’s
books, and 24% of the children in households were 10 or more books are available. Access for books is smaller for
those children living in the interior of the country, for those children in the poorest families, and living in Amerindian
households (Figure 73).
Figure 73: Percentage of children living in households that has for the child 10 or more children’s books,
Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
7.1) Early Child Development Index
2014 MICS has calculated an Early Child Development Index (ECDI) to help in assessing the developmental status
of children in Guyana. The index is based on selected milestones that children are expected to achieve by ages three
and four, in four different domains: Physical growth, literacy and numeracy skills, socio-emotional development and
readiness to learn. ECDI is calculated as the percentage of children who are developmentally on track in at least three
of these four domains. For more information on the methodology please see MICS document.
Around 86% of children aged 36-59 months in Guyana are developmentally on track, with few differences based on
socio-economic characteristics and Regions. For example, children (i) from Amerindian families; (ii) from the poorest
families; and (iii) living in the interior of the country have the smallest ECDI (73.2%, 78% and 78.5%, respectively)
(Figure 74). In terms of regions, children living in Regions 1, 7, 8 and 9 are far beyond the average for the country
(Figure 75). The results also show the importance of children to attend ECE institutions: the ECDI for children attending
ECE was 91.4% in comparison to 76.5% of those children not enrolled in ECE.
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Figure 74: Early child development index score by socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 75: Early child development index score by regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Among the four domains, children are on track in the physical and learning ones, followed by social-emotional and
literacy-numeracy (Figure 76).
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Figure 76: Percentage of children age 36-59 months who are developmentally on track for indicated
domains
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
7.2) Main Causes relate to low ECE enrolment
Figure 77 summarizes the main immediate, underlying and structural causes that influence the low access to formal
ECE services for some disadvantage groups in Guyana.
Figure 77: Causal Tree for Low Access to Formal ECE Services
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The differences in access and quality of education among regions and socio-economic profiles can be attributed to
accessibility difficulties; isolation of settlements; lack of adequate trained personnel and, in some cases, language
barrier (Krammer & Crandon, April 2015). Especially for the hinterlands, as mentioned before, accessibility to some
communities is very difficult, with no regular bus routes, very poor roads, and, in some extreme cases, boats are the
most used mean of transport. The sparse population and the difficulty of access make services delivery a problem. For
older children, as it is going to be discussed later in this document, walking from home to and from school is common.
For younger children, this is not a choice for parents. Some larger communities might have ECE programmes being
offered within the primary school building, for others that does not happen.
7.3) Bottlenecks and Determinants
In terms of bottlenecks, on the parents’ side, a mix of social and cultural practices and the financial situation
of the families hinder the access to early childhood education, and it limits the interaction between parents and
young children. Stakeholders mentioned that for certain parents, ECE is not recognized as part of the child’s formal
education. That helps to explain why 4 in each 10 children between 36 and 59 months are not in ECE institutions.
Despite the availability of tuition free Nursery Schools, access to them is still bounded by the financial capacity of the
family. As mentioned, less than 50% of the children between the ages of 3 and 5 in the poor families are enrolled in
ECE institutions. That indicates other costs that might be connected to ECE, such as uniforms, meals and transport.
Besides, for those more remote areas, as mentioned, the poor access to the government facilities is a major obstacle.
The interaction between parents and young children (in this case younger than 5 years of age) does not happen
with most of the families in Guyana. Barriers that prevent parents from engaging more fully with infants and young
children include parents’ lack of knowledge about child development, and lack of awareness that verbal interaction
with children is important. Parents might be held back by mental models based on traditional beliefs that some
practices can be harmful to the child or by a fear of ridicule for violating a social norm against talking to infants (The
World Bank, 2015).
Moreover, the harsh economic situation of the country forces parents to spend long hours working and being absent
of their houses. In some cases, in searching for better economic opportunities in the interior of the country (mining
and logging) and abroad, many parents – especially fathers – do not live with their children. As it is going to be
explored later in this Situation Analysis, the father’s absence from home is considered by many stakeholders in
Guyana as one of the principal causes of misbehaviour among adolescents, influencing school dropouts and their
behaviour in society.
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Part IV:
The formative years: Childhood
(from 6 to 11 years)
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During childhood, the dimensions of education and protection of children’s
rights take on a greater relevance during development. It is a stage when
the physical, intellectual, social and emotional capacities acquired in early
childhood are consolidated. Within this idea, chapter 8 deals with primary
education and special needs education. The chapter also uses the
opportunity to discuss the struggles that children and adults with special
needs face in the country.
Chapter 9 starts the debate on violence against children, discussing the
use of corporal punishment as a form of discipline. As in the previous
chapter, child discipline is not exclusive of the 6 to 11 group. Nonetheless,
this is the group that cannot react to this type of violence and, most of
the time, will accept it silently. The discussion on child discipline creates
a bridge with the next part of the Situation Analysis that covers the
adolescent years. In that part the major topics related to child protection are going to be presented and discussed.
Box
In one of the visited indigenous
communities, ECE services were
offered in a multilateral school,
where younger children were
separated from older ones by the
blackboards. Multi-grade teaching
is common. The caveat was that
the teacher did not speak the
local language, so communication
between pupils and the instructor
was difficult.
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Chapter 8: The Right to Education
8.1) Primary Education
Primary education is mandatory in Guyana, covering children between the ages of 6 and 11. There were 94,843
children enrolled in the six grades of primary education in the 2011/2012 academic year (Ministry of Education, 2012),
49% of them were girls (Figure 79). The vast majority of pupils (93%) were enrolled in free public government schools.
According to the 2014 MICS, on average, 85% of the children attending first class of primary school in 2014 attended
preschool in the previous year, an increase when compared to 2006 when only 65% of the children had attended
preschool (Bureau of Statistics and UNICEF Guyana, 2008). There is not much variation in terms of preschool
attendance between poorest and richest families, and between urban and rural areas. The main difference is seen
when the regions are taken into consideration. Among the ten regions, Region 2, followed by Region 1, have the
smaller proportion of boys and girls entering primary education with the preschool background (Figure 78).
Figure 78: Percentage of children attending first grade who attended preschool in previous year, by
Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Due to delays in analysing the 2012 Census, the country does not have
available an official net enrolment rate (NER) for children at primary
education. The lack of official rates does not allow for a proper discussion
on the efficiency of the system. Official data from the Ministry of Education
shows that in absolute numbers, the number of boys and girls in grades
5 and 6 is bigger than the number of pupils in the initial years of primary
education, with not much difference between boys and girls (Figure 79).
Total enrolment by regions will follow the demographic distribution for the
country, i.e., for those regions with higher populations – Region 4, for
example – the total enrolment of children in primary schools is going to be
higher than for those regions with smaller populations – Regions 7 and 8.
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Figure 79: Number of boys and girls enrolled in primary education, public and private institutions, Guyana,
2011/2012
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
Numbers from the 2014 Multiple Indicator Cluster Survey show that the Net Attendance Ratio (NAR)
for primary education was 97%, with no variation in terms of gender, region, area, wealth quintile and ethnicity. Also,
the MICS shows that a group of children is starting primary education at an older age than the recommended 6 years.
In 2014, around 10% of children at age six were out of primary education, the majority of them were still attending
preschool (and therefore starting primary education older than the recommended age), and a smaller group was out
of school.
Around 96% of the children who start grade 1 in the past reached grade 6 (last grade of primary education in Guyana),
showing an improvement when compared to 2006, when 71% of the children would reach grade 6 (2006 MICS). As
depicted in Figure 80, in 2014, primary school completeness starts showing a tendency that is very clear in secondary
education: the fact that more girls are finishing their formal studies than boys.
Figure 80: Percentage of pupils who reach grade 6 by gender, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
One possible reason for the high percentage of children finishing primary education is connected to the automatic
promotion policy (Grade Retention policy) implemented by the Ministry of Education in 2011 and revised in 2013. The
initial policy allowed for all students to be promoted to the next grade regardless of their performance at the annual
assessments. However, the revised policy allows for students to repeat a grade if they score below the overall pass
mark set by the school in more than 50% of the subjects (Bureau of Statistics, Ministry of Public Health and UNICEF
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Guyana, April 2015).
The primary completion rate was 109% for 2014, also suggesting that there are children starting their primary
education at older age than the recommended. In terms of transition to secondary education, 96% of the children,
regardless of sex, who were attending the last grade of primary school in the previous school year, were found to be
attending the first grade of secondary school in the school year of the 2014 MICS survey.
While access to primary education is important, guaranteeing quality education for all children in the country is the
prerequisite for achieving equity, and for the fully development of individuals and society (UNESCO, 2005). Quality
and equitable educations at primary and secondary schools are in the core of the Sustainable Development Goals
(Target 4.1). Different measures of quality exist worldwide. In Guyana, the new MoE Strategic Plan tries to emphasize
the importance of quality education through a list of outcomes that should be achieved by 2018 (see box below).
Box:
Quality in Education:
The MoE in its 2014 – 2018 strategic plan indicates the following as their outcomes:
Good learning achievements, especially for literacy, mathematics, and science, with an increasing percentage
of students scoring at advanced levels;
High levels of internal efficiency (high attendance rates, low repetition rates, low dropout rates, high completion
rates for each level of education);
High levels of equity (low differences on enrolment rates, learning scores and internal efficiency rates between
sub groups of students).
Some current measures in quality of education at primary level are associated with the academic and professional
qualifications of teachers – the assumption being that qualified and trained teachers will help to improve learning
(Ministry of Education, 2015c). Around 73% of all the teachers in primary education in Guyana were considered to be
trained to be teaching at that level. That national average hides regional inequalities depicted in Figure 81.
Figure 81: % of trained teachers in Primary Public Schools, by Region, Guyana, 2011/2012
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
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Access to education material, in particular textbooks, is seen as an indication of quality so the ratio of students to a
book is another indicator with the ideal being one book per student for each subject. In theory, all children should have
access to free books for mathematics, English and science. Nonetheless, interviews and focus groups show that the
distribution of books for those children in the most remote areas is sometimes a problem, and occasionally children
only have access to their books weeks after the educational years has started.
Access to computers, computer programmes and properly equipped laboratories and workshops, is also seen as
essential to foster learning. According to information provided by the Ministry of Education, out of the 436 government
primary schools (numbers from the 2011-2012 Educational Digest) 83 of them had computer labs, in regions 2, 3, 4,
5, 6, 7, 9, 10 and Georgetown. Therefore, the vast majority of primary schools in the country do not have electricity
and, consequently, children at school do not have access to the Internet or any type of multimedia method. As a
matter of fact, in using households as proxy of schools that have access to electricity, only 56% of the households in
the interior have electricity in comparison to 91% of the households in the coastal areas. Differences are also seen
among regions: 25% in Region 9; 27% in Region 1; and 47% in Regions 7 & 8; compared with between 78 and 94%
of households in the other regions (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
In the same line, despite the fact that more primary schools have access to water and sanitation today than in 2008
– the estimate from 2008 was 51% of primary schools and the number for 2013 registers 68% of the primary schools
with access to water and sanitation (UNICEF, Feb 2015) –, the numbers are still far from ideal, affecting thousands
of children.
Another measure of quality of education is the pupil-teacher ratio. In theory, smaller the number of children per
teacher, higher is going to be the attention that the teacher can provide to the students, increasing their chances of
learning. On average, this ratio was 23 students per teacher in the 2011/2012 academic year, with some differences
between private and public institutions (Table 17). Trained teachers also influence the quality of education. According
to the Ministry of Education, there were a little bit more than 4 thousand primary schools teachers in Guyana in
2011/12. Out of the total number of teachers, 2,840 or 70% of them were considered trained to be teaching at primary
level. The average ratio pupil/trained teacher for both private and public schools was 33.
Table 17: Pupil/Teacher Ratio in private and public primary schools, Guyana, 2011/2012
Public Private Country
Pupil Teacher Ratio 24 15 23
Pupil/Trained Teacher Ratio 33 33 33
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
The difference between these four measures of quality of education contributes to the gap between coastal and
hinterland in terms of student’s achievements in primary education. Despite the fact that standardize tests are not the
best option to measure the outcome of education (Baker, 1988), they provide a quantitative measure that can help
decision-makers to identify problems and plan their actions. In Guyana, quality of primary education can be compared
over time using the grades of the National Grade Six Examinations (NGSE), the exam that classifies the students
based on their scores in math, English, science and social studies.
On the average, student performance on the NGSE has improved between 2009 and 2013 (Figure 82), with some
significant improvements in the case of mathematics. Despite this positive trend, in looking at the data with equity
lenses, the progress has not been similar in coastal in hinterland areas.
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Figure 82: Percentage of pupils scoring 50% or more on NGSE, 2009 and 2013
Source: National Grade Six Assessment Analysis 2009 and 2013.
It is true that both hinterlands and coastal areas had better grades in 2013 than 2009; nonetheless, the gap between
these areas was not reduced, and, in fact, has increased. For instance, in 2009, the difference between the hinterlands
and the coastal area for mathematics was 15 percentage points. In 2013, despite the fact that more students in the
hinterlands were achieving 50% of the grades when compared to 2009, the gap has increased to 24 percentage
points (Figure 83). Similar increase in the gap happened with English (Figure 84) and Science (Figure 85).
Figure 83: Percentage of children achieving 50% or more in Mathematics, Hinterland and Coastal areas,
Guyana, 2009 and 2013
Source: National Grade Six Assessment Analysis 2009 and 2013.
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Figure 84: Percentage of children achieving 50% or more in English, Hinterland and Coastal areas, Guyana,
2009 and 2013
Source: National Grade Six Assessment Analysis 2009 and 2013.
Figure 85: Percentage of children scoring 50% or more in Science, Hinterland and Coastal areas, Guyana,
2009 and 2013
Source: National Grade Six Assessment Analysis 2009 and 2013.
One major element that influences the outcomes of education in coastal and interior areas is related to the language
barriers that some populations face in the interior of Guyana. Assessment commissioned by UNICEF and conducted
with the full participation of the MoE in 2012 show the need to accommodate the traditional local languages to English
in a way that students are not penalized for not having learned English at home. At the same time, the assessment
shows the concern with the traditional languages in the country so they are not considered to be a second class
language, leading to their extinction (UNICEF Guyana, Dec 2012). Qualitative information points to the fact that the
country has nine different Amerindian tribes each with their own language. Besides, in the border regions, due to the
frequent migrations, Portuguese and Spanish are common languages among the population. It is possible that some
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children will only have a formal contact with English when they start their primary education, creating a difference
between them and those boys and girls who are immersed in the country’s official language since they were born.
As the teaching aid and tests are written in English, it is expected that students from the coastal and urban areas will
outperform the pupils from the hinterlands. Besides, the majority of teachers at all levels are not trained in English as
Second Language (ESL) and in cross-cultural instructions (UNICEF Guyana, Dec 2012). Moreover, some teachers –
especially those from outside the regions – are not used to the local languages.
The language barriers will influence learning in primary school, and they will also be one of the reasons why some
students drop from secondary school. While no study has been conducted, there is reason to speculate that the use
of English language in the classrooms and the exclusion of indigenous languages may be a contributing factors to
the dropout rates in schools in indigenous communities (UNICEF Guyana, Dec 2012).
Despite improvements in the grades over time, different sectors of the government have expressed concern with the
quality of education in the country. For instance, the Ministry of Finance on its Budget Speech called attention that
Guyana “cannot ignore the abysmal results for Mathematics and English in this country, where more than half of our
students are unable to establish that they have general proficiency in these two foundational subjects” (Minister of
Finance, Aug 2015).
A) Bottlenecks and Determinants in Primary Education
As mentioned, the lack of official enrolment rates jeopardizes an assessment of coverage of the system, i.e., it is
not known if all children between ages of 6 and 11 are enrolled in primary education, and if they are finishing it.
Nonetheless, the difference in quality of education between the hinterland and coastal areas is clear, and summarized
in the following excerpt from the Ministry of Education, that also indicates some of the main determinants that reinforce
this gap:
“While there has been significant improvement in the physical structures at this level, many primary schools are still
in an open classroom system. Some schools in hinterland communities have no access to a source of power and in
general it is more difficult to get resources into these schools. Many of the smaller schools are multi grade schools (a
teacher teaches two or more grades) and they are mainly located in the hinterland regions and in the remote riverine
areas of coastal regions. Unfortunately these are also the areas, which have a lower proportion of trained teachers.
Nationally over 70% of primary school teachers are now trained but in the hinterland regions the proportion falls to
51%” (Ministry of Education, 2015c).
On one hand, government has been trying to close the gap between the different regions of the country with policies
focusing on the demand side (families) and on the supply side (teachers and schools). For instance, in order to
increase enrolment and retention in primary education, in 2008, the Government implemented school feeding, school
uniform, and textbook programs targeting nursery and primary schools, which has resulted in improved school
attendance among children in the hinterland (PAHO, 2012). At the same time, the School Welfare Unit has developed
indicators for characterizing and locating actual and potential exclusion; identified barriers to inclusion; and proposed
strategies to remove barriers (Ministry of Education, 2015c).
On the other hand, despite all the efforts, the policies are not being efficient enough to guarantee that the benefits
are enough for all children in the country, especially those located in the most remote areas. For example, despite
the fact that assistance to parents to buy uniforms for their children are in place, interviews have identified that some
parents do not know their children could have access to that benefit. For those parents who access the benefit, the
major complaint was that the subsidy is only enough to buy one uniform for each child, and that uniform should last
for the whole year. Besides, the assistance does not cover eyeglasses for those children who need it. Parents can
apply for extra benefits from the School Welfare Unit, but the process does not seem to be clear, and involves some
bureaucratic steps that create another layer of difficulty for some parents.
Another financial barrier for the families is related to the cost of going to school. Families have to afford the child’s
transport to school, and, as discussed before, for some children, that involves boat trips and/or walking for more than
one hour. The distance and the accessibility to school were identified as a major deterrent in ECE, and they continue
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to be a problem in primary and secondary levels. The difference is that in primary school children are older, and in
some areas of the country, it becomes normal for them to walk for more than 1 hour to and from school.
Focusing on the supply side, government has also been trying to address the gaps in primary education through
actions to increase the quality and retention of teachers in the most needed areas. Anecdotal evidence points that
most of the teachers want to be placed in the coastal schools, where infrastructures at school and in the cities are
better. Anecdotal evidence also shows that those teachers who were being brought to the country’s capital for training
would try to remain in the city, sometimes abandoning their teaching careers in the interior of the country. In order to
avoid that problem, to increase the number of teachers being trained, and to make the process more cost efficient,
teachers in the hinterland are being trained through a Distance Education Training Program. Despite not being
formally evaluated, stakeholders link the improvement in teacher qualification to this programme.
Government has also institutionalized two formal incentives trying to attract and keep qualified teachers to the interior
of the country: (i) the remote area incentive – available to everyone working as a teacher in the Hinterland; and
(ii) the hard-line allowance – available for a teacher coming from the Coastland. Both incentives are based on the
distance from an urban centre or town. For example, if a teacher in Region 9 is closer to Lethem town, the incentive
would be G$5,000 per month (around USD 25); further off would be G$7,000 a month (around USD 34). However,
stakeholders mentioned that the incentives still do not compensate for the higher costs and challenges a teacher
incurs while living and working in the Hinterland. Some may have to provide for two homes where their families are
still dwelling on the Coast.
8.2) Children with Special Needs
Survey from 2013 indicates that most of out of school children
that need special education are in the group between 6 and
12 years of age (National Centre for Educational Resources
Development, 2013).
Currently, the country has no official information on the number
of adults and children with disabilities and/or special needs
who live in the territory, and how many of them are enrolled at
school. The World Health Organization estimates that 10% of
the population in 2013 had some type of disability, a number that
would be higher than the 6.3% suggested by the 2002 census
(National Centre for Educational Resources Development,
2013). Consequently, it is impossible with today’s information to
have any measurement of efficiency of the educational system
for that population, and to affirm that the right for education
for children with special needs is being realized. Despite this
fact, it is consensus among the stakeholders in Guyana that
the number of children in special education institutions is far
from the reality, and the current structure does not attend all
that need.
A) Bottlenecks and Determinants related to education for children with special needs
National policy demands that children with special needs should be placed in the mainstreamed schools. However,
due to institutional capacity of the school system – lack of specialized teachers, support staff and infrastructure, few
are the special needs students in the regular schools. As a matter of fact, access to educational opportunities
is seen as one of the major bottlenecks in the current system. For instance, a 2005 survey commissioned by the
National Commission on Disability (NCD) found out that 15% of all persons with special needs have never attended
school, and the proportion increases to 42% among those under 16 years of age (National Commission on Disability,
UNICEF Guyana and VSO, 2005).
Box: Guyana School Feeding Programme
Guyana currently has a national School
Feeding programme that seeks to address
the issue of nutrition and specifically in the
hinterland regions.
A World Bank Evaluation from the Guyana
Community-Based School Feeding Program
(The World Bank, June 2013) has identified
that the program improved community
participation in schools and children’s
human development outcomes: enrolment
in the schools have increased by 16%; more
children were attending school; children
who were part of the schools where the
program was being implemented grow more
than children from other schools; scores
have improved; and school participation in
classroom activities increased.
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Access is limited due to the location of the schools that provide Special Education Services and due the associated
cost related to transport children from and to the schools. The majority of Special Needs schools are located in
Region 4, and more specifically in the capital – Georgetown. The long distances that some children have to travel
to these schools inhibit their attendance also because of financial constraints. Even when vocational training is
available for those older children with special needs, some cannot complete due to the cost of transportation (Ministry
of Education, 2015a). Data shows that among those who answered the 2005 survey, 79% of families caring for a
person with special needs have experienced financial difficulties. The main reason for that is the attention that is
necessary for caring for a persons with disability limiting the main care givers level of engagement in employment,
and consequently reducing the overall family income.
There are also social and cultural practices and beliefs that hamper a more inclusive education in Guyana. For
some parents, the fact that they have a child who requires special attention is seen as a burden and considered to be
shameful. Adding to that, parents do not know their rights and the available support that they could get from different
organizations. Other “normal” children also present negative attitudes towards those who need special education.
In this line, there are different reports of bullying and aggression against these children. The NCD 2005 survey has
shown that 44% of the respondents have experienced negative attitudes or behaviours as a result of their disability.
In sum, as mentioned by the UN Committee on the Rights of the Child, societal discrimination against children with
disabilities remains widespread (UN Committee on the Rights of the Child, 2013).
On the supply side, few are the institutions that are prepared to receive these children in terms of infrastructure
(washrooms, ramps, etc.) and in terms of staff capacity. There are few new teachers being trained to handle children
with special needs – most of the teachers who go into training are those who already work with special needs
children. The teachers’ training institution offers a module in special education. Across the Regions, with the support
from UNICEF training programmes for teaching to the blind/visually impaired and the deaf have begun. Nonetheless,
the country still has a massive shortage of specialized teachers and qualified staff. Aggravating the situation is the
absence of a career path for designated Special Education Needs (SEN) teachers; promotion is sought through
appointment to traditional schools, thus draining the already depleted SEN teaching force (Ministry of Education,
2015a).
Therefore, inclusive education and training of teachers for its provision
remain severely limited, particularly for children with sensory, cognitive, and/
or mental impairments, which leads to the majority of children with disabilities
staying at home, resulting in isolation, stigmatization and compromised
access to employment opportunities and social services (UN Committee on
the Rights of the Child, 2013). The reality is that children with disabilities have
difficulties in access not only schools, but also health services, employment
and even social and recreational opportunities. The country’s infrastructure
is not accessible for children and adults with motor impairments; and even
in the country’s capital, sidewalks, buildings and roads are not completely
accessible.
Sustainable Development
Goals (SDGs)
Target 4.a: Build and upgrade
education facilities that are
child, disability and gender
sensitive and provide safe, non-
violent, inclusive and effective
learning environments for all.
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Chapter 9: The Right to be Protected
9.1 Corporal Punishment
While discipline is important in the formation of a child’s behaviour, corporal punishment at school or at
home is a violation of a child’s basic human rights, which includes the right to protection against any form
of violence and the right to respect for their physical integrity and human dignity. Corporal punishment
interferes with the learning process and with children’s cognitive, sensory, and social emotional development
. Research has connected corporal punishment to increase in antisocial behaviour in adolescents and to the
recurrence of sexual and domestic abuse and violence (Global Initiative to End All corporal Punishment of Children,
May 2015). Corporal punishment is a form of physical abuse against children, and it is considered by many as a form
of domestic violence.
In Guyana, corporal punishment is still legal – with the exception of the courts and the juvenile justice system, where it
has been repealed from the laws. A 2005 study involving nearly 4,000 children aged 3-17 in Guyana found that 81%
had been beaten or hit with a belt, cane, whip or other object; children as young as 3 years reported being disciplined
by their parents with an object. One third of children described physical punishments leading to injury, including
bleeding skin, broken bones and blacking out (Global Initiative to End All Corporal Punishment of Children, 2012).
The use of corporal punishment in Guyana has been slightly reduced over time. In 2006, around 74% of
the children between 1 and 14 years of age in Guyana had suffered a form of violent discipline in the month
preceding the data collection, which would include psychological aggression and/or physical punishment. In
2014, 70% of children suffered corporal punishment. Boys are more prompt to receive violent discipline than
girls. At the same time, violent discipline is independent of the household’ socio-economic characteristics (Figure
86), and the region where the child lives (Figure 87), for instance, while 87% of the children were disciplined
through a violent method in Region 9, the same is not true in Region 1, where less than 48% suffered this type
of violence. In the same age group, 6.4% of the children had suffered some sort of severe physical punishment
.
Figure 86: % of children 1-14 years disciplined through a violent method by socio-economic
characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
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Figure 87: % of children 1-14 years disciplined through a violent method by Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
A) Causes related to corporal punishment
Despite some differences among regions and socio-economic groups, corporal punishment is so entrenched in
the society that it is practiced at almost the same level by all socio-economic groups (Figure 86), independently
of poverty, place of residency or ethnicity. There is consensus in the country that the practice is rooted in Guyana’
societal norms, and it is not seen as a form of violence against children; instead, it is considered by many as an
effective mechanism of discipline. As a matter of fact, around 50% of respondents of a 2011 survey mentioned that
corporal punishment is necessary to bring up children properly (UNICEF Guyana, Nov 2015).
At home, bad behaviour is perceived to be best corrected by whipping and be administered by any parent, older
sibling or other adult family member, and this can be exacerbated by the abuse of alcohol and/or other drugs by
parents. At schools, the Ministry of Education has been trying to phase out the practice from public schools but there
is resistance from different levels of society including parents, teachers and unions. Some teachers defend the idea
that without some lashes – especially in the younger groups – there would be chaos in the classrooms (Ministry of
Social Protection and UNICEF Guyana, June 2014). Figure 88 depicts the main immediate, underlying and structural
causes related to corporal punishment in Guyana.
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Figure 88: Causal Tree related to corporal punishment
B) Bottlenecks and Determinants
Guyana’s legislation related to corporal punishment is confuse and sometimes contradictory, and could be considered
as a major bottleneck to end this practice. The Protection of Children Act differentiates between corporal punishment
and physical abuse, nonetheless, the identification is not straight forward, and it is subject to assessment by the
Child Protection Officers who is called to intervene. As mentioned by interviewees, if a child is exposed to a couple
of lashes, and a parent frequently uses this form of discipline, the officers will work with the parent to promote non-
violent forms of discipline, without major punishments for fathers and/or mothers. The Act is clear on a child who has
been assaulted, that parent will be arrested and charged.
At schools, the current policy, which restricts administering corporal punishment to head teachers and senior teachers
with an accompanying “Maintenance of Classroom Discipline Manual”, has proven ineffective (UNICEF Guyana,
Nov 2015), and positive forms of discipline are being disseminated in society. Some private schools have banned
the practice. In this line, different NGOs and government officials are working with parents and teachers to change
behaviour towards non-violent discipline methods.
While some might advocate that violence against young children is connected to the poverty status of the family, the
results of the 2014 MICS shown that this argument is not true, since corporal punishment is practiced independently
of the family wealth status. In that sense, on the demand side, bottlenecks and barriers that interfere in the current
situation are more connected to social norms and cultural practices than any other reason. The fact is that corporal
punishment has being practiced generation after generation and it is accepted as a suitable form of discipline.
One of the problems of using corporal punishment as a form of discipline is the message that violence is a suitable
method of correcting someone’s attitude and/or behaviour. That message is being sent to children since young ages,
creating a self reinforcing situation where later in life the same concept is going to be used generating cases of
domestic violence and abuse against children and women. The discipline through violence is one of many “forms of
violence” that children face in Guyana. Part V of the situation analysis will describe other forms of violence that are
initiated or aggravated by the practice of corporal punishment.
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9.2 Child Involved in Economic Activities and Household chores
In Guyana, around 25% of children aged 5-17 years are engaged in some form of economic activity28. The older
the child, higher is the chance that he/she is going to be working for longer hours. Table 18 depicts the percentage
of children working in economic activities for three different age groups. The bulk of children involved in economic
activities and child considered to be working are between 12 and 17 years of age, which is discussed in chapter 13.3.
Table 18: Percentage of children involved in of economic activities during the week previous to the survey,
Guyana, 2014
Age Group %
5 to 111 16.9
12 to 142 31.1
15 to 173 34.9
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
On average, 17% of the children between ages of 5 and 11 are engaged
in some form of economic activity for at least one hour (17.6% for girls
and 16% for boys). That involvement is higher in Region 9 (69% of the
children), in the interior of the country (31% of the children), among the
poorest families (29% in comparison to 13% of children in the richest
families), and among Amerindian families (35%) (Table 19).
In terms of household chores, on average, almost 57% of the children
between 5 and 11 were helping at home (58% among boys and 55%
among girls). Table 19 shows that the same characteristics involved in
being engaged in economic activities also apply to household chores,
i.e., those children in Region 9, from the interior of the country, in the
poorest families, and from an Amerindian ethnicity are more susceptible
to be involved in household chores. One important factor to mention is
that among the children who are helping at home, 57% of them attend
school, and 34% did not, indicating that household chores might start
when children are young, and therefore, before they start their formal
primary education.
Table 19: Percentage of children 5 to 11 years of age involved in economic activity and household chores,
by socio-economic characteristics and Regions, Guyana, 2014
Economic activity for
at least one hour
Household chores
less than 28 hours
Total 16.9 56.5
Boys 16.1 58.2
Girls 17.6 54.9
Region 1 11.7 55.6
Region 2 17.4 52.7
Region 3 12.3 58
28 Economic activity (paid or unpaid) is any work on plot / farm / food garden; looking after animals; helping in family or relative’s business,
running own business; producing or selling articles / handicrafts / clothes / food or agricultural products; or any other activity in return for income
in cash or in kind. For detailed definitions of child labour please access the 2014 MICS report (Bureau of Statistics, Ministry of Health and
UNICEF Guyana, April 2015).
The voice of adolescents:
Is corporal punishment a form of
discipline?“The older generation
views it as a form of discipline and
the younger generations who are
aware of their rights now view it as
a form of violence. So the view is
changing to more non-violent forms
of punishment. Young teachers do
not administer corporal punishment
but sit students down and speak to
them and be more of a friend to their
student. On account of this some
students choose to not listen or
show respect to their teachers.”
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Economic activity for
at least one hour
Household chores
less than 28 hours
Region 4 10.7 53.9
Region 5 9.9 52.8
Region 6 20.4 46
Regions 7 & 8 24.5 70.4
Region 9 69.2 90
Region 10 15.8 61.7
Urban 12.9 48.2
Rural 18.2 59.4
Coastal 13.2 53
Urban Coastal 10.8 45.9
Rural Coastal 14.2 55.6
Interior 30.9 70.2
Poorest 29.1 69.1
Second 12.7 56.5
Middle 13 49.1
Fourth 9.9 55
Richest 13.6 46
East Indian 16 50.8
African 12.3 59.9
Amerindian 34.7 73.5
Mixed Race 13.8 52.1
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Causes, bottlenecks and determinants related to children involved in economic activities and household chores
are discussed in chapter 13.3.
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Part V:
The emergent years: Adolescents
(from 12 to 17 years)
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Early adolescence marks the onset of puberty and recent brain research reveals that adolescence involves a critical
transition for cognitive development. Early adolescence involves experimentation with new ways of behaving,
transitioning into a time of risk-taking as well as greater responsibilities. As adolescent boys and girls grow, they begin
to develop a greater sense of identity that affects decisions and life choices. At this stage, investment must focus on
those adolescents who are most at risk of passing the legacy of poverty and discrimination to the next generation
(UNICEF, April 2012).
During adolescence, gender norms and roles tend to consolidate and the developmental paths of girls and boys
begin to diverge. Although particular experiences vary by cultural and socio-economic contexts, the onset of puberty
can often mark an increase in the mobility of an adolescent boy, while that of a girl is often decreased. She may face
limitations in the ability to make decisions affecting her education, work, marriage, and relationships. Discriminatory
social and cultural gender norms also negatively affect boys, constraining them to concepts of masculinity that
perpetuate discrimination and keep them from realizing their full potential, including in roles as partners and caregivers
(UNICEF, April 2012).
This part of the situation analysis has four chapters. Chapter 10 presents the problems related to secondary education,
focusing on the stakeholders’ perception that adolescents are dropping out of school before finishing their formal
education. Chapter 11 deals with teenage pregnancy. While teenage pregnancy could be seen with “health” eyes, the
main concern is the protection aspect of it. Chapter 12 deals with adolescents and HIV. Finally, chapter 13 discusses
many aspects relate to child protection, including domestic violence, different types of abuse and children in contact
with the law, among others. As it happens in the other parts, some of the problems presented in this part of the
Situation Analysis are not exclusive of boys and girls in the adolescent group – child labour, for example – but the
decision was to have the discussion in one place so the topic could be analysed with more narrowed eyes.
Also, similar to the other chapters, the discussion starts with a brief description of the problem, and jumps into an
analysis of causes and determinants. This analysis is sometimes explicit taking the shape of a subchapter, and in
other times it happens within the main text.
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Chapter 10: The Right to Education: Secondary Education
10.1) Enrolment Numbers
Similar to primary education, an official net enrolment rate (NER) is not available, jeopardizing any analysis of the
efficiency of the system. The Ministry of Education acknowledges that 82,091 boys and girls were enrolled in private
and public secondary schools in the country for the school year 2011/2012 (latest dataset available), most of them in
public general secondary schools (Figure 89).
Figure 89: Percentage of students enrolled in public and private institutions, secondary level, Guyana,
2011/2012
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
As mentioned in Chapter 3.1, the Secondary Departments of Primary Schools (SDPS) hosts those students who did
not perform well in the National Grade Six Examinations (NGSE), and do not immediately qualify to attend a general
secondary school, and/or those students who cannot afford going to secondary schools. In general, 15% of the
students attending public secondary schools in Guyana in the 2011/2012 academic-year were in SDPS. The national
average hides a significant inequality among the regions (Figure 90).
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Figure 90: Percentage of students in General Secondary Schools and Secondary Department of Primary
Schools, by region, Guyana, 2011/2012
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
10.2) Gender Parity at Secondary Education
While the majority of students at primary level were boys, the situation is different in secondary education. Among
the children enrolled at secondary level in 2011/2012, 51% of them were girls and 49% were boys. Starting in Form
3, there are more girls than boys enrolled at school, and that difference becomes very clear in Form 5 (Figure
91). Possible causes for more girls than boys in secondary education are related to school dropouts, topic to be
discussed later on this chapter.
Figure 91: Total number of boys and girls enrolled in secondary education in Guyana, by grade, 2011/2012
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
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10.3) School Attendance, Out of school children and School Dropouts
Different stakeholders in the country agreed that children might be enrolled at school, but guaranteeing their
attendance is a different challenge. Secondary Net Attendance Ratio (NAR) for the country29 in 2014 was 84.5%,
being 88% for girls and 81% for boys, indicating that among those who are enrolled in school, 15% of them do not go
to school (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Net attendance varies by
region (Figure 92); and by area, wealth quintile and ethnicity (Figure 93). Table 20 presents the same disaggregation
by gender. Possible causes related to high levels of absence are very similar to those connected to the elevated
number of out-of-school children and school dropouts, topics that are explored a little later in the text.
Figure 92: Secondary Net Attendance Ratio by region, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 93: Secondary Net Attendance Ratio by socio-economic status, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
29 MICS did not differentiate between public and private secondary schools, or between general and Secondary Departments of Primary
Schools.
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Table 20: Net attendance ratio, boys and girls, by socio-economic characteristics, Guyana, 2014
Boys Girls Total
Total 81.0 87.9 84.5
Region Region 1 59.2 71.5 65.4
Region 2 73.2 79.6 77.0
Region 3 82.0 88.3 85.0
Region 4 83.4 90.4 86.9
Region 5 79.8 88.7 84.3
Region 6 77.5 87.4 82.3
Region 7 & 8 68.3 78.6 74.4
Region 9 84.0 83.5 83.7
Region 10 89.6 90.6 90.0
Area Urban 85.2 94.1 89.6
Rural 79.5 85.7 82.6
Coastal 81.6 89.5 85.6
Urban Coastal 82.5 94.3 88.5
Rural Coastal 81.3 87.8 84.5
Interior 77.5 79.1 78.4
Wealth index
quintile
Poorest 72.7 76.0 74.3
Second 74.4 88.0 80.6
Middle 80.7 91.0 85.9
Fourth 89.3 91.2 90.3
Richest 92.7 96.1 94.5
Ethnicity of
household head
East Indian 76.9 84.8 81.0
African 88.9 96.4 92.2
Amerindian 68.8 77.8 73.6
Mixed Race 80.1 87.5 84.1
Others/Missing/DK 39.0 73.9 63.5
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Out of school children at secondary level is a reality for the country.
According to the 2014 MICS, 14.4% of children between 12 and 16
years of age were not attending secondary school. The country average
conceals regional (Figure 94) and socio economic inequalities (Figure
95). For instance in Region 2, 22% of boys and girls between the ages
of 12 and 16 are out of school – meaning that they are not in primary nor
secondary institutions. Similarly, one in each five boys and girls in the
same age group in poor families, and living in Amerindian families are
also out of secondary school.
The Voice of Adolescents
Why are there more girls than boys
in high school?
“Because of poverty. Parents would
send their girls to school and have
their boys work to earn an income for
the family. It is easier for boys to find
a job than a girl as some business
would hire a small boy over a small
girl.”
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Figure 94: Secondary Level Out of School Population by Region, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 95: Secondary Level Out of School Population by Socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
While on average more boys are out of school than girls – 63.7% of the out-of-school population are boys, and 36.3%
are girls – when the information is disaggregated at different socio-economic indicators new patterns will appear. For
instance, poverty pushes an almost similar number of boys and girls to be out of school. Among those children out
of school in the poorest quintile, 46% of them are girls, compared to 10% of girls in the richest quintiles (Figure 96).
Similarly in Region 2, 7 and 8, 50% the secondary level out of school population are girls, and in Region 9, more girls
are out of school than boys (Figure 97).
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Figure 96: Percentage of secondary level out of school students, by gender and wealth quintile, Guyana,
2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 97: Percentage of secondary level out-of-school students by gender and region, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Usually, the secondary out-of-school population has three origins (UNICEF and UNESCO Institute for Statistics,
2011). First, those children who are still in primary level and will start secondary education late. The second group
is formed by those children who will never attend school, and the third group by those children who were at school
but for different reasons dropped out. The first group is not a concern in Guyana since boys and girls are still at
school and are expected to move from primary to secondary education – however, one might say that these are the
adolescents who have higher propensity to drop out later. As a matter of fact, among children 12 and 16 years of age,
only 1.2% was still in primary school (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
The second group is also minimum in the country since most of the children are entering the formal education system
(2014 MICS data shows that the literacy rate for the country is 98%, and NAR for primary education is almost 97%).
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The third group is the one where the majority of out-of-school children in Guyana are placed, i.e. adolescents enter
secondary education but do not finish their formal studies.
Numbers from the Ministry of Education for the school year 2011/2012 present a dropout rate of 7% for that academic
year (Ministry of Education, 2012). 2014 MICS analysis shows that at age 14, boys and girls start dropping out of
school with higher intensity, reaching a point when at age 16, 35.1% of the boys at that age are going to be out of
school (Figure 98).
Figure 98: Percentage of out-of-school children by age and gender, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
School dropouts are not recent phenomena. Data shows that starting in 2007 the school life expectancy
at secondary education for boys and girls start to be different (Figure 99). While the indicator for boys has been
constant since the early 2000’s, for girls there is a constant improvement along the years. This might be an evidence
that policies of incentives might had influenced girls to stay more years in school than boys.
Figure 99: School life expectancy in secondary education, 1999-2012, Guyana
Source: World Bank (http://data.worldbank.org/)
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A) Causes for school absence and dropouts
School absences and school dropouts are rooted in very similar causes. Differently from other countries, the Ministry
of Education does not officially monitors and publishes the causes of absence and dropouts. Hence, in order to try
to determine these causes in Guyana, a mix of quantitative and qualitative methods were used. These are depicted
in Figure 100.
Figure 100: Causal tree for school absence and dropouts in Guyana
B) Bottlenecks and Determinants of school dropouts
The economic situation of the family (financial access) is one of the major causes that influence absence and
dropouts; i.e., poverty will directly influence in the child’s propensity to be at school. The financial aspect is connected
to many small indirect costs that when added up can significantly impact the household’s budget, especially for
families with many children. For instance, as it happens in primary education, there is no public transport to and
from school in both urban and interior areas of the country, creating the need for parents to pay for it. The difficulty of
access and the cost associated to school access in the interior areas was already mentioned. Despite the fact that
the urban areas do not suffer the same difficulties of access of the interior areas of Guyana (unpaved and dark roads,
distance villages, access by boats etc.), some distances in the urban centres create a need of transport by car or bus,
being translated into extra expenses for some families.
In the same line, while the books for the four basics subjects are available for free, parents have to afford the books
for specific subjects, and, in the case of the most remote areas of the country, parents also have to pay for private
tutors to teach these subjects since some schools do not have specialized teachers available. Young people that
participated in focus groups in Guyana mentioned that the lack of free meals at school also hinder the presence of
adolescents at secondary school – the government meal programme only covers ECE and primary level. As parents
have to provide lunch or money for food, it was mentioned that some boys and girls feel ashamed for not having that
money, and prefer to stay away from school. Also, it was mentioned that it is common that students go to school in
the morning, leave in the lunchtime and do not come back in the afternoon.
The financial aspect also pushes the older children to do chores at home such as take care of younger siblings
or older relatives at home or in the community. As mentioned in chapter 7, day cares are mostly private owned.
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In a situation where the mother and the father have to work, occasionally the older child has to stay home so the
younger child is not alone. As a matter of fact, 2014 MICS shows that 3% of children aged 0-59 months were left in
the care of other children, and the same proportion (3%) were left alone. Rural children (6%) were twice as likely to
be left with inadequate care as urban children (3%) and interior children (11%) were almost three times as likely as
coastal children (4%). Inadequate care was more prevalent among children whose mothers had no education (12%),
as opposed to children whose mothers had at least primary education (3-6%), and among children living in the
poorest households (10%), as opposed to children living in wealthier households (1-4%). Great regional disparities
are observed, with the highest percentage found in Region 9 (21%), followed by Regions 7 & 8 (10%) then by Region
6 (8%). Inadequate care was also most prevalent in children living in households with an Amerindian household head
(14%). 2014 MICS did not capture the situation in terms of head of household; nonetheless, according to informants
in the country, this situation seems to be more frequent in single parents households headed by women.
Maybe one of the most evident aspects of the influence of the financial situation in dropouts and absences is seen
when child labour is taken into consideration. Most of the stakeholders – including adolescents – mentioned that
the main cause for boys and girls to be out of school is the need for work, or their inclination to work due to
disappointment with the school curriculum. Child labour is discussed later in this section (chapter 13), but the fact
that adolescents – mainly boys – are attracted to the labour market before being fully prepared create a vicious cycle
that perpetuates poverty in the country: unprepared workers have higher chances to be employed in unstable jobs,
have smaller salaries, and are extremely vulnerable to economic oscillation in the country’s economy. Most of the
adolescents who work are doing it illegally, at small shops or farms. In some regions, attendance is highly affected
during rice harvesting season when boys and girls are going to help their families or make some extra money working
in bigger farms. Qualitative assessment done in the country link the low skill jobs with higher levels of frustration,
elevated cases of violence against women and high level of suicides.
As mentioned, poverty is not the only factor that drives adolescents to look for jobs. Two other factors also influence that
decision. First, rooted on the supply category of determinants, stakeholders mentioned that the quality of secondary
education – topic to be explored in section 10.4 – does not match students’ expectations, and consequently the school
curriculum is not attractive to a large portion of male students. The main complains mentioned that the curriculum
is too academic and not practical enough. Similarly, some pupils – usually those who are older for their grade, who
have learning difficulties or whose main language is not English – cannot cope with the curriculum at secondary level,
and see as their only option to drop out of school and look for jobs. In order to address this problem, Government of
Guyana has trying to revitalize the Technical Vocational Skills Program (TVET) programme.
The second factor that creates an incentive for early insertion of boys in the labour market was mentioned by different
stakeholder in Guyana as a mix of social norms and social practices that promotes that boys have to explore the
world and be adventurous, while girls have to be protected by their families and be prepared to get married. This
type of collective expectation creates an incentive for boys to leave school and start working, while preserves girls at
school for longer terms. As a matter of fact, as it is going to be explored
later, this determinant also influences how boys behave at home and in
society, affecting their propensity to consume alcohol and other drugs,
and their involvement with non-legal activities. For girls, this determinant
influences in early marriages.
Lack of parenting at home, especially for secondary male students, was
seen as one factor that influences them to leave school without finishing
their formal education. Stakeholders in Guyana strongly associated the
lack of parenting with the father’s absence from home, and in those
single parent households. For a single parent, being absent from the
house is, in most of the times, not an option, but a coping mechanism to
financially sustain the house, especially in places where one job does not
guarantee a salary that is enough for ensuring the wellbeing of the family.
Lack of parental supervision should not be seen as irresponsibility on the
part of the mother or the father, but as a failure of the State and the Social
Protection System that does not guarantee safe spaces for children to
stay while their mothers are working, and cannot guarantee policies that
The voice of Adolescents
If education is free, why can’t some
persons afford to come to school?
“While education is free, students still
need uniforms, pens, pencils, books,
textbooks and other school supplies,
which their parents cannot afford.
Even with uniform vouchers parents
still need to pay to sew the uniform.”
“The school does not provide lunch
and most kids cannot afford to buy
lunch, they would go home and return
to school after lunchtime. The children
who live far cannot go home and
therefore most of them don’t eat.”
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complement low salaries and alleviate their vulnerability.
Related to the lack of a male figure at home, one of the causes related to the high number of school dropouts among
boys was associated with the small number of male teachers in the system. As depicted in Figure 101, the majority
of teachers in primary and secondary schools are women, and according to different stakeholders, boys – especially
those coming from single parents households headed by women – do not find a male figure at home or at school,
making them less inclined to stay at school.
Figure 101: Teachers by gender, primary and secondary general public schools, Guyana, 2011/2012
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
One factor reported by stakeholders is the undesirable influence of remittances in adolescent’s behaviour and
their propensity to stay in school. As seen, remittances are extremely important for the country’s economy and in
many instances they work as a safety net for many families in Guyana. Despite its importance, for some people, the
fact that adolescents have easy access to money being sent by their parents or relatives abroad create a situation
where they do not need to put any effort on their academic career and still receive some money at the end of the
month, or whenever they ask for. According to the interviewees, remittances are creating a generation of adolescents
and young adults who erroneously believe they do need to invest in a professional career.
For girls, one of the main causes of school absence and dropout is teenage pregnancy. As it is going to be explored
later (chapter 11), one in every five women in the country had started childbearing during their adolescence. Causes
for teenage pregnancy are also explored in chapter 11, but the consequences of it are related to girls abandoning
school and not returning to finish their formal studies. Girls are allowed to stay at school during pregnancy, but after
delivering few have the support from their families and/or public authorities to continue their studies.
Despite the fact that violence at school was not considered to be one major factor that influences children to drop
out of school, be absent, or as a factor that influences student’s propensity to learn; stakeholders mentioned that
some boys and girls are going to verbally attack each other and sometimes get into physical fights. Besides, there
are reports of abuse against sexual minorities in school. Some LGBT students reported being harassed by their
peers and when they approached their teachers for support, they were punished because of their assumed or actual
sexual orientation or gender identity. Further, there have been reported cases where if a child is identified as gay,
whether real or perceived, that child is neglected or sometimes verbally abused by the teacher in the presence of
other students, with derogatory remarks (Red Thread, AIDS, FACT and SASOD, Feb 2013). As a consequence,
some adolescents decide to drop out of school to avoid these types of violation.
Worldwide, quality of education is one of the most important determinants that influence the decision of boys and girls
in finishing their formal secondary education and advancing into tertiary level. The quality of education is explored in
the next subsection.
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10.4) Quality of Secondary Education
Similar to primary education, guaranteeing quality of secondary education is the major challenge that the country
faces. About 68% of the teachers were considered to be qualified to be teaching at secondary school. Regions 7, 8
and 6 present the smaller percentages of qualified teachers in the country (Figure 102). Related to this point is the fact
that children in the interior of the country do not have teachers at school to teach the specialized topics. As mentioned
before, in some regions, if pupils want to prepare to the specialized CSEC exams they have to hire private tutors. That
reality contrasts with the urban areas where specialized teachers are available in public secondary schools.
Figure 102: % of qualified teachers at public secondary schools, by Regions, Guyana
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
Similar to primary education, the government should guarantee access to educational material for all the students at
secondary level. Qualitative assessment has shown that while the majority of students in the hinterlands at secondary
level have access to the four core subject books – English, Mathematics, Social Studies and Science –, access to
specialized books and materials is not equitable since students have to buy those books.
In terms of school infrastructure, access to computers, laboratories and workshops, the situation is the same as
primary schools: those students in the hinterland and in the interior of the country are in a worse off situation than
those in the coastal/urban areas. The country does not have a measure of how many secondary schools have
electricity, and consequently access to computers and Internet. Using MICS 2014 data of access to a computer as
proxy, access to modern technologies at schools would be quite low. According to the MICS results, only 54% of boys
and girls age 15 to 19 had access to a computer in the month previous to the data collection. Access to a computer
varies according to poverty level. Adolescents in the richest families have three times the chance to have access to
a computer than those living in poor families (Figure 103). MICS data also shows that only 21% of adolescents in
Amerindian families have access to computers. Similarly, access is reduced for those adolescents living in Regions
1, 7, 8 and 9 (15.3% of the adolescents have access to computers), and those children living in the interior of the
country (38% have access).
Figure 103: % of children with access to a computer at least once in the previous month, 2014
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Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Access to Internet among the young population is a little better than access to a computer. 56% of boys and girls in
Guyana have accessed the Internet at least once in the moth preceding the 2014 MICS survey. The reason for that
is that adolescents use their smartphones to connect to the Internet.
Students from the interior of the country have reported that the fact they do not have access to Internet and new
technologies at school creates an unfair difference with those students that are enrolled in schools where electricity
is available – generally in the urban areas. According to the students, those pupils in the urban areas have better
chances of learning than those who live in the hinterlands, and, consequently, have higher chances of getting better
jobs in the future.
It was also noticed by the pupils at secondary level, by teachers and by government officials that school infrastructure
at all levels needs to be upgraded: bathrooms and classrooms are dirty, chairs and desks are broken and sometimes
insufficient for all students, and when it rains – what is quite frequent at some times of the year – water drops from
The voice of adolescents
Do you know students who dropped out of school?
“Yes, there are few from the village that are working. They dropped out of school at an early age, some because
the parents are not working regularly or are not supportive.”
“I know a lot of dropouts. They dropped out of school due to teenage pregnancy, financial problems, illness,
disability, or the need to support their family by working. Some parents can’t afford to send their kids to school.
I have a friend who dropped out of school.”
“Yes. Most of the dropouts are wayward kids and their parents don’t seem to care. They may be putting
themselves at risk and the females may become pregnant.”
“Yes, I have a family member who dropped out due to peer pressure; some are delinquent, and they prefer to
smoke, drink or use drugs. Most females drop out when they get pregnant.”
“A child coming from a home with five or more siblings the parents cannot afford to purchase school uniforms
and other school supplies. Hence parents would usually send the child with the most potential to school and the
rest would stay at home or go to work, or follows bad company which leads to the use of drugs and alcohol.”
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holes in the roof. Heat can be unbearable hindering student’s capacity to concentrate. In general classrooms have
no air-conditioning, and students have mentioned that where electricity is available, some fans do not work properly,
making noises that also disturb students’ concentration.
Despite the fact that the general pupil/teacher ratio for private secondary schools is smaller than the ratio for public
secondary schools, the ratio of qualified teachers is actually better in public institutions than private ones (Table 21).
That is the result of the investment that the country is doing in training teachers in its entire territory.
Table 21: Pupil/Teacher ratio for secondary level, Guyana, 2011/2012
Public Private
Pupil Teacher Ratio 21 14
Pupil/Trained Teacher Ratio 31 49
Source: 2011/2012 Education Digest (Ministry of Education, 2012)
The voice of adolescents
“What would you change at school?” was one of the questions asked for all the students who participated in
interviews and focus groups. The following were some of the answers from them:
“There is a library in the school but it is not operating as it should and while there is a computer lab there is not
teacher for the subject area.”
“There are no sports facilities such as basketball or football courts.”
“Improve the standard of the facilities available to help the students, and the way in which the school is
organized; the quality of resources available to use for example the labs and the access to textbooks. At
present the textbooks are supplied by the school but many of the students still don’t have access.”
“There is need for more teachers and should offer more subjects. The school also needs better surroundings;
better facilities; it needs to be repaired; and electricity.”
“The quality of teaching in the areas of Mathematics and Social Studies can be improved, there are limited or
no teachers for these subjects. The classrooms are not comfortable- they are too small- and the school roof
leaks during the rainy season; sometimes students may even have to relocate to other classrooms because of
the rain.”
Analogous to primary education, quality of secondary education at coastal and interior areas could be assessed
using standardized tests, in this case the results from the 2008 and 2013 Caribbean Secondary Education Certificate
Examination (CSEC). The first point that calls attention and demands further investigation by the Ministry of Education
is the fact that for boys and girls, independently of where they leave, the scores for mathematics for 2013 are worse
than 2008 (Figure 104). Besides, it is worrisome that only 7% of the girls living in the hinterlands have passed in
mathematics in 2013.
The second point that also should be flagged is that, despite the improvement of grades in English for boys and girls
(Figure 105), the gap in percentage points between the hinterland and coastal areas’ scores in 2008 and 2013 did not
change for the girls, and, in fact, increased for the boys. The Ministry of Education (Ministry of Education, 2015c) has
identified the differences in qualified teachers as the main reason for this difference. As mentioned before, while this
is an important factor, other factors explored in the primary education section and in throughout this chapter shows
that lacks of investments in infrastructure, books, and in the curriculum are also part of the system that defines how
students are performing in the CSEC exams.
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Figure 104: CSEC Scores in Mathematics, Hinterland and Coastal Areas, Boys and Girls, Guyana, 2008 and
2013
Source: (Ministry of Education, 2015c)
Figure 105: CSEC Scores in English, Hinterland and Coastal Areas, Boys and Girls, Guyana, 2008 and 2013
Source: (Ministry of Education, 2015c)
One eminent consequence of the elevated numbers of adolescents who stop their formal education before finishing
the secondary education, in combination with the low quality of education at secondary level, is the lack of work skills
that most of the adolescents in Guyana will present. This problem is aggravated when, as described in the initial
pages of this SitAn, unemployment rates for the overall population are estimated to be high; creating a situation
where few are the opportunities for the young generation, and where even the skilled youth have to accept low-skill
jobs to survive. Chapter 13 describes the situation in terms of child labour and it emphasizes some points related to
employability of the young population in Guyana.
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Chapter 11: Teenage Pregnancy
Adolescent pregnancy is a concern that involves (i) health: worldwide evidence shows that pregnancy among young
girls is dangerous for both the mother and the baby (UNICEF, 2011); (ii) education: the 2009 Guyana Demographic and
Health Survey (DHS) revealed that early childbearing, particularly among teenagers, has had negative socioeconomic
and sociocultural consequences, such as early school dropout (PAHO, 2012); and (iii) child protection: young girls
could become pregnant due to lack of empowerment, lack of education and as victims of sexual violence, indicating
failures in the protection system, Including the immediate protective environment of the family, school, religious
institution and community.
The rates of teenage pregnancy in Guyana did not change between 2007 and 2010: around 20% of the births in the
country happened among adolescents (PAHO, 2012). According to the 2014 MICS, adolescent birth rate stands at
74 per 1,000 women – the country’s general fertility rate is about 81/1,000.
About 15% of the girls between ages 15 and 19 in Guyana had begun child bearing, with different rates depending on
the area that the girl lives, her poverty status, and her ethnicity (Figure 106). For example, one in every five Amerindian
girls between ages of 15 and 19 was a mother at the time of the survey, and one in every four girls who lived in poor
houses in Guyana have started childbearing, in comparison to 1 in every 10 girls living in richer households.
Figure 106: Percentage of women between ages 15 and 19 who have begun childbearing, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
11.1) Causes and Bottlenecks related to Teenage Pregnancy
As analysed by UNFPA (June 2014), pregnancies among adolescents have multiple structural causes and bottlenecks.
There are social causes, such as poverty, level of education, area of residence, beliefs, tradition and culture, among
others, which are correlated to behavioural patterns. The girls most likely to have a live birth before age 18 reside in
rural and remote areas, have little or no education, and live in the poorest households (UNFPA, 2013).
In Guyana, teenage pregnancy could be explained by three immediate causes that interconnect among themselves:
early sexual debut, unprotected sex and early marriage. Each one of these causes is influenced by underlying and
structural causes such as poverty, individual behaviour, beliefs and traditions and by abuse and violence (Figure 107).
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Figure 107: Possible causes of Adolescent Pregnancy
While the official age of sexual consent in Guyana is 16 years old, on average, 5% of the women had their first
sexual relationship before the age of 15. That rate is much higher for women in poor families (12.5%), women living
in the interior of the country (10%), and for those who are Amerindians (11%) (Figure 108). The situation is disturbing
in Region 1, where almost 1 in every 4 women had started their sexual life before the age of 15 (Figure 109). One
point that these statistics do not show is if the early sexual debut was consensual or it was forced. In many cases,
first intercourse is forced, which highlights the underlying issue of gender-based sexual violence and the need for
prevention and response strategies (UNFPA, June 2014). As a matter of fact, 2008/2009 Biological Behavioural
Surveillance Survey (BBSS) mentions that almost 24% of the secondary school girls who have started their sexual
life were forced by someone to have sex (Red Thread, AIDS, FACT and SASOD, Feb 2013). Connected to this matter
are repeated reports of incest in Guyana in the most remote areas, sometimes accepted by cultural traditions, and
motivated by the consumption of alcohol and other drugs.
Figure 108: % of girls who had sex before the age of 15, by socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
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Figure 109: % of girls who had sex before the age of 15, by Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
While violence explains part of the early sexual debut of boys and girls, social norms also influence the adolescent
decision to start their sexual life. Peer pressure, lack of dialogue with parents and no guidance at school are seen as
three factors that will increase the chances of early sexual debut. Stakeholders mention that unsupervised teenagers,
especially those living in single-parents households have higher chances of starting their sexual life below the age of
16, and without any type of parent counseling.
In terms of use of contraceptives (related to unprotected sex) by sexually active adolescents, according to the 2014
MICS, there was no clear pattern between contraception use and age of women. However, 13% of sexually active
adolescents (young women aged 15-19 years) mentioned to be using contraceptives in their sexual relationships, a
number that is below the country average (34%), and the lowest among all other age groups. Contraception use is
highest among women aged 25-34 years (41%). The use of contraceptives is influenced by three factors. First, there
are health systems bottlenecks and/or legal procedures (legislation) that limit adolescents’ access to reproductive
and sexual health services. In this line, there are situations where adolescents (under the age of majority), who are
sexually active, encounter legal barriers to accessing contraception, information and counselling. Girls under the age
of 16 do not have access to Sexual and Reproductive Health (SRH) services without parental approval (Government
of Guyana, 2014). Second, the lower use of contraceptives is connected to lack of empowerment of girls and older
women. Male partners reject the use of any type of protection and girls have to submit to their demands. Lack of
empowerment is related to lack of information, and fear of being beaten and abused. Third, qualitative reports also
indicate that some religions are still very much against the use of condoms and other contraceptives, with the fear
that the incentive of using them would send a message of incentive to young people to have sex. As reported by
some stakeholders, part of society in Guyana still believes that the discussion of sexual behaviour is instigating
children to have sex, instead of educating them to the possible consequences. When children have sexual questions,
the responses they receive from adults are often punitive, rather than educational (Red Thread, AIDS, FACT and
SASOD, Feb 2013). This affects not only the propensity of a girl to be pregnant, but also risks her life in contracting
HIV and/or other sexual transmitted diseases.
Child/early marriage is not a common practice in Guyana, nonetheless, among girls between 15 and 19 years of age,
13.3% of them were married or in union (cohabiting) at the time of the 2014 MICS survey, a slightly reduction when
compared to 14.1% in 2006 (2006 MICS). Early marriage is influenced by different socio-economic characteristics
such as poverty and ethnicity (Figure 110). Among those women who were married at the time of the 2014 MICS
survey, 4.4% married before the age of 15, and 27% married before the age of 18. Similar to girls, 13.4% of the boys
between 15 and 19 years of age were also married in 2014.
Figure 110: Percentage of women ages 15 to 19 years old currently married/in union, by socio-economic
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characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Individual behaviour is influenced by knowledge acquired at school and at home. On the supply side, schools do
not offer comprehensive sex education; consequently adolescents often rely on information (frequently inaccurate)
from peers about sexuality, pregnancy and contraception (UNFPA, June 2014). Guyana has institutionalized the
Health and Family Life Education (HFLE) programme as a tool to address sexuality and other topics that would
promote wellbeing, and discuss social development issues during the child’s school learning process. The idea is
to mainstream life skills subjects – including sexual education – through the school curriculum, with the objective to
reduce cases of teenage pregnancy, bullying, school dropouts, HIV infections and alcohol and drugs consumption.
Evaluation of the HFLE programme (Ministry of Education and UNICEF Guyana, Feb 2014) shows that despite the
fact that the programme is considered to be extremely relevant, there is no conclusion if it has been effective in
achieving its results.
Moreover, the evaluation found the same evidence as the interviews conducted in Guyana at the end of 2015 for
this SitAn: the fact that teachers are selective in the topics they teach when the subject is sexual behaviour and
sexual education. The main reasons for that selection were identified as (i) lack of training in the topics being taught;
and (ii) teachers’ personal views and opinions, influencing their decision on which subjects to teach. For instance,
stakeholders mentioned that due to social and cultural taboos, teachers do not feel comfortable talking about sex
outside of the biological reproductive subject, and prefer to skip content related to sexual behaviour and sexuality.
Interviewees also mentioned cases where teachers would impose their own view on the topic being presented,
jeopardizing the objective of the HFLE programme. While teachers might have their own bias on the topic, they do
not find any systems in place to explore the internal conflicts between their personal and professional values in order
The Voice of Adolescents: Availability of services for adolescents
“Sometimes the service providers are also to be held accountable. The schools in Guyana do not have sexual
reproductive health information, education and training. Nurses at health clinics do not want to give the young
girls contraceptives. Lack of acceptance of age appropriate sex education program in school by parents and
some teachers also contributes to teenage pregnancy. Sometimes the young women themselves cannot be
held accountable, when due to the pressures at home and around they are forced into teenage pregnancy.”
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to effectively deliver the curriculum and address the needs of all their students, including those who are lesbian, gay,
bisexual and transgender (LGBT) (Red Thread, AIDS, FACT and SASOD, Feb 2013).
Poverty is seen as a structural cause that influences all the other causes related to teenage pregnancy. Nonetheless,
many stakeholders also reported that in more remote regions, and in most extreme cases, poverty is a direct factor
that pushes families to try to have their young daughters married, and one way to accomplish that is to have the girl
pregnant. In this line, intergenerational sex is also seen as one important factor in the elevated number of girls who
get pregnant at early ages. Among the girls between 15 and 24 years of age who had sex in the last 12 months, 12%
had intercourse with men 10 or more years older. For the girls between 15 and 17 years of age, 11% of them had sex
with men 10 years older than them. Intergenerational sex varies slightly based on the family wealth. While 14% of
girls between the age 15 and 24 in the poorest households had sex with older men, the rate for the richest families is
10.4% (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).
The voice of adolescents: Culture and teenage pregnancy
In a focus group with adolescents and young adults, we asked about how culture influences teenage pregnancy.
This is the answer of one of the participants:
“Culture has an influence on teenage pregnancy. Within a year or two of high school some parents marry off
their girls. In the Indian culture children are married at an early age. When a young person cannot find jobs,
culture forces them to start a family. Marriage is a way to cope with poverty where parents arrange for their
children to marry someone from abroad so that they can migrate or to arrange a marriage into rich families.
There are a lot of arranged marriages in the Indian communities, which also lead to depression and suicide.
Children in these circumstances hardly have a say as against those in a much better off position.”
The causes and consequences of elevated numbers of teenage pregnancy are worrisome for all the reasons here
discussed. Unprotected sex not only elevates the chances of teenage pregnancy, but also creates a new risk for the
youth population: of being infected with HIV and other sexual transmitted diseases. Topic to be further explored in
the next chapter.
The Voice of Adolescents:
Is teenage pregnancy common? Do you know any teenage mothers?
“I know of a few cases. In most cases, the partners are usually older and the girls suffer low self-esteem. I am
not sure if they wanted to become pregnant or whether it was an accident. In most cases it is unplanned; but
the girls ought to have known the consequences of having sex and taken steps to protect themselves. I don’t
believe they were empowered enough to encourage the young men to use condoms.”
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Chapter 12: Adolescents and HIV/AIDS
HIV/AIDS became a serious concern in the country after 2004. Following
Haiti, Guyana at that time had the second highest incidence of HIV/AIDS
in the Caribbean, and AIDS was considered the second leading cause of
death in the country (Ministry of Social Protection and UNICEF Guyana,
June 2014).
The overall prevalence of HIV infection has been on the decline in Guyana.
As reported by the 2014 Guyana AIDS Response Progress Report (GARPR),
the country’s adult HIV prevalence is estimated to be 1.4%, representing a
reduction when compared to 2.4% in 2004. At the end of 2014, a total of 751
new cases of HIV were diagnosed compared with 758 cases reported in
2013, also a reduction when compared to 2009 when 1,176 new cases were
reported (Figure 111) (Government of Guyana, 2015b). Despite the reduction
represents progress, government and partners should further investigate if
it represents a real reduction of people being contaminated or failures in
identifying positive cases due to lack of testing.
Figure 111: Number of new HIV and AIDS cases, Guyana, 2001-2014
Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).
Since 2003, more women have being reporting positive HIV cases than men. Moreover, the highest number of
reported cases of HIV in 2014 occurred in the 25-49 age group accounting for 61.7% (463/751) of all cases compared
with 67.7% in 2013. Region 4 continued to have the highest proportion, of all HIV cases in 2014 with 72.8% of all
cases compared with 75.4% in 2013 (Government of Guyana, 2015b). The relatively higher notification of cases
in Region 4 can be attributed to the larger population size and the higher concentration of HIV services, including
counselling and testing.
The Biological and Behavioural Surveillance Survey (BBSS) 2014 showed a sharp decrease in the HIV prevalence
among female sex workers (FSWs), from 26.6% in 2005 to 5.5% in 2014. There was also a marked decrease in
prevalence among men who have sex with men (MSM) from 21.2% in 2005 to 4.9% in 2014, and among miners from
6.5% in 2000 to 1% in 2014. Several populations were surveyed for the first time in 2014 with HIV prevalence reported
as follows: Loggers 1.3%, male sex workers (MSWs) 5.1%, and trans-genders 8.4% (Government of Guyana, 2015b).
The diagnostic capacity of the treatment and care programme continued to be supported by the National Public
Box: The HFLE Programme
The HFLE targets (i) social
and interpersonal skills, such
as communication, refusal,
assertiveness, and empathy; (ii)
cognitive skills, such as decision-
making, critical thinking and
self-evaluation skills; and (iii)
emotional coping skills, such
as self-awareness, self-control,
and conflict resolution (Ministry
of Education, 2015c)
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Health Reference Laboratory (NPHRL), which provides CD4, viral load and DNA
polymerase chain reaction (PCR) testing. The laboratories of 5 government
hospitals in Regions 2, 3, 6, 7 and 10, also provided CD4 testing. Three of these
hospitals are regional hospitals.
During 2014, treatment and care services were delivered through 22 treatment
sites. A total of 5,041 HIV patients (55.8% females and 44.2% males) were listed
on the register in the care and treatment programme at the end of 2014 with
4,295 (85.2% of the patients) receiving antiretroviral therapy (ART). There were
602 new enrolments during the year, including 17 children. ARV is available
for free, but similar to the case of pregnant women who are identified as HIV
positive and stop taking the medicine, there are cases where patients do not
come back for follow up or for new dosages of ARV. That seems to be common
in the interior of the country where due to economic factors migration is high,
pushing families to search for better economic opportunities in different places.
Besides, HIV patients also suffer a heavy stigma that influences their willingness
to seek for medication and treatment in some regions. For instance, it was reported that in the interior of the country,
the HIV specialists coming from the capital schedules monthly consultations for patients, all in the same day. The
community already knows that those in the health facility at that day are seeing a doctor due to HIV, increasing
stigmatization of those seeking for treatment, and, consequently, also increasing the chances that people would stop
treatment.
12.1) Causes, Bottlenecks and Barriers related to HIV/AIDS among Adolescents
For the adolescent and youth adult groups in Guyana, HIV is largely transmitted through unprotected sex, which is
influenced by a series of underlying and structural factors depicted in Figure 112.
Figure 112: Causal Tree for HIV and STDs infections among adolescents
As discussed in Chapter 1130, the elevated rates of teenage pregnancy in Guyana is an indication that unprotected sex
is common in the country, creating the additional risk for adolescents to be exposed to sexual transmitted diseases,
30 Most of the issues related to adolescent’ sexual behaviour, including early sexual debut, individual behaviour, and use of condoms were
discussed in Chapter 11 (Teenage pregnancy).
HIV Key Affected Populations
In Guyana, the following are
considered the key affected
populations in relation to HIV,
i.e., the populations who are
more in risk of contracting it:
Men who have sex with men
(MSM)
Trans-genders
Sex workers
Miners and Loggers
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including HIV. Adolescents, especially the girls are of great concern.
Sexual risk behaviour is also associated with adolescents having
multiple sex partners without using condoms. In this line, the 2014
MICS report mentioned that around 2.4% of the women between
15 and 24 years of age had more than one partner in the last 12
months, in comparison to 15% among men in the same age group.
In looking specifically at the group between 15 and 19 years of age,
numbers are smaller: 1.6% for girls, and 10% for boys. Around 50%
of the youth population between 15 and 24 years old who had more
than one sexual partner in the last 12 months had reported using
a condom last time they had sex (Bureau of Statistics, Ministry of
Public Health and UNICEF Guyana, April 2015).
One of the most important prerequisites for reducing the rate of HIV
infection is accurate knowledge of how HIV is transmitted and
strategies for preventing transmission. According to the MICS
results, in Guyana, a large majority of the women and men aged
15-49 years have heard of AIDS – 98% and 97%, respectively.
However, the percentage of those who know of both main ways of
preventing HIV transmission – having only one faithful uninfected
partner and using a condom every time – was 75% for women and
74% for men.
Less than half of the adolescent population between 15 and
19 years of age (47.7% for women, and 33.2% for men) have
comprehensive knowledge on HIV and AIDS, i.e., they know
that (i) consistent use of a condom during sexual intercourse and
having just one uninfected faithful partner can reduce the chance
of getting HIV; (ii) a healthy-looking person can have HIV, and (iii) are able to reject the two most common local
misconceptions about transmission/prevention of HIV in the country. As a matter of fact, among all the age groups
in the research, the group between 15 and 19 for both men and women has the smaller rate of comprehensive
knowledge.
For the population between 15 and 49 years of age31, comprehensive knowledge on HIV is also small: 55.6% for
women and 48.6% for men. Comprehensive knowledge was particularly low among both women and men living in
Region 5 (28% and 18%, respectively) as well as those living in households with an Amerindian household head
(39% and 34%, respectively). Only in Region 9 the comprehensive knowledge of men age 15 to 49 years old is
higher than women. In all other regions, and all other socio-economic characteristics men know less on HIV/AIDS
than women (Table 22).
Table 22: % of population between 15 and 49 years of age with Comprehensive Knowledge on HIV by socio-
economic characteristics and region, Guyana, 2014
Women Men
Country 55.6 48.6
Urban 67.5 64.7
Rural 51.2 42.8
Coastal 56.2 49.0
Urban Coastal 66.9 66.5
Rural Coastal 52.3 42.7
31 2014 MICS results did not present this information for the population between 15 and 19 years of age.
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Women Men
Interior 51.5 45.4
Region 1 42.7 35.2
Region 2 64.9 37.2
Region 3 47.8 46.5
Region 4 59.8 55.2
Region 5 27.6 17.9
Region 6 63.3 53.0
Region 7 & 8 39.7 37.8
Region 9 37.4 45.5
Region 10 69.5 49.8
Poorest 40.2 33.9
Second 49.3 38.3
Middle 54.9 52.1
Fourth 61.7 50.3
Richest 67.1 66.0
East Indian 50.4 43.7
African 62.8 55.0
Amerindian 38.9 34.1
Mixed Race 63.6 58.2
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Despite the fact that 81% of the girls between ages of 15 and 19, and 71% of adolescent boys in the same age group
know a place to get tested for HIV, the rates for those who were actually tested are much smaller (30.6% and 20% for
girls and boys respectively) (Figure 113).
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Figure 113: % of boys and girls ages 15 to 19 with knowledge of a place for HIV testing, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
In terms of legislation and policies (enabling environment), in response to the rising challenge of HIV/AIDS and
other health issues, the Ministry of Education (MoE) has been working in cooperation with the Ministry of Public
Health in two policies aimed at secondary school students: first, the school health and nutrition (SHN) and HIV/AIDS
policy was disseminated in 2009; and second, the Health and Family Life Education (HFLE) programme, which
focuses on reducing teenage pregnancy and HIV prevention. As mentioned previously in chapter 11, the HFLE 2013
evaluation revealed that if the intervention is to have greater positive impact, much more work needs to be done in the
area of teacher training; learning materials; teacher attitudes towards sensitive topics; parental involvement; whole
school approach; and effective referral systems (Ministry of Education and UNICEF Guyana, Feb 2014).
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Chapter 13: The Right to be Protected
Sustainable Development Goal 16: Promote peaceful and inclusive societies for sustainable
development, provide access to justice for all and build effective, accountable and inclusive
institutions at all levels
Target 16.2: End abuse, exploitation, trafficking and all forms of violence against and torture of children
The abuses, different forms of violence and violations of rights described in this chapter are all interconnected.
The idea to separate the violations into six subsections has as objective to emphasise the issues; nonetheless, the
causes, bottlenecks and barriers related to domestic violence, for instance, share common grounds with sexual,
psychological and physical abuse, as well as child trafficking and child labour. This chapter also covers mental health
– an important issue flagged by different stakeholders in the country; explores the situation of children in contact with
the law, and describes how adolescents are participating in decision making at home, school and society in general.
13.1) Domestic Violence
In homes and families, children suffer as witnesses of domestic violence and as victims of child abuse and neglect
(UNICEF Regional Office for Latin America and the Caribbean, 2006). Frequently the domestic violence that has
women as their main victims is extended to boys and girls of all ages.
Between 2011 and 2013, the Crime and Social Observatory (CSO) from the Ministry of Public Security has registered
more than 9,200 different types of domestic violence cases in Guyana, with 65% of them involving assault (
Table 23). Between January and October of 2015, 17 women were murdered by their partners32.
Table 23: Domestic Violence cases registered by type, Guyana, 2011-2013
Domestic Violence Reports Cases 2011-2013 % of total cases
Assault 5,998 65%
Threatening Language 1,486 16%
Abusive Language 763 8%
Provoking breach of peace 354 4%
Threatening behavior 248 3%
Other 368 4%
Total 9,217 100%
Source: Crime and Social Observatory (CSO), (UNICEF Guyana, Nov 2015)
Despite the fact that the majority of victims are older than 25 years old, there are a significant percentage of children
(8%) and young adults (16%) being victims of domestic violence (Figure 114).
32 Source: Guyana Chronicle, Thursday, November 26, 2016.
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Figure 114: Age distribution of victims of domestic violence, 2011-2013
Source: Crime and Social Observatory (CSO), (UNICEF Guyana, Nov 2015)
Causes, bottlenecks and determinants of domestic violence
Domestic violence has a straight connection to gender-based violence (GBV). According to PAHO (PAHO, 2012),
gender-based violence is widespread in Guyana and rising among all socioeconomic and ethnic groups, affecting
more women than men. Between 2006 and 2007, there was an estimated 50% increase in the total number of GBV
victims, 3,600 more than the previous year. The largest increase was recorded in Berbice (Regions 5 and 6), where
reported cases rise steeply from approximately 300 in 2006 to 1,890 in 2007, representing a 500% increase. At
least one in three Guyanese women has reportedly been a victim of GBV, and Help and Shelter, a nongovernmental
organization working in this area, served 324 female clients between January and July of 2008. Of these, 128 were
of African descent, 112 of East Indian descent, and 84 from other ethnic groups (PAHO, 2012).
A mix of social norms and social and cultural practices have been identified as the main factors that influence
violence against women. In this sense, using a sociological perspective, gender-based violence, and attitudes
toward it, could be subdivided into two sets of causes: those at the individual level and those at the social level. For
the individual, gender-based violence is largely driven by factors related to gender inequality, childhood experiences
and the enactment of harmful forms of masculinity (Fulu, et al., 2013). Violence against women is related to the power
control that men try to exercise over the women, which is also extended to the children (UNICEF, 2012).
Overall, 10% of men and women between 15 and 49 years old believes it is justifiable to a husband hit his wife if
she goes out without telling him, neglects the children, argues with him, refuses sex with him or if she burns the food
(Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015), a considerable reduction when
compared to 18% in 2006 (Bureau of Statistics and UNICEF Guyana, 2008). Table 24 compares the perspectives of
women and men towards violence, and displays how different socio-economic aspects influence in the behaviour. For
instance, domestic violence is more acceptable among those in the rural areas than in urban settlements, for both
men and women. Also, the poorest the family, highest is the acceptance of wife beating. Another factor that should
be taken into consideration is the fact that the highest level of acceptance of wife beating happens in the Amerindian
community, one in every four adults believe it is justifiable to hit the wife. High numbers are also present in Regions
9 and 1 (for both women and men), Region 5 (mainly for women), and Region 7/8 for men.
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Table 24: Percentage of women and men (15-49 yeas) who believe a husband is justified in beating his wife,
by gender and socio-economic characteristics, Guyana, 2014
Women Men
Country 10.2 9.6
Urban 2.8 5.4
Rural 12.9 11.1
Coastal 9.4 8.5
Urban Coastal 2.7 5.4
Rural Coastal 11.9 9.6
Interior 15.6 17.8
Region 1 14.8 25.8
Region 2 20.1 9.1
Region 3 12.8 15.3
Region 4 7.3 7.2
Region 5 20.5 8.6
Region 6 5.7 5.3
Region 7 & 8 16.4 18.1
Region 9 27.4 31.5
Region 10 4.2 7.1
Poorest 19.0 17.8
Second 12.2 9.7
Middle 10.5 8.5
Fourth 6.6 7.7
Richest 5.2 5.4
East Indian 12.9 10.1
African 4.8 5.2
Amerindian 26.6 25.5
Mixed Race 6.1 9.5
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
At the social level, violence and attitudes toward gender are created based on the country’s history, and how other
social factors are constructed in society, including how religion and culture shape morals, practices and attitudes
(UNFPA, 2009).
In this sense, lack of punishment for those men that perpetrate violence against women (and, as it is going to be
explored later, against children) was appointed as one factor that reinforces violent acts in the country. For example,
between January and November of 2015, 582 cases of domestic violence were reported in Berbice, from these, 326
reached the court, and only 17 men were convicted33. According to stakeholders, the belief of impunity reinforces
violent behaviour among different populations in Guyana. In many cases, the perpetrator is let go when reports are
made. Victims refuse to give statements to the police or to the courts, afraid of being stigmatized or being object of
33 In 2014, Berbice had similar numbers: 585 reports of domestic violence and 19 convictions. Source: Stabroek News, November 21, 2015.
Guyana | Situation Analysis of Children and Women
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future violence. Poverty also hinders reporting against domestic violence. In many instances, the perpetrator is the
only provider for the family, and if he is arrested, mother and children will not the necessary financial means to support
themselves.
In terms of legislation, the Sexual Offences Act was passed in May 2010 to strengthen measures for gender based
violation prevention, and it makes spousal rape illegal. A National Policy for Domestic Violence is in place, with a
special unit established in the Ministry of Labour, Human Services, and Social Security to oversee and monitor its
implementation.
13.2) Sexual, psychological and physical abuse
For UNICEF34, there is significant evidence that violence, exploitation and abuse can affect the child’s physical
and mental health in the short and longer term, impairing their ability to learn and socialize, and impacting their
transition to adulthood with adverse consequences later in life. Violence, exploitation and abuse are often practiced
by someone known to the child, including parents, other family members, caretakers, teachers, employers, law
enforcement authorities, state and non-state actors and other children. Worldwide, only a small proportion of acts of
violence, exploitation and abuse are reported and investigated, and few perpetrators are held accountable.
According to numbers reported by UNICEF (UNICEF Guyana, Nov 2015) and originated from the Childcare and
Protection Agency (CPA), housed in the Ministry of Social Protection, the number of children being abused in the
country has been reduced between 2011 and 2014 (
Table 25). Children neglect is still the main type of violation suffered by children, followed by physical and sexual
abuse.
Table 25: Types of Child Abuse Reported By Gender, 2011, 2013 and 2014
2011 2013 2014
Boys Girls Total Boys Girls Total Boys Girls Total
Physical 350 488 838 277 307 584 279 210 489
Sexual 63 652 715 80 590 670 60 568 628
Verbal 107 200 307 106 141 247 71 94 165
Neglect 860 1,017 1,877 789 863 1,652 675 662 1,337
Abandoned 38 56 94 38 45 83 26 27 53
Total 1,418 2,413 3,831 1,290 1,946 3,236 1,111 1,561 2,672
Source: Childcare and Protection Agency (CPA), (UNICEF Guyana, Nov 2015)
Preliminary information from the CPA indicates that 1,915 cases of abuse were reported between January and
September of 2015: 1042 cases of neglect, 492 cases of Sexual Abuse and
381 cases of Physical Abuse. Historically girls are the main subjects of the
different forms of abuse. 58% of the cases reported in 2014 were against girls
(Figure 115).
34 http://www.unicef.org/protection/57929_57972.html. Accessed on June 1, 2015.
“Our family system is broken,
and many times persons who
are in abusive relationships do
not have that family support, so
they remain silent”.
Social Protection Minister
Volda Lawrence, Guyana
Chronicle, November 26, 2015.
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Figure 115: Gender distribution of child abuse cases, Guyana, 2011, 2013 and 2014
Source: Childcare and Protection Agency (CPA), (UNICEF Guyana, Nov 2015)
Despite the fact that the data does not distinguish between different ethnicities in the country, Amerindian children in
Guyana have been reported to experience higher levels of physical and sexual abuse than children from the general
population (UNICEF Regional Office for Latin America and the Caribbean, 2006). Besides, anecdotal evidence
collected in Guyana points to more cases of violence against children happening in the poorest communities.
Causes, bottlenecks and determinants of abuse against children
The main causes and bottlenecks of child abuse are rooted in social norms and social and cultural practices that
are being conducted for years in the country. These are strengthened by lack of implementation of the legislation,
weak monitoring of cases, underreporting and impunity.
In terms of social norms and practices, all those social and cultural determinants that influence on violence against
women (section 13.1) also help to explain the situation in terms of different abuses suffered by children. Similarly, the
issues with corporal punishment (presented in chapter 9) are extended into adolescence.
Sexual exploitation and abuse remain prevalent and socially tolerated, particularly if it involves girls. The cultural and
social roots of sexual abuse of females is also illuminated by the fact that many girls believed that sexual harassment
is ‘normal’ and is usually instigated by a women’s choice of clothing and behaviour. For example, a large proportion
of the children interviewed in Guyana for UNICEF’s study on violence against children believed that girls were often
the instigators of sexual abuse as they wore revealing clothing (UNICEF Regional Office for Latin America and the
Caribbean, 2006).
Interviewees in the country have mentioned that there is a cycle of abuse where fathers and mothers who presently
abuse their children were victims in the past. In this sense, some forms of abuse are actually considered acceptable
and transmitted from one generation to another (UNICEF, 2012). The perpetuation of this cycle shows that measures
have to be taken to change behavioural aspects of the community. Also related to social norms are the complicity
of families, neighbours and society in general in accepting the abuse, and consequently the general silence around
violence, abuse and exploitation.
Regarding legislation, on one hand, the country has enacted legislation to strengthen the protection of children from
sexual abuse and exploitation, including the Sexual Offence Act of 2010, the 2009 Protection of Children Act and
the 2008 Prevention of Crime Act. On the other hand, the consensus among stakeholders in the country is that the
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enforcement of the legislation is a major bottleneck in the system. The legislation is considered to be quite advanced;
nevertheless, stakeholders agreed that it is not implemented, as it should. Lack of implementation is related to weak
internal systems to enforce the law – few are the cases where police officers are punished for not pursuing a case of
abuse – and lack of knowledge among those who should implement the legislation. Besides, government agencies
that handle cases of abuse against children do not have sufficient staff to investigate all the cases. The police
Juvenile Branch has three officers stated in Georgetown to cover the whole country. Despite the fact that they try as
much as possible to cooperate with regional polices, the number is insufficient to properly investigate all those who
are accused of committing crimes against children.
As appointed by the UN Committee on the Rights of the Child, the country has lack of data and information on the
root causes and extent of sexual exploitation and abuse of children, as well as inadequate monitoring and reporting
mechanisms (UN Committee on the Rights of the Child, 2013). Guyana has no electronic distinct or centralized
data collection system for cases related to children – most of the systems are decentralized and paper-based. For
instance, the Juvenile Branch does not have an online database to monitor cases, and no real-time summary reports
of the problems that happen in the country involving children (either as victims or as perpetrators). In order to have
access to the data, someone from the branch has to call on the different police divisions and ask them to send in their
reports, which are not always on time. As mentioned by stakeholders, the Ministry’s reported numbers are always
different from the Juvenile Branch numbers. It was felt that the lapse in data collection was a result of the divisions
failing to collect information, file it and reporting it properly. This hampers not only the Juvenile Branch in preparing
their annual reports, but also the whole child protection system that does not have accurate and real-time data to plan
and manage for results. Consequently, the lack of harmonizing data in child protection issues jeopardizes monitoring
their situation, and the development of public policies to specific address some issues.
Underreporting happens due to failures in the protective system of victims and witnesses. Victims and witnesses
are afraid of being stigmatized – creating a double burden on them –, afraid of suffering other forms of violence
and/or, afraid of not having the necessary support if the perpetrator is sent to jail. Stakeholders’ perception is that
impunity is high and, consequently, if victims report their cases, they are going to suffer more. The financial situation
is an important component in the victim’s decision to report abuse. When children and women have a financial
dependence on the perpetrator, they are going to lose their only financial support if the perpetrator is sent to jail. As
widely discussed in Guyana, some cases of abuse are reported to the police, but later they are dropped by the victims
or their families in fear that something worse could happen to them. In this line, teachers and health workers might
have the ability to identify cases, but there is silence from them since the reporting might actually put them in risk of
being threatened by the perpetrators.
Anecdotal reports suggest that the consequences of sexual abuse are often that the child (and sometimes the
mother) is forced to leave their home or community and experience extensive dislocation in their lives. However, the
perpetrator often remains unpunished and does not receive any rehabilitative services. It is therefore likely that the
perpetrator will sexually abuse another young victim in the future (UNICEF Regional Office for Latin America and the
Caribbean, 2006).
As mentioned in discussion on domestic violence, impunity is seen as one of the major bottlenecks in relation
to prevent abuse against children, influencing adult’s behaviour and hampering the reporting of cases. Anecdotal
evidence collected in Guyana shows that the process for arresting and prosecuting someone accused of child abuse
is long and bureaucratic. In many cases families do not have a feedback from the police and/or from the courts about
how the process is running. According to stakeholders, it is common that perpetrators of physical and sexual abuses
try to compensate the victims and their families with money or other goods. In some cases, the police or local leaders
suggest the act of compensation.
Assessment conducted by the Ministry of Social Protection and UNICEF (Ministry of Social Protection and UNICEF
Guyana, June 2014) shows that children living in the hinterland and in the coastal communities did not feel that
police officers or their parents could protect them from abuse. Corruption and poverty were cited as the primary
reasons. Children stated that police officers were known to yield to persons with wealth and parents could not protect
them since they were either poor or fearful of the police. It therefore means that the rebuilding of public trust in law
enforcement officers starting with children at the community level is an important component of child safety.
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Even in cases where the perpetrator is reported, the legal procedures can prevent prosecution35. For example, as
reported by UNICEF (UNICEF Regional Office for Latin America and the Caribbean, 2006), in Guyana, children need
to be able to give credible evidence and the defence lawyers are often so intimidating that the child becomes upset
and confused and the evidence is declared not credible. In this line, according to the country’s legislation, the accused
has to be held for 72 hours, in which time the police must bring their case36. As mentioned by many stakeholders,
this time is not enough to investigate and build a case when children are involved. Consequently, it is common that
those who abuse children are walking away with no punishment. As mentioned by one of the interviewees: “If persons
perceive the law to be ineffective in terms of prosecution and enforcement there will always be a negative attitude of
the offenders in the commission of these offences. It is therefore necessary to strengthen the investigative process,
which will result in a better attitude towards the commission of these offences, in that they would be less likely to
commit such acts”.
Children in Need of Alternative Care
Children in need of alternative care could be characterize into three groups: (i) those boys and girls who lost one or
two parents; (ii) those children who do not receive acceptable care from their parents due to neglect or other form of
abuse; and (iii) children in detention – this last group is discussed in section 13.5. In 2003, there were an estimated
number of 22,000 orphans in Guyana, 7 thousand of them due to HIV/AIDS. The estimates for 2010 were 23,000
orphans, 9 thousand due to HIV/AIDS (Greene, 2009). Not all of the cases related to child abuse are referred as
cases where the child needs to be taken from their parents.
Assessment commissioned by the Ministry of Social Protection and UNICEF (Ministry of Social Protection and
UNICEF Guyana, June 2014) mentions different forms of alternative care in Guyana. Institutional care is the most
common form of alternative care provided by the State. Other types of alternative care, such as adoption and foster
care (and many other variations of family - and community-based care) are also practiced to some extent. In practice,
these forms of care and their many variations constitute a full spectrum of alternative care environments known as
the continuum of care. In Guyana, most children outside of parental care live with their extended families in kinship
care arrangements. The placement of children in institutions is usually a last resort, and only used when all other
placement options have been exhausted
There are 23 children homes in Guyana, three are state owned and 20 are privately owned. Over 800 children
were living in these homes at the end of 2012 with 212 of these children in the government managed children
homes. According to reports, the CPA is experiencing great difficulties in maintaining the caregiver to child ratio at the
residential homes and 2012 saw an even greater escalation of this situation. Pertinent data on residential facilities
are not available, thereby making it difficult to ascertain accuracy on age and other needed information. (Ministry of
Social Protection and UNICEF Guyana, June 2014).
Guyana does not currently have an alternative care policy - along the process has started. Besides, Guyana is not
a party to the Hague Convention on international adoption. In that sense, there are many concerns expressed by
the UN Committee on the Rights of the Child in relation to those children who need to be placed in alternative care,
among them: (i) there are increasing numbers of children, particularly those from single-parent families, being placed
in institutional care; (ii) there are no safeguards and procedures for ensuring that institutional care is genuinely used
as a measure of last resort; (iii) the alternative family and community-based options for children deprived of a family
environment or children with special protection needs are inadequate in scope and quality; (iv) there are insufficient
efforts being made to reunite children in institutional care with their biological families, resulting in many of these
children remaining in institutions until the age of 18 years; and (v) the Visiting Committees monitoring the institutions
do not adequately ensure the quality of care provided and the protection of children from violence and abuse at such
facilities (UN Committee on the Rights of the Child, 2013).
35 In order to fix this problem, Government through NGO-Public partnership and UNICEF have supported one-stop centers to support reporting
on abuse.
36 The 72 hours is the longest time a person can remain in police custody, without being charged. However, an extension can be requested.
In terms of completing an investigation before requesting legal advice, three months are allotted. If a man is arrested on a report of abuse, the
police can either request an extension on his time or release him on bail and have him report to the station the next day or every other day or
every week depending on how the investigations are going. A juvenile may not be forth coming with their statement as it takes time, sometimes
days. Thus time can be requested in order to acquire that statement.
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13.3) Child Trafficking and Child Labour
Child Trafficking
The Sustainable Development Goals on its Target 5.1 calls for an elimination of all forms of violence against women
and girls, including trafficking, sexual and other types of exploitation. Worldwide, trafficking in persons and human
trafficking – including child trafficking – has been used as umbrella terms for the act of recruiting, harbouring,
transporting, providing, or obtaining a person for the purpose of exploitation such as compelled labour or commercial
sex acts. For UNICEF, child trafficking is a violation of their rights; it interferes with their well-being and denies them
the opportunity to reach their full potential.
Human trafficking can include, but does not require, movement. People may be considered trafficking victims
regardless of whether they were born into a state of servitude, were exploited in their hometown, were transported
to the exploitative situation, previously consented to work for a trafficker, or participated in a crime as a direct result
of being subjected to trafficking. At the heart of this phenomenon is the traffickers’ goal of exploiting and enslaving
their victims and the myriad coercive and deceptive practices they use to do so (US Department of State, July 2015).
Guyana is considered by the US Department of State as a Tier 2 Watch List Country; i.e., it does not fully comply
with the United Sates 2000 Trafficking Victims Protection Act’s (TVPA) minimum standards, but is making significant
efforts for it. The country is a source and destination for men, women and children subjected to sex trafficking and
forced labour.
Worldwide the number of persons and children as victims of human trafficking are difficult to be monitored,
and many cases are underreported. The Ministry of Labour, Human Services, and Social Security reported
80 suspected cases, and 179 confirmed victims of human trafficking between 2013 and 2015. 91% of the
victims were women (Table 26). Among the victims, 50% were children under the age of 18, with some as
young as 11 and 13 years of age (Table 27).
Table 26: Cases of Human Trafficking, Guyana, 2013-2015
2013 2014 2015 Total
# of suspected cases reported 26 26 28 80
# of confirmed victims 52 57 61 170
# Men 8 6 1 15
# Female 44 51 60 155
% Children 68% 45% 41% 50%
Source: Communication received from The Ministry of Labour, Human Services, and Social Security in May of
2016.
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Table 27: Age of victims of trafficking, Guyana, 2013-2015
Age of Victim 2013 2014 2015 Grand Total
11 1 1
13 1 1 3 5
14 4 5 3 12
15 9 5 5 19
16 9 2 5 16
17 4 9 4 17
18 5 3 3 11
Total Children 32 25 24 81
Total Adults 15 31 35 81
Source: Communication received from The Ministry of Labour, Human Services, and Social Security in May of
2016.
Causes and bottlenecks related to child trafficking
Human trafficking in Guyana is partially connected to the extractive industries that move a significant part of
the country’s GDP. Although communities can benefit from such industries by using these natural resources for
sustainable development; mining, drilling, and quarrying activities often occur in relatively remote areas with minimal
infrastructure and limited rule of law, leading to the development of makeshift communities, such as mining “boom
towns,” that are vulnerable to crime. There are evidence of sex trafficking near gold mines in Guyana, as well as
in the mines near the borders of Brazil, Suriname and Venezuela. In that sense, the 2015 Trafficking in Persons
Report mentions that children are particularly vulnerable to sex trafficking and forced labour, mainly due to limited
government presence in the interior, and the unethical activities involving some police officers in the country. In the
same line, Guyanese nationals are subjected to sex and labour trafficking in Suriname, Jamaica, and other countries
in the Caribbean region (US Department of State, July 2015).
Child trafficking is a concerned, but it is not yet seen as being the consequence of organize criminal groups acting
in the country. For most of those involved in fighting the problem, it happens through referrals and invitations. Child
trafficking is fuelled by a myriad of underlying and structural causes that involve cultural attitudes, disintegration of the
family structure, lack of parent’s knowledge on the schemes used by traffickers, lack of work opportunities and lack
of adequate law enforcement, legal protection, prosecution or sanction, among other causes. On the background of
all these causes is the financial situation of individuals and families: it is common understanding among stakeholders
in Guyana that child and adult human trafficking is entrenched and self-enforced by poverty.
Anecdotal evidence points to the fact that economic vulnerable families will support their children to work in small
shops and/or bars near the mines in order to increase the household’s income. While some children might start
working as vendors, shop owners usually take control of the children and use them to bring costumers to the bar/
shop. In most extreme cases, different stakeholders mentioned cases of mothers who prostitute their daughters since
that is the most immediate source of income they might have. While girls are the main victims of trafficking, qualitative
information collected in Guyana show that boys are also sent by their families to work in illegal mining areas, logging,
or in farms.
Despite efforts from the government in fighting human trafficking – for example, government has a unit to combat
this crime, has released its anti-trafficking action plan in June 2014 and it has been implementing the Combating
Trafficking of Persons Act of 2005 – Guyana’s response to the problem is still lagging behind. Analysis from the US
Department of State (US Department of State, July 2015) mentions that law enforcement efforts remain insufficient,
and weak law enforcement efforts have been hindering the process of holding traffickers accountable. The situation is
aggravated since government does not have enough law enforcement agents trained and acting to prevent this type
of crime. For instance, the Trafficking in Persons Unit – hosted in the Ministry of Social Protection – had in November
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of 2015 two officers to cover the whole country. Besides, police officers and local government officials who work in the
most remote areas of the country are not fully capacitated to identify and fight cases of child trafficking, contributing
to one of the major bottlenecks: the challenge to identify and prosecute those involved with trafficking.
Stakeholders also mentioned weak cooperation between the different government actors involved in the problem,
among them, it was mentioned that the Guyana Geology and Mines Commission (GGMC), institution responsible
for regulating the mining sector in the country, sometimes makes a “blind eye” to the problem. As well as the cases
of child abuse, underreporting of cases also occurs since people in the community – including teachers and health
staff – do not feel empowered for reporting those cases since the results are unknown. If the process is not clear and
efficient, people become afraid of possible retaliations from those accused of trafficking.
According to stakeholders, the courts in Guyana are also not fully prepared to conduct and prosecute cases of human
trafficking, including those involving children. There were few convictions reported in 2014, and internal assessments
have demonstrated that Government’s efforts to investigate, prosecute, and convict traffickers and identify and assist
victims remained limited, with few support to local based NGOs that could help to identify and assist victims. Adding
to that, there are reports of cases not being prosecuted, and convicted traffickers being released on bail while they
wait for their appeal on court (US Department of State, July 2015).
Child Labour
Child trafficking has a straight relationship with child involvement in economic activity and child labour37.
In looking at different socio-economic characteristics, around 56% of children between the ages of 12 and 14 years
old were involved in economic activities in the interior areas of the country (Figure 116). Children in the Amerindians
communities have a higher probability of working in comparing to other ethnicities. Most of these working children are
located in Region 9, where 3 in each 4 boys and girls in this age group are engaged in economic activities (Figure
117).
Figure 116: Percentage of children age 12-14 years involved in economic activities for at least 14 hours a
week by socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
37 As described in Chapter 9, economic activity (paid or unpaid) is any work on plot / farm / food garden; looking after animals; helping in family
or relative’s business, running own business; producing or selling articles / handicrafts / clothes / food or agricultural products; or any other
activity in return for income in cash or in kind. For the age group between 12 and 14 years of age and the group between 15 and 17 years of
age, if a child is involved in economic activity for less than 14 and 43 hours in a week (respectively), he/she is not considered to be victim of
child labour. If the boy or girl works for more than 14 or 43 hours, respectively, then the situation is characterized as child labour. For detailed
definitions of child labour please access the 2014 MICS report (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015).
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Figure 117: Percentage of children age 12-14 years involved in economic activities for at least 14 hours a
week by Regions, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Similar to the age group between 12 and 14 years old, the chances of being involved in economic activities for
the children in the group between 15 and 17 increase if they are from the Amerindian community, if they live in the
Government Response to Human Trafficking
Guyana is equipped with the Combating of Trafficking in Persons Act No. 2 of 2005, which provides the
legal basis for law enforcement actions with regard to trafficking in persons. The introduction of the piece of
legislation followed Guyana’s ratification of the United Nations Convention against Transnational Organized
Crime (UNTOC) and its supporting instrument, the Protocol to Prevent, Suppress and Punish Trafficking in
Persons, Especially Women and Children.
Guyana established a Ministerial Task Force on Trafficking in Persons. The Task Force was established in
February 2007 and is an inter-agency body intended to meet monthly to plan, implement, monitor and evaluate
national strategies in response to issues relating to trafficking in persons.
From the inception, the Ministerial Task Force has been chaired by the Ministry of Public Security, then Ministry
of Home Affairs, and has featured a number of Agencies - both Governmental and Non-Governmental – which
are each represented by an individual who is regarded as a Focal Point person to assist in expediting inter-
agency cooperation. Initially, the Task Force was comprised of seven Agencies: The then Ministries of Home
Affairs; Labour, Human Services and Social Security; Legal Affairs; Foreign Affairs and Amerindian Affairs;
along with Help & Shelter and Food for the Poor. Overtime, the composition of the Task Force has expanded
to also include the Ministry of Local Government, Ministry of Natural Resources and the Environment, Guyana
Geology and Mines Commission.
Source: Communication from the Ministerial Task Force on Trafficking in Persons, received in May of 2016
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interior of the country, and if they are from poor families (Figure 118). There are more boys than girls working on this
age group. Region 9 is also where proportionally more children between ages 15 and 17 are engaged in economic
activities (Figure 119).
Figure 118: Percentage of children age 15-17 years involved in economic activities for at least 43 hours a
week by Socio-economic characteristics, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Figure 119: Percentage of children age 15-17 years involved in economic activities for at least 43 hours a
week by Region, Guyana, 2014
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
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Overall, among all children 5 to 17 years of age 18% of them are considered to be engaged in child labour, i.e., they
work over the limit stipulated as involved in economic activity. That number is higher than the number estimated by
the 2006 MICS when 16.4% of the children were considered to be involved in child labour (Bureau of Statistics and
UNICEF Guyana, 2008). In 2014, 13% of children were considered to be working under hazardous conditions. Table
28 depicts the 2014 information disaggregated by different socio-economic characteristics.
Table 28: % of child labour and % of children working under hazardous conditions, Guyana, 2014
% of children engaged in
child labour
% Children working
under hazardous
conditions
Total Country 18.3 12.5
Sex
Male 19.7 14.5
Female 17 10.5
Region
Region 1 23 15
Region 2 21.5 15
Region 3 16.3 11.3
Region 4 11.2 6.2
Region 5 13.8 10
Region 6 18 9.9
Regions 7 & 8 35.3 30.2
Region 9 70.7 56.6
Region 10 27.8 24.9
Area
Urban 14.5 9.5
Rural 19.7 13.6
Coastal 14.2 8.6
Urban Coastal 11.4 6
Rural Coastal 15.3 9.6
Interior 37.1 30.2
School attendance
Yes 18.2 12.1
No 18.9 15.3
Wealth index quintile
Poorest 32 24
Second 15 11.5
Middle 14.8 8.7
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% of children engaged in
child labour
% Children working
under hazardous
conditions
Fourth 12.8 8.6
Richest 11.6 5
Ethnicity
East Indian 16 9.4
African 16 10.8
Amerindian 40.9 33.5
Mixed Race 13.1 8.8
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Most of the children involved in child labour are working in the agriculture sector (including farming, forestry and
fishing); industry (construction, welding and mining); and services (domestic work, work in bars and restaurants, and
street vending). As mentioned, the country also has evidence that some children are involved in economic activities
characterized as worst form of child labour, such as commercial sexual exploitation as result of human trafficking (US
Department of Labor, 2014)
Despite the fact that household chores cannot be characterized as economic activity, if not managed well they can
deviate time from the child time of studying and playing. Around 68% of the children between the ages of 5 and
17 interviewed for the 2014 MICS survey were involved in household chores. The older the child, higher is his/her
involvement in household chores. Starting at age 12, more girls are involved in these activities than boys. Other
characteristics that also determine household chores are related to where the child lives (interior or coastal areas),
the wealth status of the family, and his/her ethnicity (Table 29).
Table 29: Percentage of children by involvement in household chores during the week previous to the
Survey, by socio-economic characteristics and age groups, Guyana, 2014
Age groups
5 to 11 12 to 14 15 to 17
Country 56.7 76.6 83.2
Male 58.5 75.5 78.9
Female 54.9 77.8 87.1
Urban 48.2 79.2 86.2
Rural 59.6 75.7 82.0
Coastal 53.1 74.2 82.7
Urban Coastal 45.9 76.4 85.4
Rural Coastal 55.8 73.3 81.6
Interior 70.5 88.2 86.4
Poorest 69.3 87.5 90.9
Second 56.5 79.4 82.6
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Age groups
5 to 11 12 to 14 15 to 17
Middle 49.1 75.4 79.0
Fourth 55.0 65.2 82.4
Richest 46.6 70.4 80.2
East Indian 51.0 62.1 77.3
African 59.9 88.3 85.0
Amerindian 73.9 84.9 92.0
Mixed Race 52.1 77.4 89.3
Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)
Causes and Bottlenecks on Child Labour
There are two main causes that push children into labour. First, the harsh economic conditions that families face
create the necessity for many parents to have their children working to support the household income. That is even
worse in single-parents households when only one adult can provide for the wellbeing of the family. Children are
seen as being able to contribute to the household income since they are young, and as they grow older, they can
have more profitable functions.
The country has no evidence on an efficiency policy that fought child labour in the past years. Much of it is seen as
common and acceptable by society.
The second cause related to child labour is the social norm found in Guyana’s society that accepts child labour as
normal, and that sees it as “character building” instead of rights violation. This social norm helps to construct what is
called in the economic literature as an “intergenerational child labour trap” (Basu, Dec 1998) (Lópes-Calva, 2002),
where young boys and girls have to work since their parents were working when they were children.
In terms of enabling environment, the UN Committee on the Rights of the Child has mentioned the need to update
the legislation and the current policies to make clear on the internal definition of child labour (UN Committee on
the Rights of the Child, 2013). The “Employment of Young Persons and Children Act” (Chapter 99:01) of the Laws
of Guyana allow for the implementation of certain conventions of the International Labour Organization that relate
to the employment of young persons and children. In this Act, a ‘child’ is defined as “a person under the age of
fifteen years” while a ‘young person’ is defined as “a person who has ceased to be a child and who is under the
age of sixteen years”. The Act prohibits the employment of a person, under the age of 15 years (child) and a young
person, at night and in an industrial undertaking (e.g. mining, transportation and construction), subject to exceptions.
The provisions of this Act do not apply to any employment or work in which only members of the same family are
employed. In addition, it does not include family and small-scale holdings producing for local consumption and not
regularly employing hired workers.
13.4) Adolescent’s Behavioural Health
Suicide is the 7th leading cause of death in Guyana38, with a mortality rate of 44.2 per 100,000 inhabitants, positioning
the country as the highest prevalence in the world – the global average is 16/100,000 (WHO, 2014b). Between 2006
and 2008, suicide was the leading cause of mortality among persons between 15 and 24-years old: 22.4% of the
deaths that occurred in that group were due to suicide (PAHO, 2012).
No one factor can explain Guyana’s high suicide rate. Newspaper article published in 2015 tries to identify possible
38 Source: World Health Rankings, using data from 2014 WHO. Available at http://www.worldlifeexpectancy.com/country-health-profile/guyana
Accessed on January 20, 2016.
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causes for the problem39: Health workers have pointed to the deep poverty in rural areas, the prevalence of alcohol
abuse (which is notorious for its contribution to successful suicides) and the ease of access to deadly substances
– one of the most frequently used suicide methods in the country is the ingestion of pesticide. As many people
are farmers, pesticides are readily available and contribute significantly to the high suicide rate. Some scholars
have theorised that exposure to certain herbicides and pesticides used in the country makes farmers more prone
to suicidal behaviour. According to the article, mental illness is misunderstood in the country, with symptoms often
mistakenly attributed to witchcraft (known locally as obeah). Communities often ostracise sufferers, and on occasion
have physically assaulted them, at times with the endorsement of religious leaders, who are highly respected figures.
While the article might deal with immediate and direct causes of suicide, other implicit factors also negatively contribute
to this decision. According to adolescents that participated of focus groups, suicide is prevalent in the region they live
(and in the country) due to youth’s inability to cope with problems. According to them, children and adolescents do
not have a good channel of communication with adults, including parents, relatives and teachers at school. Besides,
schools do not have counsellors to help those boys and girls that are experiencing difficult situation. Quoting the
words of one adolescent that participated in one focus group:
“Many of the suicides are related to relationship issues. For example, there are girls that cannot share their problem
with a parent because they are ashamed. Sometimes it is a cultural influence. There are stories that some girls
committed suicide when they were told they had to marry older men – arranged marriage is still a reality in some
parts of Guyana. So lack of counselling at school and parental skills all contribute to the high prevalence in suicide
in the Region.”
Other factors might also contribute to high prevalence of suicide among
the youth population. Among them, the lack of economic perspectives
is considered to be very influential in the decision of some youth to take
their own life. The fact that jobs are difficult in the country – as mentioned
unemployment rate for the youth population is much higher than the
country average – influences the present behavioural state of the youth,
and creates doubts about the future perspectives in terms of work, family
and relationships. Some young people cannot handle the pressure, and
suicide becomes the only way out.
While some stakeholders have the position that the number of suicides is not that alarming, and cases are over
reported by the media; suicide is part of the adolescents’ reality. For example, the results for the 2010 Global School
Survey for Guyana show that 23% of the children between ages 13 and 15 had seriously considered attempting
suicide in the 12 months previous to the survey (19% for boys, and 29% for girls) (WHO and CDC, 2010). Besides, the
same survey shows that only 37% of the students interviewed to the survey considered that their parents understood
their problems and worries (38% for boys and 36% for girls), indicating that there is the need to further investigate
and strength the relationship between parents and their children.
13.5) Children in Contact with the Law and Juvenile Justice
Children in contact with the law have become a concern in Guyana. Data for the number of children in contact with
the law comes from two different sources: the Juvenile Holding Centre and the New Opportunity Corps40. In 2014,
there were 214 boys and girls in the Juvenile Holding Centre, a number that is slightly higher than the previous year
(Figure 120).
39 The Guardian Internet Version. Published on June 3, 2015. http://www.theguardian.com/global-development-professionals-network/2015/
jun/03/guyana-mental-illness-witchcraft-and-the-highest-suicide-rate-in-the-world. Accessed on October 12, 2015.
40 Please refer to chapter 3.3 to better understand the juvenile system in Guyana and the relationships among the different institutions that are
part of it.
Voice of Adolescents:
Have you ever helped out your
family or relatives at a shop?
“Yes, after school or on the
weekends either by selling at times
when my parents are busy, for no
remuneration at all.”
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Figure 120: Number of boys and girls admitted in the Juvenile Holding Centre, 2011-2014
Source: Juvenile Holding Centre, (UNICEF Guyana, Nov 2015)
Out of the 831 children and adolescents admitted in the Juvenile Holding Centre between 2011 and 2014, 70% were
boys. Most of the boys were admitted accused of theft (break, enter and larceny). For girls, wandering was the main
cause of admission (Table 30).
Table 30: Main alleged crimes committed by boys and girls, Guyana, 2011-2014
Boys Total % of total crimes Girls Total
% of total
crimes
Break, Enter and Larceny 153 27% 6 2%
Wandering 99 17% 164 64%
Simple Larceny 89 15% 20 8%
Robbery Underarms 38 7% 0 0%
Robbery 23 4% 0 0%
Murder 7 1% 2 1%
Other crimes 167 29% 63 25%
Total 576 100% 255 100%
Source: Juvenile Holding Centre, (UNICEF Guyana, Nov 2015)
In September 2015, 84 children and adolescents were residents in the New Opportunity Corps (NOC), 55% of them
boys. Among those who were sentenced, 56% were due to wandering and 33% due to crimes related to theft. Further
crimes involve assault, and possession of narcotics, among others. Most of the children at NOC are from Region 4
(also reflecting the biggest population in the country), but some expressive numbers are from Regions 3 and 5.
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Causes and bottlenecks related to children in contact with the law
On the demand side, the most probable and recurrent cause that influences children to commit acts against the law
is poverty and lack of economic opportunities. The economic situation of some families is a major determinant for
some children to steal or commit small non-violent crimes
Social and cultural practices are also determinants that influence the propensity of children to violate the law.
First, children grown up in an environment at home and in society where violence is acceptable, for instance, most
of the adolescents were beaten when children as a form of being educated (corporal punishment was discussed in
chapter 8) and, consequently, the use of force becomes an acceptable way to make a statement. Second, different
stakeholders mentioned that adolescents are attracted to the image of violent characters observed in movies, video-
clips or portrayed in video games and music, and that negative image influences their behaviour in society. Both
cases indicate that the continuous mentoring process that should happen in the relationship between parents and
children/adolescents is not happening. For instance, 42% of the children who answered the 2010 Global Health
Survey mentioned that their parents, in most of the time, did not know what they were doing in their free time (WHO
and CDC, 2010).
As a matter of fact, many stakeholders mentioned that the relationship between parents and children is becoming so
problematic that some parents do not know how to handle their children, and the solution found for some is to report
boys and girls to the police as they were committing wandering. While there are calls to remove wandering from the
statute books, many seen it as a precursor to committing various crimes, and for some families, it becomes a solution
to fix a problem that parents do not know how to solve.
Cultural practices also influence in the ingestion of drugs and alcohol, both considered being elements that
encourage children to drop out of school, become violent and commit illegal acts. The 2010 Global School Survey
(WHO and CDC, 2010) identified that 39% of the boys and girls in Guyana between the ages of 13 and 15 had
drank alcohol in the 30 days before the survey. 29% of the students drank so much that they were really drunk one
or more times during their life (Table 31). Around 7% of secondary students (11% for boys and 4% for girls) had
tried marijuana before (Inter-American Drug Abuse Control Commission, 2015), a number that is considered low by
different stakeholders in the country that work with adolescents and young populations.
Table 31: % Alcohol consumption, students between 13 and 15 years of age, Guyana, 2010
Total Boys Girls
Percentage of students who drank at least one drink containing alcohol on
one or more of the past 30 days
39.2 44.1 34.3
Among students who ever had a drink of alcohol (other than a few sips),
the percentage who had their first drink of alcohol before age of 14 years
79.0 80.5 77.1
Percentage of students who drank so much alcohol that they were really
drunk one or more times
29.3 34.7 24.5
Source: (WHO and CDC, 2010)
Guyana has no public rehabilitation facilities to provide the relevant care and treatment services to children and
adolescent s who are affected by drug and alcohol use. The private resident facilities that do exist have high enrolment
costs attached to and some families can ill afford to pay because of their economic circumstance.
According to the stakeholders, impunity and lack of law enforcement create a perception in adolescents that they
cannot and do not need to follow the rules, opening spaces for them to commit crimes. When children realize there is
little or no form of sanctions for their negative behaviours they will feel empowered to exercise such negative forms
of attitude or behaviours against whom they desire. For instance, interviewees had mentioned anecdotal reports of
older children threatening teachers, and attacking younger siblings and even their parents and relatives.
On the supply side, assessment conducted by the Ministry of Social Protection and UNICEF (Ministry of Social
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Protection and UNICEF Guyana, June 2014) point to a series of issues to be corrected and improvements that
need to be done so children in contact with the law have their rights realized, and have increased their chances of
rehabilitation. Some of these issues are related to (i) duplication of services being
offered by different government agencies, without proper coordination of efforts,
leading to resources not being efficiently distributed; (ii) lack of clear coordination
in the overall response and prevention related to children in contact with the
law; (iii) nonexistence of public policies targeting the most poor families trying to
alleviate the economic situation of vulnerable children and their families; and (iv)
development of rehabilitation measures that can effectively reintegrate children
in contact with the law in society; among others.
The juvenile system in Guyana (briefly described in chapter 3.3) is not exclusive to children; i.e., there is no separate
Judge or Magistrate that attends to Juvenile cases – in some instances, a court is temporarily appointed as a
“juvenile court”. The country has no special skills training for officers of Court such as prosecutors, magistrates and
judges working with children. The absence of specialized training of court officers on child justice can lead to lack
of understanding on how to address child related matters and to manage other court officers such as prosecutors,
lawyers and social workers who may not always be sensitive to the child’s needs (Ministry of Social Protection and
UNICEF Guyana, June 2014).
Also connected to this point, as mentioned by different stakeholders, is the lack of human and financial resources that
have made the Juvenile Branch unable to execute its mandate. As mentioned before, the unit has no internal capacity
to investigate all the crimes that are committed against and by children in Guyana, and when it tries to cooperate with
regional authorities, lack of communication and increased bureaucracy become a bottleneck.
The assessment also identified problems with the coordination in the juvenile justice system. A well-functioning
system requires a clear understanding of the systemic structures and strong interagency coordination. However, this
coordination does not work smoothly for children and key stakeholders in this process voiced their concerns over the
weaknesses in the system. Children may be delayed for extended periods in holding centres and are sometimes
sent to NOC without a probation report or birth certificate. For instance, 32% of the children are sentenced without
a probation report. One anecdotal report cites a case where a child was placed before the court on a capital offence
and was left for more than three years within the system, which resulted in him facing trial at age 18, the age of an
adult. The child was subsequently tried as an adult (Ministry of Social Protection and UNICEF Guyana, June 2014).
13.6) Participation in Decision Making
Child participation is one of the guiding principles of the Convention on the Rights of the Child. The principle affirms
that children are full-fledged persons who have the right to express their views in all matters affecting them and
requires that those views be heard and given due weight in accordance with the child’s age and maturity. It recognizes
the potential of children to enrich decision-making processes, to share perspectives and to participate as citizens and
actors of change (UNICEF, 2005).
In practice, according to the UN Committee on the Rights of the Child (UN Committee on the Rights of the Child,
2013), respect for this right remains limited, with no systematic approach in place for the participation of children and
young people in local governance. The UN Committee on the Rights of the Child raised that sociocultural attitudes
and traditions continue to restrain children from freely expressing their views in schools, courts and within the family.
During the process of developing this situation analysis, many children, from different parts of the country, gender,
ages, ethnicities and wealth statuses were consulted formally and informally. As expected, they presented many
different realities and points of view; nonetheless, all had one point in common: they all mentioned not having any
space to participate at school. While school is not the only environment where the child lives, it is the space where he/
she spends 1/3 of his/her day, and it is an environment where learning is the main goal. In theory, the school could be
the space where participation should be taught and practiced. “Participation” was such a distant concept that children
did not know what the word meant, and the vast majority reacted positively with the chance to have their voices heard
by the school management and by the teachers.
While all the students were receptive to the idea of participation at school, at home and in their community; they also
Voice of Adolescents:
“Many of the students upon
completing school cannot
find proper jobs and they end
up turning to prostitution and
illegal activities.”
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shared a concerned that some adults might not be prepared to listen to their
opinions and take them seriously. Students mentioned that their participation
only becomes effective if teachers are ready to listen and respect their opinions.
Children and adolescent mentioned that sometimes they are given a chance to
participate at home, but the majority of the decisions lay with the adults. At the
same time, participation in community is inexistent. They did not recognize any
open spaces where they could interact with their community in order to have
their voices heard.
Voice of Adolescents:
“No one has ever asked us
what we would like to change
about the school. If given
the opportunity, we would be
glad to share our ideas/views
and feelings on the areas for
improvement in the school.”
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Part VI:
Conclusions and Recommendations
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Conclusions
Guyana has improved some of its socio-economic conditions over the past
decades. For instance, (i) the country’s GDP has showing positive trends since
2006, and in particular years it has been higher than the average for the Latin
America & Caribbean; (ii) under 5 mortality has been reduced; (iii) antenatal
care provided by a skilled professional has improved from 81% in 2006 to
91% in 2014, and similarly, delivery by a skilled health provider increased
from 83% to 92% in the same period; (iv) the MDG commitment of halving the
proportion of people suffering from hunger was achieved; (v) moderate and
severe stunting has been reduced from 18.3% in 2006 to 12% in 2014, and
severe stunting from 10% to 3.4% in the same period; (vi) breastfeeding rates
have increased from 75% in 2006 to almost 90% in 2014; (vii) rates of acute
respiratory infection wend down between 2006 and 2014 for more than 50%
(4.7% in 2006 and 2.2% in 2014); (viii) the percentage of children under age
5 left alone or in the care of another younger child was reduced from 11% to
5% between 2006 and 2014; (ix) more children are finishing primary school in
2014 when compared to 2006; and (x) acceptance towards hitting or beating a
wife are less prominent now than it was in 2006; among other developments.
Despite all the improvements, inequity is a major factor in Guyana, i.e., boys
and girls do not have access to the same quality of education, health and child protection due to structural problems
described in this document. The country’s averages hinder serious differences, and create different vulnerable
groups that demand special attention. Vulnerability is connected to the risk of deprivation, losing assets, being
physically or psychologically hurt, or losing life due to different threats in the environment that surrounds the child and
his/her family. The notion of vulnerable populations is common in emergency preparedness analysis; nonetheless,
the concept can be adapted to indicate those situations where social and economic changes create a risk for the
population. Within this idea, vulnerability is related to a family not having enough financial resources, but it is also
connected to not having access to proper public policies that provide the systemic protection that boys and girls
should have at different ages in order for them to have their rights realized.
The Situation Analysis points to different groups of vulnerable children and women in Guyana. These vulnerabilities
are created and/or emphasized by the four dimensions of inequality utilized throughout the report: geographical,
gender, household economic status, and ethnicity.
The first group of vulnerable children and women are those who live in the hinterland. As shown, for almost all
indicators used to describe the situation of children, those living in the hinterland are in a worse off situation than
those in the coastal areas: child mortality rates are higher; not all children are being fully immunized; 1/3 of the births
are not registered in some regions of the hinterland; child labour is a reality, and school attendance for primary and
secondary education are the lowest of the country; among other issues.
The second group of vulnerable children and women are the Amerindians. Historically they live in the interior of
Guyana (hinterland) and share the same problems as other ethnicities that inhabit those areas; nonetheless, if the
Amerindians are analysed isolated from other groups, maybe with the exception of nutrition, they do present the worst
indicators among all the population in Guyana. For instance, 34% of the births for the Amerindians happen at home;
only 54% of the children between 0 and 5 are fully vaccinated; 60% of the Amerindian children do not attend Early
Childhood Education programmes; 22% of Amerindian girls between 15 and 19 years of age are mothers; and 1 in
every 4 men from the Amerindian ethnicity believes hitting a woman is justifiable; among others.
A third group identified as vulnerable are those children with disabilities and special needs. The lack of data on
this population is worrisome, and signals that the country does not properly addresses their needs. Without knowing
how many boys and girls have special needs, it is not possible to know if they have access to school and health
facilities, and if they have their rights realized.
Children living in single-parents households, especially those headed by women were identified as a fourth
Voice of Adolescents:
Do you have a chance to
express yourself at school,
or interact with teachers and
share ideas?
“There are spelling bee,
debating and impromptu
speaking competitions at
school; I participate in spelling
bee most times. The students
are rarely given the opportunity
to interact with teachers or the
HM and share ideas or aid in
decision making.”
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group of vulnerable children. Recent information on the correct number of households’ arrangements like these is
not known and available data does not present that disaggregation; however, different interviewees have mentioned
that these types of families are common in Guyana41. These family arrangements are driven by the harsh economic
situation that pushes parents – mainly men – to search for jobs abroad and/or in the most remote areas of the country
(mining and logging). In single-parent households, when a mother – of father – is not home, children are affected in
different ways. One direct danger for children is that in being alone, they are susceptible to being abused by older
children and/or adults. Besides, as mentioned, the lack of a male figure at home was identified as correlated to school
dropouts, and to behavioural problems, especially with boys.
The fifth group represents a stand-alone group, but it was also identified as the major cause of all other vulnerabilities:
poverty. Not all poor families are going to have their children out-of-school, or will have cases of domestic violence.
However, statistically, poor families in Guyana have higher chances of living in a worst-off situation. Children living in
poor families have smaller chances of having access to computers and books; they are more susceptible to domestic
violence and other types of abuses; they have higher chances of being stunted and have higher chances of being out
of school; among other problems.
Despite the fact that the SitAn identified five main vulnerable groups, these are not insulated, i.e., children in one
group might also be exposed to the situation described in a second or third group (Figure 121). For example, a child
who lives in a female-headed single-parent household might also live in the hinterland, and in a poor family. One
point that all these vulnerable groups have in common is that they are exacerbated by the poverty status of the family.
Poverty is in the core of most, if not all, the problems that affect children and adolescents.
Figure 121: Vulnerable child populations in Guyana
The situation of children and women in Guyana is influenced by different immediate, underlying and structural causes,
which are then reinforced by many bottlenecks that prevent boys and girls to fully access their rights. The importance
of identifying the causes and bottlenecks is related to helping government and different stakeholders to construct
public policies that target the most vulnerable populations based on an assessment of the reasons that influence that
situation. The SitAn document acted as the first stage in this process: it identified broad bottlenecks that explain the
situation. The second stage would be to intensify the analysis, so for each problem acknowledged in the document a
thorough map of causes, bottlenecks and determinants can be constructed.
41 According to the 2009 DHS (Ministry of Health, Bureau of Statistics and USAID, Oct 2010), 13% of the households in the country were single-
person households; nonetheless, the survey did not identify single-person households headed by women.
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Throughout the SitAn document, the bottlenecks were characterised based on the four UNICEF’s determinant
categories: enabling environment, supply, demand and quality. Similar to the vulnerability groups, the bottlenecks
and determinants are not isolated and they act together to influence the situation of children and women. Using the
four determinants categories, the SitAn has found the following:
In terms of enabling environment, Social Norms are extremely influential in the situation of children and women,
and they can be used in favour or against the vulnerable groups. Some social norms in Guyana still hinder the full
realization of child rights in the country. For example, stakeholders mentioned that society still differentiates between
how boys and girls should be raised by their parents: boys should adventure the world, and girls should be protected.
This type of norm influences school dropouts, child labour and many of the violent behaviours that boys present in
the country.
In general, the country has a set of legislations and policies related to children issues that were considered to
be comprehensive and updated – some exceptions were flagged concerning child protection issues. The overall
consensus among the stakeholders is that while legislation exists, implementation of the rules is weak and insufficient.
Corruption, lack of resources (personnel, infrastructure, etc.) and not enough knowledge were commonly associated
with gaps in the implementation of the laws. Besides, impunity was seen as one major bottleneck that influences
perpetrators to continuing committing crimes, and victims and witnesses not to report abuses.
One gap also identified by different stakeholders was the management and coordination of policies related to
children. The Childcare and Protection Agency (CPA), housed in the Ministry of Social Protection is the specialized
agency for child protection in the country; nonetheless, the agency does not cover other aspects related to children
and adolescents such as health, education, employability and culture, for example. Coordination among the different
areas (health, education and child protection), covering different geographical locus (regions, urban/rural and coastal/
interior) and different stakeholders (NGOs, government, civil society and international organizations) was tried in the
past, but different sources in the country mentioned they did not achieve results, and became less frequent in the
recent years. Even inside one specific thematic area, child protection, for example, the different actors do not seem
to coordinate their actions, and opportunities to improve the situation are lost.
One of the reasons why the SitAn document follows a life-cycle approach is to make clear to stakeholders that the
rights of the children cannot be seeing compartmentalized into health, education and child protection. As mentioned
in the introduction of this document, children have different demands at different ages, and these correspond to
a cross sectorial and systemic approach that demand a strong coordination from different line ministers and their
different units.
The analysis of the country budget made on chapter 3.4 mentioned that around 35% of the country expenditure
could be connected to expenses related to children, most of them related to education. A child budget analysis is
important to evaluate the efficiency of the expenses related to children, and, in using the data, to make adjustments
targeting the most vulnerable groups. In this sense, the objective of the analysis presented in this SitAn document
is not to evaluate the public expenditure, nor to do any type of judgement, but to show that it is possible to track
government expending, and it is feasible to create a monitoring system that could allow civil society to monitor the
efficiency of the expenses in the realization of children’s rights. In this sense, the national budget should not be seen
as a bottleneck now, since a further analysis is necessary; however, different government officials complained that
their offices do not have enough resources (monetary and staff) to fully implement their mandate, contributing to the
lack of implementation reported by the stakeholders.
On the supply side category, the two determinants – availability of essential commodities and access to adequately
staffed services, facilities and information – were identified as major bottlenecks in Guyana. For those vulnerable
children and women living in the interior of the country, access to school, health facilities and police are challenging,
and, sometimes, almost impossible. For some populations, the geographical characteristic in the hinterland makes
that access only possible by boat or by special cars. As mentioned in the main text of this document, difficulties of
access will hinder women’s access to prenatal care, delivery and postnatal care; it will make younger children stay
home instead of going to Early Childhood Services; and it will influence mothers not to take their children to health
care if their situation is not identified as an emergency. Moreover, it was also identified that those school children in
the hinterland do not have access to books, school supplies all the teachers they need so they can compete fairly
with those children living in the coastal area, and, consequently, have better chances to advance in their studies and/
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or look for a professional qualification.
Among the three determinants considered in the demand category, only two were identified as important for Guyana.
The different ethnicities that pacifically cohabit in Guyana create different social and cultural practices and beliefs
that impede a generalization on how they actually influence the realization of child rights. Nonetheless, social and
cultural practices are in the root of many violations of child rights. For example, the fact that part of the Indian
population in the country arranges the marriages of girls influences school dropouts, adolescent pregnancy, and was
considered as one of the causes of high levels of suicides among young populations. Another example comes from
the Amerindian community where, the mix of cultural practice and abuse of alcohol and other drugs are identified as
causes to incest.
Social practices influence how children behave at school and at home. Rates of alcohol consumption among
adolescents and early sexual debut are elevated, and are associated with peer pressure and the need for adolescents
to fit-in. Violence against women and children are also rooted in a mix of social and cultural practices and social
norms. The fact that corporal punishment is seen as an appropriate educational method sends the message that the
use of force and violence is acceptable, and they can be used at any age.
Despite the fact that the government assumes most of the financial costs for services and practices related to
education and health, different indirect costs were identified as major barriers to the realization of some rights.
Education is free, but families have to afford transportation to school and, as mentioned, in the interior of the country
that might indicate boat or special cars. Also in the interior of the country, those families who want to invest in their
children’s education have to hire private tutors for subjects that should be taught at school but are not.
The financial cost is alleviated or aggravated by the economic condition of the family. For the wealthy families, the
financial costs of some services are not prohibitive, for the poorest ones, some small values might indicate big gaps
in their monthly budget. Once more, poverty not only interferes with the propensity of being a vulnerable child, but
poverty also aggravates how all the determinants here presented will impact on the child’s life cycle. For a family with
monetary resources, distance, difficulty of access to school and private tutors are not as expensive as a family who
lives in poverty.
Despite being central to all the problems related to children, poverty has not being measured since 2006. At that
time, almost 50% of the children in the country were living in poverty. After 2006, the world was hit by the economic
crisis in 2008, and the international markets for those products that Guyana export have not being stable. Chances
are that some of those children who lived in poverty in 2006 grown up to still live in poverty today, but at this time, as
fathers and mothers.
The country has adopted Poverty Reduction Strategy Papers – the last one covering the years between 2011 and
2015 – as guidance to reduce poverty. The Strategy followed a traditional poverty alleviation approach; i.e., it followed
a traditional economic mechanism: alleviating income constraints during childhood would enable parents to buy
goods and services that would support child development. The idea is that economic improvements for the family
would immediate translate into benefits for the children. That direct link is not always true. For example, evidence
has suggested that traditional economic mechanisms – such as cash transfer programmes – cannot be translated in
improvements in early childhood development, unless they have specific conditionality’s or mechanisms related to it
(The World Bank, 2015).
All the 8 determinants here used to categorize the bottlenecks are influenced by the poverty status of the family, and
by the quality of care that is available for the children and women in the country. It is not expected that all children
have the same facility to reach school, but at least it would be expected that those children living in the coast would
have the same level of quality of education than those living in the hinterland. Unfortunately, that is not the case
in Guyana. National exams have shown that for primary and secondary education, scores for those pupils in the
hinterland are worse than those in the coast. In fact, the gap between them has increased; indicating that the situation
today is worse than it was in the past.
Quality of health in the interior of the country is also worse than in the coastal area. There are no emergency obstetric
units in the hinterland – the only one available is in Georgetown, and the most serious cases related to children and
adults have to be treated in the capital. Similarly, anecdotal reports also mention those living in the interior of the
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country complain about the quality of the police force, and how that influences in their lack trust in that public authority.
The 2016 Situation Analysis of Children and Women in Guyana covered different aspects that directly and indirectly
affect the life of children and women in the country. Nevertheless, the document does not extinguish the analysis of
many themes that were raised in the document, nor it covers all the possible characteristics related to the life of the
child. The SitAn was based on different readings, data sources and direct qualitative data collection that involved
dozens of stakeholders, from different backgrounds, in the country. The documents used for the SitAn are extremely
rich, and it is recommended that the reader access them in order to get a more accurate perspective on most of the
themes presented in the document – the full list of references is at the end of the document.
Statistically sound and internationally comparable estimates on a range of indicators on children and women,
especially on the most disadvantaged, are essential for developing evidence-based policies and programmes, aimed
at identify and responding to their needs. UNICEF continues promotes the realisation of children and women’s rights
and well-being, which remain at the centre of the post-2015 agenda. In Guyana, as in countries around the world,
an understanding of the situation of children is regarded as a fundamental step towards eradicating inequities and
enhancing inter-generational equity. It is also essential to inform programmes aimed at strengthening children’s ability
to reach their potential as productive, engaged, and capable citizens.
Data generation and management in Guyana have increased with a greater national emphasis on evidence-informed
action. Over the last fifteen years, household data, not older than five years, have been always available for decision-
making. These include the MICS 2000; Population and Housing Census 2002; MICS 2006; Demographic and Health
Survey 2009 and MICS 2014, punctuated by a number of other studies and evaluations. However, there has been
an evident lack of harmonization of the disaggregation, collection and reporting of information, making it difficult to
conduct trend and other comparative analyses, to help determine real progress across key indicators, over time.
Deliberate steps were taken in the conduct of the most recent MICS (2014) to ensure the level of disaggregation
in the MICS mirrored, as much as possible, the Demographic and Household Survey (DHS 2009). A decision was
taken to continually advocate for all data in subsequent national surveys to be disaggregated accordingly, to allow
for comparisons and aggregation of results. However, there is still some ways to go especially towards establishing
a roadmap for harmonisation especially at the sub-national level and ensuring consensus among developmental
partners and other stakeholders. In directly supporting the harmonisation of data, especially on women and children,
partners are indirectly advocating for the realisation of children’s right to survival, development, protection and
participation as is outlined in the Convention of the Rights of the Child (CRC) as well as the inalienable rights of
women as articulated in the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW).
Qualitative data for the document complemented the quantitative data available, and it was collected at the end of
2015, few months after the election that legitimately change the government, and elected a new party after 23 years.
The new government is an opportunity to evaluate those policies that were being implemented, keeping the ones
that were successful, changing those that need to be improved, and designing new programmes that can effectively
diminish the inequalities that are present in the country. The new government is going to govern the country at the
same time that the Sustainable Development Goals (SDGs) are being shaped.
The SDGs represent a shift in global cooperation, giving voice for the most vulnerable populations, and clearly
indicating that inequities have to be reduced, otherwise sustainable development at any level is not achievable.
Children, youth and future generations are referenced as central to the Sustainable Development Goals. Children
are directly related to 12 of the goals, and indirectly by the other 5 (please see the list of goals in Annex 3). The SDGs
call for explicit targets on reducing inequality, ending violence against children and combating child poverty. At the
same time, UNICEF emphasizes the importance of “leaving no one behind.” Reaching first the poorest and most
disadvantaged children must be reflected in all targets, indicators and national implementation frameworks as they
are developed (UNICEF, 2014).
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Recommendations
The list of recommendations below reflects past suggestions found in many of the readings, as well as the
recommendations made by different stakeholders.
Poverty and Vulnerabilities
• Following SDG Targets 1.1 and 1.242, to develop and implement a methodology to yearly measure poverty and
vulnerabilities, capturing the different cultural peculiarities in the country. The method should allow for monitoring
poverty at national level, and, at the same time disaggregate poverty for different ages, regions, geographical
areas and ethnicities. The method for monitoring poverty should clearly define child poverty, and should adopt
a multidimensional measure that complements the monetary method.
• Taking into consideration SDG Target 1.343, to strengthen support to families in situations of vulnerability, in
particular single-parent families through systematic, long-term policies and programmes to ensure access to
social services and sustainable income opportunities;
Children with special needs and disabilities44
• Conduct a national assessment to identify the number and the situation of children with special needs and
disabilities in the country in order to develop public policies to address their needs.
• Undertake long-term awareness-raising programmes in order to combat negative societal attitudes prevailing
against children with disabilities;
• Allocate adequate human, technical and financial resources for ensuring the availability of health, rehabilitation
services and education for children with special needs, and in doing so prioritize addressing the situation in the
hinterland;
• Develop a disability education action plan to specifically identify current inadequacies in resources, and to
establish clear objectives with concrete timelines for the implementation of measures to address the educational
needs of children with disabilities, incorporating their inclusion in the mainstream education system to the greatest
extent possible.
Coordination of policies for children and child budget45
• Establish or designate a specific high-level governmental body for the overall coordination of all activities relevant
for the implementation of the CRC, and ensure that it has sufficient authority and adequate human, technical and
financial resources to effectively coordinate actions for children’s rights;
• Implement a child budget methodology (a suggested methodology is presented in this Situation Analysis) to track
government expenses related to children, guaranteeing an online monitoring tool where civil society can monitor
the expenses.
42 SDG Target 1.1: By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day.
SDG Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions
according to national definitions.
43 SDG Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve
substantial coverage of the poor and the vulnerable.
44 elements from (UN Committee on the Rights of the Child, 2013)
45 Using elements from (UN Committee on the Rights of the Child, 2013)
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Education46
• Guarantee equitable resources for education at all levels, including the allocation of adequate human, technical
and financial resources for the most vulnerable regions of the country aiming to equalize the current gap in terms
of quality;
• Continue to train teachers and staff in the Health and Family Life Education (HFLE) programme, make behaviour
counsellors available at all schools of the country, and increase the channels of communication between teachers
and students for topics related to social behaviour, sexuality and comportment.
• Emphasize career guidance for students beginning at the last years of primary education, and help students
at secondary level to understand careers paths and how their choices in secondary school influence in their
professional development in the future.
• Strength alternative curriculums for secondary education, including the development of vocational schools that
mix theory with practical application of concepts.
• Work with the Bureau of Statistics to produce and make available data related to education so proper public
policies can be developed, and resources better managed.
Health47
• Strengthen the coordination and collaboration mechanisms between the different actors involved in maternal and
child health services, including the identification of clear roles and responsibilities among different stakeholders.
• Eliminate the shortage of skilled personnel currently serving within the public health sector, especially in the
interior regions of the country, and guarantee training for all the staff in the system.
• Guarantee enough budgetary resources to address the shortage of equipment and supplies, including HIV rapid
testing.
• Create effective monitoring and evaluation systems to ensure adherence to the regulatory framework and
continuous adjustment to existing programmes based on expected and actual outcomes and results.
• Improve the infrastructure of health facilities in the hinterland including the establishment of additional waiting
rooms to host pregnant women waiting for delivery and in the post-delivery period.
• Develop and implement a strategy to overcome cultural barriers that currently discourage women from accessing
care in a timely manner during pregnancy, including training staff to be culturally sensitive.
• Assess the immediate and underlying causes of suicide among the youth48 in the country and develop coordinated
public policies (health, education and social protection) to address the findings.
Birth registration
• Modernize and update birth registration procedures in Guyana.
• Implement a communication campaign emphasizing the importance of the birth certificate for children.
46 Using elements from (UN Committee on the Rights of the Child, 2013) (Ministry of Education, July 2013)
47 Using elements from (Government of Guyana, 2014).
48 Topic discussed in section 13.4 (adolescent’s behavioral health).
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Human and Child Trafficking49
• Vigorously investigate and prosecute sex and labour trafficking cases and hold convicted traffickers accountable
with time in prison that is commensurate with the severity of the crime.
• Revise legislation to increase the time perpetrators are sentenced to jail – today the maximum time of imprisonment
is 5 years.
• Develop child-sensitive investigation procedures and court procedures that protect the privacy of children and
minimize their re-traumatization.
• In partnership with NGOs, develop and publicize written standard operating procedures to guide and encourage
front-line officials—including police, health, immigration, labour, mining, and forestry personnel—to identify and
protect victims of forced labour and forced prostitution;
• Train the current police force in methods to investigate and arrest those involved in human trafficking, and
capacitate magistrate in judging cases related to human trafficking.
• Use communication strategies to educate the population on identifying and reporting suspect cases of human/
child trafficking.
Child Abuse50
• Strengthen awareness-raising and education programmes including campaigns with the involvement of children
in order to educate the population to identify, prevent and report cases of child abuse.
• Strengthen the country’s legal framework and legal enforcement mechanisms at the national and local level,
increasing the implementation of the current laws and regulations.
• Develop a long-term societal behaviour change campaign to reduce sexual abuse and its acceptability, especially
of girls, as well as to address harmful cultural practices involving child abuse and exploitation.
• Ensure the implementation of programmes and policies for the prevention, recovery and reintegration of child
victims of abuse.
Corporal Punishment
• Create appropriate and clear measures to prohibit corporal punishment at home and at schools.
• Strengthen and expand awareness-raising and education programmes and campaigns, promoting positive and
alternative forms of discipline and respect for children’s rights.
Children in Contact with the Law51
• Raise the minimum age for criminal responsibility to an internationally acceptable level;
• Provide adequate diversionary options for children as part of wider reforms in the court system in order to ensure
that detention is the last resort;
• Allocate adequate human, technical and financial resources for ensuring that children in contact with the law
49 Using elements from (US Department of State, July 2015).
50 Using elements from (UN Committee on the Rights of the Child, 2013)
51 Using elements from (UN Committee on the Rights of the Child, 2013)
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receive free legal advice and representation;
• Establish additional juvenile detention and rehabilitation facilities, particularly in its hinterland region, and ensure
regular independent monitoring and inspection of all facilities in which children and youth are placed to ensure
that Convention-compliant standards of treatment and care are maintained;
• Make use, if relevant, of the technical assistance tools developed by the United Nations Interagency Panel on
Juvenile Justice and its members, including the United Nations Office on Drugs and Crime (UNODC), UNICEF,
Office of the United Nations High Commissioner for Human Rights (OHCHR) and non-governmental organizations,
and seek technical assistance in the area of juvenile justice from members of the Panel.
Child Participation52
• Train teachers and principals in the importance of child participation at school and society.
• Develop toolkits for public consultations on national policy development to standardize these consultations at a
high level of inclusiveness and participation;
• Undertake programmes and awareness-raising activities to promote the meaningful and empowered participation
of all children, within the family, community, and schools, including within student council bodies – with particular
attention to children in vulnerable situations.
52 Using elements from (UN Committee on the Rights of the Child, 2013)
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Annex 1: International Conventions ratified by Guyana
International Conventions Signature Ratification/
Accession
International Convention on the Elimination of All Forms of Racial
Discrimination: 1965 (1969)
1968 1977
International Covenant on Civil and Political Rights: 1966 (1976) 1968 1977
Optional Protocol to the International Covenant on Civil and
Political Rights 1966 (1976)
NA 1999
Second Optional Protocol to the International Covenant on Civil
and Political Rights, aiming at the abolition of the death penalty:
1989
NA NA
International Covenant on Economic, Social and Cultural Rights:
1966 (1976)
1968 1977
Optional Protocol to the International Covenant on Economic,
Social and Cultural Rights: 2008
NA NA
Convention on the Elimination of All Forms of Discrimination
against Women: 1979
1980 1980
Optional Protocol to the Convention on the Elimination of All
Forms of Discrimination against Women: 1999
NA NA
Convention against Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment: 1984 (1987)
1988 1988
Optional Protocol to the Convention against Torture and Other
Cruel, Inhuman or Degrading Treatment or Punishment: 2002
(2006)
NA NA
Convention on the Rights of the Child: 1990 1990 1991
Optional Protocol to the Convention on the Rights of the Child on
the involvement of children in armed conflict: 2000 (2002)
NA 2010
Optional Protocol to the Convention on the Rights of the Child
on the sale of children, child prostitution and child pornography:
2000 (2002)
NA 2010
Optional Protocol to the Convention on the Rights of the Child on
a communications procedure: 2011 (2014)
NA NA
International Convention on the Protection of the Rights of All
Migrant Workers and Members of their Families: 1990
2005 2010
International Convention for the Protection of all Persons from
Enforced Disappearance: 2006
NA NA
Convention on the Rights of Persons with Disabilities: 2006 2007 2014
Optional Protocol to the Convention on the Rights of Persons
with Disabilities: 2006
NA NA
Source: United Nations Human Rights website (http://indicators.ohchr.org/): accessed on October 5, 2015.
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Annex 2: Child Budget Methodology
Two simple methods were developed to calculate how much of the national budget is allocated for programmes and
projects that could directly impact on the situation of children. The first (so-called general child budget allocation)
included the total budget allocated for those agencies that conduct policies, programmes and projects that will
have direct influence on children. The second method (called specific child budget) tried to go into the details of
the expenditure of those selected agencies at programme level, excluding those values that were allocated for
administrative purposes.
All the values are coming from the Volume 1 of the Estimates of the Public Sector Budget (Government of Guyana,
2015).
General Child Budget Allocation
This method:
• Considers all the allocated values for the agencies
• Keeps the budget of different agencies separate
Table 32 depicts the list of Agencies used for the general allocation. If all the values are taken into consideration,
roughly 42% of the expenses of the country were allocated for children.
Table 32: Summary of values used to calculate general child budget allocation, Guyana, 2015
Agencies
2015 Budget
Allocation
G$ (,000)
% Total
Allocation
41 Ministry of Education 7,874,640 4.8%
40 Ministry of Education 6,624,583 4.0%
46 Georgetown Public Hospital Corporation 4,010,772 2.5%
47 Ministry of Health 6,612,537 4.0%
43 Ministry of Public Health 5,987,592 3.7%
44 Ministry of Culture, Youth and Sport 1,077,471 0.7%
48 Ministry of Labour, Human Services and Social
Sec. 5,973,500 3.7%
49 Ministry of Social Protection 4,056,921 2.5%
Sum allocated for the Regions 26,527,470 16.2%
Total Related to Children 68,745,486 42.0%
Other Government expenses 94,906,145 58.0%
Total Guyana Budget 163,651,631
Specific Child Budget
This method:
• Excludes those values that were identified as administrative;
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• Excludes those values at regional level that are not related to education and health;
• Divides the allocated budget into four categories: Education; Health; Youth and Culture; and Child Protection
• Add the total values allocated to education and health in the regions into the Health and Education categories
• Combines the allocations of the Ministry of Labour and Ministry of Social Protection into the child protection
category.
• Combines the allocations of the Ministry of Health, Ministry of Public Health and Georgetown Public Hospital
into the Health category.
Table 33 depicts the subcategories used to calculate the specific child budget. 35% of the total budget was allocated
to activities related to children.
Table 33: Summary of values used to calculate the specific child budget, Guyana, 2015
Agency/Sub-programme 2015 Budget Allocation Percentage
Education G$ (,000)
414 Training and Development 696,484
415 Education Delivery 4,405,904
402 Training and Development 1,071,681
403 Nursery Education 891,274
404 Primary Education 1,350,512
405 Secondary Education 1,762,682
407 Cultural Preservation and Conservation 232,991
408 Youth 113,643
Regions 15,450,974
Total Education 25,976,145 16%
Health
Georgetown Public Hospital Corporation 4,010,772
472 Diseases Control 337,077
473 Primary Health Care Services 542,991
474 Regional and Clinical Services 4,124,024
477 Rehabilitation Services 206,533
432 Disease Control 946,240
433 Family Health Care Services 238,131
434 Regional & Clinical Services 3,859,555
437 Disability and Rehabilitation Services 90,057
Regions 5,973,850
Total Health 20,329,230 12%
Youth and Culture
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Agency/Sub-programme 2015 Budget Allocation Percentage
Education G$ (,000)
442 Culture 338,481
443 Youth 359,517
444 Sport 260,681
Total Youth and Culture 958,679 1%
Child Protection
482 Social Services 5,394,934
484 Child Care and Protection 253,080
492 Social Services 3,504,528
494 Child Care and Protection 205,999
Total Child Protection 9,358,541 6%
Total Specific Child Budget 56,622,595 35%
Total Country Budget 163,651,631
Limitations
Both methods have the same limitations.
First, they average all the expenses as being related to children. For example, both calculations consider all the
expenses for the Georgetown Public Hospital Corporation as being connected to children. In reality, that is not true,
since adults also use the hospital facilities for many different treatments. The same conscious mistake is practiced
with the budget of all other agencies. Another example: the values for education and health for the regions were
integrally considered in both methods, when, in reality, some of those values might be allocated to administrative
purposes, not directly providing services for children. Similar situation happens to both Social Services values (482
and 492) that cover a much larger public than only children.
Despite the fact that the specific child budget method tries to reduce this error when it excludes those budgetary items
that are explicitly related to administration, it fails when it averages all other items.
The second limitation is that the methods do not include other sectors that also influence in the life of the child, such
as water and sanitation, and the expenses with security (police, legal affairs, etc.).
These two limitations point to one conclusion, one question and two recommendations in relation to the development
of a child budget. The conclusion is that the child budget – i.e., the amount of the national budget destined to
children – is much smaller than the 35% calculated by the specific child budget method.
The question is related to the added value of calculating a child budget in the country. While there are clear advantages
on tracking those expenses related to children, the decision of monitoring the child budget has to be agreed between
government and civil society, and a new monitoring system should be used to monitor year expenses related to
children, and to compare different years.
If monitoring of the child budget is considered to be a good input for public policies, the recommendations would
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be. First, government and stakeholders should agree on which items should be monitored by the child budget; i.e.,
if water and sanitation, for example should be taken into consideration, or not, and if those expenses related to
management should also be considered since they result in changes for those services being offered for children.
Second, government has to work on its financial monitoring systems to allow for easy tracking those expenses related
to children. With today’s technology, and using the preselected expenses agreed with stakeholders (recommendation
1), a marker should be created in the country’s budgetary system allowing for the monitoring of the budget for children
at real time.
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Annex 3: The Sustainable Development Goals
The SDGs have 17 Goals listed as follows:
• Goal 1: End poverty in all its forms everywhere
• Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture
• Goal 3: Ensure healthy lives and promote well-being for all ages
• Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
• Goal 5: Achieve gender equality and empower all women and girls
• Goal 6: Ensure availability and sustainable management of water and sanitation for all
• Goal 7: Ensure access to affordable, reliable, sustainable and modern energy for all
• Goal 8: Promote inclusive and sustainable economic growth, full and productive employment and decent work
for all
• Goal 9: Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation
• Goal 10: Reduce inequality within and among countries
• Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable
• Goal 12: Ensure sustainable consumption and production patterns
• Goal 13: Take urgent action to combat climate change and its impacts
• Goal 14: Conserve and use the oceans, seas and marine resources for sustainable development
• Goal 15: Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests,
combat desertification, and halt and reverse land degradation and halt biodiversity loss
• Goal 16: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all
and build effective, accountable and inclusive institutions at all levels
• Goal 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development
For more information on the SDGs please access:
http://www.un.org/sustainabledevelopment/sustainable-development-goals/
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Annex 4: Equity and Equality in the scope of the Situation
Analysis.
Table 34 depicts the main differences and similarities between a rights-based and equity based approaches used in
the situation analysis of children and women. These two approaches do not cancel each other; on the contrary, they
are complementary and reinforce the debate over the realization of children’s rights.
Table 34: Human Rights and Equity-based perspectives
Rights-based approach Equity-based approach
Definition: Application of human rights principles in
child survival, growth, development and participation.
Respect, protect, fulfil
Definition: Application of an equity-focused approach in the
realization of child rights
Poorest, most marginalized, deprived of opportunities, etc.
Scope: All children have the right to survive, develop
and reach full potential regardless of gender,
race, religious beliefs, income, physical attributes,
geographical location or other status.
Scope: All children have equal opportunity to survive,
develop and reach full potential without discrimination, bias
or favouritism. Focus is on the most marginalized children.
Guiding principles: Accountability, Universality,
indivisibility, and participation. Justice overriding
theme
Guiding principles: Equity is distinct from equality. Equality
requires all to have same resources, while equity requires
all to have equal opportunity to access the same resources.
Concept of equity is universal with social justice
Violations of child rights arise when the basic child
rights are not realized as per CRC four principles:
non-discrimination; best interest of the child; right to
survive, grow and develop; and the right to participate/
be heard.
Concept of progressive realization of rights.
Inequities arise when certain population groups are unfairly
or unjustly deprived of basic resources that are available to
other groups.
It is important to emphasize that equity is distinct from equality, and, consequently, inequity (or lack of equity) is also
different from inequality (or the lack of equality).
Inequality is characterized by differences among populations, groups or people. These differences can be the result
of natural personal characteristics – some individuals might have a higher propensity for studying science than social
studies – or can be created by failures in society, causing some to have better opportunities than others. Inequity
is related to lack of access to goods and services due to structural problems in the country or territory. Inequity
happens when inequalities are being generated and/or aggravated by failures in how socio-economic policies are
implemented. For example, the fact that the place where a child is born, its gender, or the actual economic situation of
her parents determines the child’s future is an equity issue. Inequities generally arise when certain population groups
are unfairly deprived of basic resources that are available to other groups (Bamberger & Segone, 2012).
In sum, equality requires everyone to have the same resources. Equity requires everyone to have same opportunity
to access the same resources. The aim of equity-focused policies is not to eliminate all differences so that everyone
has the same level of income, health, and education, among others. Rather, the goal is to eliminate the unfair and
avoidable circumstances that deprive children of their rights.
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Photo Credits:
Pg. 17 ©UNICEF Guyana/Jordan Mansfield
Pg. 23 ©UNICEF Guyana
Pg. 49 ©UNICEF Guyana/Kojo Mc Pherson
Pg. 101 ©UNICEF Guyana/Phillip Williams
Pg. 117 ©UNICEF Guyana/Kojo Mc Pherson
Pg. 163 ©UNICEF Guyana/Kojo Mc Pherson
United Nations Children’s Fund (UNICEF)
Guyana
2016
