Barbados’ draft policy on Testing for HIV is currently under review, obtaining input from key stakeholders prior to its submission by January 2009.
At a recent consultation at the Pan-American Health Organisation (PAHO), Acting Chief Medical Officer, Dr. Anton Best, outlined the rationale for the policy. He noted that while a lot of testing was ongoing in public and private clinics “more needed to be done in terms of improving what they have been doing and in terms of getting more people to be tested for HIV.”
Explaining that part of the rationale was to look at HIV testing as a public health intervention, Dr. Best stressed that it was essential for more people to know their HIV status.
He said: “The more people we get to know their status, the evidence is that people living with HIV do change their sexual behaviours – they do start using condoms if they weren’t using them before, they do reduce partners – a lot of our patients have been disclosing to their partners their HIV status and that would help reduce the transmission that you are seeing within the community, but you have to know your status first of all.
“HIV testing is regarded as a fundamental public health intervention and we have never had a framework for HIV testing and as one of the countries in the UN you are charged with the responsibility of achieving what is referred to as universal access by 2010 – to all HIV services – prevention, treatment, care and support services.
HIV testing is regarded as the gate-way into those services – so whether you are HIV positive or negative, HIV testing is absolutely critical.”
It was also pointed out that the HAART programme was the most successful aspect of the expanded HIV/AIDS programme in 2001. “We have had successful reductions in respect of morbidity (in terms of the number of people being sick and reduction in hospital days and mortality).
Notwithstanding this, Dr. Best disclosed that there were some areas in which success had not been realised. He explained:
“We have not been successful in reducing the incidence of HIV. Over the last 10 to 15 years our incidence (or the number of cases that we diagnose on an annual basis) has been stable. We haven’t made any impact there from what we have been able to see.”
Stating that 2001 to 2006 showed a significant decline in AIDS deaths, the CMO (Ag) revealed that between 2006 and 2007 these deaths were going back up. He added that some 175 to 190 cases of HIV were being diagnosed on an annual basis while the number of AIDS cases or persons in a more severe immune compromised state had been going down. “That is due in part to the HAART programme, where we are providing anti-retroviral therapy to persons before they meet the criteria for diagnosis of AIDS and then that trend is reversed – because you reverse the natural history of HIV disease,” he declared.
Dr. Best acknowledged that deaths from AIDS were of concern to the Ministry just as much as the HIV incidence. He said: “We had a peak of deaths in the mid -90s and then from 2001 we then had a very sharp decline in death – there was a little spike in 2005, which we have not yet figured out why. Then in 2006 and we went back up there in 2007 – this is of statistical significance and of concern to us.”
In elaborating on this rise, the CMO (Ag) said: “It tells us that a lot of cases that we are picking up we are diagnosing too late.
Persons are coming into hospital when their CD4 counts are basically in the breach and although anti-retroviral therapy can reverse that, had we picked them up probably two, three, four years earlier, with HIV disease, closer to when they would have actually acquired HIV, their chances of survival would have been significantly better than when we diagnosed them in hospital.”
The draft policy document covers six policy areas and recognises the preservation of human rights as an important tenet in HIV/AIDS testing. It addresses HIV testing in institutions such as prison, HIV testing in pregnancy; referral after Testing for HIV and testing for insurance purpose and sets the tone for how rapid testing – a quick form of HIV testing that will soon be introduced – will be done in Barbados.
Barbados’ experience with the HIV/AIDS epidemic spans 24 years, having begun in 1984, when the first two cases of AIDS were reported. Commercial testing for HIV, however, began in 1985 and the HIV/AIDS programme was expanded in 2001. A critical part of that expanded programme was the provision of anti-retroviral therapy which allowed a near fatal disease to be now deemed a chronic disease in the same vein as diabetes and hypertension. It is considered a chronic disease because it is better managed.