With funding from the UK-based Frontline AIDS,, SASOD Guyana conducted a study to assess how key populations (KPs) experienced HIV services in Guyana during the COVID-19 pandemic. The findings of the qualitative assessment were launched to the media virtually last Friday morning.
SASOD Guyana’s Human Rights Coordinator, Kobe Smith, who served as the interviewer on the research team, presented the methodology, findings and recommendations at Friday’s launch.
Smith related that the qualitative assessment was conducted in the four (4) most populous of Guyana’s ten (10) administrative regions (Regions Three, Four, Five and Six), which is home to more than 75% of the population. The data was collected during November and December 2020. The collection process utilized convenience and snowball sampling of men who have sex with men (MSM) and transgender women over 18 years of age, residing within any of the four (4) regions of interest and who had accessed HIV services (preventative or for treatment) from March 2020 to the interview date. At least one service provider from each region was also interviewed to triangulate the findings. Interviews were conducted online or via telephone using a semi-structured interview guide, involved informed consent, and were audiotaped for subsequent transcription.
According to Smith, the study found that all the persons living with HIV (PLHIV) who were interviewed were able to access treatment services during the pandemic, while others went for testing and collection of condoms and lubricants mainly through civil society organizations (CSOs). No one tried to access pre-exposure prophylaxis (PrEP), and two persons had never heard of the intervention. He noted that 58% of the study participants identified as PLHIV.
There were many good other experiences relayed, such as travel allowances being provided for clients in Region Six and the friendliness of healthcare professionals. Having services still open, being able to uplift medications, social workers consistently following up and sometimes offering assistance unrelated to HIV, and the smooth testing process were also highlighted as good practices. Gratitude was expressed by several persons for the hampers provided by the National AIDS Programme Secretariat (NAPS) and CSOs like SASOD Guyana.
The study also found that support for mental health was a big issue for the participants – for themselves, for others, and as one person made sure to emphasize, for trans sex workers who face many layers of stigmatization with few mental health resources.
It was noted however noted that the Skeldon Public Hospital has no social workers and would refer persons needing assistance to the local CSO, Family Awareness Consciousness Togetherness (FACT). Others said that COVID-19 decreased the mental health support that was available, although the CSOs were trying their best, or that they had access to informal sources of support in the form of a peer counsellor or CSO staff; United Bricklayers in Region Six was specially mentioned in this regard.
Other areas highlighted from improvement by KPs in the coastal regions included the need for financial and nutritional support, longer interaction times to build rapport with the doctors when attending treatment services, and assistance in explaining the new antiretroviral (ARV) regimen change and increased substance abuse, especially among trans sex workers.
Smith went on to share that the assessment shows that the pandemic has placed a strain on both clients and providers. Without directing the national public health measures, two particularly important strategies could help to ameliorate the stress at this level: having a focused, key-population-specific plan, and implementing increased comprehensive mental health access points for both clients and providers.
On behalf of SASOD Guyana, Smith presented the recommendations emanating from the study which included that the food hampers that have been delivered so far should be sustained, at least in the short term, and that the provision of transportation reimbursements for clients should be considered.
Smith revealed that some clients were unaware that they would be allowed to see a doctor if they had complaints that needed to be addressed urgently and resented not having their vitals taken along with routine consultations. The study proposes telemedicine to overcome these issues, but the lack of regular, quality and widespread internet services required to enable this may not be possible. Expanding clinic hours that cater to clients in treatment and letting them know the criteria with which they would be allowed to consult with a doctor should be considered as an alternative approach.
Based on the findings, SASOD Guyana is calling on the Government of Guyana to urgently prioritise mental health. Given the country’s high suicide rate and taboos around the subject, collaborating with CSOs and service delivery centres to ensure all clients know about their access procedures and are reached, will require an increase in the cadre of available social workers and mental health professionals, as well as, accompanying sensitization campaigns.
Smith lamented that the situation in Region Six with regards to a lack of testers/counsellors and social workers within the public healthcare system is particularly troubling and should also be urgently addressed.
SASOD Guyana’s Research Consultant, Alessandra Hereman, who also presented at Friday’s virtual media launch shared that she has developed an advocacy toolkit and will be leading a virtual training programme with sixty (60) key populations across the four study regions to sensitize them to lobby for improved KP-friendly HIV services in order to bring action to the study.
SASOD Guyana’s Managing Director and co-investigator of the study, Joel Simpson, revealed that the report will then be presented to five (5) key health officials: The Minister of Health, Chief Medical Officer, Director of Disease Control, Programme Manager of the National AIDS Programme Secretariat, and the Director of the National Care and Treatment Centre.
Public health researcher and consultant, Dr. Nastassia Rambarran, who served as the principal investigator, designed the study instruments, analyzed the data and compiled the study report.
