Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694831641827.pdf (Guyana)
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 TABLE OF CONTENTS Page No.
Acronyms Acknowledgements 1.0 Background/ Introduction 2.0 Workshop Format 2.1The Opening Ceremony 2.2 The Working Sessions 2.2.1 Session 1 2.2.2 Session 2 2.2.3 Session 3 2.2.4 Session 4 2.2.5 Session 5 2.2.6 Session 6 2.2.7 Discussions 3.0 Closing Session and Press Briefing 4.0 Evaluation/ Feedback APPENDIX 2 4 5 6 6 11 11 17 18 24 26 26 27 27 32 ACRONYMS ACP TPS AIDS ARV CARE C CDC CIDA CSIH ESAC EU GFATM GPA/WHO GUM HIV ICPD IPAA MBBS MD - MP MPH MTP NAC NAP NGO(s) NSP ORISE PAHO/WHO PANCAP PEPFAR PhD PLWHA PMTCT POA RCA RSP SC STI TB UN UNAIDS UNFPA UNGASS African Caribbean and Pacific Group of States All countries (French - Tous Les Pays) Acquired Immuno - Deficiency Syndrome Anti retroviral Caribbean Epidemiology Centre Centre for Disease Control Canadian International Development Agency Canadian Society for International Health Enhanced Support to HIV/AIDS in the Caribbean European Union Global Fund for AIDS, Tuberculosis and Malaria Global Programme on AIDS/ World Health Organisation Genital Urinary Medicine Human Immuno - Deficiency Virus International Conference on Population and Development International Partnership Against AIDS in Africa Bachelor of Medicine and Bachelor of Surgery Medical Doctor Member of Parliament Master of Public Health Medium Term Plan National AIDS Committee National AIDS Programme Non Governmental Organisation(s) National Strategic Plan Oakland Ridge Institute for Science and Education Pan American Health Organisation/ World Health Organisation Pan Caribbean Partnership Against HIV/AIDS President's Emergency Plan for HIV/AIDS Relief Doctor of Philosophy (Graduate of a Doctoral Programme) Persons Living With HIV/AIDS Prevention of Mother To Child Transmission of HIV/AIDS Programme of Action Caribbean Region (French - Region Des Caraibes) Regional Strategic Plan Senior Council Sexually Transmitted Infection Tuberculosis United Nations Joint United Nations Programme on HIV/AIDS United Nations Population Fund United Nations General Assembly 2 USA UWI VCT United States of America University of the West Indies Voluntary Counseling and Testing 3 ( ACKNOWLEDGEMENTS The successful coordination of this workshop constituted a challenge which could not have been adequately negotiated without the sterling contributions of several individuals and organizations.
These include: The Staff of the National Assembly( Mr. Maurice Henry and Ms. Claudia Greenidge), who provided efficient support services; The Members of the Parliamentary Sectoral Committee on Social Services, who assisted with the coordination and organization of the workshop; Participating Parliamentarians, for their bi-partisan and collaborative approach coupled with their incisive and lively contributions; The Presenters, for their well-researched presentations; Mr. Colin Chichester — Rapporteur, who ensured that the deliberations at the workshop were adequately and accurately recorded and documented; Ms. Gloria Cummings — for Secretarial Support Ms Patrice La Fleur and the staff of UNFPA, who assisted with the coordination and organization of the workshop; Sincere and heartfelt thanks to all.
4 1.0 BACKGROUND/INTRODUCTION The United Nations Population Fund (UNFPA) is cognisant of the collaborative efforts of all stakeholders at the international, regional, national and civil society levels to prevent the spread of HIV/AIDS and to provide care and treatment for those living with HIV/AIDS.

The efforts of Non Governmental Organisations (NGOs) to provide access to information, services and resources for prevention, protection, care and treatment have not gone unnoticed.
There is also an important role for governments and in particular legislators to address issues of legislation and policy in relation to areas such as Stigma and Discrimination and Work Place Policies for Persons Living with and affected by HIV/AIDS.

UNFPA recognises that in order to have effective interventions there has to be the active involvement of legislators, policy and decision makers and all stakeholders creating an enabling environment for HIV Prevention.
To this end in 2004 UNFPA and the Inter-American Parliamentary Group organised a two-day workshop for Caribbean Parliamentarians in Trinidad and Tobago to focus on actions to reduce the incidence and to formulate appropriate legislations.

Two Guyanese parliamentarians Dr. Bheri Ramsarran and Ms. Nurlene Nestor participated in the Trinidad and Tobago workshop and agreed as a Guyanese delegation on their return to host a similar workshop for all Guyanese parliamentarians.
With this in mind the services of the Parliamentary Sectoral Committee on Social Services were engaged and with the combined and vigorous efforts of Dr. Ramsarran, Ms. Indra Chandarpal, and Ms. Volda Lawrence, Past and Present Chairpersons respectively, other members of the said Committee and UNFPA Liaison Officer, Ms. Patrice LaFleur, this workshop became a reality.

5 2.0 WORKSHOP FORMAT The workshop consisted of two (2) parts, the Opening Ceremony and the Working Sessions.
DAY ONE Morning 2.1 The Opening Ceremony This section of the workshop was chaired by Ms. Clarissa Rheil, M.P and Deputy Speaker of the National Assembly.

It was graced with the distinguished presence of: The Honourable Chief Justice and acting Chancellor of the Judiciary, Mr. Carl Singh.

The Honourable Minister of Health, Dr. Leslie Ramsammy.

The Honourable Speaker of the National Assembly, Mr. Ham Ramkarran, SC.

The Honourable Leader of the Opposition, Mr. Robert Corbin.
The UN Theme Group Chairperson on HIV/AIDS and PAHO/WHO representative, Dr. Bernadette Theodore — Gandhi, and Members of the Diplomatic Corps.

Presenters at the opening ceremony included: - Chairperson of the Parliamentary Sectoral Committee on Social Services - Mrs. Volda Lawrence, MP.

The Honourable speaker of the National Assembly, Mr. Harp Ramkarran, MP, SC.

UNFPA/Guyana Liaison Officer - Ms. Patrice La Fleur.
The UN Theme Group on HIV/AIDS Chairperson and PAHO/WHO representative, Dr. Bernadette Theodore — Gandhi.

- The Honourable Minister of Health, Dr. Leslie Ramsammy.

6 2.1.1 Ms. Clarissa Rheil In her introductory remarks, Ms. Clarissa Rheil, M.P, commended the organizers of the workshop for such a laudable initiative, given the HIV/AIDS pandemic sweeping the world.
According to her, "the deleterious effect of HIV/AIDS has transcended the health sector and ultimately has serious economic implications for any society which does not work assiduously to prevent control and ultimately halt its rampage."

She opined that if as a body of legislators the MPs take up the challenge, the horrendous statistics on HIV/AIDS would be significantly reduced.
2.1.2 Ms. Volda Lawrence The next presenter Mrs. Volda Lawrence prefaced her introduction of His Honour, the Speaker of the National Assembly, by commenting on the startling situation facing Guyana in respect of the scourge of HIV/AIDS and lamented on the lack of involvement of the policy makers in dealing with the problem.

She exhorted all parliamentarians to make a commitment towards a safe environment thereby securing the future of Guyana.
2.1.3 His Honour, Mr. Harri Ramkarran In welcoming the participants to the workshop the Honourable Speaker Mr. Ramkarran endorsed the comments made by the previous presenters as regards the HIV/AIDS problem that was affecting the whole of Guyana, and underscored the need for parliamentarians on both sides of the house to work together towards dealing with the challenging issue of HIV/AIDS.
He observed "according to reports, the infection rate in Guyana is the highest in the (Caribbean) Caricom countries and Guyanese are very grateful for the focus and attention which we have received so far and the assistance which have been given by the donor partners and others in combating HIV/AIDS."

Mr. Ramkarran pointed out that the workshop was vitally necessary in the fight against HIV/AIDS and as such deserved the support of all stakeholders.
He therefore took the opportunity to extend congratulations and thanks to the organizers.
According to The Honourable Speaker, given that the programme was designed to equip parliamentarians with the requisite knowledge and ability as well as the importance of taking leadership positions in the fight against HIV/AIDS, "We need to be imbued with the understanding that we and our 7 country are directly affected by the proliferation of this deadly disease" He opined that as parliamentarians and leaders in society, "we owe it to our constituency to be involved."
Mr. Ramkarran referred to a series of reforms embarked upon by the National Assembly in 2001 which was recommended by the constitutional reform commission in 1999 and the Herdmanston accord in 1997and informed the workshop "these reforms are now completed and they have enhanced the capacity of the National Assembly to influence the direction of policy as regards all areas of governance including HIV AIDS policy in the health sector."
He added, "the sectoral committee on social services is a product of those reforms and this workshop shows that it is proceeding in an innovative way" The Honourable Speaker informed the participants that the committees could engage the National Assembly by way of its reports accompanied by a motion to adopt or by a specific motion on HIV/AIDS.
He suggested that the engagement of the National Assembly offered great possibilities for attracting national attention to the issues because the press as well as the public pays great attention to what transpires in parliament.

Mr. Ramkarran bemoaned the fact that the work of the sectoral committees was not getting the exposure that is afforded to the larger assembly and alluded to two recently passed bills which reflected total cooperation and collaboration by the committee members.
He added, "it is my experience, my unerring experience that whenever important issues are consigned to committees of the National Assembly, the debates are highly productive and almost completely non-confrontational."

Mr. Ramkarran concluded his presentation by reiterating his congratulations and gratitude to the organizers of the workshop.
2.1.4 Ms. Patrice La Fleur Ms. Patrice La Fleur, UNFPA Liasion Officer brought greetings from the Representative of the United Nations Population Fund for the English and Dutch Speaking Caribbean, Mr. Harold Robinson and extended on his behalf congratulations to the Honourable Speaker and Members of the National Assembly on the occasion of the significant meeting of parliamentarians, in their quest to fight the dreaded epidemic which is decimating millions of people.
8 Ms La Fleur suggested that this was a historic occasion for Guyana, when policy and decision makers at the highest level can gather together in an atmosphere of unity and purpose to discuss one of the most frightening diseases the world has seen in this century.

According to her, "the HIVAIDS epidemic, which has touched every continent in the world, continues to have a staggering impact on people's health and on the social and economic stability of nations.
Globally millions of people have already died and as we meet here people, women, men, young people and children are dying while others are being infected."
She informed the participants that, based on UNFPA's extensive experience in 'rights based reproductive health, advocacy and programming, and in addressing population and development concerns and building on interventions to address the reproductive needs of young people and to safeguard motherhood, UNFPA has concentrated its Prevention Initiatives in three core areas: 1.
Preventing HIV infections in young people age 10-24 years with a focus on:- o The development and dissemination of information, education and communication and behaviour change communication campaigns for HIV prevention with young people in institutional and community contexts • Quality education for young people both in and out of school q Establishment of 'youth friendly' reproductive and sexual health services that include voluntary counselling and testing for HIV o Social Marketing strategies and alternative condom distribution strategies for sexually active young people.
2.

Condom programming (both male and female) in the context of STI/HIV prevention ensuring that there is an awareness of the importance of condom use and addressing issues of myths, misperceptions and fears about condoms.

3.
Preventing HIV infections in pregnant women through four Prongs:- o Preventing HIV infection in HIV negative women 9 q Prevention of unwanted pregnancies among HIV infected women q Prevention of HIV-transmission from the HIV infected women to their infants through provision of antiretroviral drugs to HIV infected pregnant women and their infants, safe delivery practices, and counselling and support for safe infant feeding practices u Provision of care and support to HIV infected women, their infants and family.
She concluded by observing that "this workshop which brings together parliamentarians under the theme 'Leadership a Vital Tool against HIVAIDS' is the beginning of a new partnership between UNFPA and parliamentarians as together we form an alliance to meet one of the greatest challenges facing the world in terms of health, development and human security.
UNFPA has every confidence in your resolve and capacities to take action and to make a difference- remembering that every infection prevented is a step towards halting the epidemic."

2.1.5 Dr Theodore — Ghandi The next speaker, Dr Theodore — Ghandi, brought greetings from the UN Theme Group on HIV/AIDS.

She commented on the fact that the MPs were uniquely and strategically positioned to play a significant role in preventing the spread of the HIV/AIDS epidemic in the Country.
She pointed out there is no known cure for the disease which has ruthlessly decimated large sections of some societies thus reversing their rate of development, whilst others are on the verge of complete collapse.

"This must not happen in Guyana" she exhorted.

2.1.6 Dr. Leslie Ramsammy The Chairperson then introduced the Honourable Minister of Health Dr. Leslie Ramsammy who delivered the keynote address.
In his wide-ranging informative and intensely passionate presentation, Dr. Ramsammy provided participants with an overview of initiatives and programmes undertaken by his Ministry to combat the ravages of HIV/AIDS.

l0 He lamented the fact that Guyana with a prevalence rate for HIV/AIDS of 2.5%, along with the rest of the Caribbean with prevalence rates ranging from 1.7% (Suriname) to 5.6% (Haiti) has so far experienced the highest rates outside of Africa.
He described himself as a "crusader" with a messianic fervour in the fight against HIV/AIDS.

He offered, "Today is a very important day.

It marks another milestone, another step forward in the fight against HIV/AIDS for Guyana ... today's meeting of Members of Parliament to discuss HIV/AIDS and Guyana's response is another front in the battle against HIV/AIDS."

He challenged those present to set the example by publicly reviewing their status thus encouraging their followers to do likewise.
The Minister concluded by suggesting "our response must be measured in small steps, in acts of kindness and dedication and great commitment and in great leaps in science and in legislative innovations to protect people and their rights.

Remember that failure to respond is a response.

It's a fatal response.

We have already dug a reservoir of permanent shame in the way we have handled the epidemic in the world.

No matter what happens now, we can only redeem ourselves."
2.1.7 Vote of Thanks The opening ceremony was brought to a fitting conclusion by Mrs. Indranie Chandarpal Deputy Chairperson of the Parliamentary Sectoral Committee on Social Services who extended the vote of thanks.

In doing so, Ms. Chandarpal reiterated the urgent need for the MPs to become agents of change with special emphasis to the challenge of HIV/AIDS.
11 2.2 The Working Sessions This section of the workshop was divided into six (6) sessions, which were moderated by Dr. Dalgeish Joseph, Mrs. Indranie Chandarpal, Dr. Bheri Ramsaran, Mr. Fredrick Cox, Mrs. Philomena Sahoye-Shury, and Mr. Deryck Bernard, respectively.

All the presenters utilised Microsoft Power Point presentations which considerably enhanced the impact of their discussions.

There were 11 presenters namely: 1.


Dr. Navindra Persaud — MBBS, MPH, PhD - Monitoring and Evaluation Officer USAID/Guyana.

2.

Mr.Roger Mclean - Lecturer, Department of Economics UWI, St. Augustine.

3.

Professor Rhoda Reddock — Head of the Centre for Gender and Development Studies UWI, St. Augustine.

4.

Ms. Chrystol Albert — Secretary G+ - Network of Persons Living with HIV/AIDS.

5.

Dr. Michel de Groulard UNAIDS Country Programme Advisor to Guyana, Suriname and PANCAP.

6.
6.

Dr. Shanti Singh —Director of the GUM Clinic of the Public Hospital Georgetown.

7.

His Excellency Ambassador of the USA, Mr. Roland Bullen.

8.

His Excellency Ambassador Mr.

Per Eklund of the European Union.

9.

Ms. Carol Kerfoot - Programme Manager, CIDA.

10.Dr.

Curtis La Fleur — Technical Coordinator, Public Health Strengthening in Guyana Project.

1 1.Dr.

Frank Anthony - Programme Manager Global Fund, Guyana.
2.2.1 SESSION 1 Moderator: Dr. Dalgeish Joseph M. P. 12 I I I 1 I I I I I I 1 I I I I I I 2.2.1.1 Presenter: Dr. Navindra Persaud — Monitoring and Evaluation Officer USAID/Guyana HIV/AIDS Reduction Programme.

Topic: An Overview of the HIV/AIDS Epidemic — Global, Regional and National Dr. Persaud's presentation focused on: The rapid growth of the epidemic, Regional variation in intensity, Poorly understood dynamics of transmission, and The need for a coordinated and targeted response.
The statistics provided by Dr. Persaud as regards the prevalence of HIV/AIDS in Guyana, the Caribbean and the rest of the world, over the period 1987 to 2003, were very revealing and alarming.

These statistics suggested that outside of Sub Saharan Africa, the Caribbean had the highest incidence of reported HIV/AIDS cases in the world.
According to the statistics provided by Dr. Persaud, Haiti with 5.6% had the highest estimated prevalence of HIV/AIDS in the Caribbean followed by Trinidad & Tobago (3.2%), the Bahamas (3.0%), Guyana (2.5%), Barbados (1.5%) and Jamaica (1.2%), respectively.

With particular reference to Guyana, Dr. Persaud pointed out that over the years the incidence of HIV/AIDS related deaths has risen consistently to the extent that it ranks among the top five (5) causes of death in Guyana.
2.2.1.2Presenter: Mr.Roger Mc Lean - Lecturer, Department of Economics UWI, St. Augustine.

Topic: The Social and Economic Impact of HIV/AIDS on the Caribbean and in particular, Guyana Mr. Mc Lean 's presentation focused on: - The Caribbean Profile (Economic, Demographic and Macroeconomic volatility).

- Why is HIV/AIDS a major cause for concern?

13 - What are the channels through which the epidemic impacts on our social & economic fabric?

- What is the extent and implications of the impact?
and - Reflections- where do we go from here?

According to Mr. Mc Lean, the epidemic impacted on both individuals and households.

He referred to the Income Earner, the Care Giver, the Educator, the Family Member, the Consumer, the Individual, the Producer and the Community Member.
Mr. McLean provided information which highlighted the Economic Impact of Workforce HIV/AIDS as it related to Direct Costs (Benefits package, recruitment, training, and HIV/AIDS related programmes), Indirect Costs (Absenteeism, morbidity on the job, limited management resources) and Systemic Costs (Loss of workplace cohesion, low workforce performance & experience).
He submitted that "there are clear implications for both business and labour from HIV/AIDS in terms of:- declining productivity levels, increased labour costs, and increased payout from pension funds, causing: o contributions to increase, o recruitment, and training costs increase, o overall costs of production increase" Mr. Mc Lean proceeded to reassure the participants that "all was not lost" he indicated that there was a Caribbean Response in the form of: - A Regional Structure — PANCAP - A Regional Strategic Plan (RSP) - National Strategic Plans informed and guided by the RSP He noted: Stakeholders must take ownership of its HIV/AIDS problem.
Partnering by participation vs. Partnering by pocket.

If it is a development problem then it requires a response from all sectors.

An early and well-coordinated response is an investment that brings significant returns vs. the price of in-action.

14 Presenter: Professor Rhoda Reddock — Head of the Centre for Gender and Development Studies UWI, St. Augustine.
Gender and HIV/AIDS Topic: Professor Reddock's presentation focused on: Understanding gender - Gender and Sexuality - Gender Analysis Gender Dimensions of HIV/AIDS and The Dynamics of Care Professor Reddock placed into perspective the fundamental concept of gender and suggested that "there are many misunderstandings about the term Gender.

For many it means simply — men and women, while for others it is another way of saying 'woman'.
These views are related but provide an inadequate basis for understanding the complexities of gender and gender relations."

Professor Reddock defined Gender as "the socially constructed behaviours, attitudes, and identities associated with masculinity and femininity."
In her examination of the Gender Dimensions of HIV/AIDS in the Caribbean the Professor pointed out that:- 0 Young girls are socialized to use their sexuality and their bodies as means of social and economic survival and for socio-economic mobility.

OThe exchange of sex for money or economic support is assumed to be a normal continuum; ranging from formal marriage to illegal sex work with many permutations in between.
Alternative Sexualities 0 The HIV epidemic allows us to reconsider our attitudes to persons with different sex/gender identities and alternative sexualities.

OIn the Caribbean such individuals have been forced underground to live lives of lies, deceit and fear.

:Although HIV/AIDS is no longer considered a homosexual disease, as a sexually transmitted infection, it opens a space for a more open understanding of all forms of sexual activity and gender identity.
15 Constructions of Pleasure and Power OUntil recently, only men were seen as active sexual beings with the prerogative to insist on sexual pleasure.

q This is changing somewhat in many Caribbean communities, where women are also claiming this right, but the sexual double standard still exists.

q Men's right to pleasure means that factors which reduce their capacity for pleasure are perceived as unmanly.

Their power and physical strength allows them to insist on this.
The Symbolic Importance of Fertility q Having one's own biological child is important for masculine and feminine gender identity.

q Among Afro-Caribbean peoples, bearing a child is a rite de passage to adulthood.

0 Among Indo-Caribbean peoples, marriage is the rite de passage to adulthood, but bearing a son is a sign of manhood.

q Fertility requires unprotected sex.


Gender Inequity and Sexual Violence q Existing gender ideologies support the idea of women forming unions with more powerful men — older, bigger, taller, wealthier, stronger etc.

q Sexual violence or the threat of gender-based violence maintains the unequal power relations between the sexes.

q Sexual relations are often accompanied by force or violence.
Professor Reddock concluded: Gender analysis provides useful insights into the meanings attached to sexual and social behaviour.

It therefore provides a better understanding of the complexities, which influence human behaviour.

Much more research is needed on the gender dimensions of HIV/AIDS generally in this region.

Gender analysis and gender- based research should be a basis for policy making in health, and all aspects of policy and planning in this region.
16 I 2.2.2.4 Presenter: Ms. Chrystol Albert — Secretary G+; Topic: The Reality of HIV/AIDS with an emphasis on Stigma and Discrimination from the perspective of a PLWHA Ms. Albert is classified as a Person Living With HIV/AIDS (PLWHA).
She afforded the participants a visual and verbal presentation of the trials and tribulations that she encountered on a daily basis as a PLWHA Crystol's very poignant, heart-rending, and heart-wrenching, story had her audience riveted - evoking, at various stages, involuntary outbursts of shock and disbelief.
Her saga described the tragedy of a young girl growing up in a single parent home becoming pregnant at the age of seventeen (whilst still in school) and discovering after a five-year relationship with the father of her child that she was HIV positive.

On being informed of her status he promptly committed _ suicide, leaving her to fend for herself and child who fortunately was not infected.
Despite her tragic circumstances, Crystol was very positive in her outlook on life and cited her future plans as: - Gaining a Diploma in Computer Science.

- Reading for a Degree in Project Management at the University of Guyana.

- Continue to share her experiences and knowledge with others, and - Getting Married At the end of her presentation she was resoundingly applauded and repeatedly commended for her bravery and commitment to educate the wider society re: the facts of living with HIV/AIDS.
1 17 DAY ONE Afternoon 2.2.2 SESSION 2 Moderator: Mrs. Indranie Chandarpal M.P.

2.2.2.1 Presenter: Dr. Michel de Groulard — UNAIDS Country Programme Advisor to Guyana, Suriname and PANCAP Tonic; The Global and Regional Response to HIV/AIDS In his presentation Dr. Groulard discussed the regional response to HIV/AIDS, by providing documentation as regards the contributions made by the various organisations towards dealing with HIV/AIDS.
He pointed out that the first responses to HIV/AIDS dated back to the period 1985-95 and involved: GPA/WHO Bilateral Cooperation NAPs Establishments • MTP Development - HIV Testing Prevention Programmes Dr. Groulard then traced the response to HIV/AIDS over the ensuing years 1996 to 2005, highlighting the contributions made by various organizations and the various programmes that were implemented.
These included: The creation of UNAIDS Multilateral Approach (NAC, IPAA) The role of PLWHAs • Civil society mobilization Advocacy for access to treatment Accelerated Access 18 - 2.2.3 SESSION 3 Moderator: Dr. Bheri Ramsarran, M.P.
2.2.3.1 Presenter: Dr. Shanti Singh —Director of the GUM Clinic of the Public Hospital Georgetown Topic: The National Response with a focus on the National Strategic Plan and all initiatives Dr. Singh's presentation focused on: - HIV/AIDS Epidemiology in the Caribbean Region.

- HIV/AIDS Epidemiology in Guyana.

- Overview of the HIV/AIDS strategic plan.

- The Implementation of the National HIV/AIDS Strategic Plan.

- Other Related Initiatives.


The alarming statistics provided by Dr. Singh as regards the HIV/AIDS Epidemiology in Guyana and the wider Caribbean coincided with those provided by the previous presenters.

It assisted in emphasizing the fact that the scourge of HIV/AIDS was indeed posing tremendous challenges to the various Health Sectors.

She summarized the Guyana situation as: Estimated national seroprevalence of about 2.5%.

HIV transmission is predominantly heterosexual.


Estimated 18,000-20,000 persons living with HIV infection.

Estimated 800 pediatric infections.

- Estimated 4000 persons need to be placed on treatment with ARV therapy.

33% of all TB patients are HIV positive.

AIDS is the leading cause of death in 25-49 year olds.

AIDS is the second leading cause of death among all causes.
Dr. Singh then provided an Overview of the HIV/AIDS Strategic Plan for the period 2002-2006, which has as its overall objective "To reduce the social and economic impact of HIV and AIDS on individuals and communities and ultimately the development of the country."

19 The presenter listed the Specific Strategic Objectives as: To reduce the risk and vulnerability to infection through prevention and control of the transmission of Sexually Transmitted Infections and HIV and promoting sexual health.
Saving/prolonging and improving quality of life of persons living with STIs/HIV/AIDS.

Dr. Singh pointed to the six (6) Guiding Principles of the Strategic Plan as: - The use of a coordinated multi/intersectoral and interdisciplinary approach.

- Upholding the rights and responsibilities of PLWHAs and striving for active/greater involvement of PLWHAs in planning and implementation of the response.

Providing information and supportive environment to empower persons to prevent further HIV transmissions.
Guaranteeing VCT and confidentiality.

Integration of care and support into health and social services.

- Minimizing and eliminating where possible any inequities between the regions.

The Components of the NSP were summarized as: Surveillance Risk reduction Care, Treatment and Support Management, coordination and policy formulation 2.2.3.2 Panel Discussion Topic: Donor Support in the Global Fight against HIV/AIDS.
Panel members (members of Diplomatic Corps) • • 1 His Excellency, Ambassador of the USA, Mr. Roland Bullen.

2 His Excellency, Ambassador Mr.

Per Eklund of the European Union.

3 Ms. Carol Kerfoot, Programme Manager CIDA.

4 Dr. Curtis La Fleur — Canadian Society for International Health.

5.

Dr. Michel de Groulard — UNAIDS Country Programme Advisor to Guyana, Suriname and PANCAP.
20 This section of the workshop involved brief presentations by members of the Donor Community, highlighting their respective governments/organizations contributions and commitment to providing support to Guyana and the wider Caribbean in their quest to reduce the challenge of HIV/AIDS.
2.2.3.2a Ambassador Bullen According to Mr. Bullen, "the United States Government working in collaboration with its many partners is pleased to collaborate with the many efforts of the Government of Guyana to reduce the incidences of HIV and AIDS.
The US Government is committed to a multi-faceted approach to combating the global HIV/AIDS pandemic through focused initiatives like the President's Emercency Plan for AIDS Relief (PEPFAR), ongoing bilateral programs and multilateral approaches like the Global Fund."

He suggested that to meet the ambitious goals set, several steps had been taken.
These included the expanded access to prevention of mother to child transmission PMTCT) services, community dialogue and action promoting - HIV prevention, reinforcing safer sexual behaviours, and reducing stigma and discrimination.

He opined that those interventions would enable approximately 1,800 persons in Guyana to receive complete anti-retroviral (ARV) treatment and care services.
The Ambassador informed the workshop that to date the US Government had committed more than US$15 million dollars to these initiatives and that progress had been made in that 36 PMTCT sites were operating and had already provided comprehensive services to 305 of all pregnant women.
Mr. Bullen concluded by reiterating his Government's commitment towards achieving the PEPFAR goals for Guyana and its continued support to the Government of Guyana in its efforts to prevent new infections and provide quality care and treatment to those Guyanese living with HIV and AIDS.
21 2.2.3.2b Ambassador Per Eklund The Ambassador opened his presentation by recalling the statement made by the PM of Dominica during the Opening of the recent Caricom Conference of Heads Government in St Lucia, "The greatest threat to the Caribbean is the HIV/AIDS pandemic.

The leaders and people of the Caribbean have the unenviable task to turn around the reputation of having the highest incidence of the virus in the word, second to Sub-Sahara Africa."
He assured the workshop that the European Union (EU) as a donor is equally concerned about the HIV pandemic and reported that they were addressing the issue through National and Regional Programmes and Thematic Budget Lines.

He indicated that the five-year National Programme for Guyana was focused on infrastructure, low-income housing, private sector development and budget support linked to poverty reduction.
Whilst in the Health Sector Guyana is benefiting from two EC projects funded under the Caribbean regional Programme, namely: -Strengthening of Medical Laboratories in the Caribbean (8ACP RCA 20) - The objective of this G$2billion project is to improve health and medical laboratory information.
- Strengthening the institutional Responses to HIV/AIDS/STI in the Caribbean (SIRHASC) (8ACP TPS 18) - The objective of this project (1.8 Billion GYD) is to contribute to minimizing the spread and impact of the HIV/AIDS epidemic through a regional approach.
Mr. Eklund reiterated the EU' s stated and preferred policy of working through true partnerships with developing countries, citing the overall objectives as: To optimise the impact of existing interventions, services and commodities aimed at preventing and fighting the major communicable diseases affecting the poorest populations.

To increase the affordability of key pharmaceuticals and diagnostics for HIV/AIDS, TB and malaria.
To increase research and development, including vaccines, microbicides and innovative treatments.

The Ambassador concluded by reiterating what was stated during the 2001 UN General Assembly Special Session on AIDS - "Strong leadership at all 22 levels of society is essential for an effective response to the epidemic.

Leadership by Governments in combating HIV/AIDS is essential and their efforts should be complemented by the full and active participation of civil society and the private sector."
2.2.3.2c The Canadian High Commission According to the two Representatives, Ms. Carol Kerfoot, Programme Manager and Dr. Curtis La Fleur, Technical Coordinator (Public Health Strengthening Project) both of CIDA, " Canada's general approach to fighting HIV/AIDS in the Caribbean is to provide direct support to the programs of multilateral, regional and national programs.
In this regard Canada has recently increased support to the GFATM and the 3*5 initiative of WHO/PAHO which has allowed these organizations to expand their programming in the region."

They informed the workshop that CIDA had three main bilateral programs totalling Cdn$33.1m for the prevention and control of HIV/AIDS in the Caribbean.
These were: - CIDA-CAREC HIV/AIDS Program II (CHAP II) — Overall goal to reduce the spread of HIV/AIDS/STI as well as to minimize the impact on individuals and communities in CAREC member countries.

The purpose is to strengthen the capacity of CAREC's 18 Member Countries to plan, manage and provide sustainable programs for the prevention and control of HIV/AIDS/STIs as well as care and support of PLWHAs.
Enhanced Support to HIV/AIDS in the Caribbean (ESAC) — Overall goal to support the implementation of the Caribbean Regional Strategic Framework for HIV/AIDS in order to reduce the spread and impact of HIV/AIDS in the Caribbean.

The purpose is to strengthen the capacity of regional organizations to address HIV/AIDS in the region in order to ensure an effective, coordinated and multi-sectoral response to the epidemic.
Public Health Strengthening in Guyana — Overall goal to improve health conditions in Guyana by strengthening the capacity of the Government of Guyana to (1) effectively plan, manage and evaluate health care services and (2) better plan, manage and deliver prevention and disease control programs for STI/HIV/AIDS and TB.
This project is being implemented by the 23 Canadian Society for International Health (CSIH) over a four year period (2003-2007) and has a total project budget of $4.9 m. 2.2.3.3 Presenter: Dr. Frank C. S. Anthony MD., MPH.

Programme Coordinator Health Sector Development Unit Ministry of Health, Programme Manager — Global Fund Guyana.
Topic: Global Fund The final presentation of the first day was done by Dr. Frank Anthony who provided details about the global fund that was available to Guyana to combat HIV/AIDS and other related diseases.

He pointed out that there were three Global Fund programs available to Guyana namely: - 'Global Fund program on HIV/AIDS.

•Global Fund program on Malaria.

'Global Fund program on Tuberculosis.


With specific reference to HIV/AIDS, Dr. Anthony provided information as follows:- Global Fund — HIV/AIDS Approval received on 1st November, 2004.

First Disbursement — 12th January, 2005.

Duration : two years Grant amount: 8,881,686 US dollars.

HIV/AIDS -Program Component • Decrease HIV/AIDS transmission.

Reduce stigma.

• Increase access to quality treatment, care and support for PLWHAs.

• Establish and strengthen social and economic support services for PLWHAs.
• Strengthen surveillance, laboratory and management systems.

24 DAY 2 - 20th July 2005 Morning 2.2.4 SESSION 4 Moderator: Mr. Fredrick Cox, Executive Director, Guyana Responsible Parenthood Association.

2.2.4.1 Presenter: Mr. Derrick Springer MPH, ORISE Fellow, CDC Global Aids Programme, Founder/Chairman Lifeline Counselling Services.

Topic: Role of NGOs in the fight against HIV/AIDS In his presentation Mr. Springer provided the NGOs' perspective.
He highlighted the Government's initial response when the first AIDS case was - diagnosed in 1987 to the establishment of various agencies to deal with STDs.

These included: - GUM Clinic in 1988 - NAPS in 1989 - NAC in 1989 Mr. Springer told the gathering that the first HIV and AIDS NGO community group (Artistes In Direct Support) was established in 1992 He then traced ensuing involvement of other NGOs in the fight against HIV/AIDS.
These included: The Guyana Human Rights Association (GHRA) Lifeline Counselling Service Hope Foundation Volunteer Youth Corps G-Plus (Network of Guyanese PLWHA) Guyana Responsible Parenthood Association (GRPA) Guyana Red Cross Society Comforting Hearts St. Francis Developers Linden Care Foundation In highlighting the impact of the epidemic Mr. Springer indicated that HIV/AIDS: - Reduces life expectancy 25 Harms child survival Burdens health care systems Exacerbates poverty and inequality Afflicts the education system Strikes business and the economy Erodes human rights Diminishes political stability and national security The presenter opined that Civil Society organizations, particularly NGOs are well placed to play a very strategic role in addressing the HIV/AIDS epidemic because of their close proximity to those affected.
He outlined the role of NGOs in the HIV/AIDS response as: Advocate for National HIV/AIDS policy.

Develop prevention and intervention programs aimed at reducing the spread of HIV.

Work with individuals, communities and workplaces to reduce stigma and discrimination.

Advocate for the involvement of people living with HIV/AIDS.

Advocate for care and treatment for PLWHA.

Provide counselling and testing aimed at encouraging people to know their HIV status.
Facilitate access to care and treatment for those testing positive.

Provide home-based care for people living with AIDS.

Collect data for monitoring and evaluating projects and programs.

Ensure that the NGO community earns its rightful place as a profession, well-treated and respected equal, with shared decision- making matched by mutual accountability.
Mr. Springer concluded his presentation by urging those present to recognize that "Parliamentarians are leaders in society and have both the mandate and public trust to act in the interests of the entire community."

26 2.2.5 SESSION 5 Moderator: Mrs Philomena Sahoye-Shury, CCH, JP, M.P.
Presenters: Regional Members of Parliament Topic: Role of Members of Parliament in the fight against HIV/AID S This session allowed Regional members of Parliament to share information as to the status/situation within their respective Regions as regards the challenge of HIV/AIDS.
Presentations were made by: - Ms. Rajcoomarie Bancroft - - Ms. Sandra Adams — - Ms. Shirley Melville — - Ms. Judith David — - Mr. Nasir Ally — - Mr. Heeralall Mohan — - Ms. Pauline Sukhai Region # 8 Region # 10 Region # 9 Region # 7 Region # 6 Region # 2 Region #1 2.2.6 SESSION 6 Moderator: Mr. Deryck Bernard M.P.
Topic: Discussion on the Final Declaration This session was devoted to discussions aimed at formulating a final declaration proclaiming their support for the efforts being made to address the challenge of HIV/AIDS in Guyana.

Utilising the Multi-Media Projector, the Moderator provided the participants with a visual representation of the proposed declaration, and solicited their contributions towards the finalisation of same.
The participants then examined, analysed and discussed the proposals on a page-by-page basis.

Not surprisingly, this was a very painstaking and exhaustive process, which took up a significant amount of time.

Intensive and detailed exchanges ensued, characterized by much "give-and-take" and healthy good-natured banter, all in the prevailing collaborative spirit of compromise.
27 The session concluded with the Parliamentarians unanimously agreeing on the exact terminology and configuration of the Final Declaration.
The Moderator fittingly brought the session to a close by observing " I think we have worked extremely well, this is another good example of what is possible when we cooperate and work together in a non-partisan fashion for the national good and as such we should congratulate ourselves for this achievement" 2.2.7 Discussions The programme provided for discussions at the end of each session.

Presenters fielded questions and provided clarification for participants on matters related to their presentations.
Participants also took the opportunity during the time provided, to make their own observations and share their experiences as regards the topics presented.

These sessions were extremely participative and interactive and engendered lively and informative debate.

Expressed uncertainties were examined, discussed and clarified as presenters reviewed and rephrased particular points.
DAY 2 Afternoon 3.0 CLOSING SESSION AND PRESS BRIEFING Chairperson: Ms. Volda Lawrence 3.1 Remarks: This session was aimed at sensitizing the press as to the content, aims, objectives, achievements and expected outcomes as regards the workshop.

Ms. Lawrence commenced the session by declaring that "we are all aware that a massive, concerted effort at all levels is all that is required to fight the scourge of HIV/AIDS in our society.
We know too well that we must transport the non-partisan way in which we worked to the entire Parliamentary body in order to generate the political will, commitment and 28 accountability to the fight towards a safe environment thereby securing the future of our nation."

The MP referred to the workshop as a tremendous success and opined that the bi-partisan approach demonstrated that with strong leadership and political will Guyanese politicians can exercise 'leadership as a tool against HIV/AIDS.'
Ms. Lawrence assured those present that the Parliamentary Sectoral Committee on Social Services intended to lay the report of the workshop and the motion derived there from in the National Assembly for debate and adoption.

The next Speaker was Ms. Patrice La Fleur, who hailed the workshop as an "historic meeting of Guyanese Parliamentarians."

The UNFPA Liaison Officer opined that the workshop would have undoubtedly provided the MPs with new insights about the HIV/AIDS epidemic.
Ms. LaFleur informed the participants that "the challenges are many, however we need to use our best efforts to reverse the spread (of HIV/AIDS), we need to reduce the incidence through our collaborative efforts."

She exhorted the participants to become advocates ensuring that there are HIV/AIDS prevention programmes in every community, especially focusing on young persons and women.
The UNFPA Liaison Officer urged the Parliamentarians to work towards ensuring that PLWHAs have access to care and treatment and promoting community development initiatives, which would address the social and economic challenges that faced the people.
Ms. La Fleur on behalf of the UNFPA family expressed gratitude to all those who contributed to the success of the workshop, especially the Staff of Parliament Office, the Members of The Parliamentary Sectoral Body on Social Services, Dr. Beri Ramsarran and the Chief Whips.

She concluded by pledging the continued support of her organization towards the reduction of the spread of HIV/AIDS.

29 Dr. Michel de Groulard, UNAIDS Country Programme Advisor to Guyana, Suriname and PANCAP was the next speaker.
He commenced his presentation by suggesting that over the years stigma and discrimination have contributed significantly towards the development and spread of HIV/AIDS.

He commented, "we have to think particularly when we deal with legislations about what it is that is not done and what we have to do to deal with the stigma and discrimination."

The Country Programme Advisor pointed out that HIV/AIDS was a worldwide phenomenon and that no country can claim to be completely free from HIV/AIDS.
He stressed the need for cross country collaboration and condemned those countries that restricted entry to PLWHAs.

In concluding, Dr. Groulard promised to work along with UNFPA and the M.Ps and the rest of Guyana towards dealing with the epidemic.
3.2 Final Declaration: The Chairperson brought the session to an appropriate end by presenting the Final Declaration as follows:- "We, the members of the National Assembly in Guyana, having participated in the forum entitled 'Leadership as a vital tool against HIV/AIDS- Guyanese Parliamentarians Fighting Against HIV, AIDS' express our gratitude to the Hon.
Speaker and Support Staff of the National Assembly, the two Chief Whips and United Nations Population Fund (UNFPA) for their support in making this event a success, and hereby: Reaffirming the 'Programme of Action VOA) of the International Conference on Population and Development(ICPD)1994, key actions to implementing the POA and the Declaration of Commitment on HIVAIDS adopted by the UN General Assembly(UNGASS) June 2001; I. Recognise a. that HIV/AIDS represents a serious threat to our population at large b. the negative impact this epidemic on our social and economic life c. that the epidemic also represents a threat to our prospects for economic growth and development.
30 2.

We commit to a. give priority to participation in the development of the appropriate legislative framework for the fight against the disease and the approval of any necessary legislative reforms.

b. use our good offices to mobilise the people of Guyana to become aware of and work together in the fight against this scourge.
c. work in our communities and other spheres of influence to eliminate the negative stigma and discrimination against persons living with and affected by HIV/AIDS d. support suitable initiatives for the education and protection of women, men, children, especially orphans and young people in the fight against HIV/AIDS e. the strengthening of the National Health System as the basis for the delivery of the programmes of prevention and treatment of HIV/AIDS.

3.
3.

We pledge to a. work together with civil society including the private sector, religious organisations, youth and sport organisations, NGOs, and networks of persons living with HIV/AIDS in the fight against this epidemic b. work in our constituencies and other areas of influence to raise awareness and encourage community participation in the fight against HIV/AIDS.

c. work in a non-partisan and collaborative way to ensure full national support for the fight against this epidemic.

4.
4.

We undertake to a. support the allocation of adequate levels of resources by the National Assembly for the fight against HIV/AIDS.

b. use our political influence to advocate for and support all initiatives and worthwhile projects at the national, regional and international levels.

c. initiate and support, wherever appropriate, Public Education Programmes for the fight against HIV/AIDS; and discrimination against persons living with HIV/AIDS.

31 5.
31 5.

We will a. advocate and support programmes which promote responsible and culturally appropriate behaviour in all communities countrywide and in particular amongst young people.

b. become actively involved in programmes for the mobilisation of financial and other resources.

c. seek to improve the effectiveness and positive impact of existing programmes for the fight against HIV/AIDS.

6.
6.

Work in collaboration with the international community and regional initiatives in the global fight against this pandemic.

7.

We undertake to a. support and initiate programmes in support of the fight in all of the regions of Guyana, widely publicise the outcome of this workshop and to undertake follow up events in support of our undertakings to support the nationwide programme."
32 4.0 Evaluation/Feedback At the conclusion of the Workshop, participants were issued with Evaluation forms which solicited their frank, honest and candid views/comments regarding the workshop.

Following is a summary of their responses:- (i) General Impression of the workshop: The majority of the participants (90%) felt that the overall quality of the workshop was good whilst a few thought that it was excellent, very good or fair.
In terms of Presentations 80% of the participants viewed the presentations as good whilst the others felt that they were excellent.

As regards materials and facilities the participants overwhelmingly (90%) felt that these were good whilst a few indicated that they were either, excellent, very good, fair or poor.

(ii) Post-workshop plans: - All (100%) of the respondents indicated that they intended to share the information received at the workshop with their colleagues.
(iii) Encourage future participation by colleagues at similar workshops: All the respondents (100%) responded in the affirmative to this question.

(iv) What did you like most about the workshop?

This question evoked varied comments from the participants all of which (100%) were complimentary of the workshop.
The consensus was that the varied and detailed information provided, coupled with the frank, forceful and dynamic presentations, had contributed significantly towards the workshop being extremely interesting and stimulating.

Positive comment was also made about the usefulness of the interaction and collaboration amongst Parliamentarians on all sides of the political divide.

(v) What aspect(s) of the workshop could have been done differently?
This question also elicited mixed reactions with some of the respondents suggesting that more time should have been allocated for 33 discussions, whilst others commented that some of the presentations were too lengthy and that there was evidence of poor time- management.

The view was also expressed that some of the moderators "spoke too much."
One participant submitted that "there should be more focus on the socio-psychological cultural issues which govern behaviour/attitudes that should be changed if the fight (against HIV/AIDS) is to succeed."

(vi) Additional Comments In response to this question, several of the respondents suggested that there should be more workshops of this nature and that more youths and PLWHAs should be involved.

The view was also expressed that more time should have been allocated for discussions.
One respondent, whilst acknowledging the value of the information shared during the course of the workshop commented on the paucity of information in respect to the legislative aspect of the topic.

There was also the suggestion that education is a major player in the fight against HIV/AIDS and as such the main target groups should be clearly identified and appropriate programmes designed to enhance their awareness levels.
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