The HIV /AIDS epidemic is still ongoing, although remarkable progress has been made in that area, it is reported that about 9 million people are unaware of their HIV status and could likely be positive (UNAIDS 2018 report). This means that the risk of contracting HIV is still ever present. In the vision of achieving 90-90-90, it is very important to be aware of the plethora of prevention and treatment methods that can be used to achieve that goal.
PrEP is another method that in conjunction with others can prevent the spread of the HIV. Sero-discordant couples and persons who may be exposed to risky practices can now be afforded an additional method of preventing the transmission of HIV. Some countries have already reported success in its implementation.
Trinidad and Tobago has made strides in the management of the HIV epidemic but there is more that can be done, case in point, the initiation of PrEP. The Family Planning Association of Trinidad and Tobago (FPATT) has decided to initiate the first step towards introducing PrEP into the country on a wider basis. That journey into PrEP would begin with PANCAP's South to South Learning Exchange using the successes of the Bahamas. So off I went to learn all that I could on a neighbouring Caribbean island.
The South to South Learning exchange involved three participants from three countries; Jamaica, Guyana and Trinidad & Tobago. Our learning experience would take place over four and a half days. I admit the experience seemed very daunting to me as this was a new field and I was the sole representative for Trinidad & Tobago.
Arriving in the Bahamas was a beautiful sight from the plane; guessing from all the faces pasted to the windows and the ‘oohhs’ and ‘ahhhs’. Arriving on Sunday evening before the start allowed me to relax and rest before the upcoming workshop.
The following day we met the PANCAP facilitators, Dr. Shanti Singh and Ms. Elizabeth Tully and all of the participants. From Monday morning to midday Friday saw a host of activities that allowed all of us to learn, experience and explore PrEP in the Bahamas and the use of Dolutegravir.
Our introduction involved meeting with members of the island’s Ministry of Health (MOH). We were greeted and formally welcomed by the CMO - Dr. Pearl McMillan and the Acting Permanent Secretary Mrs. King Rolle and given a brief overview of the days ahead.
The participants were given the grand tour of Princess Margaret’s Hospital, in particular the areas that dealt with the management of HIV.
Having to do a vision board allowed the country’s participants to analyze and think about the current response to HIV. We reflected on the strengths and weaknesses that exist within the participating organizations, I however, preferred to refer to weakness as ‘worry areas’ and strengths as ‘muscle’. Having the guidance by our facilitators, we were able to clearly show the next steps towards implementing PrEP. Our sense of childlike creativity was shown by the use of colour, style and personal art. Each board was presented and discussed. This would form the basis of the country's organization next step in implementing PrEP.
Other presentations involved learning about HIV in the Bahamas, how they met with the need for prevention, testing, treatment and management. We learned about the many services provided. The organization of the National AIDS Programme (NAP) and the Bahamas current response with respect to the 90-90-90 vision.
A really interesting and insightful activity was the panel discussion by the members of CSOs. This was really ‘eye opening’ as it concreted the need to have CSO involvement in the management of HIV in a country. Throughout every aspect of our site visits and interactions, we saw the positive impact of involving the community.
Another unexpected discovery was the provision of testing services in an area that was not enclosed. How was this possible? Here we were at a community building with an open tent where other persons would see who was arriving for HIV testing. Pre testing education was conducted in the open but post testing education and results were given in a very private and confidential setting.
A yet another eye opener and ‘wow’ experience was seeing the very same staff members everywhere we went, and I do mean ‘everywhere’. As employees of the MOH, they were compensated but what we saw in terms of dedication, commitment and perseverance was far beyond compensation and the call of duty. The small cohort of staff, currently led by Dr. Nikkiah Forbes, operated the usual HIV related adult testing clinic, treatment clinic, follow up clinics, contact tracing ,home visits, paediatric clinics, antenatal clinics, laboratory, outreach programs, patient notes updates and filing.
In addition there was an afterschool program that provided tutoring and hot meals for HIV infected and affected children, as well as following up with medication compliance. They also hosted vacation camps for these and other kids. For me it was truly heart rendering to see service providers putting in all heart in the care they gave.
Bahamas having a National AIDS Program (NAP) was truly successful in addressing the challenges at hand with HIV. The support, commitment and dedication of health care staff and community members was crucial to the successful implementation of any HIV program in the Bahamas. From their practices and international support, for example WHO PrEP tool, we felt that we were now able to move in the right direction in starting PrEP.
This was truly an enjoyable and rewarding South to South learning exchange. I mingled, I laughed, I ate (excellent food and conch salad), I discovered and I grew in knowledge.