Time has come for the provision of PrEP within the Guyanese public healthcare system

Dear Editor, Pre-Exposure Prophylaxis (PrEP) is medicine that can reduce the chance of getting HIV by more than 90% and can reduce the chances even more when combined with condoms. The medication works by stopping HIV from taking hold and spreading throughout the body if there is exposure to the virus and it has been proven to be safe and effective in high-risk groups all over the world. For the last four years, the World Health Organization has been recommending PrEP as an additional HIV prevention choice, but uptake in the Caribbean has been slow, but steadily increasing. Currently, the Bahamas and Barbados are the only two countries that provide PrEP to persons who meet the criteria for use, but Suriname, St Lucia, Grenada, Cuba, and Jamaica either provide PrEP to certain populations or have plans to start provision in 2019.

Guyana’s Society Against Sexual Orientation Discrimination (SASOD Guyana) conducted an assessment on the knowledge, attitudes and delivery preferences on PrEP among men who have sex with men and transgender persons earlier this year, and from the focus groups held in five regions, it was found that 60% of the participants had never heard of PrEP before. This was especially the case for persons who lived outside of Region 4. Once persons became aware of it however, almost everyone was interested in taking it for their personal protection. This led to the conclusion that there is the need for a lot more education and sensitisation on PrEP, especially involving NGOs within this effort, and that the time has come for the provision of PrEP within the Guyanese public healthcare system. Starting PrEP in Guyana will entail the use of a medication that is already present in the country and that is already procured at fairly low cost. Studies in other countries have demonstrated that the savings a country receives from the HIV infections avoided by using PrEP makes it a cost-effective prevention measure.

The theme for this year’s World AIDS Day is “Know your status” which emphasises HIV testing as a strategy that also empowers people to make choices about HIV prevention, so they can better protect themselves and their sexual partners. Before persons can be placed on

PrEP, they must know their status because the medication is only for HIV-negative persons. Being on PrEP helps to strengthen the entire HIV care continuum in the country because persons must present for initial and regular testing, increasing engagement with the health service system and also providing opportunities for linking any HIV-positive persons into care and treatment. Know your status so that you can know whether you should be using PrEP as an additional prevention measure to continue to stay HIV-negative. Yours faithfully, Dr Nastassia Rambarran Dr Roger Welch and Joel Simpson for SASOD Guyana