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Monday, May 01, 2006

PAHO ups the ante against the pandemic
Ruel Johnson

In this Guyana Chronicle file photo from October of last year, Dr. Enias Baganizi (left) hands over items donated to the Prison Service to then Acting Director of the Georgetown Prison, Mr. Poshanand Tohal. Second from left is PAHO Representative to Guyana, Dr. Bernadette Theodore-Gandi, and next to her is Ms. Barbara Deodat, President of the Nemesis Development Association.

Enias Baganizi’s boyish looks and his tendency to flash a high wattage smile seem out of sync with several things about him. There are the strands of grey that fleck his otherwise black hair for example. There is the solemnity of the professional title of Doctor before his name. And one would probably expect a Rwandan man with a decade and a half of experience working in HIV/AIDS in various countries around the world to look a bit more haggard and battle-scarred than Dr. Baganizi does.

The youthfulness and affability are misleading though; it is hard to find someone more serious, or more focused when it comes to the question of fighting HIV/AIDS than he is.

Dr. Baganizi started out his engagement with the disease in 1989 in his native Rwanda where he worked with the WHO Global Programme on HIV/AIDS, a little known programme preceding the enormous budgets and publicity campaigns which mark today’s HIV/AIDS projects, like President George W. Bush’s President’s Emergency Plan For AIDS Relief (PEPFAR), a US$15 billion project focusing on providing funding to the countries most affected by AIDS over a five-year period.

His experience working in Rwanda linked to work in other African countries like Burkina Faso, Benin, and Mozambique where he resided while in the employ of the Canadian International Development Agency (CIDA); and also in Mali, Senegal and Nigeria where he travelled on shorter technical assistance visits for the U.S. Center for Disease Control (CDC) based in Atlanta.

Baganizi’s appointment as its HIV/AIDS Country Officer – a post he took up in March, 2005 – marked a definitive shift in gears as regards Pan American Health Organisation’s (PAHO) involvement in the fight against the disease.

“This is the first time that PAHO has a fulltime focal point [person] for HIV/AIDS in Guyana,” Baganizi told Guyana Chronicle. The modesty of the office he shares with his Administrative Assistant, Angel Bhojedat adds to the illusion that the Doctor has less on his plate than he actually does.

Dr. Baganizi’s arrival came with just nine months left for the country to reach its specific U.N. 3 by 5 Initiative goal, the provision of anti-retroviral (ARV) treatment to half of the 2000 persons estimated to need it urgently. By the 31st of December, 2005 ARV treatment was being provided on a steady, sustainable basis to some 1,200 persons, twenty percent more than the number targeted; this thanks in no small part in PAHO’s intervention.

With PAHO’s considerable assistance and input, all the major stakeholder organisations dealing with AIDS in Guyana have now developed a National Five Year Strategic Plan for HIV/AIDS, which will cover the period 2006-2010. This includes not only sister U.N. organisations like UNAIDS, UNICEF, UNDP, UNFPA, UNESCO and the ILO but also the various other donor agencies like CIDA, the EU, and PEPFAR through USAID.

Recognising that the sheer number of players involved in various programmes locally, Dr. Baganizi says that there is movement currently underway to prevent or reduce duplication of efforts, and the associated wastage of funds and resources.

“At PAHO, we are working with other international agencies to harmonise and align our interventions at the country level,” he explains.

This means the implementation of what is known as the 3 Ones Initiative. The initiative stipulates that there should be: one national framework for fighting the disease; one coordinating body, which is the Presidential Commission on HIV/AIDS; and one monitoring and evaluation body.

Regarding the perception that HIV/AIDS receives a disproportionate amount of funding – in relation to other illnesses – from the international donor community Dr. Baganizi is not so sure that this is accurate. He points out that on the global scale, the request for US$6 billion by U.N. Secretary General Kofi Annan to fight AIDS has met with an inadequate response at best.

In relation to the national situation, Dr. Baganizi points out that the perception that HIV/AIDS is over-funded may be based on a narrow view of what constitutes the fight against the disease. While most persons see AIDS issues as restricted to those like the provision of ARVs, stigma and discrimination PR campaigns, and the provision of free condoms, the PAHO officer says that the problem is so pervasive that it affects, or is affected by, many other seemingly unrelated areas; and much of the money made available under the auspices of HIV/AIDS programmes is allocated to areas which appear to only tangentially affect the central problem of AIDS.

“There are funds in PEPFAR for malaria,” he points out by way of example. Which makes sense; one of the key effects of malaria is that it debilitates the body’s natural immune system, making it even more vulnerable to HIV infection. It makes even more sense if one factors in that the incidence of malaria is higher in the hinterland of Guyana, the mining communities in particular, where the ABC’s of prevention – abstain, be faithful, use a condom – may be less strictly adhered to than on the coast.

“HIV/AIDS is not a health issue only,” Baganizi explains, “It is cultural, it is economic, it is everything you can think of. When you are funding HIV/AIDS, you are not funding a disease, you are funding the survival of a whole country. The fact is we need more money.”

During the year 2006, PAHO will be working to expand on, enhance, and consolidate its work on several fronts in the battle against HIV/AIDS. This is going to encompass both improving quality of care as well as increasing access to services covering most aspects of HIV/AIDS related health issues including the areas of Voluntary Counselling and Testing; Stigma and Discrimination; and, of course, Treatment and Care, inclusive of the provision of ARVs.

According to Baganizi, during the upcoming year, PAHO will also continue providing technical support following four main strategic objectives. The first, centred upon the increasing of the political commitment to and leadership in fighting the disease, is intended to ultimately broaden and strengthen the formulation and implementation of HIV/AIDS policy in Guyana by building alliances among organisations and strengthening the capacity of communities to respond effectively to the threat.

The second strategic objective, the strengthening of health systems and services for HIV/AIDS treatment, is anticipated to increase the Ministry of Health’s capacity to deliver even more efficient and effective services in clinical and diagnostic management, including care and psychological support. To this end, a rapid assessment of human resources in health in Guyana will be conducted to inform the action plan.

The third major strategic objective during the upcoming year will be interventions geared to prevent the spread of HIV infections. This will entail supporting the Ministry in its ability to develop, implement and evaluate programmes geared to communicate the dangers of HIV/AIDS to vulnerable populations like youth, women (particularly female sex workers), men who have sex with men, prisoners and people living with HIV/AIDS. Hopefully, says Baganizi, this strategy will lead to positive behaviour change in these groups.

The organisation has been rendering technical assistance, for example, to the Nemesis Development Association, a local NGO which provides information on HIV/AIDS information to prisoners at various official detention facilities around the country. The findings of a qualitative survey on behaviours in two vulnerable groups – commercial sex workers, and men who have sex with men – will officially be released at the end of June this year.

The fourth strategic objective is to be able to take record of the lessons learnt so that they can be put to use as the organisation’s engagement with the problem of the HIV/AIDS pandemic continues.

All in all, it’s going to make for some pretty hard work in the months ahead for the PAHO focal point and his admin assistant, Angel. After fifteen years in the trenches however, it is doubtful whether the arduous task ahead is going lower the wattage of Dr. Enias Baganizi’s smile or cause any of his hairs to becoming any greyer.

Guyana Chronicle