It is time to move the National AIDS Secretariat from the President’s Office to the Ministry of Health & Social Welfare

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It is time to move the National AIDS Secretariat from the President’s Office to the Ministry of Health & Social Welfare

By Publius maximus.

The president has no medical training, nor do staff at his office. As currently constituted, having the National Aids Secretariat (NAS) at the Office of the President is an administrative barrier to increasing HIV testing uptake in at risk groups in The Gambia. In their most recent National Strategic Plan For HIV and AIDS (found here:http://www.nas.gm/index.php/hiv-service-3/hiv-service-4), NAS itself acknowledges that “The National AIDS council (NAC) has not being meeting regularly and thus affecting policy and strategic direction as well as oversight of the national response” to HIV.  In order to improve HIV outcomes, therefore, it is prudent to delegate the responsibility of the HIV response to professionals who are trained and experienced in managing HIV- and that is not at the OP but at the Ministry of Health.

One of the major consequences of the current arrangement is that high risk populations are not adequately screened, and patients go through the Gambian health system hiding their diagnosis because both society and the system stigmatizes a diagnosis of HIV. Granted, some of the problems stem from decades of dictatorship in which those at the apex of government (headed by Jammeh, and unfortunately some medical doctors) promulgated very harmful practices in the form the Gambia Presidential AIDS Treatment program (PATP). It is now time for President Adama Barrow to break away from this traumatic legacy and do the right thing.

Currently, the estimated prevalence of HIV in the Gambia is estimated at between 1 in a 100 to 1 in 50 persons in different populations. The true prevalence however is unknown, because many people are infected without knowing it. Anytime a patient presents to a health facility with an acute problem (especially an infection) there is always the possibility that a weakened immune system due to HIV underlies that presentation. As currently written and implemented however, the National AIDS policy places unnecessary barriers to medical providers’ provision of medical care as they are unable to directly consent and test such patients at the point of care without involving “trained medical counselors” in what has been called Voluntary Counseling and Testing (VCT).  Medical doctors are trained to consent patients for all kinds of things, including surgery, and other invasive procedures that carry far more risks than that of an HIV blood test, yet they are not required to delegate the consent process to specially trained “counselors” as they are required to do for of HIV testing at the moment.  While it is important to protect the confidentiality of people with HIV, it is also important reconcile our national HIV testing strategy with what has been shown to improve outcomes.

A strategy of universal screening is the best way to increase uptake of HIV testing among people at risk and important to reduce late diagnosis. Early diagnosis improves treatment outcomes. Many countries have adopted this strategy including the UK’s national institute of clinical excellence and the United States Centers for Disease prevention. Some countries (Zimbabwe, Zambia and Malawi) according to the World Health Organization have even adopted self-testing initiatives that do not require unnecessary procedures.

Every Gambian should be encouraged to get tested because HIV is no longer a death sentence that it used to be in the past. Treatments are available and it is a well-known fact that the government gets a lot of development assistance from the Global Fund for HIV related work.  The fact that the program is challenged by interruptions in care due to preventable things like lack of testing kits is reflective of poor management, in part due to the current arrangement where the governing body is hosted at the wrong office.

It is also time to review the HIV/AID Prevention Act (2015) and remove all administrative procedures or clauses that are barriers to universal testing. The president is therefore encouraged to act now by moving NAS to the appropriate ministry so that those who are qualified to execute a coherent strategy are given an opportunity to do what they are trained to do. This leaves the President more time to focus on important development issues at hand.

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