-The story of National Testing in Guyana
IT IS the largest public health activity on the annual calendar of the National AIDS Programme Secretariat/ Ministry of Health and stands as a glaring testimony to the incredible indentation achieved in battling stigma and discrimination. It is a staunch example of effective multi-sector collaboration and a reminder of what can be accomplished when persons work together for a common goal. It is also indicative of the commitment of Guyanese to embrace behaviour change, and get actively involved in the fight against HIV/AIDS.
It is an obtrusive illustration of political commitment, national unity, fortitude and pride. It is representative of a resolute achievement in the prevention of new HIV transmissions and access to care and treatment.
It is Guyana’s Annual National Week of Testing activity which has exceeded expectations, charted new territory and stands as a glaring success story throughout the world. It gives credence to the words of Vince Lombardi, who said: “We would accomplish many more things if we worked together and did not think of them as impossible.”

Capacity vs. Demand
The year was 2005, and Guyana already had an impressive amount of prevention and other strategies and programmes in place, aimed at stemming the growing incidence of HIV cases.
The care and treatment programme for Persons Living with HIV had begun some years before and was making inroads in the provision of anti-retrovirals and other essential services.
Voluntary Counselling and Testing was introduced by the Government of Guyana in the  late 90s as a feature of its National HIV prevention strategy, with the recognition that this service promotes and sustains behaviour change, contributes to improving the quality of life of individuals and their families, and plays a pivotal role in reducing stigma.
Against this backdrop, having persons know their status formed one of the guiding principles of the 2000-2007 Strategic Plan for HIV/AIDS.
Then an unfortunate and disturbing phenomenon began to emerge: it became clear that the increased capacity to conduct HIV testing was not reciprocated by the recipients of the service. In other words, the capacity outstripped the demand. One of the main hindrances for the measured response to accessing VCT services was the active stigma and discrimination that existed.
As VCT Country Coordinator, Debra Success-Hall recalled: “At that time, people would literally sneak in and out of the testing sites or pretend that they were going for some other service, they wanted to be tested but didn’t want anyone to know.”
Thus began the conceptualization to have an event aimed at encouraging Guyanese to reduce HIV stigma, encourage testing, as well as identify persons who are HIV-positive and unaware of their status.
“As long as we waited on people to come to us, we would have always had low levels of testing; we needed to go to them.  While we were doing testing every day, we needed an event during which the activity would be intensified … The genesis of National Week of Testing was initiated to ensure that the testing capacity matched the demand and to reach out to Guyanese with this service on their terms and in their space,” Health Minister, Dr Leslie Ramsammy explained.
Programme Manager of the National AIDS Programme Secretariat, Dr. Shanti Singh, explained that another reason for establishing National Testing Week was to create a heightened interest in VCT services.
The vision and objective  six years ago was pretty simple: to establish a testing day aimed at encouraging persons to know their status and help erase the stigma attached to getting tested for HIV, as well as prevent new infections by increasing awareness, education and access to Voluntary Counselling and Testing. It would have been almost impossible to imagine the magnitude of success that this event would enjoy.

Breaking new ground
On November 17, 2006, the Ministry of Health/National AIDS Programme, in collaboration with international and local partners, conducted Guyana’s first National Testing Day initiative  under the theme: ‘Time is Running Out; Get Tested Now’.  A target was set to motivate 1000 Guyanese to access testing.
Its 36 fixed sites and 82 Prevention of Mother to Child Transmission (PMPCT) sites were used to conduct testing across the country. Temporary sites were also set up in Regions One (Barima-Waini), Eight (Potaro-Siparuni) and Nine (Upper Takutu-Upper Essequibo), and a mobile team traversed the streets of the city providing additional service.
According to Ms. Success- Hall, even though there was optimism, there was also a bit of apprehension. “ It was our first testing initiative, so we didn’t really know what to expect,” she said, adding: “Back then, getting people to openly get tested was a challenge, and here we were with a target of testing a thousand persons  in one day … I guess it was normal to have a little bit of anxiety.” But by the close of day, close to 1,200 persons had been tested.
With renewed faith, the target for the next year was set at 2,500, and was surpassed by an equal amount, representing a paradigm shift in the mindset of Guyanese toward accessing testing.
Minister Ramsammy described that initiative as “a huge success in which new partnerships were forged  in the fight against HIV/AIDS.” He also observed: “When the challenging target was set for 2,500, many persons believed that the ministry of health was ambitious, but we not only achieved but surpassed our target…”
The long queues at the testing sites around the country in 2007 sent two very clear messages: Guyanese wanted to know their status, and the stigma attached to openly accessing testing was decreasing.
“It showed us clearly that our messages and persuasions to people were working; people wanted to get tested, and we were going to give them what they wanted,” Dr.  Ramsammy said.
Against that backdrop, 2008 saw the extension and expansion of the testing initiative from one day to an entire week, with an impressive target of 10,000 persons. And as a further act of motivating and encouraging Guyanese to access the service, the initiative of having  persons of influence access public HIV testing prior to the official week of testing was launched.
That year, leaders from the government, religious groups and the Diplomatic Corps , as well as Prime Minister Samuel Hinds, Dr. Ramsammy, US Ambassador to Guyana, Mr. John Melvin Jones along with members of the media fraternity were among those publicly tested.
Over the years, this group has expanded to include entertainers, sports persons, Members of Parliament, and last year, popular DJs. Almost 12.000 persons came forward for testing in 2008, surpassing the target by almost two thousand.
A new standard in the Caribbean was also set by Guyana that year, in that it was the first country to have an entire week dedicated to HIV Testing.
And while the United States conducted its first Day of Testing in 2006, and Barbados theirs at some point in time, it is Guyana that holds the distinction of being the first Caribbean country to conduct a National Testing Week.
National Testing Week continued to grow from strength to strength with each passing year. As the target increased, so did the turnout of Guyanese to access testing, almost as if in a determined bid to eradicate the lingering residue of stigma and discrimination that existed.
Last year, in excess of 35,000 persons accessed testing throughout the ten administrative regions of Guyana at more than five hundred testing sites. In 2009, that figure stood at 27, 365, and in 2008, 15 724. The figures continue to surpass the set target by a wide margin each year.
The total number of persons that tested positive last year was 218, representing a prevalence of about 0.7 per cent. This percentage corresponds with the 2010 UNAIDS/WHO report which listed Guyana as having an HIV prevalence of about 1.2 per cent.
The results of the National Week of Testing is concurring that there has been a reduction of the HIV prevalence cases in Guyana over the years. The UNAIDS/WHO Report used to traditionally, around 2000-2001, report a prevalence of three to five per cent.
The Health Ministry’s PMTCT (Prevention of Mother-to-Child Transmission) data for this year is showing about one per cent, and other studies are showing between 0.7 and 1.1 per cent. There have been almost 350,000 tests carried out over the three-year period from 2007 to 2010.
Last year’s National Week of Testing also surpassed the Caribbean’s which netted a total of 8,000 persons Caribbean-wide in a testing campaign spearheaded by Scotia Bank and PANCAP (Pan-Caribbean Partnership against HIV and AIDS).
Guyana’s testing week has become such a huge success story, that apart from being lauded regionally and internationally, it is also being used as a ‘best practice’ for other countries to emulate.

The secret of success
So what is the secret behind the great success? What are the factors that have caused a simple initiative which began with the simple goal of encouraging Guyanese to access more testing just five years ago to catapult to an archetype for HIV testing in the region?
Minister Ramsammy believes that one of the main reasons is the remarkable job done by the National AIDS Programme Secretariat in convincing the public that their actions must be in-sync with their level of knowledge.
“We have always had messages out there teaching about prevention strategies, but our Behavioural Surveillance Surveys indicated that this knowledge did not necessarily translate into action…NAPS effectively addressed that, and each year, when people come out in large numbers, it is indicating that their actions now match their knowledge and they are creating a paradigm shift in stigma and discrimination,” the minister said.
He noted the fact that entire families and groups of friends  come together to be tested, and request their results in front of their companions is “a remarkable change in behaviour with regard to how the public perceive HIV testing.”
The fact that Testing Week is a national effort rather than a Ministry of Health/NAPS initiative is another reason why it has recorded such remarkable success. Multi-sector organizations have embraced the initiative, and play an active role at every level of the activity.
“This is another true example of the effective outcome of the public/ private sector partnership that we have always worked for and encouraged,” Minister Ramsammy stated. However, the willingness of the Guyanese populace to improve and take responsibility for their health and by extension their lives is the main reason why Minister Ramsammy believes the initiative has enjoyed the incredible success it has.
He noted that all of the lofty plans and visions and the incredible amount of resources expended was all hinged on the receptiveness and response of the public.
He expressed appreciation to the Guyanese populace describing them as ‘the most important partners in the fight against HIV/AIDS and true ambassadors of the cause.”
Dr. Singh was especially high in praise for the unwavering contributions and support of the technical partners and donor agencies which she described as “indispensible’
He pointed out that having in excess of 300 testing sites and certified, trained counselor /testers  in a country as small as Guyana is nothing short of a phenomenal achievement” and expressed extreme pride in the high level of  quality assurance that is exhibited during testing week.
“When we say the process is safe and reliable we mean just that and I as Minister of Health am proud that we have never had one single incident that can accurately dispute that’

National Testing Week 2011
As could be imagined, work to ensure the smooth and effective functionality of such a humongous event begins months before the activity.
A steering committee, which comprises several sub committees such as Public Relations, Procurement, Mobilization, Logistics and Quality Assurance, is established to facilitate the numerous tasks to be executed.
One of the most important aspects each year is the refreshers training courses which are conducted throughout the country for Counselor/ Testers.
This training begins as early as March.
According to Ms Success-Hall, this training is necessary in order to ensure consistency and standardization in the delivery of VCT services during National Testing Week.
This is against the backdrop that not all Counselor/testers that work during this critical week are employed and trained by the Ministry of Health.
Quality assurance of the process is of utmost importance for the Ministry of Health/National AIDS Programme Secretariat, and it is also in this regard that the refreshers’ training is conducted.
In reiterating this goal for the third consecutive year, the testing week will be held under the theme “Safe and reliable: Get Tested Now”
With more than 345 fully trained and certified counselor/testers throughout the length and breadth of Guyana on standby and ready to begin work at more than 300 temporary and 125 fixed sites, 2011 National Testing Week is set to outdo itself yet again.
The line ministries, private sector organizations, faith based groups and civil society have given their commitment and cooperation in ensuring that this years’ activity is a raving success once again and are fully on board.
A number of new and exciting initiatives are to be added to this years’ activity, including offering testing for Malaria and Tuberculosis in hinterland regions where this infection is prevalent, such as regions nine and eight.
While a new target has not been set, it is expected that last year’s target will be surpassed.

Beyond 2011
Someone once asked the question: “ where do you go when you have reached the top? The answer given was “to create a new ceiling.”
This is exactly what Health Minister Dr Leslie Ramsammy has in mind for National Testing Week, along with also expanding horizontally.
“We have done a lot but it would be a fateful mistake to become complacent,’ he noted
He also believes that while the HIV programme has benefitted from aggressive resources it would be a critical flaw to continue to isolate it from other diseases.
In this regard, the way forward is to have national testing week emerge into a period of testing for all the chronic non communicable diseases.
“National Testing Week is traditionally held in November, between Caribbean Wellness Month in September, which focuses on Chronic Non Communicable Diseases and World AIDS Day which is observed on December 1. My vision is to link the two and have National Week of Testing be a catalyst for testing both non communicable and communicable diseases.
Like any other success story, National Testing Week has not been devoid of its fair share of challenges. Chief among them  access to some hinterland regions with difficult terrain.
As Guyana prepares to officially commence another National Week of Testing tomorrow, Minister Ramsammy charged Guyanese with “continuing to improve the course which you have charted by coming out to be tested and encouraging your friends and family members to do the same. You need to do this for yourselves .You have placed Guyana on the map and it’s your civil duty to continue.”
He specifically encouraged men to “lead the way in your family by accessing testing”
He urged that apart from testing persons can also volunteer to participate in a number of other areas.
National Testing Week is being observed here from tomorrow to Friday.