Barbados looks to eliminate transmission
Barbados is undertaking an aggressive campaign to eliminate AIDS here with the introduction of a programme to suppress the HIV virus to the point where it would become ineffective.
The Ministry of Health has begun dispensing the full anti-retroviral treatment to infected persons regardless of the severity of their illnesses.
Honorary Director of the Barbados Ministry of Health HIV Laboratory Dr Clive Landis said the programme, Treat All, was for the good of infected individuals and the country as a whole.
“It is fantastic that Barbados is leading the way with Treat All because this is going to arrest the progress of the disease. And it’s been shown over and over again from studies, that the earlier you intervene the better it is for the patient, and it is also better for the public because you don’t have people who are walking around who are very ill with high viral levels,” Dr Landis said last night during a lecture on Eliminating AIDS In Barbados Through Rational Decision Making at the Cave Hill Campus of the University of the West Indies.
“This is the standard of care, and we’re leading the way.”
He explained that international bodies such as the World Health Organization had recommended rationalization of HIV treatment dosage so the most severely infected people who had reached a threshold of a white blood cell count of 500 would get the life-saving drugs.
However, Barbados decided last week to ignore that recommendation and to provide every infected person with the full course of treatment.
“Forget about thresholds of how sick you are with CD4 [white blood cells count], whether you’ve fallen below 200 and you’re really quite sick, or more recently we would say, ‘let’s raise that because people are too sick we would raise it to 350’.
“Treat All is the best practice. Not even all European countries have introduced that. I haven’t found out about any developing countries that have introduced it,” Dr Landis told the audience.
The scientific researcher explained that the decision to treat every infected person stemmed from the effectiveness of Highly Active Anti-retroviral Therapy (HAART), the treatment for HIV which consists of a combination of at least three drugs that suppress replication of the virus.
Dr Landis said that before HAART the presence of HIV in the population and deaths from AIDS were almost equal, meaning that an HIV infected person was more likely to eventually die from AIDS.
However, he said the number of “AIDS deaths just plummeted” after its introduction “and it has categorically shown that it does not mean if someone is treated with HIV, there is more possibility for infection”.
Dr Landis stressed that a similar aggressive approach had led to the elimination of mother-to-child HIV/AIDS transmission here, earning Barbados recognition from the UNAIDS – the joint United Nations programme on HIV/AID – as the second country in the world, after Cuba, to get to this stage.
“If a mother has HIV, and we treat the mother, the [unborn] child won’t get it. So we’re treating the mother [therefore] she cannot transmit HIV to the child, if she is on treatment . . . in Barbados we’ve eliminated it. We don’t have any children left below the age of ten with HIV.
“In the last eight years there were 175 births to mothers with HIV, and there were only two children who were born with HIV.
“We have eliminated HIV [births] in this country. It is a stupendous achievement,” he said.
Dr Landis said it was persistent treatment could contain the virus to the stage where it had become ineffective.
“You can suppress that virus to the point where you can’t measure it in any body fluid, whether it is blood, semen, sweat, tears, anything. What’s been shown is that when you have viral suppression, you are not infectious,” he assured.