ILO will continue to build upon the experience and achievements of the USDOL/ILO Workplace Education Project in Guyana that, over the past three years, has focused on overcoming HIV/AIDS employment-related stigma and discrimination, reducing risk behaviors among more than 30,000 workers from twenty-three target enterprises and increasing sustained employment for workers living with HIV/AIDS (PLWHA) with target enterprises. In FY07, particular focus will be placed on increasing access to voluntary counselling and testing (VCT) services for employees through the workplace programs. Capacity will be developed within workplace health services, as well as through collaboration with the GHARP-supported NGOs to offer mobile VCT at the workplace.

The Guyana Sugar Corporation, Guysuco, will lead the development of on-site workplace counselling and testing services through the incorporation of VCT into their company health care infrastructure. USDOL/ILO will collaborate with MoH and GHARP to train company health care workers to become certified counsellor/testers, who will then offer VCT services to Guysuco employees and provide referrals to care and treatment. To increase the number of workers who know their status but do not have on-site health services at the workplace, the ILO, in collaboration with GHARP-supported NGOs, will provide mobile testing to their employees at the workplace. All counselling and testing services will be addressed with a targeted approach to ensure male access.

Targets

Target Target Value Not Applicable Number of service outlets providing counseling and testing 9
according to national and international standards Number of individuals who received counseling and testing for HIV 450
and received their test results (including TB) Number of individuals trained in counseling and testing according to 24
national and international standards

Target Populations: Business community/private sector

Key Legislative Issues Addressing male norms and behaviors Stigma and discrimination

Coverage Areas Demerara-Mahaica (4)

East Berbice-Corentyne (6)

Upper Demerara-Berbice (10)

Essequibo Islands-West Demerara (3)

Table 3.3.10: Program Planning Overview Program Area: HIV/AIDS Treatment/ARV Drugs Budget Code: HTXD Program Area Code: 10 Total Planned Funding for Program Area: $ 2,877,832.00

Program Area Context:

Treatment, care and prevention programs depend on a reliable and efficient supply of essential drugs and other commodities. Initially, supply chain management presented the greatest challenge to the USG effort to provide ARVs and other HIV/AIDS related medicines to Guyana as the MOH Materials Management Unit (MMU) lacked sufficient storage and managerial capacity to handle the increased flow of commodities. In conjunction with the Government of Guyana, the USG team discussed and developed the idea of a third-party warehouse as an intermediary solution that would address the immediate storage needs of all the HIV/AIDS commodities and serve as a model and training ground for supply chain best practices. After many months of dialogue and preparation on behalf of the USG team and the MOH and other key PEPFAR partners, this Annex warehouse has been established. The Annex is operated and managed by the Partnership for Supply Chain Management in close coordination with the MOH. All HIV/AIDS related health commodities in Guyana will be stored and distributed via the Annex and include ARVs, test kits and reagents from the Government of Guyana, PEPFAR, Global Fund, World Bank, CRS AIDS Relief, and the Clinton Foundation.

During FY07, the vision of PEPFAR Guyana is to continue to strengthen and build the capacity of the MOH MMU to ensure a steady supply of drugs, laboratory supplies, rapid test kits, and other HIV/AIDS commodities through improvements to infrastructure, transport, information systems and human resource capacity. This vision includes a gradual transition and capacity building strategy led by the Partnership's Supply Chain Management System (SCMS). USG Guyana's ultimate goal is to fully integrate the Annex and all HIV/AIDS commodities into an improved MOH supply chain system which includes strengthening the roles and capacities of other government institutions such as the National Food & Drug Department, the National Pharmacy unit and the National Blood Transfusion Service in addition to the MMU.

As of September 2006, over 1,500 individuals are receiving ART in Guyana. Currently 24 adults are receiving second line therapy and 140 children are expected to be on ART by the end of FY06. To effectively meet the procurement needs of the ART program in Guyana, the USG has coordinated closely with the MOH and the Global Fund. While Global Fund has provided adult first line ARVs, PEPFAR has been responsible for the procurement of adult second-line and pediatric first and second line ARVs, in addition to OI and STI drugs. The continued collaboration between USG, World Bank, Global Fund and the MOH will be reinforced and formalized this next year as Guyana is one of the first countries selected for joint procurement planning under the USG/WB/GF procurement working group. A new procurement committee led by the MOH and comprised of key stakeholders will be officially established next year.

The national standard treatment guidelines in Guyana have recently been revised and the standard first line treatment now includes an ARV previously only used in their second line regime. SCMS has facilitated and prepared a revised Global Fund quantification to reflect the new guidelines. Despite the changes, it is still expected in FY07 that Global Fund will purchase all adult first line ARVs and PEPFAR will continue to procure adult second line and pediatric first and second line ARVs and emergency first line ARVs as needed. The stock of pediatric ARV formulations in Guyana has significantly increased this year with a one time in-kind donation from the Clinton Foundation. In addition, the percentage of pediatric patients using pediatric formulations is smaller than expected and patients are switching from oral solutions to tablets earlier than previously anticipated. Forecasts for pediatric ARVs have been adjusted accordingly.

Working together with all key donors and treatment partners SCMS has coordinated a national quantification of ARV and other commodity needs in FY06. The issuance of items or consumption correlated to number of patients treated has been used to prepare a forecast of needs based on actual usage. An inventory system and dispensing tool has been piloted in 06 and during 07 will be introduced and maintained at each supported facility.

Table 3.3.10:

The efforts of the ILO will continue to build upon the experience and achievements of the USDOL/ILO Workplace Education Project in Guyana that over the past three years has focused on overcoming HIV/AIDS employment-related stigma and discrimination, reducing risk behaviors among more than 30,000 workers from twenty-three target enterprises and increasing sustained employment for workers living with HIV/AIDS (PLWHA) from the target enterprises. Special emphasis will be placed on referring workers from the partner enterprises to VCT and treatment services provided by community-based organizations. The Project will also build on the collaborative arrangements with the GHARP Project with the objective of having one PEPFAR private sector initiative in Guyana, but the goal is to consolidate the two separate workplace programs into one that is led by the Department of Labor/ILO. On this basis, the aim is to expand the reach of the program to include an additional ten to fifteen enterprises. The eventual goal is to develop this into a sustainable program as the world of work component of the national response to HIV/AIDS.

The program will continue to utilize the existing and well-functioning collaborative arrangements with the Ministry of Labour, Human Services and Social Security, the employers' and workers' organizations, and the network of nongovernmental organizations (NGOs) to reach workers in the target enterprises as well as employees. Action will continue to be pursued at the national, community and enterprise levels. It will include support for enforcement initiatives for the national workplace policy and regulations, enhancing the capacity of national agencies to provide HIV/AIDS training, review of the draft protocol to link NGOs to target enterprises, development of enterprise-specific behavior change communication (BCC) programs, and development of referral systems for, or in-house training for the delivery of VCT (including a targeted approach to ensuring male access), treatment, and care and support for workers and their family members. It will also include the development of training and BCC materials and the strengthening of the monitoring mechanism.

The ILO Code of Practice on HIV/AIDS and the World of Work, which has been developed by a group of experts from governments, workers' and employers' organizations will continue to be the principle guide and framework for action.

Deliverable/Additional Targets: •10 additional enterprises with an adopted HIV/AIDS workplace policy •Protocol to link NGOs to target enterprises finalized •Workplace-specific BCC materials developed