In FY 2012, the Department of Defense (DOD) in Guyana will be moving from support to the Guyana Defense Force (GDF) for service delivery to building public health institutions from disease surveillance and response. The GDF will maintain an independent health system with clinics at each of its bases. To ensure that the GDF members are in good health and are not vectors for diseases, development of a routine surveillance system and response capacity will link to the national health system. To provide more accurate data on the behaviors and military base locations that will present the greatest risk for transmission amongst the GDF members at bases or deployment, the National Public Health Reference Laboratory (NPHRL), the GDF laboratory and the USG have conducted a behavioral and biological survey (SABERS), the first of its kind in Guyana. SABERS will collect results for HIV and other STI, and results will be incorporated into a capacity building plan by NPHRL with help from the USG. Based on the SABERS results, targeted prevention activities will also continue to scale up not only at GDF locations but also to reach GDF family members and the civilian communities surrounding the military bases. Efforts will also be made to establish an electronic health record to institute an e-health educator at every medical clinic and health facility of the GDF. As the MOH develops their own electronic disease reporting system and medical record, the open access nature of the system can export in any form needed by the national health system, allowing the capacity for reporting, analysis over time and strengthening of an essential component of the health system. Note: The entirety of funding for this program, $347,625, will be carryover funds from FY11.

Clinic-based basic health care and support will be provided to HIV-infected members of the Guyana Defnese Force (GDF). Access for HIV-infected ranks to the diagnosis and treatment of opportunistic and sexually transmitted diseases will be ensured. Laboratory and pharmacy support will be continued. One doctor/health care provider will attend the Military HIV/AIDS Training Course where training will be provided in the diagnosis and management of HIV complications (neurologic, oral, skin, pulmonary, opportunistic and ophthalmic emergencies) and on mental health and ethical issues in HIV patients. Support will be provided for this individual to train other GDF health care personnel to provide health care and support for HIV-infected personnel. Additionally, training will continue with the GDF nurses and medics by the Ministry of Health. A referral network into the civilian health care system will be established to provide health care and support beyond the support available in the GDF. Activity tracking and reporting mechanisms will be continued.

Provision of technical assistance to the Guyana Defense Force (GDF) medical personnel will be continued to enable diagnosis and treatment of tuberculosis (TB) in HIV-infected individuals within the GDF. Training, educational resources and standard operating procedures for TB-HIV management will be provided in collaboration with the National Chest Clinic. Training, local organization capacity development and strategic information activities will be done in conjunction with activities in the HBHC program area. Equipment and laboratory supplies to maintain this program area will be procured as part of the HLAB program area. The GDF will implement HIV counseling and testing (C&T) for all TB patients and TB screening.

Laboratory personnel training will be continued for the Guyana Defense Force (GDF) laboratory personnel to strengthen and maintain skills and capabilities acquired. Technical assistance will be provided in developing logistics mechanisms to sustain basic laboratory capabilities. Strengthening of laboratory systems and facilities will support HIV/AIDS related activities including procurement of equipment, reagents, commodities, the provision of quality assurance and other technical assistance.

The epidemiology of HIV/AIDS in the Guyana Defense Force (GDF) will be established through increased surveillance and analysis of strategic information from the HIV Seroprevalence and Behavioral Epidemiology Risk Survey (SABERS). The GDF will have an established health information management system that increases availability of HIV/AIDS strategic information. Collaboration with the USG country team will be established for a strategic information and monitoring and evaluation (M&E) program for HIV/AIDS prevention/treatment activities in the GDF that will be compatible with the PEPFAR M&E system. Collaboration will also lead to the development of a health information management system to: 1) Increase availability of HIV/AIDS strategic information 2) Develop and manage HIV/AIDS interventions3) Develop policies and programs and 4) Assure confidentiality and appropriate referral. Existing data will be analyzed from SABERS and additional surveys conducted to establish HIV/AIDS prevalence and incidence within the GDF. Human resource capacity will be built with the hiring of a Surveillance officer and sustainability for M&E will be improved through training and the development of a monitoring program. Information technology materials will be procured for implementation of PEPFAR initiatives with the GDF (e.g.) computers, software, projector, screen flipcharts etc.

One Guyana Defense Force (GDF) health care provider will attend the Military International HIV Training Program in San Diego, California where comprehensive training will provide a conceptual background and practical experience in HIV management, management of common opportunistic infections, policies and operational aspects of clinical and military management of HIV infected personnel and their families. HIV diagnostics and the laboratory diagnostics of parasitic diseases and opportunistic infections will be taught. Vital concepts and methods of epidemiology and biostatics will address the critical public health issues including surveillance, bias, confounding and study design using and evaluating medical information and use of statistics from the HIV Seroprevalence and Behavioral Epidemiology Risk Survey (SABERS) will be reviewed. Training and experience in database development, maintenance and data entry will be provided. Key elements of health communication messages and social marketing efforts to promote HIV prevention, voluntary testing and counseling (VCT), relevant software, library and medical researching skills will be enhanced with the provision of multi-purpose health Netbooks.

This activity will provide male circumcision and counseling and testing for those who seek circumcision surgery in accordance with international standards and international guidance. Approximately 40-70 males in the Guyana Defense Force (GDF) will also be counseled on the need for abstinence from sexual activity during wound healing, wound care instructions and post-operative clinical assessments and care also promotion of correct and consistent use of condoms. Activities for supportive supervision and quality assurance will be performed by registrars from the Georgetown Hospital. Training programs will be established and education materials provided. Provision of equipment and commodities will be in support of male circumcision procedures.

Medical and laboratory personnel including doctors, nurses, phlebotomists, laboratory technicians and medics will continue to be trained in the implementation of universal precautions in all the Guyana Defense Force (GDF) clinical settings. Refresher training will be held in standard, safe blood drawing, sample handling techniques, infection prevention and control, waste management, needle stick precautions/post-exposure prophylaxis and safe phlebotomy and lancet procedures. Commodity security will include sustained availability of bio-hazard bags, safety disposable containers, gloves, lancets and single-use syringes. Monitoring of safety precautions will be continued internally by the trained, certified laboratory supervisor for injection safety and waste management.

This program area targets officer cadets, recruits of both male and females aged 18-25 and male ranks aged 18-30 deployed to outlying posts. Training will continue to support medical personnel and peer educators to provide AB messages. Additionally, leadership positions will be encouraged to provide prevention education to their subordinates. Activities will be extended beyond Georgetown to outlying military posts in Regions 1, 2, 3, 5, 6, 7, 9 & 10. Peer education will be supplemented through the distribution of HIV/AIDS prevention information, education and communication (IEC) materials. Fifteen HIV/AIDS awareness sessions will be continuous with the integration at military training sessions and national HIV/AIDS prevention activities in collaboration with the National AIDS Program Secretariat (NAPS) at the Ministry of Health (MOH). Activity reporting mechanisms will be implemented by supportive supervision from Youth Challenge Guyana, standardized IEC materials and record keeping of registration will be maintained.

Counseling and testing (C&T) by trained counselors will be available at all four counseling and testing sites at Base Camp Ayanganna, Base Camp Stephenson, Coast Guard and Base Camp Seweyo. C&T will continue to be performed in accordance with international guidelines and will include targeted ABC messages. Reduction of stigma and discrimination will be emphasized, including implementation of mechanisms to maintain the anonymity of those tested and confidentiality of their test results. Linkages into the civilian health sector for referrals of HIV positive ranks will be maintained. Plans are also underway to increase the service portfolio at C&T sites to provide other health related services such as domestic violence, psychosocial and alcohol and substance abuse counseling. Refresher training will be continued on an annual basis and in collaboration with the National AIDS Program Secretariat (NAPS) national activities. Data collection and activity reporting mechanisms will continue and maintained with monitoring by NAPS.

Ranks of the Guyana Defense Force (GDF) will continue to train and promote preventing HIV transmission within the force including prevention messages, sexually transmitted infection (STI) management and programs to reduce other risks of persons. Currently, male and female condoms are available through the National AIDS Program Secretariat (NAPS) and distributed to all bases and locations. Safe sex messages will include partner reduction, consistent and correct condom use and correct knowledge of HIV transmission with special focus to the role of men in adopting safer sex behaviors to protect themselves and their partners/families. Sensitivity to issues surrounding stigma and discrimination will be emphasized. Population-targeted information, education and communication (IEC) materials will be continued to be reproduced and distributed. Activity tracking and reporting mechanisms will continue internally.