innovative: Dr Raymond Noel

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T&T doctor wins PAHO award for AIDS study

...helping Tobago couples prevent HIV transmission to each other

A local doctor specialising in HIV/AIDS treatment and working with Tobago couples has won a prestigious award on behalf of Trinidad and Tobago for his work.

The award won by Dr Raymond Noel, of the Tobago Health Promotion Clinic, is one of two winning entries selected from among 26 countries entered in the IV Competition of Best Practices in Incorporating a Gender Perspective in Health—Emphasis on HIV, organised by the Office of Gender, Diversity and Human Rights of the Pan-American Health Organisation (PAHO). Dr Noel will receive his award at PAHO's celebration of International Women's Day on March 8 in Washington DC in the US.

Dr Noel, through the Tobago Health Promotion Clinic and with the support of PAHO, submitted the project "Prevention in Discordant HIV-Positive Couples" for evaluation.

He explained to the Sunday Express, via e-mail, that discordant heterosexual couples are couples where one person is HIV-positive and the other is not.

He said the clinic was able to prevent 56 people from getting HIV while keeping the couples together.

Eleven babies were born to the couples in the study, none of them becoming HIV-positive, and there were no complications with the pregnancies, he said. Dr Noel said seven of the HIV-negative girlfriends of HIV-positive men gave birth to babies who were prevented from getting infected by taking medication (pre-exposure prophylaxis) through a planned pregnancy programme.

He reported one break-up among the couples where the man deliberately stopped taking medication and infected the woman.

The study was done in Tobago over six years, with no budget or support from the Tobago House of Assembly, he said.

A release from the members of the PAHO evaluation panel for the competition highlighted the following aspects of the programme:

• it had a commendable duration of six years

• it targeted diverse population groups, including 100 per cent of HIV-positive discordant couples

• both men and women participated in the programme and its planning of solutions. This is apparent in the individual and joint counselling sessions of the couples

• the programme's development and implementation was based on evidence of gender disparities and analysis that included the perspective gender

• actors from different sectors of civil society, such as the health promotion team and a church pastor, participated in the implementation of the programme.

• specific strategies for women and men were to the individual and couples' needs and even transformed the unequal power relations between sexes. This is particularly evident in the high ARV adherence during pregnancy

• even with a small budget and limited staff, the programme had innovative, adaptive responses to problems such as the HIV "blame game", leading to gender violence; under-reporting; human rights abuses; and an increase in risk factors owing to gender disparities in Tobago.

• it showed evidence of growth and sustainability. The number of discordant couples enlisted in the programme grew from three to 60. Staff was cross-trained. The community, HIV service organisations and the programme for prevention from mother-to-child transmission (PMTCT) became partners.

• it has had a multiplier effect. The programme has expanded across the island to include all HIV-positive mothers in the PMTCT programme and the participation of private physicians, the community, and church on issues related to HIV disclosure and keeping couples together. In addition, community HIV testing sessions have been implemented in parks and public places.

The purpose of the competition is to identify projects that best address the different needs and opportunities of men and women of diverse population groups in the field of gender-sensitive health, particularly those that try to transform the attitudes of health workers, men and women, in order to improve the opportunity of both sexes to enjoy good health.

Programmes were awarded in two categories:

1. Public or private sector organisation (ministry of health, ministry of education, national women's mechanisms, non-governmental organisations, academic institutions, etc) that articulate works in the health sector and is developing a prevention, treatment and care of HIV programme with a perspective on gender equality in health.

2. An organisation that is developing a regional, national, or local programme that is supported by PAHO and incorporates a perspective of gender equality in health.

After the evaluation of the 26 projects, three finalists for Category 1—Argentina, Chile and Costa Rica—and two finalists for Category 2—Guatemala and Trinidad and Tobago—were selected.

Argentina was the winner in Category 1 and Trinidad and Tobago won in Category 2.

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