Important note: this will be a graded assignment! This will serve as an online discussion forum for many of the issues and questions and specifics from the novel that are important and we will not have time in class to discuss.  Thus, this assignment will help guide you through some of the major themes in the novel.  Complete the assignment using the following guidelines: 1) Choose a quote from the one of the first three sections of the novel. 2) Write it out, and post it on the forum as a discussion thread.  Write out the full quote, include the page number.  The quote should be only one or two lines long.  Do not post a full paragraph. 3) Write a paragraph explaining the significance of the quote.  Use the following questions to guide you, but do not simply answer the questions in order.  Why did you choose this quote?  What makes it important?  How does it connect or relate to the rest of the novel? 4) Do this twice as two separate postings. 5) Do not post the same quote as someone else.  6) Make sure your own quotes are from two separate chapters of the novel. HIV in Sex Workers in Guyana 9 Public Health Informatics Name Course Institution Professor’s Name Date of Submission Introduction HIV/AIDS is a national catastrophe as well as an international crisis. HIV/AIDS is one of the leading worldwide challenges alongside others such as global warming, nuclear war, continuing conflicts and international trade and fiscal policies. This catastrophe represents one of the utmost possible dangers to attaining the Millennium Development Goals (MDGs). Many people are more vulnerable and more exposed to HIV/AIDS as compared to others. A good example is the sex workers, comprising of all those employed in the sex industry from the staff helping curb HIV/AIDS to those doing the act to earn money. One of the countries faced with this problem is Guyana which is a country in South America. This nation has confidently established programs and policies that are intended to reduce the effect that HIV/AIDS has had on the country. Between 2002 and 2006, a national strategy was laid to board on go-getting programs which were being reinforced by the Central Government during the time when very few local and international NGOs were prepared and enthusiastic to get involved in the fight against HIV/AIDS in Guyana. The country’s response and fight against HIV/AIDS started initially the first case was reported in the year 1987 (Dr. Shanti Singh, 2012, pg. 13). Since that time, the country worked hand in hand with its stakeholders towards the public threat. In this report, we shall discuss various aspects surrounding HIV/AIDS in sex workers of Guyana and the Public Health Informatics informed approaches for monitoring or managing HIV in sex workers in the country. Apart from description of the problem above, this report shall focus on existing statistics describing this issue, the traditional government or institutional data sources that could help to ...

1. Important note: this will be a graded assignment!
This will serve as an online discussion forum for many of the
issues and questions and specifics from the novel that are
important and we will not have time in class to discuss. Thus,
this assignment will help guide you through some of the major
themes in the novel.
Complete the assignment using the following guidelines:
1) Choose a quote from the one of the first three sections of the
novel.
2) Write it out, and post it on the forum as a discussion thread.
Write out the full quote, include the page number. The quote
should be only one or two lines long. Do not post a full
paragraph.
3) Write a paragraph explaining the significance of the quote.
Use the following questions to guide you, but do not simply
answer the questions in order. Why did you choose this
quote? What makes it important? How does it connect or relate
to the rest of the novel?
4) Do this twice as two separate postings.
5) Do not post the same quote as someone else.
6) Make sure your own quotes are from two separate chapters of
the novel.
HIV in Sex Workers in Guyana 9
Public Health Informatics
Name

2. Course
Institution
Professor’s Name
Date of Submission
Introduction
HIV/AIDS is a national catastrophe as well as an international
crisis. HIV/AIDS is one of the leading worldwide challenges
alongside others such as global warming, nuclear war,
continuing conflicts and international trade and fiscal policies.
This catastrophe represents one of the utmost possible dangers
to attaining the Millennium Development Goals (MDGs). Many
people are more vulnerable and more exposed to HIV/AIDS as
compared to others. A good example is the sex workers,
comprising of all those employed in the sex industry from the
staff helping curb HIV/AIDS to those doing the act to earn
money. One of the countries faced with this problem is Guyana
which is a country in South America. This nation has
confidently established programs and policies that are intended
to reduce the effect that HIV/AIDS has had on the country.
Between 2002 and 2006, a national strategy was laid to board on
go-getting programs which were being reinforced by the Central
Government during the time when very few local and
international NGOs were prepared and enthusiastic to get
involved in the fight against HIV/AIDS in Guyana. The
country’s response and fight against HIV/AIDS started initially
the first case was reported in the year 1987 (Dr. Shanti Singh,
2012, pg. 13). Since that time, the country worked hand in hand
with its stakeholders towards the public threat.
In this report, we shall discuss various aspects surrounding
HIV/AIDS in sex workers of Guyana and the Public Health
Informatics informed approaches for monitoring or managing
HIV in sex workers in the country. Apart from description of

3. the problem above, this report shall focus on existing statistics
describing this issue, the traditional government or institutional
data sources that could help to shed light on its prevalence or
patterns, and explain why these might not be sufficient and
suggest non-traditional information sources and methods of data
capture that might be useful. We shall also give suggestions on
how the data could be analyzed and visualized to support public
health intelligence or to inform interventions and services.
The country of Guyana has an HIV/AIDS prevalence of about
1.1%. This is a proof of the significant strides in fighting the
epidemic in Guyana which is recognized locally and also
globally. The HIV/AIDS infection has been on the increase
since the first case was reported in 1987 with an accumulation
of 1899 AIDS cases and 9473 HIV cases between 2002 and 2011
(Ministry of health, 2007-2011, pg. 18). However, the number
of new AIDS infection decreased progressively since 2004 with
972 and 62 cases of HIV and AIDS respectively reported in
2011(Republic of Guyana, 2014, pg.9-10). In 2003, adult HIV
prevalence in Guyana was estimated to be 2.5% with extremes
of 0.8% and 7.7% for low and high extremes respectively
(Esther, 2013, pg. 35). According to UNAIDS in research done
in 2013, the adult prevalence was estimated to be 1.4% which
was a great decrease from 2.5% and 2.4% of 2003 and 2004
respectively (Keith et al, 1997). Since 2010, the ratio of AIDS
infection male-female has been on the increase for the female
side with a ratio of 1:4 in 2014 (Republic of Guyana, 2014,
pg.9-10). In 2014, the highest number of HIV/AIDS cases was
reported in individuals between the age of 25-49 and it
accounted for 61.7% of all cases. In 2014, the Biological and
Behavioral Surveillance Survey (BBSS) exhibited a sharp
reduction in the HIV prevalence amongst female sex workers
(FSWs) as compared to 26.6% in 2005 and 5.5% in 2014.
However, amongst the MSMs the prevalence decreased from
21.1% in 2005 to 4.9% in 2014 according to the BBSS report. In
the juniors’ prevalence reduced from 6.5% in 2000 to 1% in
2014.

4. Guyana’s most recent Biological Behavioral Surveillance
Survey (BBSS) described HIV risk shapes and vulnerabilities
for KPs; hot spots for transmission; and estimated size of key
subpopulations. Key findings of the BBSS 2014 include
(Advancing Partners and communities, 2015, pg. 5):
• 34% of female sex workers (FSW) and 28% of male sex
workers (MSW) were found in Region 4; 22% FSW and 33%
MSW were found in Region 6
• 44% of FSW and 48% MSW have comprehensive HIV
knowledge
• Information on the risks of anal sex has not reached the right
people. Condom use and anal sex needs to be renewed focus
• 52% of FSW and 35% MSW felt that their risk of becoming
infected was high
• 54% FSW reported finding clients in discos, 49% said finding
customers in hotels, 47% reported finding clients on the street
and 21% reported finding clients in brothels
• 40% FSW and 39% MSW reported consistent condom use with
regular partner while 68% FSW and 52% MSW reported the
same with clients and consistent condom use by FSW with its
customers declined by 12% between 2009 and 2014
• 82% of FSW had been tested at least once compared to 60%
MSW
• 11% of FSW reported being reached by “Keep the Lights On”
Peer Educator within the past 12 months compared to 39% in
2009
• 24% of MSM reported being reached by “Keep the Lights On”
or “Path for Life” Peer Educator in 2014
• Partner violence and rape are major problems that need to be
addressed in all key populations
• Boys less than 18 years who identified as transgender (TG)
involved in transactional sex were consistently less aware of
available services than other youth engaged in sex work.
Such data like the one provided by BBSS helps future
generations to keep track of the epidemic in sex workers of
Guyana. HIV/AIDS being a killer epidemic increase the

5. prevalence of the disease needs to be increased by providing
good and reliable data sources that will create awareness to all
ages of people and most importantly a source that will reach the
sex workers efficiently. The sources that provide such data are
either supported by the government or NGOs and private
institutions. These two sectors provide the data either in
traditional data sources or non-traditional data sources.
Traditional data sources comprise of reports and press releases
but majorly reports (Marin et al., 1983, pg.65-80). These
sources though not enough help shed light on the prevalence and
patterns of HIV/AIDS infection in sex workers of Guyana.
According to research, the sex workers of Guyana are not as
much resistant to change as we may think. From the statistics
above it is clear that the rate of HIV infection went down since
2000 and this was as a result of vigorous awareness created by
the sex workers (Marin et al., 1983, pg.65-80). The traditional
use sources of data to the government helped the government of
Guyana to establish bold measures to help the sex workers and
to reduce the rate of spread of the epidemic in the country. The
disadvantage with these sources is that they might not reach the
people directly and that very few people will be achieved.
However, these traditional methods might not be sufficient, and
that’s when I would suggest the use of non-traditional
information sources and methods of data capture that might be
useful (Marin et al., 1983, pg.65-80). The non-traditional data
sources comprise of social media and news reports such as
Twitter, YouTube, Instagram amongst others. For instance, in
Guyana, Twitter has become a major and modern media
communication platform for the citizens, government, agencies
among others to get information on sensitive issues such as the
HIV/AIDS epidemic. Non-traditional data sources on HIV/AIDS
includes all relevant information that is collected from sources
that are out of the scope of the current methods of data
collection in the country. These sources cover a broad spectrum,
from small sources such as smartphones to combined metadata
from the social media. Non-traditional sources are an ideal

6. source for statistical agency use as it is provided controlled and
designed by the agency (Marin et al., 1983, pg.65-80). This
implies that any identified errors will be controlled under one
control such as a first-class likelihood survey fixed by the
agency. Furthermore, such data sources can be controlled by
more than one NGO or even several local governments in
Guyana. Some of the sources include traffic cameras. Non-
traditional sources result from autonomous choices, and it is not
easy to conceptualize, and errors are few.
As such I would recommend the use of the following non-
traditional sources as useful in enhancing high HIV/AIDs
prevalence in Guyana and especially information on HIV/AIDS
sex workers in the country. One of these sources is the news
report that captures raw information in the form of spoken or
verbal information where the media can interview the Sex
workers and pass the information or through taking pictures
(Marin et al., 1983, pg.65-80). This can help by pushing the
government to offer health and sex workers rules that work in
reducing the spread of the epidemic. Another source I would
recommend is the use of local government, news and citizen
tweets about HIV/AIDS in sex workers of Guyana. The local
government tweeting involves posting reported information in
Twitter providing information and warnings about the spread of
the epidemic, giving the right advice to the sex workers and
ideology of use of a condom. The news tweet involves the
information posted on Twitter by news organizations while
citizen tweeting involves real-time information which is
publicly posted on Twitter by individuals who do not represent
any news agency. These individuals may be the sex workers
themselves tweeting real-time information about the epidemic.
This information is paramount in providing public support to
health intelligence or even to inform interventions and services
through analysis and visualization. The best method of analysis
is a secondary analysis which implies the use of available
information to find the solutions to health issues such as the
HIV/AIDS epidemic. The advantage of this method is that it

7. can be used to solve significant data from surveys. However,
there is an overall agreement involved in sharing the results if
the data is large scale. The fundamental ethical issues related to
secondary data analysis remain similar; they are more persistent
with the introduction of innovative technologies. Sharing,
storage and compiling of data have become easier and quicker.
Similarly, there are developing concerns and challenges with
data security and confidentiality. However, the serious concerns
about secondary data analysis revolve around possible harm to
personal matters and the problem of return for an agreement.
This analysis depends on the quantity of the information at
hand. In case the data does not have any classifying information
or it is entirely coded such that the researcher lacks the access
to the codes; the data will not require full review by the board
of ethics. The board should only confirm if the data is unsigned.
Nevertheless, in case if the data has some signed information
about the sex worker participants or any information that can
lead to recognizing the members, the board will have to make a
complete review of the proposal (Boryc, 2010, pg.482-491). The
researcher or the source of the data should thus explain why it
is inevitable to have enclosed information to reply to the
research question and should also entitle how the sex workers’
discretion and the confidentiality of the information will be
secured. Upon certification of the data provided, the data is then
analyzed to provide health solutions on how to prevent or
reduce the spread of HIV/AIDS amongst the sex workers in the
country.
To monitor and manage this epidemic in Guyana, the use of
informatics-informed approaches is crucial to ensure the true
prevalence is enhanced. HIV/AIDS being one of the causes of
death in Guyana, which is a nation with a high prevalence of the
epidemic, the use of an informatics-informed approach will be
very efficient. SIDATRAT is one of the informatics systems
which are widely utilized in the Caribbean region. It ensures
proper monitoring and follows of drug administration (Aragoné
et al, 2012, pg. 5-9). The system functions on the web platform

8. and uses a MySQL, PHP and Apache server and helps in
recording the overall information of the patient. SIDATRAT can
compile AIDS information, classification, infection rates, HIV
subtype and resistance studies, drug regimen, follow-ups, any
side effects from drugs, survival rate, and also the number of
patients under treatments. The system follows the client-server
philosophy and allows the access by authorized users through
the health informatics networks (Aragoné et al, 2012, pg. 5-9).
The system can offer daily support care for HIV/AIDS patients
and universal access to antiretroviral therapy.
References
Advancing Partners and communities, 2015, Advancing Partners
& Communities (APC) GuyanaProject Solicitation No. GH-0 21
Delivering Effective HIV Prevention, Testing and Care
Services for Key Populations in Guyana:
https://www.advancingpartners.org/sites/default/files/apc_
gh-021_solicitation_ 07_17_2015_0.pdf
Aragonés, C., Campos, J.R., Pérez, D., Martínez, A. and Pérez,
J., 2012. SIDATRAT: informatics to improve HIV/AIDS
care. MEDICC review, 14(4), pp.5-9.
Boryc, K., Anastario, M.P., Dann, G., Chi, B., Cicatelli, B.,
Steilen, M., Gordon‐Boyle, K.,
Dr. Shanti Singh, 2012, End Of Term Review Guyana National
HIV/AIDS Strategy2007-2011:
http://hivhealthclearinghouse.unesco.org/sites/default/files
/resources/Guyana_End_of_T rm_Review_May_9_2012.pdf
Esther M McIntosh et al., 2013, A Qualitative Research Study
on HIV Vulnerability among Young Key Affected Populations
in Guyana:
https://www.unicef.org/guyana/YKAP_Final_Report_31_Ju
ly_2013.pdf
Guyana Operational Plan Report FY 2012, :

9. http://www.pepfar.gov/documents/organization/212144.pdf
Keith H. Carter Bhiro P. Harry Michael Jeune and Devian
Nicholson, 1997, HIV risk perception, risk behavior, and
seroprevalence among female commercial sex workers in
Georgetown, Guyana:
http://www.scielosp.org/scielo.php?script=sci_arttext&pid
=S1020-49891997000600005
Marin, B.V.O., Marin, G., Padilla, A.M. and De La Rocha, C.,
1983. Utilization of traditionaland non-traditional sources of
health care among Hispanics. Hispanic Journal of Behavioral
Sciences, 5(1), pp.65-80.
Ministry of health, 2007-2011, Guyana National HIV/AIDS
Strategy 2007-2011:
http://www.pancap.org/docs/NSP/Guyana_NSP.pdf
Republic of Guyana, 2014, Guyana Aids Response Progress
Report Republic Of Guyana:
http://www.unaids.org/sites/default/files/country/document
s/GUY_narrative_report_201 .pdf.
Singh, S. and Morris, M., 2010. A Needs Assessment of Clients
With HIV in a Home Based Care Program in Guyana. Public
Health Nursing, 27(6), pp.482-491.