Miss World Caribbean 2014

Rafieya Husain also copped the Beauty with a Purpose Award of the Miss World 2014. Huge accomplishment for the Guyanese Diaspora and Guyana!!!

Rafieya Husain

Rafieya Husain – Placed in top 10 – Miss World 2014

Rafieya HUSAIN (Guyana) – Placed in the top 10! Huge!!!

Rafieya HUSAIN (Guyana) – in top 10 at Miss World 2014

Rafieya Husain

Rafieya Husain – Placed in top 10 – Miss World 2014

Miss World 2014 – Crowning Moment – Miss South Africa – YouTube

Miss World 2014 – Crowning Moment – Miss South Africa – YouTube.

Prorogation of Parliament

Prem Misir notes: The Constitution of Guyana allows for General and Regional Elections every five (5) years, and there generally is no disagreement on the invocation of this constitutional provision. Yet when there was the recent prorogation of Parliament, another constitutional provision, the combined Opposition forces continue to lambaste the President for effecting this proclamation. The combined Opposition forces still opine that the prorogation should not have been proclaimed because it removes the voice of the people. But the combined Opposition forces are up in arms largely because they perceive prorogation as an attempt to thwart their strategy to bring down the PPP/C Government through some anti-government parliamentary no-confidence motion. Yet, in the eyes of the Government, prorogation was and still is an attempt to enable some dialog among the parliamentary groups, to revisit concerns with fresh insights. And history will record this 10th Parliament as the probably the worst in Guyana’s political history, as it was not a performance-based Parliament. And it should be made quite clear that prorogation is a constitutional provision that can be invoked by any government, if necessary. The prorogation of Parliament was not an illegal act!!

Partner Notification as a Prevention Strategy


Partner Notification as a Prevention Strategy:

A Social System Perspective

Part 3


This paper was published: Misir, P., 1999. AIDS PATIENT CARE and STDs, 13(6), pp.327-334.

Stigmatization and discrimination continue to negatively affect the victims of AIDS. Stigma is a mark of social disgrace that places the infected person apart from those who see themselves as “normal.” Goffman14 perceives the stigmatized individual as having a “spoiled identity” due to negative evaluations by others. Persons consumed by AIDS are seen as having a spoiled identity by some sections of the population considered to be normal. Legislation on its own will not reduce the stigma experienced by people with AIDS.

The AIDS stigmatized image is reinforced by incorrect information. This misrepresentation and mythology of the disease need disclosure discussion, and clarification; they should not be incorporated as the basis for social policies. Stigma can be reduced by “normalizing” the illness. Attempts can also be made to show that not only “deviants” contact HIV. Conrad15 points out that “we need to develop policies that focus on changing the image of AIDS and confront directly the stigma, resistance to information, and the unnecessary fears of the disease. Given the social meaning of AIDS, this will not be easy.” One needs to believe, however it can be done. Partner notification programs will be much more successful if the stigmatized images of AIDS are reduced or eliminated.





Partner notification programs, rooted in voluntarisitic choice, have become integral to HIV prevention strategies in most states. These programs are manifested in terms of either provider referral (third party referral) and/or patient (client) referral. Provider referral refers to a situation in which the patient requests assistance from the public health department to help locate his/her sexual/needle-sharing contacts/partners. Patient referral has to do with a situation in which the patient notifies his/her own sexual/needle-sharing contacts/partners.

Partner notification facilitates primary and secondary prevention of HIV infection, as shown by the following data from a study by the New York City Department of Health.16 In 1996, 572 HIV-positive patients were interviewed in the partner notification program. The interview yielded 485 contacts with a contact index of 0.9. Of these 485 contacts, 82 previously tested positive; approximately 218 contacts were given pretest counseling and tested for the HIV infection; 185 partners were not tested; 12.2% of the partners

tested positive. The contact index in 1995 was 0.8, and 12.5% of the partners contacted were tested and found to be HIV-positive. These data are elicited from third party referrals, which seem to have a fair measure of success.






Strategies for implementing partner notification were applied at a Gothenberg Clinic in Sweden. General characteristics of the Swedish approach included the following9:

  • Partner notification effected shortly after diagnosis
  • Sexual history traced to 3-4 years or more
  • Concern for civil rights manifested by truly enabling patients to participate
  • Patients encouraged to reveal information on contacts, any medical examination done, sex techniques utilized, and condom usage
  • Method of referral made via letter to the partner, without disclosing reason for the meeting

This partner notification scheme was successful, and was based on a system of third party referral.

In a follow-up evaluative study9 of the Gothenberg Clinic, it became clear that a partner notification program is supportable if the following criteria are met:

  • Guarantee of good medical care
  • Guarantee of good psychosocial care
  • Support of diagnosed patients

These criteria will not be met in the foreseeable future in the United States. Indeed, President Clinton recently admitted that because of a misjudgment relating to probable need, antiretrovirals will not be covered for HIV-infected Medicaid patients until the onset of AIDS.

The follow-up evaluative study in Sweden recommends less as opposed to more involvement by the public health department in contact tracing. The results support the position that a system in which the client is dealt with by clinically active health care providers, where names of patients and partners never get out of the clinic, is better for the person with HIV infection than a system using the public health department resources. Partner notification tasks in this process are also better effected by a specially trained counselor than by the physician.

The New York State law to amend public health relating to HIV infection, Chapter 163, makes no  clear provisions for guaranteeing good medical care, psychosocial care, or support for HIV-infected patients. These criteria have been associated with supportable partner notification programs. The legal situation in New York relies heavily on public health personnel to make provider referral happen outside of the clinic setting. Applying this strategy could not only make confidentiality of information violable, but could result in failure of partner notification programs. The major objection to partner notification is HIV name reporting.

The lack of anonymity may prevent many people from being tested. This is a very important issue to the HIV-infected community and should be addressed. Various coding systems have been suggested to retain anonymity in the face of name reporting, which should also be mentioned, but these code systems are apparently very costly to develop and implement and imprecise as well. Further, index patients and partners were linked by internal code numbers at each clinic. The index patient’s name and their partner’s test results are not disclosed in medical communications. The HIV test results of notified partners are never revealed to the index patient. Between 1985 and 1991, there was an 18.4% increase in reported cases.







While these principles of partner notification may work well in Sweden, they can present serious problems within the U.S. health care setting. Value differences exist between the two countries: Americans are more likely to view poverty as an individual problem, whereas in Sweden, poverty is seen as the product of the economic system. In effect, in the United States, emphasis is on “equality of opportunity,” whereas in Sweden focus is on “equality of result.” In Sweden, considerable authority is vested in government, while “less government”, at least regarding this issue in the United States seems to be the case.

Klass17 indicated that U.S. individualism and social and ethnic heterogeneity have produced  “fractionalized understandings of citizenship.” In Sweden, citizenship is rooted in solidarity and universal entitlement. This approach is evidenced by two-thirds of Sweden’s $190 billion budget being allocated for healthcare, with everyone being covered through the state. This is not so in the United States. Rodwin18 argues that the United States has a small public hospital policy, and with no national health insurance, a multipayer system exists. Those patients with more resources can afford the best health care. Therefore, for the aforementioned reasons, the principles for an effective partner notification program as described in the Swedish research, may not have direct applicability in the United States. This point becomes clear when one keeps in mind that many AIDS patients are either uninsured or underserved in the United States. On a more specific note, the New York City Planning Prevention Group (PPG) has had discussions about partner notification. However, so far the PPG has not accorded a precise priority status to partner notification. The research literature19-21 is quite clear about the significance of partner notification in secondary prevention.



  1. Goffman E. Stigma. Englewood Cliff, NJ: Prentice-Hall, 1963:30-31.
  2. Conrad P. The social meaning of AIDS. In: Conrad P, Kern R, eds. The Sociology of Health and Illness: Critical Perspectives, 3rd ed. New York: St. Martin’s, 1990:285-292.
  3. Annual Report 1996. New York City Department of Health, Commission of Disease Intervention, Bureau of STD Control.
  4. Klass, G. Explaining America and the welfare state: an alternative theory. Br J Polit Sei 1985;15:427.
  5. Rodwin VG. Comparative health systems: a policy perspective. In: Kovner AR, ed. Health Care Delivery in the United States. New York: Springer, 1990.
  6. West GR, Stark KA. Partner notification for HIV prevention: a critical reexamination. AIDS Educ Prev 1997;9(Suppl B):68-78.
  7. Pattman RS, Gould EM. Partner notification for HIV infection in the United Kingdom: a look back on seven years experience in Newcastle Upon Tyne. Genitourin Med 1993;69:94-97.
  8. Pavia AT, Benyo M, Niler L. Partner notification for control of HIV: results after 2 years of a statewide program in Utah. Am J Public Health 1993;83:1418-1424.

Partner Notification as a Prevention Strategy


Partner Notification as a Prevention Strategy:

A Social System Perspective

Part 2


This paper was published: Misir, P., 1999. AIDS PATIENT CARE and STDs, 13(6), pp.327-334.


The transmission of AIDS constitutes a harm done to others and therefore needs to be addressed

strategically to modify high-risk behavior, paying particular attention to privacy and confidentiality. Bayer and Toomey4 present two approaches being used in partner notification programs: the duty of physicians to warn where the physician has knowledge of the identity of the person at risk and contact

tracing where the physician may be unaware of the identity of the person(s) at risk. The authors  contend that partner notification programs have been embroiled in controversy where processes that are essentially voluntary are perceived as mandatory, and those that observe confidentiality are seen as an invasion of privacy.

Ethical issues predominate in virtually all planning discussions of partner notification.

Some of these issues are the duty to warn, the right to know, the responsibility to protect the

public health, the right of confidentiality and privacy, the need for protection against discrimination,

and the duty to protect the family and social relationships. Confidentiality of the patient’s data must be protected as “the patient in analysis must learn to free associate and to break down resistance to deal with unconscious threatening thoughts and feelings. To revoke secrecy after encouraging such risk-taking is to threaten all future interactions.”Confidentiality, if perceived by the patient to be secured, may enable the patient to provide full disclosure of symptoms, causes, and persons exposed. Confidentiality also is necessary to safeguard the rights of privacy. However, Walters6 argues that there are valid grounds for violating the principle of confidentiality. First, the principle of confidentiality may conflict with the rights of the patient himself, as when the patient may be a threat to himself. Second, the principle may produce a conflict with the rights of an innocent third party, as in the case of a bride-to-be who may not know the bridegroom-to-be has a viral infection, but her physician knows. Should the physician provide full disclosure? In such a case, the physician can invoke a “privilege to disclose” and effect the warning, even if the HIV-infected individual withholds consent. Third, the principle may generate a conflict between confidentiality and societal interests, as when physicians report communicable diseases. Violation of confidentiality therefore has to be assessed on an individual basis and carefully balanced against any adverse impact on society. This violation cannot be applied as a general rule in the physician-patient relationship, especially in the case of AIDS as a viral infection.




Partner notification must be voluntary to satisfy the needs, will, and perceptions of different

constituencies, and to eliminate objections presented against its usage. Some criticisms of partner notification are as follows:


  • Too expensive to effect partner notification programs
  • No curative treatment for AIDS
  • Personal stigmatization and discrimination against AIDS


Potterat et al.7 argued against these objections. Voluntary partner notification of HIV status is cost effective when we consider that all of the 35,000 cases of syphilis (CDC, MMWR, 1988), 40% of gonorrhea8 (CDC, STD, 1988), and a number of chlamydia cases, are methodically checked for sexual partner data. For 100,000 AIDS cases, the cost of a partner notification program in the United Sates is estimated to be $20 million annually. In Sweden, the cost factor is $460 U.S. per newly identified HIV-positive patient,9 quite comparable to the unit cost of $810 for a new HIV patient in the United States.10 The costs have to be weighed against the benefits of halting the spread of HIV. However, the issue of cost for easily treatable STDs, in which transmission is blocked by readily available treatment, is very different from that of HIV, where there is no cure or drug to block transmission. The issue of curability is distinct from one of treatment with the intention to eliminating the spread of HIV, as is virtually possible for all other STDs. Nevertheless, the partner notification approach could be a preventive measure if it is effective in identifying new cases.

Brandt2 makes the point that negative social meanings and inadequate public funding related to venereal disease (VD) can impede medical efforts. Even with the discovery of penicillin, VD researchers  expressed indifference as they believed a cure for syphilis would promote sexual promiscuity. Thus, the cost factor in the treatment of AIDS is not only dependent upon its potential results, but also upon the negative social images associated with the disease.

Another argument against partner notification is its negligible value,7 as currently there is no cure for AIDS. Despite this fact, there is treatment. Early administration of zidovudine (AZT) extends the symptomless period of infection.11 Mortality among patients with advanced HIV infection declined from 29.7 per 100 person-years in 1995 to 8.8 per 100 person-years in the second quarter of 1997,12 a change attributable to the availability of HAART. Prophylaxis against P. carinii pneumonia and other opportunistic infections, reduces their frequency and severity.13 The incurability of AIDS at this time requires a new thrust toward developing a better quality of life for persons infected with HIV/AIDS and creating a priority for the development of effective partner notification programs, with the intent to eliminate the further spread of HIV.



  1. Bayer R, Toomey K. HIV prevention and the two faces of partner notification. Am J Public Health 1992;82: 1158-1164.
  2. Ruben HL, Ruben DD. Confidentiality and privileged communications: the psychotherapeutic relationship revisited. Med Ann DC 1972;41:364-368.
  3. Walters L. The principle of medical confidentiality. In: Mappes TA, Zembaty JS, eds. Biomédical Ethic. New York: McGraw-Hill, 1991:162-165.
  4. Potterat JJ, Spencer NE, Woodhouse DE. Partner notification in the control of the human immunodeficiency virus infection. Am J Public Health 1989;79:874-876.
  5. Centers for Disease Control and Prevention. Syphilis and congenital syphilis—United States, 1985-1987. MMWR 1988;37:4876-4879.
  6. Gieseck J, Ramstedt K, Granath F. Efficacy of partner notification for HIV infection. Lancet 1991;338:1096-1100.
  7. Wykoff RF, Heath CW Jr, Hollis SL. Contact tracing to identify human immunodeficiency virus infection in a rural community. JAMA 1988;259:3563-3566.
  8. Volbering PA, Lagakos SW, Koch MA. Zidovudine in asymptomatic human immune deficiency virus infection: controlled trial in persons with fewer than 500 CD4 cells-positive cells per cubic millimeter. N Engl J Med 1990;322:941-949.
  9. Palella FJ Jr. Declining morbidity and mortality among patients with human immunodeficiency virus

infection. N Engl J Med 1998;338:853-860.

  1. Leoung GS, Feigal DW, Montgomery A. Aerolized pentamidine for prophylaxis against Pneumocystis

carinii pneumonia: the San Francisco community prophylaxis trial. N Engl J Med 1990;323:769-775.

World AIDS Day 2014

World AIDS Day 2014

Partner Notification as a Prevention Strategy

By Dr. Prem Misir

December 1, 2014 is World AIDS Day 2014. And the UNAIDS Gap Report (UNAIDS, 2014) indicates that 19 million of the 35 million people living with HIV are unaware that they are stricken with HIV. The UNAIDS Executive Director Dr. Michel Sidibé in his World AIDS Day 2014 message talked about disintegrating the epidemic permanently. He noted the urgency of accessing the people left behind – young women and adolescent girls, men having sex with men, migrants, prisoners, sex workers, and people who inject drugs. Dr. Sidibé explained that reaching these key populations requires strengthened health systems and Fast-Track Targets as 90-90-90 where by 2020, 90% of people living with HIV would know of their status, 90% who are HIV+ would be on treatment, and 90% on treatment would have reduced viral loads. Today, I present my published paper on provider referral and contact referral as mechanisms for the notification of HIV and AIDS as part of the process of reaching key populations.


UNAIDS. 2014. The Gap Report [Online]. Available: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf [Accessed November 29, 2014.



Partner Notification as a Prevention Strategy:

A Social System Perspective

Part 1




This paper was published: Misir, P., 1999. AIDS PATIENT CARE and STDs, 13(6), pp.327-334.




Provider referral and contact referral are two established means to provide notification of contagious,

but treatable diseases, as has been done for tuberculosis and sexually transmitted

diseases (e.g., syphilis). Because AIDS is at this time an incurable disease, programs of notification

have proved highly controversial. The author examines recent adjustments to the New

York State public health law regarding HIV/AIDS notification mechanisms. A literature review

supports further discussion of ethical and partner notification issues as they bear on the

perception and objections of various constituencies, stigmatization, and principles of confidentiality.

Both U.S. and Swedish strategies to partner notification are outlined as well as

why these schemes may not be interchangeable based on culture differences; points for general

improvement are drawn from this comparison. A social system perspective based on the

social functions of adaptation, goal attainment, integration, and latency (pattern maintenance)

is introduced as a means to address the barriers inherent in HIV/AIDS notification programs

and to enhance counseling programs—the objective being that knowledge and understanding

of the patient’s culture and social context can give providers additional tools with which

to stop the spread of HIV/AIDS and bring people to treatment earlier.





“Despite the well-established role of public health departments in identifying and notifying the sexual contacts of those reported to have venereal diseases, this strategy of intervention-designed to break the chain of disease transmission-played no role to the early response to AIDS.”1


Identifying and notifying sexual contacts of those stricken with HIV has proven to be controversial, largely as a result of its incurable status and the stigma attached to it. Notification of a disease is carried out through patient referral where the patient informs his/her partners, by provider referral (also called “contact tracing”), where the public health department notifies the sexual partners, and by contract referral, where the client is encouraged to notify his her partners, on condition that the healthcare worker will trace any partner who does not contact the clinic within a contracted time period.


Partner notification has been utilized as a standard health practice for combating the transmission of treatable sexually transmitted diseases (STDs) since 1937 and has worked well. At that time, partner notification was used to halt the spread of syphilis.2 Today, the scourge of HIV demands a more comprehensive, effective, and rapid implementation of partner notification as public health policy. The term “partners” refers to sex partners and injecting drug users (IDUs) who engage in needle-sharing. Research data demonstrates a growing interest in partner notification with many states and constituencies acknowledging its efficacy in contributing to constraining the spread of HIV. The Centers for Disease Control and Prevention (CDC) recommendations suggest that public health department staff should inform known partners in cases where an HIV-infected patient refuses to comply.


New York State recently reinforced its partner notification mechanisms through the passage of an act to amend the public health law, pertaining to HIV infection and reporting cases of this infection to spouses and known sexual partners.3 This law was enacted on July 7, 1998 and covers the following provisions on the duty to report and the procedure of contact tracing:


  • Every physician or other personnel authorized by law to arrange for diagnostic tests, or provide a medical diagnosis, or any laboratory administering this test, shall immediately upon first diagnosis that the person is HIV-infected, or upon first diagnosis that a person is assailed with AIDS, or upon first diagnosis that a person is beset with HIV-related illness, report such case to the Health Commissioner.
  • Every Health Commissioner, upon establishing that such reported case, or other identified known case of HIV infection, justifies contact tracing, shall personally inform the known contacts of the protected person.
  • The contact shall be notified of the characteristics of HIV, the known viral transmission routes, risks of prenatal and perinatal transmission, actions the person can effect to further reduce viral transmission, and community-based organizations (CBOs) accessible to the person that dispense counseling, medical care and treatment, and additional information of other appropriate services for HIV-infected persons.
  • Any physician or other public health personnel effecting this notification must make the notification in person.


The New York State law provides mechanisms for the use of provider referral, and no opportunity

is given to the patient to inform contacts about the infection status. Greater utilization is made of public health personnel outside of clinic settings to achieve provider referral. However, at the core of partner notification are the issues of ethics and law.



  1. Bayer R. Private Acts, Social Consequences: AIDS and the Politics of Public Health. New Brunswick, NJ: Rutgers University Press, 1991.
  2. Brandt AM. No Magic Bullet. New York: Oxford University Press, 1985.
  3. New York State Public Health Law. Article 27-F (HIV Confidentiality Law), Chapter 163, 1998.



It’s time to fix our broken immigration system | The White House

It’s time to fix our broken immigration system | The White House.

AFP Photo

AFP Photo.

The many faces of prorogation…good and bad

The many faces of prorogation…good and bad

By Dr. Prem Misir

The prorogation or temporary suspension of parliamentary activity in Guyana is real and is a historical first. It is a done deal. But the view on whether or not prorogation is a good thing depends on who you are talking with. And, indeed, the feelings about the suspension of parliament are strong, in that there are sections of the electorate who support it and other sections of the electorate who oppose.

In this case, one could argue that the electorate is divided on the matter. And so the logical option is to call a general election. Hypothetically, you have this election, results are out, and again you have a divided electorate where some sections vote for the winning party and other sections vote for the losing parties. Are the after-effects, that is, emotions and arguments for and against, of the prorogation and an election not fairly similar?

Yet the winning party in an election proceeds to form a government. In the end, given that the election is free and fair, sections of the electorate opposed to the winning party eventually adjust to living with the outcome. In addition, we should note that in a democracy, both the principles of prorogation and an election are grounded in constitutional provisions and constitutional conventions. If people on the whole live with the election results, notwithstanding their dissatisfaction with the results, why are the Opposition politicians spinning the prorogation as some kind of evil, or that the President has committed an unconstitutional act? The proclamation for proroguing parliament is constitutional.

But this recent prorogation has invoked the wrath of the combined Opposition Alliance for Change (AFC) and A Partnership for National Unity (APNU). There is this argument now that the President by proclaiming a prorogation has committed an undemocratic act, even though the act is constitutional.

In fact, what the AFC and APNU are saying is that parliament represents the will of the people who have  now become politically voiceless, and as such the act of prorogation itself is undemocratic. The Speaker of the National Assembly also shares this view. In pursuing this line of thinking, some opposed to the prorogation contend that the framers of the constitution inserted prorogation as a constitutional provision, but they did not intend for any president to use it; for its effect will make the elected representatives voiceless.

That is a strange argument, for if a provision is clearly articulated in a constitution, a good probability exists that it will be utilized if the circumstances warrant it. Without reliable and valid evidence, how would those who promote this view know about the intentions of these founding fathers? They have not presented any evidence of the framers’ intentions?

Well, those resisting prorogation have primarily focused on outcomes or effects; these include, among others, the following: the minority People’s Progressive Party/Civic (PPP/C) Government will spend outlandishly, or will engage in some kind of spending spree; the will of the people will not be advanced; the emergence of a dictatorship. But little attention is focused on the causes of prorogation. What brought about the prorogation in the first place?

On the face of it, it appears that prorogation occurred because of the no-confidence motion against the PPP/C Government; the combined Opposition would have won the no-confidence vote against the ruling party PPP/C, by virtue of the Opposition’s numeric majority of one in the National Assembly.

In three Canadian cases, two federal and one provincial, the governments that prorogued parliament were all minority governments (Horgan, 2014, p.465); suggesting that minority governments may be more inclined toward invoking prorogation, in order to sustain its legislative agenda and capital programs and projects.

However, in Westminster-style parliamentary systems, prorogation is used as a legitimate parliamentary device when a government legislative program ends, or when it wants to institute a new legislative program (Horgan, 2014, p.457). The ruling party has a legislative agenda  for the remaining two years or so of the 10th Parliament, and these include, among others, the following: Supplementary Appropriation (No.1 for 2014) Bill 2014; Anti-Money Laundering and Countering the Financing of Terrorism(Amendment) Bill 2013; Broadcasting (Amendment) Bill 2013; Procurement (Amendment) Bill 2013; Constitution (Amendment) Bill 2013; Telecommunications Bill 2012; Public Utilities Commission (Amendment) Bill 2012; Recording Of Court Proceedings Bill 2014. Any ruling party and the PPP/C is no exception, will want to execute its legislative agenda as part of its nation building mandate.

And with several bills not current and languishing in parliament, and combined with a practically dysfunctional committee system, there is definitively parliamentary gridlock inimical to development and democratic growth. This prorogation period which could be six months or less, presents parliamentarians with an ample opportunity to find ways to break the parliamentary gridlock. Gridlock exists because people have conflicting ideological perspectives and power interests and have no proclivity to compromise. Conflict resolution requires, for starters, meaningful interaction through parliamentarians’ consciousness of their public role, their responsibility and accountability to the people.

Indeed, prorogation like so many things has many faces of what is good and what is bad; and given the constant parliamentary gridlock, an evil phenomenon, and the urgency for its resolution, why not seek out the goodness in prorogation as a possible means toward permanently ending the parliamentary congestion? And even if prorogation is as bad as the antagonists contend, beneath its pathology, there is goodness.


HORGAN, G. W. 2014. Partisan-motivated prorogation and the Westminster model: a comparative perspective. Commonwealth & Comparative Politics, 52, 455-472.


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