Background
Haiti, or Ayiti in Creole, the first independent country borne of slave rebellion in 1804, is populated primarily by descendents of slaves taken from Africa by the Europeans. Haiti is slightly smaller than Maryland and encompasses the western third of the island of Hispaniola.
Less than two hours by plane from Miami, Haiti has the highest number of HIV/AIDS cases in the Caribbean. Ten percent of those living with HIV in Haiti are children, and in 2005 there were an estimated 400,000 orphans, many of whose parents died of AIDS.
Traditional medicine continues to play an important role in Haiti. Voodoo priests and priestesses are considered to be traditional healers. Catholicism is the official religion, but it is said by many that voodoo is the national religion.
Haiti shares an island with the Dominican Republic, but the two countries differ greatly. The HIV rate in Haiti is three times that of the Dominican Republic. Socially and economically, the Dominican Republic is also more stable, with a higher life expectancy and a gross national income per capita that is five times as high as Haiti’s.
The face of HIV
In 1982, the Centers for Disease Control and Prevention put Haitian-born U.S. residents on the list of “groups at highest risk of acquiring AIDS” along with intravenous drug users, hemophiliacs and homosexual and bisexual men. The stigma attached to the disease at that time affected immigrant Haitians in their searches for employment, citizenship and more. Years later, just being Haitian was no longer considered to be a risk factor in itself, but the damage had been done. Discrimination against Haitians, along with other high-risk groups, and ignorance about the transmission of HIV/AIDS had spread.
The first cases of AIDS in Haiti were reported in the early 1980s at the same time that cases were being reported among Haitian-Americans and others in the United States.
The percentage of those infected by the disease in Haiti has continued to decline in the last decade. In 1993, the rate of pregnant women testing HIV-positive was 6.2 percent; by 2003, the rate had declined by half, to 3.1 percent.
Although there are excellent models of treatment in Haiti and although the rates of those infected with the disease are declining, there is also a need to be wary of the numbers. According to the POLICY Project of the Futures Group, several factors have combined to slow the disease in Haiti. One of the primary reasons is blood safety intervention efforts in the early stages of the epidemic. Another is the death of many AIDS patients.
Challenges to fighting the HIV epidemic
Currently, more than 70 percent of the Haitian population lives below the level of absolute poverty established by the United Nations. The poverty is illustrated by Haiti’s need for PEPFAR’s “Life Extending Treatment Package,” which, as described by the 2005 Country Operational Plan, provides necessities that are unavailable to most patients in Haiti. Those include oral rehydration salts, safe water purification solution, multivitamins, zinc tablets, ibuprofen, acetaminophen, a toothbrush, and toothpaste. The package is funded by PEPFAR (the President’s Emergency Plan for AIDS Relief) through the U.S. Agency for International Development and is for people living with HIV/AIDS.
For the last 13 years, U.N. forces have been in Haiti attempting to provide stability to the battered country. The United Nations Stabilization Mission in Haiti was established in April 2004, and its mandate has been extended to Feb. 15, 2007.
In the absence of an effective military, police force, judicial system and working infrastructure, the new Brazilian-led force is trying to provide security for the Haitian civilian population, but there are many obstacles. Poverty, chronic malnutrition, food insecurity, violence, inadequate infrastructure, deforestation and hurricanes all limit the work that the U.N. forces can do. In addition, human rights groups are saying that the forces themselves aren’t immune to violence, with reports of attacks against the troops as well as of troop violence against Haitians.
Publicly funded health care is limited, and resources are extremely constrained. The General Hospital in Port-au-Prince serves the majority poor population of the city. However, during an April 2006 visit by an ICIJ reporter, there was a general strike at the hospital and all nonessential staff, including doctors, were absent. A pharmacist at the hospital said the strike occurred because the staff had not been paid for two months.
Finally, an additional serious obstacle to preventing and treating HIV/AIDS is the current rate of violence against women in Haiti. According to a report written by Haiti’s Ministry of Public Health and Population in 2005, although there have been interventions to stop the violence, the incidence of gang rape and sexual violence against women continues to increase.
Haitian government response
The Haitian government willingly collaborates with international and domestic organizations to combat HIV. The Ministry of Public Health and Population describes multiple obstacles to controlling the epidemic in Haiti. These include sexual promiscuity, discrimination and stigmatization; violence against women and girls; male chauvinism; women’s limited powers in decision making; women’s lack of financial independence; low rates of condom use; and high rates of sexually transmitted diseases.
One of the many HIV/AIDS treatment models that has been used in Haiti and has now spread to other countries is the idea of directly observed therapy, a strategy originally used to treat tuberculosis. The treatment, which involves a community health worker who delivers medicines to patients on a daily basis, was originally promoted in Haiti by the Boston-based organization Partners in Health. Ellen Powers, the executive director of Project Medishare, a nonprofit health care organization in Thomonde said, “In a way, Haiti is more advanced than the U.S., [because] directly observed therapy has now been adopted in the U.S. after trials in Haiti.”
U.S. government response
In 2003, Haiti was designated one of PEPFAR’s “focus countries” by President Bush, and it has received more than $135 million in the three years since then through his plan to fight HIV/AIDS.
In fiscal 2005, Haiti received $13.8 million for prevention activities, or 31.6 percent of the country’s total PEFPAR funding for prevention, care and treatment. Another $10.6 million — or 23.4 percent — went to care, while treatment activities were allocated $19.7 million — or 45 percent.
In addition, Haiti has received almost $60 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The U.S. is responding to HIV in Haiti with funding for treatment, prevention and care through PEPFAR, and through the Global Fund. The two groups are working together and trying not to overlap in their services. And although there is hope under the new administration of President René Préval, there is still much work to be done.
Haitians have been fighting the epidemic for nearly thirty years. As a result, international organizations and development groups have tried a wide variety of prevention, treatment and care methods.
“Haiti has been an experiment for everywhere else,” Powers said. “Haitian doctors from Partners in Health are now going to work in Rwanda. Everything has been tried in Haiti, but the programs’ effectiveness is hard to monitor. Everything has been done, which is part of the problem. There is no coordination on the ground, only at the top level.”