In-depth: Haiti and HIV: "Gen espwa" - new hope dawns
HAITI: Fighting HIV a task as tough as the island
PORT-AU-PRINCE, 26 October 2007 (IRIN) - A fall in HIV rates in Haiti over the last few years is welcome news but celebrations may be premature: the country's political fragility and endemic poverty are serious challenges to maintaining those gains.
HIV prevalence was estimated at 5.6 percent by the United Nations in 2003; in 2006 it had dropped to 3.6 percent, but the rate still remains the highest in the Caribbean and Latin American regions.
Some AIDS workers treat the new figures with caution, pointing out that the survey was not conducted in the same number of sentinel sites or among the same section of the population as in 2003.
Others are more willing to err on the side of optimism. "It is true that there have been many deaths, which could account for part of the decline, but we must also acknowledge work being undertaken to combat this epidemic," said Dr Brunel Delonnay of the Ministry of Public Health and Population's HIV/AIDS coordination unit.
AIDS in Haiti has a special history, linked to the emergence of the epidemic on the west coast of the United States in the 1980s. The Caribbean island was initially seen by many as the source of the virus, and its spread often attributed to the "four H's" - homosexuals, haemophiliacs, heroin-users and Haitians.
"Haiti had to defend itself against this idea until it was finally recognised that the epidemic came from outside and spread within the country," said Delonnay.
An estimated 190,000 people out of a population of 8 million were living with the virus at the end of 2005, but Haiti's political fragility kept donor assistance away. That has begun to change, prompted to an extent by concern over the rate of emigration: around two million Haitians live and work in the United States.
Donors turn up
A degree of political stability has been achieved since the forced exile of former president Jean-Bertrand Aristide in 2004, and the deployment of more than 8,000 peacekeepers and humanitarian workers under the United Nations stabilising force in Haiti, MINUSTAH.
|It is frustrating having to wait for partners to be able to take action
In 2002 and 2006, the Global Fund to Fight AIDS, Tuberculosis and Malaria awarded two five-year grants. The US President's Emergency Plan for AIDS Relief (PEPFAR) has also invested heavily in Haiti, and plans to spend US$84.7 million in 2007. The two agencies are the country's largest funders of anti-AIDS programmes.
Currently, 10,445 people living with HIV receive free life-prolonging antiretroviral drugs, less than a quarter of those in need; the government's target is to reach 25,000 people.
AIDS workers have noted an uptake in the use of condoms, particularly in urban areas, but are aware that it is still early days.
The weak state institutions struggle to coordinate the myriad programmes that have taken off with the injection of foreign funding. More than 65 percent of the national budget comes from international sponsors, and when it comes to AIDS that figure hits 80 percent.
"Sometimes we learn about what is going on by chance, as it is difficult to access information [from our partners]. It is frustrating having to wait for partners to be able to take action," said Delonnay. "The only solution is to be proactive, to demonstrate that you are flexible, to see where particular projects are heading and if they are doing good work. We must then attempt to monitor and work with them."
In an attempt to affirm its regulatory role, particularly with regard to a civil society that is as strong as the state is weak, the authorities are stepping up the fight against AIDS.
The job is huge. HIV and tuberculosis (TB) coinfection is on the rise, as is multidrug-resistant TB. Health care in rural areas, where two-thirds of the population live, is particularly bad. The countryside is remote and mountainous, and there is a national shortage of qualified health workers.
Stigma against people living with the virus is high, with a widespread and deep-seated belief that HIV infection is linked to the supernatural, which makes prevention work all the more difficult.
The challenges go well beyond public health. One in three Haitians over the age of 15 is unemployed, and violence against women, particularly sexual violence, has reached worrying levels. Social services are dilapidated and foreign investment to help lift Haiti out of its poverty remains limited.
* "Gen espwa", have hope in Haitian Creole