In-depth: Haiti and HIV: "Gen espwa" - new hope dawns
HAITI: "We must try our best"
There is pressure on the government to establish a 'solidarity fund' for HIV in case of political turmoil
Port-au-Prince, 29 October 2007 (IRIN) - Combating AIDS in Haiti is almost exclusively financed by international organisations; what would happen if the funding dried up? It is a concern not only for people living with the virus, but also for activists trying to build a sustainable response to the epidemic.
Away from a busy, noisy road in a Port-au-Prince shantytown, dozens of patients wait their turn in the courtyard of the largest HIV/AIDS treatment centre in the capital. They avert their eyes as two hospital porters remove a body covered with a white sheet.
In 2006, between 140,000 and 150,000 people passed through the doors of the Gheskio Centre, in an area nicknamed "Kosovo" by locals due to the bouts of violence that have broken out over the last few years.
HIV-positive patients receive their antiretroviral (ARV) drugs here, thanks mainly to funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President's Emergency Plan for AIDS Relief.
HIV is not the only thing the patients have in common: the majority are young girls from the city's poorest communities, often infected with both HIV and tuberculosis. HIV is yet another burden for them to endure in a country where 65 percent of people live below the poverty line and one in 12 children do not reach the age of five.
"If you only knew the misery these people suffer - they get up very early, without any food, in an attempt find a means to survive; they finish at nightfall, and when they return [to the shantytowns] in the evening, they can become the victims of gangs," said Dr Jean-William Pape, co-founder and director of the Gheskio Center.
According to the Brussels-based think-tank the International Crisis Group: "Post-conflict and transitional assistance is only starting to trickle into the capital, whose communes have still not perceived the start of a new era. Likewise, donor and government coordination is not yet efficient." [www.crisisgroup.org
Accessing ARVs - which slows the progression of HIV - depends on internationally funded treatment programmes. "When we take our pills, we thank the people in [rich] countries who work hard to pay the taxes that pay for our medication," said Jean-Sorel Beaujour, executive director of the National Solidarity Association for People Living With and Affected by HIV/AIDS (known by the French acronym, ASON).
"But we are scared: if problems arise, what will the government do to pay for our medication?" he added. Beaujour believes the government needs to establish a 'solidarity fund' to ensure that treatment could continue if Haiti's political volatility led donors to pull the plug.
"We pay taxes here too, and the state has spent a lot of money on international political lobbying," he added. "This expenditure could [finance] healthcare."
The government appears to have taken some notice, and will try to address the issue in its 2008-2011 strategic plan to fight AIDS, said Dr Brunel Delonnay, a senior official in the HIV/AIDS, malaria and tuberculosis programme coordination unit.
"Haiti has huge financial problems, but we have set out a strategic focus to create the resources for sustainable HIV/AIDS programmes," he told IRIN/PlusNews. "The state intends to allocate a budget for this."
Many AIDS workers believe the focus should go beyond financing AIDS programmes; the entire health service needs to be overhauled. "What is the point of giving a patient AIDS treatment if they die from malaria?" said Pape of the Gheskio Center.
Most of the main provincial hospitals were built during the two decades of American occupation of Haiti, which ended in 1934. They were designed to cater to the needs of thousands, but today serve hundreds of thousands.
"The AIDS epidemic is an opportunity to strengthen the health system," noted Dr Carl François, technical director of the Global Fund's programme at Sogebank, the foundation managing the Fund's grant on behalf of Haitian beneficiaries.
Sustainable funding, however, is a critical problem. The government relies on foreign aid for 60 percent of its budget, and most Haitians are too poor to bear the cost of an overhauled health system.
One-third of people over the age of 15 are unemployed. "There are not enough employers or people employed to finance a social security system," said François.
Training and retaining health professionals in Haiti, which has 1.2 doctors per 10,000 inhabitants, is another hurdle. One in four Haitians lives abroad - including many trained health workers. The Gheskio Centre, whose roles include training and scientific research, is beginning to give the future of Haiti's health system serious thought.
"We are interested in developing countries, to see what can be integrated here," explained Pape. "Should our health system be public or private? Should it be co-financed or not? Should the authorities supervise the system or run it? It is an urgent issue for our young doctors and nurses too, as they need to know what system they will be working in."
Whatever the country's difficulties, this is an urgent issue for people living with HIV. "We are poor, but we must try our best," said Beaujour.