February
7, 2003
HISTORICAL
CONTEXT
-
The AIDS crisis
appears on a continuum of infectious diseases plaguing Haiti.
After World War II when the World Health Organization began reporting
on health conditions, the chief cause of death among infants was gastroenteritis,
measles, tetanus and TB. Malnutrition
was widespread. By 1981 when
the first cases of AIDS began to arise, the major causes of childhood
death in Haiti continued to be diarrhea, pneumonia and tetanus.
-
Once cases of this still
mysterious disease appeared in Haiti, Haitians were included in the now
infamous list of 4-Hs homosexual, hemophiliac, heroin user, Haitian
as carriers of the disease. Haitians
lost jobs in the service industry and were barred from certain forms of
employment.
- But
the stigmatization raised the level of consciousness about AIDS.
In the late 1980’s the Haitian community in the U.S. organized
one of the largest anti-AIDS rallies in front of the New York offices
of the Center for Disease Control to demand that Haitians be dropped from
the list.
- On
the medical and scientific front, the early stigmatization
of Haitians led doctors in Haiti in the early 1980s to document case studies
of patients presenting symptoms of AIDS.
In 1982 the GHESKIO Center emerged as the first AIDS research and
treatment center. Many of
the first medical journal articles which helped forge a greater understanding
of the HIV virus were based on data collected in Haiti.
- In
Haiti, as in other countries suffering from the AIDS pandemic, the lack
of clean water, sanitation, education and infrastructure has
contributed to exacerbating the crisis.
STATISTICS
-
Haiti’s
national HIV/AIDS
infection rate is
between 4½ to 6%, with rates as high as 13% in rural areas,
giving Haiti the highest HIV infection rates in
the Western Hemisphere.
-
There are approximately
300,000 Haitians living with HIV/AIDS.
-
Haiti has the highest
tuberculosis infection rate in the Western Hemisphere.
-
There are 1.2 doctors,
1.3 nurses and 0.04 dentists per 10,000 Haitians, mostly concentrated
in the capital.
-
40% of the Haitian
population is without access to primary health care.
-
The child mortality
rate is 80 deaths per 1,000 births.
-
Average life expectancy
is 49.6 years.
THE
IMPACT OF THE EMBARGO ON HEALTH CONDITIONS
-
On
July 21, 1998, the Haitian government
and the IDB signed a $22.5 million loan for Phase I of a project
to “decentralize and reorganize” the Haitian health care system.
-
The funds would be used
to construct low-cost community health centers, train community health agents,
and purchase medical equipment and essential medicines. The
ultimate objective of Phase I was
to reduce the high infant mortality rate, reduce the high juvenile death
rate and reduce birth rates.
-
This health loan, as well
as close to $150 million in humanitarian loans, has been blocked by a U.S.
led embargo against Haiti.
-
Dr. Paul Farmer,
medical director of a private health facility in Haiti’s Central Plateau
that treats patients infected with HIV/AIDS, tuberculosis and other diseases,
reports that “the aid embargo has in effect rendered the Ministry
of Health incapable of reviving the national network of clinics and hospitals.”
Dr. Farmer’s facility, which is normally equipped to receive no more
than 35,000 visits per year, last year saw 200,000 ambulatory patients.
He attributes this rise to, ”dramatically diminished ability
of the public-health system to respond to the needs of the Haitian people.
The Ministry of Health, the only institution with a mandate to serve
the entire population, has been strapped by financial constraints.”
-
Last year, Dr. Bill
Pape, co-founder of GHESKIO, wrote to the IDB president urging that the
health loan be released because, “a battle against AIDS is directly
linked to the reorganization of the health system.”
-
Assistance through the NGO
sector is simply not enough and is no substitute for a comprehensive public
health policy. In its 2001
newsletter, the Haitian Health Foundation, a non-profit U.S. organization
receiving funds from USAID working in Haiti wrote, “the number of
villages that we serve has grown from 15 to 92 with a population that now
stands at more than 200,000. Despite
this dramatic increase, USAID has failed to keep pace.”
-
Despite this position
taken by leading NGO healthcare providers, a recent U.S. Senate delegation
to Haiti confirmed that the U.S. will continue its policy to block funds
directly to the Haitian government.
EFFORTS
-
The government
of Haiti has centered its national health program on improving maternal
and pre-natal health conditions. The
School of Mid-wifery was renovated and reopened, as well as the maternity
wards of eight public hospitals.
-
An aggressive campaign
to vaccinate children against measles, rubella, polio and other childhood
diseases is in place.
-
The government
of Haiti’s cooperation with Cuba has led to the expansion of the number
of physicians in areas of the country with no doctors and the training
of upwards of 400 Haitian medical students.
-
On the HIV/AIDS
front, Haiti was one of the first countries to sign a Grant Agreement
with the Global Fund for AIDS, Malaria and Tuberculosis. The
two-year grant for $17,945,045 million will finance a broad sector of
private and public expert AIDS/care providers in the prevention, testing
and treatment of AIDS.
-
Ground breaking
drug treatment to full blown AIDS patients is underway at a hospital run
by Partners in Health in a very poor community in Haiti’s Central Plateau.
-
Haiti is part of
an important 3-country HIV/AIDS trial vaccination program.
