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New York, June 26, 2001
“Everyone has a Right to Live”
Last month, when President Aristide launched the initiation of Haiti's five-year strategic plan for a government-led national response to HIV/AIDS pandemic, he anchored his remarks in the fundamental truth that “everyone has the right to live.”
Everyone has the right to live. The 35 million people worldwide living with HIV/AIDS; the 260,000 people living with the disease in Haiti.
This panel necessarily opens a host of issues about the interrelatedness of HIV/AIDS, poverty, gender inequality and development. The fight against AIDS must, both in theory and in practice, be also a fight against poverty because we know if you live in poverty you are likely to be poorly educated, to be malnourished, and to suffer inequality if you are a woman, to have less access to basic medicines and healthcare. And these are the conditions that facilitate the spread of HIV/AIDS.
Yet in Haiti the fight against AIDS and the fight against poverty are being dangerously treated like two separate and distinct fights. Urgently needed resources to decrease a 53% illiteracy rate, build needed infrastructure, reform and modernize a decrepit healthcare system, and create potable water distribution systems are being withheld, while we are told that there is “money for the AIDS fight.” There is only one fight: the fight against poverty that has contributed to the 90% HIV/AIDS infection rate in the developing world. The more we understand this and simultaneously on all fronts of this battle, the more effective we will all be in this one fight.
Despite limited resources, Haiti has been able to mount a defense against AIDS. They include an aggressive prevention campaign, a program to prevent against mother to child transmissions, the launching of a trial vaccination program, and a limited anti-retroviral drug treatment for people with HIV. These efforts deserve to be amplified and expanded to the national level. While the cure for AIDS still eludes us, anti-retroviral therapy gives life to the victims of AIDS. If indeed everyone has the right to live, then victims of AIDS necessarily have the right to this drug therapy. Esther Boucicaut, a member of our delegation who is here with us is living testament to the life sustaining value of this treatment.
Haiti knows what it must do. The Ministry of Health in close partnership with NGOs active in the treatment and prevention of HIV/AIDS have come a long way from the early, dark days of this disease when Haitians were branded a high risk category for AIDS on the now infamous 4-H list -- Haitian, homosexual, hemophiliac and heroin-users -- and in 1993 when Haitians were among the political refugees otherwise eligible for political asylum were denied asylum because of their HIV status. However, despite these efforts being deployed today, Haiti finds itself first among the nations of the Caribbean impacted by HIV/AIDS.
At present the national incidence of HIV infection stands between 4.5% and 6%, with approximately 30,000 new cases being reported every year. Since 1988, 300,000 Haitians have died from AIDS. Today 5 Haitians die from AIDS every one-hour. 163,000 children have been orphaned by this killer disease.
But the greater tragedy is that AIDS appears to be on a continuum of infectious diseases plaguing Haiti. Tuberculosis, measles, diarrhea, pneumonia, tetanus -- exacerbated by malnutrition -- are still killing people in Haiti. Haiti's vulnerability and the vulnerability of other poor countries to these diseases, HIV/AIDS and infectious disease have far reaching causes.
We are living the catastrophic results of the introduction of the HIV virus onto a healthcare tableau that is a breeding ground for the virus. With 92% of all the adults, 97% of all women, and 98% of all children infected with HIV living in the developing world, we know that poverty is a co-factor of AIDS. Therefore if we want to effectively address AIDS, we must address the other indices of poverty.
But today in Haiti international financing for Haiti has been frozen notwithstanding the AIDS pandemic which the international community labels the greatest crisis of the 20th century.
A very word on why: a dispute about the method of calculation used to determine second round electoral races for 8 senate seats. This electoral crisis has wrongly been allowed to snowball into a political crisis. And as a result, international aid has been suspended. Eight million Haitians, 260,000 victims of a fatal, debilitating disease are being punished.
As the resolution to this political crisis has been offered by the government it must trigger the release of funds -- funds to implement the government's program rooted in the principle of investing in people. It is a program that seeks to provide education, health, and access to Haitians in the countryside, those they call moun andeyò (people outside) who have been historically excluded from the political and social life of the nation.
The Declaration of Commitment that will be signed by the member States during the course of this special General Assembly specifically states that helping countries alleviate poverty and achieve sustainable development will strengthen their national capacity to combat HIV/AIDS. And that the HIV/AIDS challenge cannot be met without new and additional resources. It is time that new and additional resources be made available to Haiti.
HIV/AIDS is impoverishing Haiti. The cost of care over the average 7-year span of the disease totals $182,000,000. Annual funeral costs for each of the 125 people with AIDS who die daily total approximately $11,406,250. HIV positive patients occupy 10-50% of an already limited number of hospital beds.
Seventy-five percent of Haitians infected are in their prime working age years. And in Haiti up to 60% of the working population is involved in the informal sector that offers no social safety net. The death of a family breadwinner is devastating.
The growing prevalence of HIV/AIDS among women in Haiti is particularly ravaging because of the central role women play in the economy. And, as heads of 30% of all households a death may mean the break-up of families, children are pulled out of school and are orphaned. It is no coincidence that the rising tide of HIV/AIDS has been accompanied by a rising tide of street children, predominantly in our capital.
The goals of the 5-year strategic plan that Haiti will begin to prepare has been set: reduce the HIV/AIDS infection rate by 33%, reduce the level of sexually transmitted disease by 50%, and reduce mother to child transmission by 50%. The approach is multi-sectoral, under the leadership of our Ministry of Health with the close collaboration of NGOs active in the treatment and prevention of HIV/AIDS, and activist Haitians living with HIV/AIDS.
Haiti has targeted interventions on all three modes of HIV transmission: sexual contact, mother to infant, and blood. The political will and the technology are there. What is missing are funds to expand these programs to the national level.
Strategies on prevention of course include aggressively marketing the use of condoms; the sale of male condoms in Haiti has jumped from 2 million in 1990 to over 11.6 million in 2000; education on the disease and how to prevent infection; the use of telephone hotlines; and caravans of artists partaking in regional campaigns in the countryside to warn against AIDS and disseminate information directly to the population.
About 30% of HIV-infected mothers will give birth to children who are also infected. If the goal of this treatment is the survival of children, the mothers must remain alive and healthy. At the very least, these mothers must be first on line to receive the anti-retroviral drug therapy.
Transmission of HIV by blood or by blood products was the major mode of transmission of HIV in women in early 1980s. As a consequence, the Ministry of Health closed the commercial blood bank which usually paid donors and put the Haitian Red Cross in charge of ALL blood banking operations in Haiti. Haiti is one of the few countries in the world with ONE institution in charge of ALL blood banking operations.
Additionally, the GHESKIO Center in Haiti has taken a lead role with Brazil and Trinidad in a trial vaccination program. Forty volunteers at low risk to become infected with HIV have enrolled in the program. The present objective of this study is to determine if whether Haitians who have low nutritional status, and high infectious burden can develop an immune response comparable to that observed in more “healthy” populations in developed countries.
Partners in Health, a Boston based health and social justice organization operates a hospital in a remote mountain village in Haiti's Central Plateau. They are able to provide the “cocktail” of expensive anti-retroviral drugs for HIV/AIDS patients free. This is followed up with regular medical checkups. Through a medical strategy called “directly observed treatment” local men and women living in the mountains surrounding the hospital are trained as health care workers who watch patients take their drugs.
But as one HIV positive woman said in a recently published article, “I go to the doctor and all I get are these prescriptions. But they don’t give me food. They don’t give me money to buy this medication. I can't eat medicine and I can’t feed it to my children.”
While a comprehensive package necessarily involves:
- Vaccine development;
- Aggressive prevention through education and barrier methods;
- Development of new prevention tools that do not depend on male approbation;
- Effective therapy for those already sick including aggressive detection and treatment of opportunistic infections and, in a subset of patients, highly active anti-retroviral therapy;
It also means a renewed effort not only to understand how poverty and gender inequality increased risk of HIV but also a strategy to address these growing inequalities.
A comprehensive HIV package is necessarily a social justice package.
Thank you.
©2003 Copyright Embassy of the Republic of Haiti
