This post is by the Global Center’s Rabita Aziz.
Photos and video by David Bryden.
A panel consisting of Haitian HIV advocates spoke today about the situation of HIV patients in a post-earthquake Haiti at a Senate briefing called “Report from the Frontlines: Living with HIV/AIDS in Haiti Post-Earthquake.” The briefing was sponsored by Senator Kirsten Gillibrand, a member of the Foreign Relations Committee who is visiting Haiti this week with Delegate Eleanor Holmes Norton and Senator Mary Landrieu, who sits on the Appropriations Committee. Other sponsors include Health GAP, UNAIDS, Partners in Health and Housing Works.
With an HIV prevalence rate between four and five percent in the capital of Port-au-Prince, Haiti faces an even larger HIV epidemic on top of a humanitarian crisis thanks to the 7.0 magnitude earthquake.
The panelists, two of whom are living with HIV, discussed the problems faced by people living with HIV in a country where most of the health infrastructure was destroyed during the January 12th earthquake.
While the survivors praised past U.S. contributions to the fight against HIV/AIDS, they expressed disappointment that President Obama’s FY 2010 Haiti Supplemental Request for USAID and the State Department, which includes $893 million for recovery and reconstruction efforts, has no mention of funding for responding to the HIV/AIDS epidemic.
The panelists stated that this lack of funding could result in thousands more becoming infected with HIV, and the reversal of ground gained thanks to PEPFAR dollars. Fewer than 40 percent of Haitians who were receiving AIDS-related care prior to the earthquake are receiving it now.
The lack of access to treatment may result in higher viral loads in patients, which increases the likelihood for transmission. The advocates stressed that treatment must be scaled up to save lives and prevent new infections from occurring.
At the time of the earthquake Liony Accelus, president of the HIV/AIDS advocacy group REHPIHIV, was at a Country Coordinating Mechanism meeting to decide on which aid groups would be primary recipients of Global Fund dollars. Everyone present at the meeting began to run out as the building began to crumble. At this point he witnessed hundreds of other people fleeing into the streets to avoid being crushed by crumbling buildings.
Upon discovering that all phone lines were down Accelus went to his home, only to discover that it had been destroyed. For the next week, Accelus and his family lived in the streets and slept under the stars. He was eventually able to obtain a tent, and is living in the tent with his family to this day. Although he continues to live in such dismal conditions, he considers himself lucky in comparison to other people living with HIV who have no access to shelter or food, let alone to treatment.
Haiti has an HIV prevalence rate of 2.2 percent. At the time of the earthquake, there were approximately 120,000 people living with HIV, of whom 43,000 were in line to receive treatment. The earthquake destroyed 46 hospitals and clinics and severely damaged 38 more, and has made it extremely difficult to obtain HIV drugs.
The panelists stated that most HIV patients are now without shelter, and on top of that face an eight hour wait in a distribution line to receive food. These conditions will greatly exacerbate their conditions while increasing chances for new infections.
Esther Boucicault, president of PHAP+ and FEBS, both coalitions made up of people living with HIV, discussed the response by other HIV advocacy groups after the earthquake. Boucicault first reached out to Housing Works, a cosponsor of the briefing, which helped put together three clinics to address the medical needs of HIV patients. Partners in Health (PIH), another sponsor of the event, provided medications and ARV treatment within days as well.
Boucicault said she received no reply from the government when her groups reached out for direct assistance. Although these groups provided much needed assistance, they don’t have the capacity to provide assistance for the tens of thousands of patients who need it. Boucicault stated that the earthquake had taken the lives of between 200,000 and 300,000 people, and that the same number would become infected with HIV if further actions are not taken to address the problem.
Edner Boucicaut, chief communications officer for CECOSIDA, spoke of the high risk of new infections due to the lack of access to treatment and medications, and to proper housing. “Conditions remain the same,” he said when speaking of the daily fight people have to endure to obtain the most basic necessities. With just two clinics in Port-au-Prince providing HIV medications, he spoke of the daily struggle of HIV patients to get their drugs.
He stated that marginalized groups are at a great risk to contract HIV. In many shanty towns and tent cities, women are forced to engage in prostitution at night to obtain vouchers to get food the next morning. Patients living in close quarters with relatives face stigma and discrimination when their HIV status is disclosed to relatives.
Dr. Wesler Lambert, director of monitoring and evaluation for Zanmi Lasante, PIH’s flagship project in Haiti, gave an account of how PEPFAR funding has turned around Haiti’s HIV epidemic in recent years. Zanmi Lasante provided ART to 2,377 patients in 2006, and that number jumped to 4,716 in 2009 due to PEPFAR funding. While more than 39,000 were tested and received counseling in 2005, more than 77,000 received the same services in 2009.
The organization has set up mobile clinics in Port-au-Prince since the earthquake, and has treated over 45,000 patients. Of the 4,127 tested for HIV, 75 tested positive. Dr. Lambert called for an increase in PEPFAR funding to address the emerging threat of new infections caused by the failure of health systems.
In his closing remarks John Hassell, the Washington director of UNAIDS, expressed his concern over the lack of language about HIV/AIDS in the 2010 Haiti supplemental funding request. No funding is included to help rebuild the HIV response through PEPFAR. PEPFAR dollars allocated to Haiti for this year are insufficient to meet the increased post-earthquake needs for reconstruction of physical infrastructure, recruitment and employment of health workers, and purchase and distribution of commodities such as condoms and drugs.
The organizations involved in the briefing recommend that an additional $100 million in supplemental funding be included for FY 2010 to rebuild clinics, provide drugs, train health workers, and set up prevention programs. UNAIDS has released a paper which provides a situational analysis of the AIDS response in Haiti, and details what needs to be done to deal with the problem. The paper can be found here.
Watch Esther Boucicault discuss the AIDS response in Haiti after the earthquake here.