One testimony to the strength of the U.S. government’s AIDS program in Haiti: Four months after the devastating 2010 earthquake, the number of those treated for AIDS was at 95 percent of pre-earthquake levels.
In addition, said senior U.S. health officials in a briefing to reporters, the number of pregnant women receiving AIDS treatment increased to 1,900 in 2010 from 1,100 a year before. In all, roughly 28,000 Haitians are receiving AIDS treatment with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) program.
Yet the officials, giving the update exactly a year after the earthquake, which the Haitian government said killed at least 250,000 people, did not skimp on the challenges still facing the government and donors.
“Challenges remain and progress is fragile,” said Thomas Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC).
The current ongoing threat is the spread of cholera. Donald Steinberg, deputy administrator of the U.S. Agency for International Development (USAID), said donors started to rebuild the health system several months after the earthquake, but then the cholera epidemic hit. Today, the country has registered 157,000 cholera cases and an estimated 3,500 people have died.
But Steinberg and other U.S. officials said that the outcome would have been worse without the U.S. AIDS infrastructure, started in 2004 under PEPFAR.
Steinberg said the emergency response used “in large part the PEPFAR facilities on the ground,” including everything from triage centers to food and supply distribution sites.
PEPFAR has 149 facilities throughout the country and all survived the earthquake, said Ambassador Eric Goosby, U.S. global AIDS coordinator. “Our sites were engaged in a wide variety of response activities, providing disaster related medical care in some sites,” he said. “In other sites, we made food, provided water, and gave shelter. The sites really became the centers of mapping for people living in tents and shelters.”
“There’s no doubt there is still much work to be done,” Goosby said.
One issue outside of the cholera epidemic is evaluating whether enough has been done to treat those with tuberculosis. One study found that 67 percent of the people on the TB registries pre-earthquake were being treated four months later – a marked contrast to AIDS treatment rebounding to 95 percent pre-earthquake levels.
Asked about the gap, CDC’s Frieden said there was no clear-cut answer. “The study was taken over a long period, from January through May [of 2010],” he said. “In that time, TB patients could have completed treatment, died, or moved. [Antiretroviral drugs have] more consistent follow-up. The big point in both is that they were strong systems in the country through the Haitian government and partners.”
Goosby agreed. “Americans should be proud of their country’s involvement,” he said. “This anniversary of one year post-earthquake is a reminder that progress can be made.”
Since the earthquake, the U.S. government, including the Defense Department, has spent more than $1 billion in Haiti to help rebuild the country. Of that, USAID has spent about $150 million for nutrition and all health issues, except the cholera response. The CDC spent $14.6 million last year.
PEPFAR’s budget, interestingly, decreased to $124.1 million in 2010 from $130.5 million in 2009.