Development & Aid, Headlines, Health, Latin America & the Caribbean

HEALTH: Innovation Triumphs in Haiti’s AIDS Fight – but for Poverty

Jane Regan

PORT-AU-PRINCE, Jun 25 2003 (IPS) - ”My mother and my godmother helped deliver him right there,” said Marie-Michelle, 27, smiling as she balanced the chubby six-month-old on one hip and pointed to the unmade bed.

She could be any young mother – her hair dishevelled, her home in disarray.. Dinner was still just an idea.

But her home is two dark windowless rooms; the furniture a sagging bed and a broken chair. There was no food waiting to be cooked for dinner because there was no food, period. Nor was there charcoal for the stove.

Outside her door, children as old as 10 are half-naked, their thin arms and legs emerging from oversized cast-off T-shirts from the United States. Her seven-year-old girl is among them, sitting in the dirty alleyway, playing jacks with rocks and pieces of scrap metal. A man in just his underpants is bathing with water he pours over his body using a metal can, the soapy suds carrying in a river of grime past the children.

Marie-Michelle lives in Cité Soleil, perhaps hemisphere’s worst slum, where 250,000 people try to survive on less than one U.S. dollar a day amidst narrow corridors, glistening open sewers and packs of wild dogs who fight over the steaming, stinking piles of garbage on the street corners of this former seaside stretch of marsh turned city dump.

And Marie-Michelle is HIV-positive.

If not for Wesnel, maybe she never would have known. At least 300,000 people, about 7.7 percent of the Haitian population, live with HIV or AIDS – many of them young women, many pregnant. Every year, some 5,000 children are born HIV-positive.

”Many HIV-positive people don’t think they have AIDS,” explained Dr. Miriam Silva of the Canadian branch of Médecins du Monde (Doctors of the World). ”They think someone has cast a spell on them.”

Silva works at St. Catherine Laboure Hospital (CHOSCAL), a run-down public health centre not far from Marie-Michelle’s house. Her programme to prevent mother-to-child transmission of HIV – a joint nationwide effort between the Haitian Group for the Study of Kaposi’s Sacroma and Opportunistic Infections (GHESKIO), a world-famous AIDS research centre, Haiti’s beleaguered public health system, private hospitals and the United Nations Children’s Fund (UNICEF) – is just one battle in the country’s war on HIV/AIDS.

Although some 70 percent of Haitian women give birth outside of hospitals, thanks to the new outreach effort by midwives who work with CHOSCAL staff, mothers-to-be like Marie-Michelle are making prenatal visits, where they receive vitamins, counselling and HIV tests.

In its first year, the programme reached almost 2,000 pregnant women. Six percent, or 111, tested positive. Ninety-nine of them agreed to pre-natal check-ups and anti-retroviral drugs just before giving birth, which reduces the chances of HIV transmission to about nine percent.

But only one-half of the 99 women stayed with the programme to the end. The rest dropped out, maybe because they went back to the countryside, maybe because they did not want people to know they were HIV-positive, maybe because the could not pay their rent and moved.

But Marie-Michelle stuck it out, and Wesnel is healthy so far.

”I’m happy my son is OK,” she said, smiling as Wesnel fell asleep in her arms and her daughter sat at her feet.

Doctors will not know for sure if he is out of danger until he is 18 months old, and Marie-Michelle, who is no longer on any medications, breast-feeds her son to supplement the formula she gets from the clinic and the little food she scrapes together, even though breast-feeding by HIV-positive moms increases chance of transmission.

If she were on the life-saving, triple-anti-retroviral cocktail, chances of transmission would be lowered, but less than one thousand of the country’s 300,000 HIV-positive people are so lucky. Only one CHOSCAL mom has made the cut, and only because of her poor health and daily lobbying.

Marie-Michelle knows she might not see her son grow up.

”They said they can’t afford the medicine I need,” she said quietly.

”It doesn’t make sense to protect the baby and not the mother,” admitted Dr. Jean William Pape of GHESKIO, which together with CHOSCAL and Partner’s in Health Hospital in Cange, a small town five hours from the capital, piloted the mother-to-child programme.

Millions of dollars in the pipeline from the United Nations Global Fund to Fight AIDS, Tuberculosis and Malaria and from Washington’s new 15-billion-dollar AIDS initiative will help change that, Pape said. Over five years, the U.N. Fund should provide 66 million U.S. dollars, and while the figures have not been announced, it is expected the Bush fund will divide over one billion dollars between Haiti and Guyana on South America’s northwest coast.

GHESKIO is helping coordinate a network of 25 clinics whose goal is to reach all of Haiti’s pregnant women. The clinics should be operating by the end of the year, but it will take a while to reach the country’s 250,000 moms-to-be, and even longer to reach all HIV-positive Haitians who need triple-therapy drugs.

”Probably 10 percent of the 300,000 infected need triple-therapy treatment immediately,” said Pape, and there still is not enough money for that.

Out in Cange, Dr. Paul Farmer and the other doctors and nurses at Partner’s in Health have been treating hundreds with anti-retrovirals since 1995. When funders told them it was not ”cost effective” to treat Haitians, they solicited drug donations and searched out the cheapest generics.

Convinced the treatment adds to a broader community-wide prevention because patients no longer engage in at-risk behaviour, and because moms and dads are kept alive to look after their children, they work with 3,500 HIV-positive men, women and children, with about 350 on triple-therapy drugs.

Farmer, an infectious diseases researcher, author, Harvard medical school professor and a founder of Partners, has led a crusade in Haiti and internationally against the notion of ”cost effectiveness”, from a moral, social, medical and even economic point of view.

”Any cost-effectiveness strategy that thinks it costs nothing to stand back and watch millions die knows little about economics,” Farmer said. ”What is the cost of having millions of AIDS orphans? Child prostitution, crime, urbanisation, alienation, children in armed conflicts – the list goes on and on.”

So does the list of Haiti’s AIDS orphans. It numbers about 163,000 and is growing.

While optimistic about the benefits of the programmes being catalysed with Global Fund money, Farmer said money alone, and especially money to non-governmental organisations (NGOs) alone, is not the answer.

”Much more money should go to the Ministry of Health,” he said.

Haiti’s public healthcare system, while improved from previous years, falls far short of reaching the population of over eight million and relies heavily on foreign assistance. Since 2001, many donors and lenders have halted support to the Haitian government due to allegedly fraudulent elections in 2000 that led to a political impasse, and because of subsequent human rights and security issues. Farmer is opposed to the blockade.

”We have to remediate this short-sightedness on the part of the so-called international community, which should be focusing its efforts on helping the public sector in Haiti rather than sabotaging it,” he said.

But the World Bank, the European Union and others say that in addition to having problems with the government for the political impasse, they also want to see better results for their money.

In April, a French government spokesman said the international community had given Haiti two billion Euros since 1995, but received ”few results” due to ”poor governance (and) degradation of security due to serious political conflicts”.

While Farmer disagrees with foreign donors, he also knows that money for the health system alone will not solve Haiti’s AIDS crisis. Ending poverty is the real cure.

Haiti’s per capita GDP and other indicators have all been going down in recent years, and that is what drives mothers like Marie-Michelle to slums like Cité Soleil. Poverty keeps her and her children out of school. Poverty also makes her vulnerable. Her partner, Wesnel’s father, so far has refused to be tested.

When asked what she most wanted in the world, Marie-Michelle said: ”health”.