BBC News - Thursday, 20 November, 2003
Nick Caistor, In Port-au-Prince, Haiti

The Caribbean nation is one of the countries hit hardest by Aids outside of sub-Saharan Africa.

In the early 1980s Haitians were held responsible for the spread of the disease in the United States and other developed countries.

But Dr Marie Deschamps, co-director of the Gheskio infectious diseases clinic in the Haitian capital Port-au-Prince says the truth was the opposite - it was foreigners who brought the disease into Haiti.

"From what we observed, in the beginning it was mostly bisexuals, foreign men who came from the United States, from Canada and from France. They would come to Haiti to meet with the bisexuals here just for money," she said

Spread of the disease

In the 20 years since then, HIV and Aids have spread through the Haitian population, both bisexual and heterosexual.

Now one in 20 Haitians has the disease, and it is the main cause of death among women of reproductive age.

Extreme poverty, especially in the Haitian countryside, has compounded the problem. Only four out of10 Haitians have safe drinking water.

There is only one doctor per 10,000 Haitians and many have to walk for hours to reach a health clinic.

Despite this, the UNAids co-ordinator in Haiti, Raul Boyle, is cautiously optimistic:

"The latest information we have from our surveys is that the rate of the epidemic has become more or less stable - at a high level, about 5%, but there's a window of hope because that is the same level it was some years ago.

"The explosion that was the scenario some people were working on is not the case now," said.

Drugs and education

The Haitian authorities and Gheskio clinic have just received $66 million from the Global Fund to fight Aids, Tuberculosis and Malaria, to be spent over the next five years to make sure that the level of infection does not increase.

Part of this money is to be used to provide antiretroviral drugs for as many HIV and Aids patients as possible.

Equally important, says the Director General of the Haitian Health Ministry, Emile Gerard Charles, is a campaign to educate Haitians about the realities of Aids.

Then the next step, in his view, is to try to change people's behaviour.

"The majority of Haitians are aware of Aids now. We use radio and TV to get our message across. The real challenge now is to get people to change their behaviour. Sometimes their beliefs mean they don't want to behave differently."

Magical view

The fact is that many Haitians, especially the five million who live in the countryside, believe that many illnesses, including Aids, are caused by magic rather than microbes.

"Haitians never believe that the reason for an illness is simple," Jan Hoet, a Belgian missionary who has worked in a remote rural area of Haiti for more than 30 years.

"For them it's not due to a virus or their behaviour, but it's done by somebody else, and enemy who is trying to do them evil."

Because of this magical view of life and sickness, Haitian peasants suffering from HIV or Aids are more likely to go and seek help from their local voodoo priest than from a government clinic.

"Why should they spend money they don't have on a treatment that is probably not effective anyway?," says Max Beauvoir, one of Haiti's most prominent voodoo priests or houngans.

We have leaves and other plants with many medicinal properties, and some patients who have come to see me are fine after 20 years,"

While not claiming to have a cure for Aids, Mr Beauvoir and many other houngans argue that their approach is more in touch with the Haitians' worldview than the remedies offered by "Western" science.

Early sexual activity

Perhaps even more of a challenge for the authorities is the predominance of sexual activity at an early age in Haiti.

The average age for young people to begin sexual relations is 12, with many young boys and girls starting to have sex as early as eight years old, according to Dr Deschamps.

This, plus the fact that half of Haiti's eight million population is under 20, makes it even more urgent that the authorities' education and prevention campaigns hit home as quickly as possible.

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