Miami Herald - March 12, 2009
*Cesar Chelala, cchelala@aol.com

The progress being made in fighting the disease has been particularly significant for a country where 60 percent of the population lives below the poverty line of $2 per day. Only four of every 10 Haitians have access to potable water, and there is one doctor for every 10,000 inhabitants.

The scenario is optimistic; the percentage of pregnant women who have tested HIV positive has declined by half over the last 10 years. But many challenges remain. The majority of the Haitian population still lacks sufficient sex education, for example. Only 15 percent of women and 28 percent of men between the ages of 15 and 24 know how to prevent HIV infection, and boys and girls are becoming sexually active at an early age, some as early as 10. In addition, infection rates have been falling more slowly in rural areas than in urban areas

Jean Pape, a Haitian doctor who has been fighting the epidemic for years in Haiti, told the PBS TV program Frontline that the high percentage of people infected with HIV "killed tourism in Haiti," which was the backbone of the Haitian economy. In addition, he pointed out that because of import restrictions, goods manufactured in Haiti could no longer be sold in the United States. Pape is the founder of the organization called GHESKIO, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections.

Progress in battling the epidemic in Haiti is due in large part to the work of people like Pape and Paul Farmer, a U.S. physician who has dedicated his life to the struggle against AIDS on this Caribbean island. Farmer created the organization Partners in Health and its HIV Equity Initiative, which is dedicated to preventing and treating AIDS in the context of primary care; improving care for tuberculosis; optimizing treatment for sexually transmitted infections; and emphasizing women's health.

So far more than 400 workers have been trained to administer free antiretroviral drugs to AIDS patients in the community, and more than 1,500 patients are currently receiving treatment for AIDS. As Farmer explained on Frontline, "I think that Haiti's lesson is if you can integrate prevention and care and make sure there's better supervision of patients with the help of community health workers. I think other countries with major AIDS epidemics . . . are going to see good results."

Pape confirms Farmer's view. "Look at Haiti," he says. "The country is in total disarray, and yet we are containing one of the most devastating diseases, which is AIDS." Pape's optimism is remarkable, particularly when you keep in mind that his clinic, located in one of the most dangerous areas of Port-au-Prince, has been the target of violence by "unidentified" groups.

According to U.N. data, 6.1 percent of the adult population was HIV positive in 2001, and AIDS has become the top cause of death among sexually active youth and adults. Thanks to prevention and control efforts, however, the percentage of infected persons had declined to 3.8 percent by late 2005.

In addition, according to studies carried out by Pape's group, the number of sexually transmitted infections -- which facilitate the transmission of HIV -- also decreased markedly during this same period.

Both Pape and Farmer have received numerous international awards and recognition for their work, which has been strongly supported by international organizations and governments.

The advances in fighting the epidemic in Haiti show that although much remains to be done to achieve better results, a committed leadership, good planning, parallel attention to prevention and care, and community involvement can successfully control this terrible epidemic, even under the worst of circumstances.

**Cesar Chelala, MD, an international public health consultant, is the author of AIDS: A Modern Epidemic, a publication of the Pan American Health Organization.

This article was re-printed with permission.
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