Haiti’s Remarkable HIV Turnaround May Be Undone by Earthquake

Global health watchers worry the island's epidemic is exploding anew as the recovery drags on.

By Rod McCullom Jan 12, 2011

A version of this article originally appeared in the Black AIDS Institute’s Black AIDS Weekly e-mail. Colorlines joins other black community media in co-publishing content from the Black AIDS Weekly.

By the beginning of 2010, Haiti had made significant progress toward lowering its once-astronomical HIV rate. In 1993, 9.4 percent of the impoverished nation was infected with HIV, a number that represented almost half the people living with HIV/AIDS in the entire Caribbean. By 2008, the adult HIV prevalence in Haiti had fallen to 2.2 percent–approximately 120,000 people, 53 percent of whom were women.

Then came the catastrophic 7.0 earthquake of Jan. 12, 2010, which flattened much of Port-au-Prince. Many hospitals and HIV/AIDS clinics were crippled, if not destroyed, and the health care system that had proudly enabled the Caribbean nation to control its HIV/AIDS epidemic collapsed.

Relief and international funding did not arrive quickly enough. Less than 40 percent of the 24,000 people prescribed antiretroviral medications had access to them. Up to a million people were displaced and began living in camps, which, with their poor sanitary conditions, soon became virtual petri dishes of disease.

UNAIDS has established mobile HIV-testing locations, plus 68 sites to provide HIV meds and 117 to prevent mother-to-child HIV transmission. Still, doctors doing HIV testing at just one tent-camp clinic "are seeing at least 15 to 20 new cases each day," notes Beatrice Dalencourt Turnier, a social mobilization officer for UNAIDS.

Compounding the misery, last fall more than 1,300 people were killed and more than 57,000 sickened when cholera swept through the camps and Port-au-Prince. Relief agencies scrambled to distribute thousands of hygiene kits to pregnant women and people living with HIV, who are extremely vulnerable to the bacteria.

"It looks the same as the very day of the quake," reports Haitian American Nadine Juste-Beckles, executive director of adult day services for Housing Works, a New York City-based nonprofit that finds homes for HIV-positive people. Juste-Beckles has returned to the island three times since the disaster.

But even one year after the tragedy, she says, the situation remains grim: "It is unimaginable that Haiti continues to face devastation, tragedy and ongoing suffering."

Rebuilding Haiti’s AIDS Infrastructure

"At least half of Port-au-Prince’s AIDS clinics appear to have been destroyed," Housing Works’ CEO, Charles King, reported after the earthquake. King and Housing Works were among the first responders to arrive in Haiti and deliver HIV meds.

Since then, Housing Works has partnered with three other New York City-based organizations–Aid for AIDS, Caribbean Women’s Health Association and Diaspora Community Services–to help fund and operate two new HIV/AIDS clinics.

The first and smaller clinic, in Port-au-Prince, is run by the PHAP+, a coalition of 12 grassroots Haitian AIDS organizations treating up to 20 people per day. The second is the Fondation Esther Boucicault Stanislas, founded by the first Haitian to publicly disclose her HIV-positive status, Esther Boucicault.

Located north of Port-au-Prince in St. Marc, outside the disaster zone, Boucicault’s clinc treats up to 75 people daily but cannot keep up with the demand, she says. Many HIV-positive Haitians have fled there.

The cholera outbreak that was once limited to Port-au-Prince now threatens St. Marc, too, relief workers say. "The situation has [become] out of control," Juste-Beckles reports.

Few Options for Gay HIV-Positive Men

SEROvie, Haiti’s largest organization serving gay and transgender people with HIV, was devastated by the quake as well. Its building was flattened, and the majority of the staff were killed.

"There has been very little progress since then," says Valentin, a 29-year-old HIV-positive Haitian American volunteer who just returned from a relief mission and prefers that his last name not be used. "SEROvie is borrowing space for support meetings and to dispense medicines to clients. But there is so much need, and few funds. And of course stigma is now even more of a problem."

SEROvie is rebuilding its presence on Facebook and trying to connect with gay and bisexual men via cell phones so that the lucky few can receive occasional text messages about medications and other services. "But that is a luxury," Valentin notes. "Most people who are poz are in the camps and have few options."

Sex in the camps is a reality, and rape, prostitution and promiscuity will almost certainly increase HIV’s spread. "I think we could well have 200,000 to 300,000 affected by HIV," says Boucicault. "Because what can you do in a tent? Nothing. Nothing, no entertainment, nothing. The only thing you can do is sex. So you have sex."

Rape was a serious problem in Haiti before the quake, but the situation for women has gotten even worse, human-rights groups say. Rapes have tripled in Port-au-Prince, according to the Pulitzer Center on Crisis Reporting, which has been monitoring HIV/AIDS in post-earthquake Haiti.

The fact that the camps still exist in the first place has been a point of frustration for many Haitians. As Colorlines Michelle Chen has reported, the country counties to await real aid that empowers locally created solutions to the crisis. Chen writes,

Though donors have pledged about $10 billion, the actual deployment of program funding has been agonizingly slow and haphazard. Talk of permanent, sustainable rebuilding of infrastructure and housing is suspended in political limbo, with hundreds of thousands still warehoused in tents. Not even the majority of the earthquake rubble has been cleared.

"Enough is enough," says Juste-Beckles. "And as a Haitian American, I have to ask, when is the suffering going to stop? When will the global community come together and address this emergent situation so the country can move forward?”

Rod McCullom, a writer and television news producer, blogs on black gay, lesbian, bisexual and transgender news and pop culture at rod20.com.