Profile of HIV/AIDS in Haiti in comparison to other states
The first case of HIV/AIDS in the Republic of Haiti was identified in the year 1982 and the country has continuously grappled with the epidemic for over twenty five years (Celentano & Beyrer 2008 p 142). The epidemic first started in the urban epicenter, Port au Prince and later on spread to the rural areas. Today, the republic of Haiti is the home to the largest HIV/AIDS epidemic in Latin America and the Caribbean. Estimates drawn from sentinel surveillance data suggested that some 190,000 adults and children were living with HIV in the year 2005 accounting for 76 percent of all HIV cases in Caribbean region. In 2005 there were 16,000 HIV-related deaths in Haiti which comprised of 84 percent of all HIV-related deaths reported in Caribbean countries (Cantwell 1986 p.85).
In addition to Cuba having the lowest HIV/AIDS prevalence in the Caribbean region and the whole world, it is one of the 51 countries with HIV/AIDS infection rate below 0.2 percent on the contrary; none of the Caribbean countries and territories have been spared from HIV/AIDS. Some Caribbean countries have the highest prevalence of HIV/AIDS among adults in Latin America and Caribbean (Farmer 2006 p.47). Haiti which has a HIV prevalence of 5.17% is the most affected country in the world outside of sub Saharan Africa (Celentano & Beyrer 2008 p 47). According to Cantwell (1992, 56), “in terms of numbers of HIV/AIDS cases in the Caribbean, there are two countries that stand out. These two countries are Haiti and the Dominican Republic accounting for 85 percent of the total number of HIV/AIDS cases in Caribbean.”
HIV/AIDS epidemic is spreading alarmingly in the Caribbean region with countries like Haiti, Bahamas, Barbados, the Dominican Republic and Guyana having generalized epidemics. This means that HIV/AIDS has spread far beyond the original sub-populations due to high numbers of irresponsible behaviors among the population a fact that research has shown that 5 percent of women attending prenatal clinics are found to be infected (Ainsworth & Vaillacourt 2005 p 41).
On the other hand Jamaica and Trinidad and Tobago have concentrated HIV/AIDS epidemics. This means that their national epidemics are still primarily affecting population groups that practice irresponsible sexual behaviors and this is bound to spread even more to the rest of the population (Dayton 1998 p 11).The Haitian AIDS epidemic is said to be generalized because it affects women as much as it affects men. In Haiti, a HIV case is not restricted to a specific social group or within certain geographical locations. Nevertheless, the most affected groups are the urban poor, who are also found to be suffering from a lot of other opportunistic diseases such as TB. A survey conducted in an urban slum in Port au Prince showed that at least 15 percent of all the adults were infected with HIV. The rate of active and thus infectious tuberculosis among these HIV-positive slum dwellers was 5,770 per 100,000 populations. In 2007, the estimated number of adults (15-49 years) with HIV/AIDS was 2.5 million while that of infected children was 8,100. Moreover, the death of infected children, in the same year was 7,200.
In 2005, about 360,000 persons were reported to be living with HIV/AIDS in the Caribbean region. Other than the AIDS ravaged sub-Saharan Africa, where the prevalence of HIV among adults aged 15 to 49 is reported to be 8.0 percent, the Caribbean region has the highest prevalence of HIV than any other region in the world (Celentano & Beyrer 2008 p 86). The primary mode of HIV transmission among adults in the Caribbean region is sexual intercourse between men and women. For that reason, the percentage of women infected with HIV/AIDS is rising and as of 2005, about 35 percent of the adults living with HIV in the Caribbean region were women. Currently, children below fourteen years account for only a small part of the known infected population in the whole of the Caribbean region. Most young children contract the virus from their already infected mothers during pregnancy, delivery or breastfeeding.
Economic and health situations in Haiti
The health situation in Haiti is in crisis and young children are the worst hit by the situation affected. The country has poor sanitation, limited access to safe drinking water, waste management problems, poor nutrition and inconsiderate as well as inadequate medical facilities (Lieberman 2009 p 56). Access to safe drinking water is also a major problem with portable water reaching less than 50 percent of the population both in rural and urban areas. A significant number of children (18%) who are below five years of age suffer from severe malnutrition. There are thousands of orphaned and abused children living in the streets and in perilous conditions just as Teenage pregnancy is common with girls aged fifteen to nineteen resulting in increased cases of sexually transmitted diseases in both teenage girls and boys. Meanwhile, there are only 2.5 doctors per 10,000 Haitians and about 75 percent of all births occur without medical attention.
In addition, diarrhea is considered one of the leading causes of death among the young children, “with other primary causes of death being intestinal infections, malnutrition and respiratory infections” (Miles & Charles 2004 p 28). But among the adolescence from ages ten to nineteen HIV/AIDS remains the highest cause of death to this age group.
Since Haiti has the second lowest per capita caloric intake in the world, malnutrition is wide spread especially among the young and the poor. Haiti’s GDP per capita is US$24 just above the sub Saharan African coverage while its social indicators are significantly lower than those of the poorest countries in the Western Hemisphere and are comparable to those of Sub Saharan Africa (HIV/AIDS: Oral and written evidence 2008). The high fertility rate exerts pressure on the environment and reduces available resources per capita for basic education, health, sanitation and access to safe drinking water.
The urbanization ratio in Haiti is below the average level in the western hemisphere as 65 percent of Haitians live below the poverty line as the high fertility rate particularly has adversely impacted the children’s growth. For instance, some of the children from low income families, in particular girls under the age of 14, are employed as domestic helpers under miserable environments while others resort to prostitution and drug business as a form of supplementing their income in order to afford basic needs and take care of their families therefore exposing them to further risks.
Substantial disparities and limited opportunities in rural areas have caused migration to urban areas which has resulted to rapid proliferation of slums in Haitian cities. Haiti’s population density of 278 persons per square km is by far the highest among the comparator countries while on the other hand the death rate in Haiti is 13 per 1,000 people a year and is about twice that of Guyana, Honduras or Nicaragua. Also, life expectancy is only 52 years which is the lowest among the Western Hemisphere countries and is a phenomenon attributed to poor access to health care services, malnutrition and insecurity created by the economic and political distress (Farmer et al. 2010 p 56).
The degree to which basic needs like food, shelter and sanitation needs are met in Haiti is very low. More than half of the population is unable to obtain the minimum food ration established by FAO whereby, a WFT report on food security and vulnerability showed that many households are facing food insecurity due to inadequate income thereby denying them the power to access these vital basic needs for instance, access to services like drinking water and health services. This is more common in rural areas and shanty towns where only 25 percent of inhabitants have access to drinking water and even fewer of the inhabitants have access to adequate health facilities. Overall, households have low access to health care centers and markets and at the same time the levels of literacy are very high due to inability to access education institutions. Additionally, access to basic social services remains very minimal whereby more than 77 percent in the 133 municipalities in Haiti lack basic services while the percentage increases in the Haitian rural areas. In rural areas, only 13.1 percent of household think that they can met their basic foods needs and another 9 percent think that they can address their health problems as compared to 33 percent and 28 percent respectively, in metropolitan areas. (Griffith 2004 p 87).
More than 70 percent of heads of households believe that poverty has increased particularly in the recent years. By job creation, controlling inflation and access to land are the primary measures recommended majority of the households who believe it would address poverty. They appeared to view the problem largely in terms of purchasing power and access to means of production. This is due to the fact that incidence of poverty is evidently higher in rural areas than in the metropolitan areas as extreme poverty is almost three times higher in rural areas than in the metropolitan area in addition, the vast majority of the poor live in rural areas where agriculture is the main activity and where basic services are virtually non-existent.
Responses to HIV/AIDS and Funding
In December 2002, “Haiti became the first country in the Western Hemisphere to receive a grant from the global fund to fight AIDS, Tuberculosis and malaria” (Lieberman 2009 23). The $25million was to assist a consortium, led by the NGO GHESKIO and including the Haitian government to run low cost clinics for people living with HIV/AIDS and tuberculosis. The GHESKIO clinics are recognized as a model of how countries facing political upheaval, poverty and crumbling infrastructure can combat AIDS. GHESKIO has developed methods of diagnosing sexually transmitted diseases and has found some less expensive drugs combinations to treat AIDS related illnesses. This NGO together with other private groups use funds provided by foundations and foreign government to buy the medicines which are however priced far beyond the means of most Haitians.
National AIDS programs (NAP) in the Caribbean were under the World Health Organization global programme on AIDS initially but later on disbanded to form UNAIDS. NAPs have received technical support and guidance from agencies such as CARICOM, the Caribbean epidemiology centre (CAREC), Pan American Health Organization (PAHO) and UNAIDS. In 1998 the Caribbean Task Force on HIV/AIDS was formed with a mandate to coordinate and strengthen the regional response to the epidemic. The Task Force was chaired by the CARICOM secretariat and included experts in key HIV/ AIDS programming areas such as the Caribbean regional Network of people living with AIDS (Long & Ankrah 1996 p 45).
The task force was the formulation of the Regional Strategic Plan (RSP). This plan provided the frame work to inform and direct the expanded response to the problem of HIV/AIDS in the region as well at the national and sector levels. The objective of the plan was therefore to provide support and guidance to national efforts to prevent and control the spread of HIV/AIDS and mitigate its consequences. It was agreed that the task force be expanded to what is now the Pan Caribbean Partnership against HIV/AIDS (PANCAP), and “the partnership established on February 14, 2001 aimed at scaling up the regional response” (Miles 2004 p.58). It operates under “the aegis of the Caribbean Community (CARICOM) secretariat and is charged with providing support to the priority actions” (Miles 2004, p.78). It aims at being the regional coordinating committee for addressing the epidemic.
Family health International is implementing the AIDS Care and Prevention Project in 25 countries including Dominican Republic and Jamaica. The AIDS communication project of the Academy of Educational Development (AED) also provides support for HIV/AIDS education and information in the initial response to HIV/AIDS it also provides residence advice assistance to some Caribbean countries. In the Dominican Republic, Haiti and Jamaica, USAID provides about US$6 million to support the STD/HIV/AIDS program at the same time the money is also used to support NGOs and private sector groups. USAID has supported the Haitian Government’s response to HIV/AIDS through the Health System 2004 project, which focuses on condom social marketing, voluntary counseling and testing for HIV as well as strategic planning (Shenton 1998 p 69).
Programs that promote change of behavior by encouraging safe sex and distribution of condoms national wide have been set up by most agencies involved in managing HIVAIDS in Haiti moreover, the country has received significant support from the global fund and USAID to promote and sell condoms while enabling most health facilities in Haiti be able to treat STIs. Vulnerability reduction activities centers primarily on factors that could lead youth and women to unsafe sex these factors include economic factors, inadequate capacity for negotiation and emotional immaturity. A number of organizations have empowerment programmes for young women, income generation activities and peer to peer networks (Singhal & Rogers 2003 p 61).
The impact reduction component comprises activities in treatment, mitigation and stigma reduction. Four centers offer combination ART; these centers are GHESKIO, the Cange Hospital in the Central Plateau of Haiti, the MARCH foundation and the Salvation Army medical centre. These centers also offer comprehensive community based support services for HIV infected individuals. Many Haitian and international health organizations are working to prevent and slow the spread of HIV. They are also working to treat Haitians who are already infected with the virus or sick with full blown AIDS. Since AIDS can be spread through sexual activities, AIDS workers are educating the Haitian people about using condoms in order to prevent the spread of HIV during sex. HIV can also spread from a mother to a baby during the birth process (Street 2004 p 76). For this reason, the AIDS workers are treating some of the HIV-positive pregnant women with drugs that can prevent this transmission. Some of the workers also distribute drugs that facilitate people with AIDS to live longer.
Haiti is the fourth poorest nation in the world while it has the highest number of people living with HIV/AIDS (Celentano & Beyrer 2008 p 12). Today, the republic of Haiti is the home to the largest HIV/AIDS epidemic in Latin America and the Caribbean. Estimates drawn from sentinel surveillance data suggested that about 190,000 adults and children were living with HIV/AIDS in the year 2005 accounting for about 76 percent of all HIV cases in Caribbean region (Cantwell 1986, 12) while on the other hand; Cuba has the lowest HIV/AIDS cases with a prevalence rate below 1 percent making HIV/AIDS in Haiti one of highest causes of death, far much higher than any other Caribbean nation. Although the neighboring countries also face similarly higher cases of HIV/AIDS, the Haitians have borne the brunt of this calamity and the problem seems to be increasing in magnitude on a daily basis.
The increased spread is associated with multiple factors ranging from economic to social factors. Several measures such as funding of AIDS prevention programs have been taken into consideration to curb the problem of HIV/AIDS. Many Haitian and international health organizations are working to prevent and slow down the spread of HIV/AIDS. They are also working to treat Haitians who are already infected with the virus or ailing from AIDS (Celentano & Beyrer 2008).
Thus in conclusion this article has explained the cases of HIV/AIDS in Haiti while giving a comparison of HIV/AIDS prevalence in Haiti and other countries like Cuba. The article has also looked at the economic situation in Haiti and the country’s response towards HIV/AIDS cases in the country.
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