Haiti

Haiti is regularly in the path of Atlantic Ocean storms, but Matthew was the most destructive hurricane in five decades and the country’s worst natural disaster since the devastating 2010 earthquake. According to the United Nations Office for the Coordination of Humanitarian Affairs, the hurricane killed 546 people, injured 438 and left thousands homeless. More than 141 000 displaced people are now living in temporary shelters.  

Jasmin Désir, a community leader of the Union to Fight against Stigma and Discrimination, said the situation on the ground remains desperate for people with very few resources. It is even worse for many people living with HIV. He said their main concern now is being able to take antiretroviral medicines “when there is no food in sight.” Currently, 806 000 people need urgent food assistance.

Renel Julien, a community organizer living with HIV, mobilizes people living with HIV to get food and water. He thinks the emotional strain of dealing with the hurricane’s aftermath has taken a toll on many in the community.

Haiti’s entire health-care system was affected by the hurricane. Medical personnel and community health workers were unable to conduct home visits in some places. Most clinics were seriously damaged and some clinics and hospitals lost all their equipment, including generators, solar panels and computers. Antiretroviral medicines and other supplies were lost during the hurricane.

In the five most affected departments (Grand’Anse, South, South-East, Nippes and North-West), there were 13 994 people living with HIV and 37 functioning HIV treatment centres before Matthew.

According to UNAIDS Haiti, the hurricane has already affected HIV prevention, support, treatment and care services. Urgent programmes are needed to ensure that the current retention rate of people on treatment (between 60% and 80%) does not decline.

“One solution could be a community distribution system,” said Yafflo Ouattara, UNAIDS Country Director for Haiti. “In the short term, this might be the best option to reach people living with HIV who do not have access to their usual services.”

The UNAIDS country office in Haiti is currently supporting the national AIDS programme to gather information on the most affected departments and to explore alternatives for HIV treatment and care. Priorities include mapping treatment centres and reviewing the supply chain for antiretroviral medicines and other supplies.

Community leaders say marginalized groups, including gay men and other men who have sex with men, transgender people and sex workers, are even more vulnerable in these circumstances. Based on a preliminary assessment conducted by nongovernmental organizations in the areas most affected by the hurricane, stigma and discrimination has become a barrier to some people in need of assistance.

“Haiti was only just beginning the development phase to rebuild infrastructure following the 2010 earthquake that destroyed much of the country,” said Edner Boucicaut, Chair of Haiti’s Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria and Country Director for Housing Works. “Having one disaster after another makes things more complicated than the typical emergency situation.”

César Núñez, Director of the UNAIDS Latin America and Caribbean Regional Support Team, said partners are working to ensure that the achievements made so far in the response to HIV are not diminished. “We are committed to ensuring that the excellent progress Haiti has made with respect to prevention and treatment is not reversed.”

UNAIDS Executive Director Michel Sidibé (left) participates in a World AIDS Day event in Pétionville, Haiti, along with United States Ambassador to Haiti, Pamela White, and Haiti’s First Lady, Sophia Martelly.

On one level, Haiti’s HIV response parallels its earthquake recovery. Although the task is far from over, national and international stakeholders have collaborated to confront the challenge and important gains have been made.

During a World AIDS Day commemoration in Pétionville, Haiti, hosted by the Ministry of Health, UNAIDS Executive Director Michel Sidibé congratulated the country on its progress toward the vision of “getting to zero:” zero new HIV infections, zero discrimination and zero zero AIDS-related deaths.

Over the past decade, the rate of new HIV infections in Haiti fell by 54%. From 2005 to 2011, there was a 47% national decline in AIDS-related deaths. By 2011, 58% of Haitians living with HIV were accessing antiretroviral therapy. Mr Sidibé expressed optimism that this positive trajectory would continue.

“I was honoured yesterday to meet the President of the Republic and I can tell you that during our conversation, it was obvious that he wanted to put AIDS at the centre of his efforts to ensure that all people have access to the information and support systems necessary for life,” Sidibé said.

These efforts, said Mr Sidibé, must focus on the country’s most vulnerable. An estimated 18% of men who have sex with men and 8% of sex workers in Haiti are living with HIV.  Nearly half of young Haitians living in camps do not have adequate knowledge about HIV.

Mr Sidibé urged Haiti’s leaders to boost efforts to reach populations at high risk of HIV infection with prevention and treatment services. He called for the passage of an HIV law that would signal zero tolerance for stigma and discrimination.

Mr Sidibé also urged the leadership of Haiti to increase domestic investments for the HIV response. Currently, more than 75% of funding for Haiti’s HIV response comes from external sources. By taking greater ownership of its national AIDS response, Haiti would join the worldwide paradigm shift “from charity to global solidarity,” said the UNAIDS Executive Director.

During the World AIDS Day ceremony, Haiti’s First Lady, Sophia Martelly, acknowledged the complex network of social issues that increase people’s risk of HIV. “Wherever educating children is problematic, there will be AIDS. Wherever basic social needs are not met, there will be AIDS. Wherever there is violence and rape, there will be AIDS. That is why there must be an in-depth approach to prevention,” said the First Lady.

“I am proud to be working alongside the President of the Republic to guarantee education for all, the strengthening of our health care system, women's empowerment and improved living conditions for the whole population,” she added.

Haiti President Michel Martelly (left) and UNAIDS Executive Director Michel Sidibé at the Ministry of Planning in Port-au-Prince.
Credit: UNAIDS

The President of Haiti ushered in World AIDS Day 2012 commemorations with a note of hope. “It would be a very beautiful success story if we could pull off an HIV-free generation,” declared President Michel Martelly, in a meeting on 30 November with UNAIDS Executive Director Michel Sidibé.

In 2011, an estimated 77% of pregnant women living with HIV in Haiti had access to services that prevent mother-to-child transmission (PMTCT) of HIV. Between 2009 and 2011 the country secured a 25% decrease in the number of children born with HIV.

“Getting to zero HIV infections in children should be the legacy of this administration,” said Mr Sidibé. “It would be a very powerful accomplishment. Two children are born with HIV in Haiti each day. Think of what it would mean if we could leave behind a generation that was born HIV-free,” he added.

President Martelly noted the moral and economic imperatives of preventing HIV in children, saying that while it costs only US $150 to prevent a child being born with HIV, it would cost hundreds of thousands of dollars to treat a person living with the virus over the course of their lives. “If you can save a mother,” he added, “you prevent a child from becoming an orphan.”

In separate meetings with Haiti’s First Lady, Sophia Martelly, and the Minister of Health, Florence Guillaume Duperval, Mr Sidibé stressed that Haiti has the potential to eliminate HIV in children and dramatically reduce AIDS-related deaths in mothers. The First Lady pointed to national efforts geared toward achieving these twin goals, including a campaign to ensure that more pregnant women—particularly those living in rural areas—access HIV testing and treatment services.

Haiti First Lady Sophia Martelly (left) and UNAIDS Executive Director Michel Sidibé at Haiti's National Palace in Port-au-Prince.
Credit: UNAIDS

The Caribbean has the highest PMTCT coverage of any developing region. Many smaller Caribbean countries are already close to eliminating new HIV infections among children. Further scale-up of PMTCT services in Haiti—one of the region’s most populous countries—will help the entire Caribbean reach closer to the goal of eliminating new HIV infections among children, a key target of the 2011 Political Declaration on HIV/AIDS.

In addition to PMTCT scale-up, Haiti has progressed in other areas of its national HIV response.  Between 2001 and 2011, for example, new HIV infections in the country declined by 54%. Haiti also attained a 47% decline in AIDS-related deaths from 2005 to 2011.

One year ago, on 11 January 2010, the Haiti earthquake devastated large parts of the capital, Port-au-Prince, with surrounding areas. Credit: UNAIDS

One year after a devastating earthquake in Haiti, the delivery of HIV prevention and treatment services appears to be back on track.

Over the past 12 months, Haiti has engaged in intensive HIV prevention campaigns in temporary settlements, where an estimated 800 000 displaced people are living. With the support of partners and UNAIDS, youth-sensitization and condom distribution programmes are now reaching tens of thousands of people.

Before the earthquake, UNAIDS estimated that 68 000 people were living with HIV in the three departments that were later impacted by the tremor—57% of the national total of 120 000. Within three months of the January 2010 earthquake, 80% of people on HIV treatment in these departments were able to access their antiretroviral drugs again. However, national coverage of antiretroviral treatment (43%) remains far from the goal of universal access.

“Every crisis presents an opportunity to move forward,” said Ernesto Guerrero, the UNAIDS Country Coordinator in Haiti. “The challenges posed by the earthquake in Haiti are no exception.”

In the aftermath of the earthquake, for example, HIV centers in Haiti have made strides in preventing mother-child-transmission of HIV. According to the US Centers for Disease Control and Prevention, an estimated 156 000 pregnant women in Haiti were tested for HIV in the fiscal year of 2010, compared to 132 000 in fiscal 2009.

Despite progress, Haiti continues to face repeated challenges. Health services are stretched and the cholera epidemic has further hindered the country’s ability to deliver HIV services. Sexual and gender-based violence in the temporary settlements is placing women at high risk of HIV infection.

According to the latest estimates from UNAIDS, 1.9% of the adult population in Haiti is living with HIV. Nearly half (46%) of all people living with HIV in the Caribbean reside in Haiti.

Functioning ARV dispensing site in Port-au-Prince after the devastating 12 of January earthquake. Credit: UNAIDS

Haitian civil society representatives visited Washington, D.C. on 6 April to mobilize political support for reconstructing the AIDS response in Haiti.

The civil society delegation, with support from UNAIDS, gave a testimony of their experiences with the earthquake and highlighted the importance of reconstructing the AIDS response with direct involvement of affected communities, especially people living with HIV. The briefing was held at Capitol Hill during a US Congressional briefing sponsored by US Senator Kirsten Gillibrand (D-NY) and attended by congressional staff, AIDS advocates and US civil society representatives.

Later that same day, the delegation from Haiti visited US Global AIDS Coordinator Ambassador Eric Goosby and his colleagues from USAID. The US government team pledged its support to encourage the Haitian government to include the involvement of people living with HIV in planning the reconstruction of the AIDS response in Haiti.

On 24 March, US President Obama asked the US Congress to approve $2.8 billion as an emergency requirement for relief and reconstruction support for Haiti following the devastating earthquake of 12 January 2010. The request is now pending before US lawmakers who will very soon vote on the proposal.

There were an estimated 120 000 people living with HIV in Haiti before the earthquake. Most of the structural damage happened in the three departments (Ouest, Sud-Est and les Nippes) that accounted for nearly 60% of the population of people living with HIV.

Following an initial rapid assessment of the situation with the Ministry of Public Health and Population, UNAIDS released a concept note Helping Haiti rebuild its AIDS response. The report explains the current situation in Haiti and what may be required to meet the immediate and intermediate AIDS response needs.

Civil society networks of people living with HIV as well as many of the organizations providing HIV services have been affected by the earthquake and are in need to be strengthened.

Functioning ARV dispensing site in Port-au-Prince after the devastating 12 of January earthquake.
Credit: UNAIDS

As Haiti begins to rebuild after the destruction left by the 7.0 magnitude earthquake that struck 10 miles outside Port-au-Prince on 12 January, first reports are coming in on the impact the tremble has had on Haiti’s AIDS response.

Haiti is the country with the most severe HIV epidemic among the Caribbean states–home to half of all people living with HIV in the region. Before the quake, there were an estimated 120 000 people living with HIV in the country with an estimated 6 800 children under the age of 15 also carrying the virus.

Data is starting to emerge on people living with HIV who have been affected by the quake and on critical infrastructure needed to provide essential services. An initial report estimates that out of 120 000 people living with HIV just under 70 000 live in affected areas. Prior to the quake, around 19 000 people were estimated to be on Anti-Retroviral Treatment (ART).

“The world has a real opportunity to rebuild Haiti better, we must sustain the outpour of support now and tomorrow,” Mr Michel Sidibé UNAIDS Executive Director said when speaking of the pledges made by the international community.

The UNAIDS country team and cosponsors are working with the government of Haiti and partners such as PEPFAR and Global Fund to Fight HIV, TB and Malaria as well as non-governmental organisations to gather information to asses the impact of the quake on clinics, lab equipment and as well as human resources. It is now critical that HIV prevention, treatment care and support services are resumed in affected areas.

The UNAIDS country team met staff working in Haiti’s oldest ART centre GHESKIO. The organization provides treatment for 6000 people of whom 80% have now been accounted for.

UN Health Cluster coordination meeting in Port-au-Prince
Credit: UNAIDS

While the clinic has suffered some damage to its structure, essential equipment and tragically also suffered human losses, staff at GHESKIO reported that they have enough stock of anti-retrovirals to cover the immediate need.

Other centres were not as fortunate. The UNAIDS country team visited the Hospital de la Paix which provides prevention of mother-to-child transmission services in Port-au-Prince. Here staff reported destruction of stock as well as lack of financial abilities to buy breast milk substitute necessary to prevent transmission from mother to child through the breast milk. Services at the clinic were only resumed 12 days after the quake.

Members of the UN country team on AIDS will visit five major PMTCT centres in the coming days to establish if similar damages are found.

An initial situational analysis indicate immediate short term needs include limiting treatment interruption, provide nutritional support of people on treatment, and make sure PMTCT services are resumed. Networks of people living with HIV report that they urgently need food and water, tents, and hygiene kit in meeting with the UNAIDS country team.

In Haiti heterosexual transmission, often tied to sex work, is the primary source of HIV transmission although emerging evidence indicated that substantial transmission is also occurring among men who have sex with men. A challenge will be to ensure that key prevention commodities are made available to the displaced populations in and around Port-au-Prince.

“We are seeing real suffering. It is in moments like this where those most at risk are forgotten. We must ensure that the marginalized members of our communities have access to HIV prevention, treatment, care and support services,” Mr Sidibé said, promising that UNAIDS would be part of the global effort to support Haiti to build a better tomorrow.

UNAIDS is committed to working with the Haitian government and other development partners such as Global Fund and PEPFAR to look at how Haiti’s AIDS response can be strengthened over the long-term.

Support is needed to re-establish the AIDS-infrastructure as well as strengthening civil society, ensuring special attention towards HIV prevention, treatment, care and support services to populations at higher risk and put in place on coordinating authority to ensure no gaps or overlaps in the national response.

As part of the United Nations family, UNAIDS stands in solidarity with the people affected by the devastating earthquake that struck Port-au-Prince on Tuesday 12 of January.

On Sunday United Nations Secretary-General Mr Ban Ki-moon reiterated the UN’s continued support to Haiti and the people affected by this natural disaster. Speaking in Port-au-Prince, Mr Ban ensured that the search and rescue operation for people trapped in the rubble was still ongoing.

As emergency relief efforts, with food, water and tents being distributed by the UN and its partners are stepped up; the UN Secretary-General stressed the importance of coordination of the emergency operation.

“My heartfelt sympathies are with the people of Haiti in these difficult times,” said Mr Michel Sidibé, UNAIDS Executive Director. “As the UN Secretary-General Ban-Ki moon has said, the international community must support Haiti during this crisis and in the long term.”

On Friday the 15 the UN launched a flash appeal for $ 600 million, which outlines the support needed to start meeting the devastation suffered by Haiti. This includes support for the National AIDS Response, and delivery of HIV prevention, treatment, care and support services.

The United Nations family too has been affected by the earthquake and it is still uncertain of the status of many of the staff. UNAIDS has accounted for all of its staff in the UNAIDS Country office and has pledged support during this crisis.

Amidst the uncertainties the world body's peacekeeping and field support departments are utilizing the social networking sites Facebook and Twitter to keep families, friends and colleagues of UN personnel in Haiti up-to-date on the latest developments

UNAIDS Deputy Executive Director Michel Sidibe
met with the Premier Ministre Haitien, Jaques-
Edouard Alexis during a high-level mission to Haiti.
May 2007.

During a high-level mission to Haiti in May, the UNAIDS delegation headed by Deputy Executive Director Michel Sidibe underlined its support to Fondation SOGEBANK, the Global Fund’s Principal Recipient in Haiti, in helping ensure greater coordination of resources for AIDS and developing a culture of multi-sectoral partnership within the country’s AIDS response.

“Haiti has made significant progress on AIDS – with Fondation SOGEBANK playing a key role in developing the response in the country. Now we must work to ensure that all resources and funding for AIDS in Haiti are reaching the people that need them—to ‘make the money work’— every sector needs to be involved,” Mr Sidibe said.

As a first event in a series of initiatives to help develop multi-sectoral partnerships in the country’s AIDS response, Fondation SOGEBANK and UNAIDS gathered a group of around 40 CEOs from leading Haitian companies to discuss the perception of AIDS among leading managers and ways in which the business sector can become more involved in AIDS issues.

The group was presented with a study launched in Haiti in 2005, in preparation of the UNGASS 2008 report, which examines the response to AIDS by 20 of the largest Haitian companies.

The study, the first of its kind to provide a baseline report on business response to AIDS, shows that the Haitian business sector is becoming progressively more involved in the response and a number of companies are implementing HIV prevention activities. The study found that Haiti’s labour-intensive workplaces such as factories have a greater awareness of, and a more active response to AIDS than do banks and similar work sites.

UNAIDS Deputy Executive Director Michel Sidibe
underlined its support to Fondation SOGEBANK,
the Global Fund’s Principal Recipient in Haiti, in
helping ensure greater coordination of resources for
AIDS.

Emphasizing the need for increased action on AIDS within the private sector, Sidibe urged the CEOs to use the study’s findings to help shape their future initiatives. “This study shows us work needs to be done in the areas of policy, legislation and cooperation within businesses. We therefore have to create synergies between governmental actions and the private sector in order to intensify the response,” he said.

To elicit a greater response from industry, UNAIDS and Fondation SOGEBANK will continue consultations with business leaders, encouraging information-sharing, joint resource mobilization and a continuous and open dialogue.

“UNAIDS will seek to assist the private sector in establishing ways for an effective, open cooperation to ensure business response that addresses the impacts and dangers of AIDS on economic growth and development of Haiti,” Sidibe said.

Haiti has the highest HIV prevalence rates in the Caribbean region: 3.8% among adults between 15 and 49 years old.