8/4/2010
Media Global
By Leslie Pitterson
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For Haitians affected by AIDS, the 12 January earthquake has left them facing continued alienation and now targeted violence in the island’s tent cities. The worsening conditions have become the primary concern of KALMI — the Creole acronym for “Kombit Ayisyen Pou Lavi Miyo” or “Haitians United for a Better Life” — a Haitian grassroots group that seeks to provide community support for those living with, and affected by the disease. The group is sponsored by Haitian Health Allies (HHA). According to HHA’s director, Marie Florence Shadlen, the earthquake has left many of the groups’ remaining members without safe shelter.
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“Before the quake, our membership stood at 800 registered. Since January 12th, we have had 640 accounted for,” Shadlen said in an interview with MediaGlobal. “Right now, at least 200 of our members have no other options for living, no family to turn to, nowhere left to go.” While the United Nations continues to finalize its plans for transitional housing in Haiti, millions of Haitians continue to receive shelter, food, and water from the humanitarian organizations on the ground working under the UN mission in Haiti, MINUSTAH’s cluster system.
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“The cluster system was incredibly effective in providing relief after the quake, but things have stalled in terms of reconstruction. It’s very hard to know who has ownership of what issues and who we can turn to with the concerns of KALMI members,” Shadlen explained. “I imagine it is easy to become overwhelmed, but at times the whole thing can feel like a complex system of avoiding responsibility.”
Haiti’s tent cities have provided little refuge for those living with HIV. According to Shadlen, many KALMI members fear for their safety in the provisional shelters.
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“Our group supports people living with the disease and people who have loved ones living with it as well. There has been a general feeling of vulnerability in the last few months as the tents have become increasingly dangerous.” While building materials for shelters are being imported into Haiti, many NGOs with the resources to build are waiting for the UN and the Haitian government to decide land allocation for the transitional shelters.
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“It’s frustrating because many of the NGOs have the materials but aren’t going to build until the land is deemed legal to build on,” said Shalden. “So you have groups with everything they need and they’re just waiting on the signal from the top to say ‘Go.’” Speaking to MediaGlobal about transitional housing, CARE’s Shelter Coordinator in Haiti, Jim Kennedy, said discrimination in the housing process was an obstacle to recovery.
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“With groups that have long been disenfranchised in Haiti, the earthquake has now put them in even tougher situations. It’s a sad reality, but there will always be unfortunately some people further to the back of the queue than the front of the queue.” Tensions have been running high in the tents. Shadlen told MediaGlobal that more KALMI members have reported incidents of rape and harassments in the tents over the last few months. “Several of the women who attend our monthly meeting in Port-au-Prince have told us how they’ve been taunted for being infected HIV, and how in the worst cases, they are being raped.”
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Shadlen recalled listening as one KALMI member who spoke about being raped in the tents and robbed of remittances she had recently received. “She told the group how they came in from the dark, attacked her and took her money. Many nodded because they had experienced it too.” The harrowing rapes and harassment have lead KALMI to lobby for representation of those affected by HIV/AIDS within MINUSTAH’s cluster system, explained Shalden.
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“The violence against many of our members is quickly becoming a frequent occurrence. In a way, the camps have fostered a darkness that is predating people and making them live in fear.” Besides the immediate violence, the long history of stigmatization of those living with HIV/AIDS in Haiti has many scared to seek medical care. “Working in the tents, we’ve seen people who are afraid to talk to our group even when they are losing a lot of weight and getting sicker,” Shadlen recalled. “They don’t want to go to a medical facility or even speak to the doctors coming through the tent. They are afraid to know what it is for certain, even though they have thought about it. The social price for being infected is so high that there are people willing to lose their lives rather than be humiliated.”
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Because of the enormous scale of infrastructure damage, medical facilities offering treatment for HIV/AIDS have been relegated to Haiti’s major cities, making access difficult for many in the rural areas. “Programs like President Bush’s PEPFAR program provided care outside of Port-au-Prince and the Conch, but the quake has rolled much of that expansion back,” said Shadlen. “It’s amazing how much the programs have retained continuity since the quake, but for many people in the camps outside the cities, they don’t trust their local care for complicated problems. Having HIV can push you out of the communities you know and so if they’re unable to get to someone they know can help, many times they’ll just keep quiet.”
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Shalden says while the plans for transitional housing remain in the works, the group has sought out funding to provide safe shelter and programs for its members. “We need funding but we have to wait on the foundational funding cycles of many of the bigger NGOs,” noted Shadlen. “In the immediate aftermath of the quake we received support as part of the initial relief effort. In the months since, I don’t know…it feels like the eyes on Haiti turned away, things just dried up.”
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While KALMI waits on funding, their members continue to struggle to survive in the camps. Shadlen says community support is what it will take to give them renewed resiliency. “Even before the quake, so many of the parents in our group said they wouldn’t take their kids to school because of how cruelly they were treated. Now in the displacement camps, they worry because they and their children are routinely trampled on, called names,” Shadlen told MediaGlobal. “We want to offer the support that it takes to allow these families to overcome these fears, to be unafraid and say ‘I’m coming back anyways.’”

The need to invest in people, develop private-public partnerships, and reduce poverty is what is needed right now in Haiti, participants in a Global Health Council panel told a packed room at the International AIDS Society conference in Vienna June 20. Participants in the panel, moderated by Jeffrey L. Sturchio, president and CEO of the Global Health Council, were Mirta Roses Periago, director of the Pan American Health Organization; Ambassador Eric Goosby, U.S. Global AIDS Coordinator; Paul Farmer, UN Deputy Special Envoy for Haiti and co-founder and executive vice president of Partners in Health; and Jean William Pape, founding and current director of GHESKIO.
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"The U.S. Government is committed to putting Haiti in a central position to determine its future," Goosby said. This means Haiti needs to take the lead in planning and deploying its resources to rebuild its infrastructure, he said. The government also needs to look at building a bridge with civil society and find a way to institutionalize the voice of the people, of civil society. "We need to reposition the motors of decision making," Goosby said.
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Farmer, whose NGO, Partners in Health, has worked in Haiti for 28 years, applauded Goosby for the U.S. government's reversal of its "hostile approach" to Haiti for the past 200 years. "The model used in the past has not been the right model," he said. The Haitian government, which had 17 percent of its workforce killed or injured and 27 out of 28 federal buildings destroyed when the quake levelled Port au Prince, must be supported in order to build capacity, he said.
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Dr. Roses, as others on the panel, lamented that only 10 percent of the $1.8 billion pledged has made its way to the country. Never has she seen a global response as she saw in the aftermath of the Jan. 12 earthquake when there was "such a loss of life, leaders and infrastructure," she said. "Suddenly, Haiti was everybody's business." And, now, she said, support cannot wane and money must be delivered because the country needs a long-term commitment, she said. Farmer noted that the number of NGOs, who flooded the country in the aftermath of the quake, presented a serious problem, even though they came with the best of intentions. He said Haiti now has the highest per capita number of NGOs in the world with the exception of India. But there is a lack of coordination and a carrot-and-stick approach is needed to improve their performance. And the stick is money, he said, as NGOs often are driven by funding. "We need to pool resources and only make the funds available when they obey the rules of the road," he said. "Haiti does not want a republic of NGOs," he said, but its own system of governance.
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"We think the country needs a chance," said Dr. Pape, who with GHESKIO published the first comprehensive description of AIDS in the developing world in 1983. The organization now covers 52 percent of ARV therapy in the country and 47 percent of all TB cases. GHESKIO this year received the Gates Award for Global Health at the Council's annual conference in June. In the wake of unprecedented destruction, 7,000 people came to GHESKIO's campus overnight, including prisoners who escaped. GHESKIO's TB hospital had entirely collapsed, there was no electricity, sanitation, communications or water, and it lost 70 percent of its workspace. Yet, the staff continued, despite the fact that 60 percent of their homes were destroyed, 24 percent had lost family members, and their own children were in need. "We have to thank the staff, who realized they had to care for their mission," Pape said.
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Pape said Haiti needs to have money coming in to improve its infrastructure. "We see no machines, just people with wheelbarrows moving debris." Dr. Marie Marcelle Deschamps, secretary general of GHESKO, said, "There is no way we can go ahead and rebuild without the coordination of NGOs." With hurricane season on top of Haiti, thousands upon thousands of people are still living in camps." She said her priority is to see children educated instead of whiling away their time in stagnation, and GHESKIO has already started a school within the camps.
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Pape said with 1.2 million people living in tents, shelter, nutrition and job opportunities are his priorities. GHESKIO's next step, he said, is to build a model village, not just for housing but to create jobs and schools. Haitians, with on-the-job training, need to and will build their own model village on land the government has given them, he said. "We need the NGOs and government to work as one, as the public-private sector. The biggest challenge is to do that," Pape said.
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Poverty reduction is key to the future of Haiti, one of the oldest republics in Latin America, Farmer said. Hospitals, schools and houses need to be built and Haitian workers need to be paid for their labors. "Here is a chance to put millions of dollars into the hands of laborers, doctors and health workers," he said. "We need to transfer $1.8 billion into Haitian pockets to relieve poverty."
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Annmarie Christensen is executive editor of GLOBAL HEALTH and director of publications and new media at the Global Health Council.

VOA
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A new study of HIV-infected people in Haiti indicates that starting treatment early could save many patients who might otherwise die of AIDS. And starting anti-AIDS medicines earlier might also save money.The World Health Organization currently recommends that patients begin taking AIDS medicines, called antiretroviral drugs, when symptoms appear or when their CD4 count drops below 200. The count measures immune cells that are killed off by the AIDS virus, HIV.
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Beginning treatment when CD4 drops to 200 works well, but a team of Haitian and American doctors at the GHESKIO clinic in Port-au-Prince wanted to see if they could do better. In the study, patients were randomly assigned either to get AIDS medicines when their CD4 count hit 200, the standard procedure, or to get the antiretrovirals earlier, when their CD4 had only dropped to 350. Researcher Daniel Fitzgerald explains that "the results of the trial showed that the rate of mortality was cut by 75 percent if antiretroviral drugs were started earlier. And also that the rates of tuberculosis" — a common side-effect of HIV infection — "that those rates were cut in half by starting earlier."
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Fitzgerald says his randomized study provides additional support for previous studies that suggested doctors are sometimes waiting too long before beginning treatment for HIV-infected patients. "I think there have been some observational, smaller studies that suggested the same thing. So when you put these observational studies together with a 'gold standard' clinical trial, the findings are overwhelming."
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The new standard of starting treatment at a CD4 count of 350 has already been embraced by the World Health Organization and the United Nations' UNAIDS program. The new treatment protocols come as the 18th International AIDS Conference is set to open in Vienna, July 18-23. The study was conducted in Haiti, one of the world's poorest countries, with one of the highest rates of HIV infection outside Africa. Antiretroviral drugs have come down in price, but starting treatment earlier can still represent a lot of money. Nevertheless, Fitzgerald says it looks like a good investment.
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"My strong belief is that it may in the long run save more money, that we're preventing a lot of tuberculosis," he says. "We're preventing people from going into the hospital. We're making people who would have been feeling sick and maybe not being able to work as much — are able to keep their jobs. So I think the tradeoffs are enough that it's really worth it to start early."
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We reached Daniel Fitzgerald at his office at Weill Cornell Medical College in New York. The paper on early HIV treatment is published in the New England Journal of Medicine.

Alertnet
7/7/2010
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International Medical Corps and the Center for Communication against HIV/AIDS, CECOSIDA, joined forces in a push for HIV testing throughout the greater Port-au-Prince area. The initiative, which focused on community mobilization and education, targeted three communities surrounding International Medical Corps clinics - Petionville and Bolosse. The promotion led up to National HIV Testing Day on June 25, a wider effort in which the two International Medical Corps clinics provided free HIV testing to the Haitian public.
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"As a newcomer to Haiti, we are honored to be a part of such a collaborative effort in the fight against HIV/AIDS," says Dr. Jojo Cangao, International Medical Corps medical director in Haiti. "By creating National HIV Testing Day, CECOSIDA has created the perfect platform for organizations like International Medical Corps to make sure more people within our communities are tested." At Petionville Camp, International Medical Corps and CECOSIDA provided HIV education to more than 600 women through Oxfam's mother's groups and trained IsraAid's youth groups to disseminate HIV messages throughout the camp using megaphones and educational materials. Community education sessions were also held at Bolosse. CECOSIDA also facilitated the training of International Medical Corps nurses in HIV testing and consultation at all three sites in preparation for National Testing Day.
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International Medical Corps and CEOCSIDA also used the World Cup as a platform for HIV/AIDS education and printed a game schedule with HIV messages that were also shared via Haitian radio and television during the World Cup games. Since its inception 25 years ago, International Medical Corps' mission has been consistent: relieve the suffering of those impacted by war, natural disaster, and disease, by delivering vital health care services that focus on training. This approach of helping people help themselves is critical to returning devastated populations to self-reliance. For more information visit: www.InternationalMedicalCorps.org.

7/1/2010
UNICEF
By Antonia Paradela
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Jeanne (not her real name) looks lovingly at her baby daughter Marie and carefully covers her cot with a mosquito net. She is sitting in the living room of a relative’s home in Port-au-Prince, the Haitian capital, in the heat of the afternoon. For Jeanne, the birth of Marie in May was an extraordinary event.
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When the earthquake struck here in January, the 28-year-old was pregnant and receiving anti-retroviral (ARV) treatment at a UNICEF-supported clinic. Jeanne had known for years that she was HIV-positive. She carefully planned her pregnancy with her husband, following medical advice so that there would be no risk of infecting him. On 12 January, when she arrived home from work, she found that her house had collapsed and that her husband was dead. She was five months pregnant.
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In the aftermath of the earthquake, Jeanne was living in a tent camp with 20 other families and mourning the loss of her husband. With no job and uncertain about the future, she did not have access to the specialized medical care and drugs she needed. 'Jeanne' (right), who is living with HIV, was five months pregnant when the 12 January earthquake struck Haiti, detroying her home and killing her husband. Above, she talks to a worker from UNICEF, which helped to refer her to appropriate care.
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“My main concern then was what would happen to my baby if I stopped taking the anti-retroviral medication,” she recalls. “I was anxious. I wanted that everything would be fine when my baby was born.” UNICEF was soon able to re-start its support for services to prevent the transmission of HIV from mothers to babies; it was then that Jeanne resumed her ARV treatment. She had a caesarean when giving birth to Marie, and a paediatrician immediately gave the newborn prophylaxis treatment to decrease her chances of becoming HIV-positive.
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“A baby who receives prophylaxis at birth and whose mother has received anti-retrovirals has only a 2 per cent chance of becoming HIV positive,” says Mireille Tribie, an HIV and AIDS specialist working for UNICEF in Port-au-Prince. So far, tests show that Marie’s HIV status is negative. More tests are needed to determine her final status. Asked how she felt when Marie was born, Jeanne’s eyes fill with tears. Her mood fluctuates: She is happy to have Marie in her life, sad that the baby’s father is not there to share her joy. Now she wants a chance to rebuild her life to give her daughter a better future.
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Because Marie received prophylaxis treatment immediately after her birth in Port-au-Prince, Haiti, her chances of becoming HIV-positive are much reduced. Haiti’s HIV prevalence rate remains among the highest in the Caribbean, although incidence levels had declined slightly before the earthquake. An estimated 6,800 children in the country are living with HIV. UNICEF is working to ensure that HIV-positive Haitians keep receiving medical care and that those taking ARV drugs do not have to discontinue their treatment. The organization continues to support the Ministry of Health in expanding services to prevent mother-to-child transmission of HIV. And in collaboration with local NGOs, it is actively involved in prevention activities for adolescents.

3/19/2010
Associated Press
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One of the heaviest rainfalls since Haiti's Jan. 12 earthquake swamped homeless camps Friday, sweeping screaming residents into eddies of water, overflowing latrines and panicking thousands. The overnight downpour sent water coursing down the slopes of a former golf course that now serves as a temporary home for about 45,000 people.
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There were no reports of deaths in the camp, a town-size maze of blue, orange and silver tarps located behind the country club used by the U.S. Army 82nd Airborne as a forward-operating base. But the deluge terrified families who just two months ago survived the collapse of their homes in the magnitude-7 earthquake and are now struggling to make do in tent-and-tarp camps that officials have repeatedly said must be relocated.
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''I was on one side (of the tarp), the children were on the other side and I was trying to push the water out,'' Jackquine Exama, a 34-year-old mother of seven, said through tears. ''I'm not used to this,'' she said. Aid workers said people were swept screaming into eddies of water and flows ripped down tents an Israeli aid group is using to teach school.
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''They were crying. There was just fear down there. It was chaos,'' said Jim Wilson of the aid group Praecipio, who came running from his own shelter up the hill when he heard the screams. After the sun rose Friday, people used sticks and their bare hands to dig drainage ditches around their tarps and shanties. Marie Elba Sylvie, 50, could not decide whether it was worth repairing damage to her lean-to of scrap wood and plastic.
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''It could be fixed but when it rains again it will be the same problem,'' said the 50-year-old mother of four. Standing water and mud also pervaded a tarp-and-tent city on the outskirts of Cite Soleil, several miles away. Residents waded through the shallow flood collecting their belongings.
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Officials know they must move many of the 1.3 million people displaced by the earthquake before the rainy season starts in earnest in April. U.N. Secretary-General Ban Ki-moon told reporters at the golf-course camp Sunday that the people living there were in particular danger.
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But after two months of searching and wrangling with landowners, the government has still not opened any of the five promised relocation sites that are better able to withstand rain and aftershocks on the capital's northeastern outskirts. Aid groups are also struggling to open their own camps.
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''It's been frustrating to us because we need to have those sites in order to build something ... better. Until we can do that people have no incentive to move,'' U.N. humanitarian chief John Holmes told The Associated Press during Ban's visit.
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''We're running out of time, honestly,'' Holmes said.

3/19/2010
Miami Herald
BY MICHAEL VASQUEZ AND CAROL ROSENBERG
mrvasquez@MiamiHerald.com
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PORT-AU-PRINCE -- Jean Rejane Geralda's main problem isn't receiving her AIDS medications -- she hasn't missed a dose -- it's putting some sort of roof over the head of her daughter, Shara. Geralda, like hundreds of thousands across post-earthquake Haiti, has been unable to obtain even a basic tent or tarpaulin from relief agencies. As the rainy season approaches, Geralda sleeps on an uncovered mattress with her newborn child in the back yard of her quake-damaged home.
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``My bed is right on the ground,'' Geralda said, a situation in stark contrast to her AIDS-related medical care, where ``I am able to get everything I need.'' Geralda's situation highlights the fact that AIDS care in Haiti, by some measure, has rebounded faster from the Jan. 12 earthquake than the country as a whole. But the post-quake conditions still present prevention challenges -- threatening what had been steady progress for a nation that accounts for half of all AIDS cases in the Caribbean.
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In recent years, Haiti's battle to reduce that number was a quiet success story. U.S.-backed AIDS programs brought the incidence of the disease down from 10 percent to 2.2 percent at the time of the Jan. 12 earthquake. Though restoring these programs has proved easier than providing shelter to the 1.3 million people left homeless by the quake, international health organizations still worry that the disaster has dealt a severe blow to AIDS treatment and prevention efforts.
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Prevention is a challenge in the tent cities. At the city's largest encampment, where an estimated 45,000 crowd the site of an old military airport, the occasional free condom distribution is not enough, said Dr. Kobel Dubique, who coordinates a clinic there. A three-pack of condoms in Haiti costs about 15 gourdes -- less than one dollar -- but that's still more than many quake-battered Haitians can afford. ``We need to be distributing more condoms,'' Dubique said. ``And free. Free, free, free.''
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Dubique said security in the tent cities must also be strengthened, as there have been at least four confirmed rapes at the camp where he works. One woman was raped twice. Camp dwellers themselves have organized into security details to reduce crime, but these security ``patrols'' are unarmed.
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Refugee International's Emilie Parry, back from a recent visit to Haiti, warns that the impromptu settlements around the city present great risks.
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``There's no lighting,'' she said. ``Women are being attacked sexually and otherwise . . . they feel very vulnerable.'' On a positive note, doctors and administrators boast that they were able to restore services to nearly all HIV/AIDS patients receiving antiretroviral treatments within days of the quake. At the GHESKIO clinic, Dr. Serena Koenig reports that all but 5 percent of the 14,000 patients on antiretroviral drugs before the quake were continuously being treated.
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Of the rest, she said, the Haiti Ministry of Health and doctors at the clinic believe some died and the others are in the countryside, where they are eligible to continue their drug therapies.
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HIV/AIDS treatment avoided interruption because, according to the U.S. Centers for Disease Control's Dr. Steven Harris, there was already a three-month supply on the island. Moreover, the U.S. program had sponsored an electronic database of AIDS patients -- a rarity in Haiti's Ministry of Health -- which allowed for greater ease in tracking the patients after the disaster.
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Clinics that were destroyed or damaged shifted to tents or other temporary quarters. At the General Hospital in Port-au-Prince, where Geralda receives care for both herself and her newborn, blue and white tents service about 50 HIV/AIDS patients per day. That's down from the pre-quake norm of 80 per day, but the number of returning patients is continually growing. By next week, the hospital plans to have its in-house computer-tracking system up and running again and should be able to better pinpoint those patients that have gone missing.
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Meantime, Geralda receives free medicine at the CDC-sponsored facility. Giralda hadn't planned on getting pregnant -- she says she was practicing safe sex -- but with the help of AIDS medications that she took during pregnancy and now administers to her newborn, there's a good chance that the child can avoid contracting the disease. ``I get very good care here,'' she said.

3/9/2010
Nature Medicine
E.Dolgin
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Haiti, which once had the highest rate of HIV and AIDS outside of sub-Saharan Africa, has in recent years seen a decrease in infections. Once lumped into what some called the US Centers for Disease Control and Prevention’s ‘4-H club’ of risk factors—homosexuals, hemophiliacs, heroin users and Haitians—the country’s HIV incidence plunged from around 6 per cent in 1995 to closer to 2 per cent in recent years.
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But the 12 January earthquake that shattered the lives of Haitians and destroyed more than half of the AIDS clinics in Port-au-Prince could threaten to reverse this progress. Profamil, an affiliate of the International Planned Parenthood Federation (IPPF), saw two of its clinics, one in Port-au-Prince and another in Jacmel, reduced to rubble in the quake. After the disaster, it organized mobile health units to provide basic health care and HIV prevention services to the temporary shelters in and around both cities.
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Even so, “the distribution chain is uneven because of the chaos,” says Carmen Barroso, IPPF’s director for the Western Hemisphere, who worries that antiretrovirals and contraceptives are not getting to all those who need them. The Gheskio clinic, among the oldest non-governmental organizations working in HIV and AIDS care in the world, also experienced earthquake damage. The walls around its downtown Port-au-Prince site and its satellite campus near the airport were destroyed, and a laboratory at the downtown site was sealed off after vials of pathogenic tuberculosis bacteria shattered.
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But many of the clinical buildings at Gheskio’s downtown complex sustained only minor structural damage. This allowed the center, which provides antiretroviral therapy to more than half of all patients in Haiti, to maintain HIV care and attend to the more than 6,000 of newly homeless people who camped out on Gheskio’s three-acre downtown property. Ultimately, the Gheskio clinic was back up and running within 24 hours of the quake.
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“I was utterly amazed by how rapidly they were able to reorganize, regroup and get right back to their mission,” says Kenneth Hover, a structural engineer at Cornell University in Ithaca, New York, who traveled to Haiti a week after the quake to assess the safety of the Gheskio buildings.
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Thanks to a disaster contingency plan, people with HIV and AIDS in Haiti had two weeks worth of extra drugs, and Gheskio staff also carried extra supply. This reserve ensured continuous treatment until an emergency shipment of drugs from the US President’s Emergency Plan for AIDS Relief arrived one week after the quake. Around 65 per cent of Gheskio’s 7,000 patients on antiretroviral or tuberculosis drugs are now receiving their medications at the main clinic in Port-au-Prince; another 15 per cent are going to four designated satellite sites throughout the city; approximately 20 per cent of patients remain unaccounted for.
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But just because HIV-positive Haitians have access to antiretrovirals doesn’t guarantee that they will maintain their treatment regimen, warns Maeve McKean, a legal fellow at the International Community of Women Living with HIV and AIDS and at the Center for Health and Gender Equity in Washington, DC. “If people don’t have food, they won’t take the drugs because it makes them so violently ill,” she says.
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"What’s more, McKean adds, because of the economic insecurity, many women desperate for food and shelter are likely to resort to sex work or stay in unhealthy relationships, which will further erode gains made in stemming the tide of HIV. “There’s at least been a setback of five years,” she says.
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As Nature Medicine went to press, the Haitian government’s ministry of health was still working on its own national plan to respond to the HIV and AIDS epidemic. The office of the country’s National Strategic HIV and AIDS Plan, first launched in 2002, was decimated by the quake.
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“It’s a very long job at this moment,” says Barbara Renamy, an advisor on communicable diseases for the Pan American Health Organization. “If the government at the central level is not working very well, you can only imagine what it’s like at the different departments.”

World Bank says greater prevention efforts needed to reverse course of HIV/AIDS epidemic
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Date: 01 Dec 2009
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Press Release No:2010/169/HDN
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WASHINGTON, December 1, 2009 — Marking World AIDS Day 2009, the World Bank today urged countries and their development partners to intensify their efforts to prevent new HIV infections to curb the continuing spread of the disease, and reaffirmed its own commitment to fund effective HIV/AIDS prevention, care, and treatment programs in developing countries.
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At a high-level World AIDS Day event this morning at Bank headquarters, a new study of HIV-infected adults in Haiti, supported by the Bank, showed that poor nutrition, aggravated by rising food prices, is reducing the effectiveness of life-saving AIDS drugs in adults who are chronically hungry and suffer from weak immune systems as a result.
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World Bank Group President Robert B. Zoellick applauded the considerable achievements by countries and development partners in expanding access to HIV prevention, care, and treatment, while also noting the enormous challenges that remain. Preventing new infections, he said, remained vital to reach the Millennium Development Goal of halting and reversing the HIV/AIDS epidemic.
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"Intensifying efforts to prevent new infections is essential if we are to ensure that AIDS treatment is sustainable. We have to reach more of those who are at greatest risk of contracting and transmitting HIV. A barrier to all our efforts against this disease is the stigma and discrimination experienced by people with HIV. This has been reduced—but it is not gone by any measure," Zoellick said in opening remarks to a high-level audience that included the Honorable Jack Lew, U.S. Deputy Secretary of State; Michel Kazatchkine, Executive Director of the Global Fund to Fight HIV/AIDS, TB, and Malaria; and Ambassador Eric Goosby, US Global AIDS Coordinator and Head of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
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Zoellick also reaffirmed the Bank's sustained commitment to funding effective HIV/AIDS programs, and added that an important factor that has hindered progress on HIV has been the lack of food security,"because when people do not have enough food to eat, treatment is less effective."
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Reinforcing the links between nutrition and effective AIDS treatment, the new Haiti report shows that hunger further weakens the immune systems of HIV-infected adults and undermines the effectiveness of their life-saving AIDS treatment.
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Dr. Bill Pape, who is Executive Director of Haiti's GHESKIO Centers and Professor of Medicine at Cornell University's Weill Medical College, said that the risk of developing AIDS and/or dying could increase by 36 percent in HIV-infected people with high levels of hunger and poor nutrition as compared to other infected adults with enough nutritious food. The new study, part of a larger research program by Cornell University, the Weill Medical College of Cornell University, and Haiti's GHESKIO Centers, provides the first-ever clinical evidence linking hunger to immune dysfunction and lower numbers of white blood cells, showing the combined impact of poverty and hunger on people living with HIV.
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Haiti, Afghanistan, and Somalia have the worst daily caloric deficit per person (460 kcal/day) in the world. With 56 percent of Haitians living on less than US$1 per day, many cannot afford to eat and malnutrition is widespread. Pape said that low baseline weight is an independent predictor of mortality in adult AIDS patients receiving antiretroviral treatment. Studies from Haiti and other countries also show that anemia is strongly associated with rapid HIV disease progression and death.
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World Bank and HIV/AIDS
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For its part, the World Bank has provided long-term support to countries since the mid-1980s for effective prevention of new HIV infections, care and treatment for infected people, and alleviation of the devastating social and economic consequences for affected families and communities. Over the past three years, the Bank has committed almost US$1 billion through grants, loans, and credits to HIV programs. Total Bank financing for HIV/AIDS since 1988 is more than US$4.2 billion. The Multi-Country HIV/AIDS Program (MAP) for Africa has made available US$1.9 billion to 35 countries, including five sub-regional (multi-country) initiatives.
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The expansion of AIDS treatment in poor countries also has thrown a spotlight on the weak and fragile state of their health systems. With just over five years left for countries to achieve the Millennium Development Goals, the Bank and its development partners have mobilized to spur better health results through stronger health systems. Countries need better health systems to deliver more effective HIV/AIDS prevention, care, and treatment services; better detection and treatment of TB and other opportunistic infections; and better health services—including for pregnant women and to enable more women to deliver their infants safely, helped by skilled attendants.
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To learn more about the World Bank Group's development response to HIV/AIDS and to view Dr. Bill Pape's new Haiti study, please click here.
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Contacts:
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Phil Hay
(202) 473-1796
phay@worldbank.org
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Melanie Mayhew
(202) 458-7891
Mobile: (202) 406-0504
mmayhew1@worldbank.org

Read the statement by the Dominican President Leonel Fernandez, then Clickon the link below to watch a video related to this issue:
http://www.youtube.com/watch?v=yOlu57YyBEg
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Released and signed by:
HECTOR PASTOR VASQUEZ FRIAS
Counselor Minister
Dominican Embassy, Haiti
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BY PASTOR VASQUEZ (Translated from French)
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The president of the Dominican Republic Leonel Fernández raised his voice in Spain (commonly called the Motherland by the Latin Americans) so that Haiti,
our closest neighbor, is including in the Latino-American community. The president of the Dominican Republic underlined that it would be an actof historical reparation to include Haiti in the Latino-American Community, owed, among other reasons, because it was the nation which marked the best example of abolition of slavery for the first time, with the revolution of the slaves which Toussaint Louverture had begun before the Haiti's Independence which was proclaimed in 1804 by Jean Jacques Dessalines.
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President Fernández had underlined that the island Hispaniola was legally the possession of Spain until 1795 when the convention of Bale was signed,
although in 1606, when the governor Antonio D' Osorio deforested the West party, Spain did not any more have interest in this part of the territory. In the Spanish party of the island there was not racial revolution, as in the case of Haiti, for reasons which do not need to be now clarified, but Spain cannot break loose from its historical responsibility in the fierce and brutal slavery against which the slaves struggled so that the west party of the island becomes what they know as Haiti today, because Spain was the one that introduced and spread the seeds of slavery and slave trade throughout the whole island at the beginning of the XVIth century.
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To include Haiti into the Latino-American summit would be not only a historical reparation but also recognition to a people that is the symbol of
struggle against slavery. The voice of President Fernandez had an echo resounding in various international forums. The first state leader to be pronounced in favor it is president Daniel Ortega of Nicaragua, who said that Haiti is located in Latin America and that it has a very close rapport with the Latin-American world and it deserves full integration in multilateralism.
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Let us say that in August of the 2008, the Vice-President of the Spanish Government, María Teresa Fernández de la Vega had visited both countries of
the island and she had promised a broader collaboration of Spain towards Haiti which includes hundred million dollars donation in the plans of
development for the years to come. The proposal of the President Leonel Fenandez could not be more timely because hours later the General Secretary of United Nations had announced the nomination of the former U.S. president Bill Clinton as special Envoy for Haiti.

http://bit.ly/nejgheskio>http://bit.ly/nejgheskio .
Dear partners and friends of GHESKIO,
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The August 20th edition of the New England Journal of Medicine released (<)>) follow up data detailing the outcomes of GHESKIO patients after five years of receiving anti-retroviral therapy (ART). Prior to the advent of ART in Haiti in 2003, 90% of AIDS patients were dead in less than 1 year and all were dead at the end of 2 years.
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We are pleased to report findings that patients followed after receiving ART had a 90% survival rate after 1 year and a survival rate of 79% after five years, an outcome comparable to the most advanced hospitals in the United States. Attached please find both the five year follow up data from this month's NEJM as well as the one year study in NEJM published in 2005.
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GHESKIO physicians who began this battle in the late 1970s would not have dreamed that this day would have been possible less than thirty years from the days when the disease was barely defined, let alone thought survivable. We are grateful to all partners, colleagues, and supporters and look forward to continuing our work together towards the realization of an HIV/AIDS free Haiti.

Date: Thursday, July 30, 2009
Source: National Public Radio (NPR)
Author: MICHEL MARTIN, host:
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We turn now to Haiti. That nation is often in the headlines for bad news. The recent deaths at sea, and Haitian's fleeing the country, the grinding poverty plaguing its citizens. Haiti struggled to overcome decades of government ineffectiveness and corruption, but now Haiti claims a remarkable success story. In the last 15 years, the HIV infection rate there stabilized and then dropped. For example, in Cite Soleil, the largest shanty town in Port-au- Prince, the U.S. census bureau estimates that the rate among pregnant women tested dropped from 10 percent in 1988 to 2 percent in 2004.
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Although Haiti continues to rank fairly high in HIV rates, the turnaround is remarkable for a nation that was once considered the Western Hemisphere's ground zero for HIV transmission in the early 1980s. Joining us to talk more about this is Judith Timyan. She is the senior HIV/AIDS advisor for the U.S. Agency for International Development in Haiti, and she joins us from her office in Port-au-Prince. Thank you so much for talking to us.
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Ms. JUDITH TIMYAN (Senior HIV AIDS advisor, U.S. Agency for International Development in Haiti): You're welcome.
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MARTIN: So, Judith, tell me why, why have the HIV/AIDS rates gone down? What's Haiti doing right?
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Ms. TIMYAN: Well, Haiti has an old epidemic. It was one of the first countries where it was identified as a disease. And so therefore the Haitians had been working on the responses to this disease for a very long time. The prevention efforts at the very beginning of the epidemic, CSA in the '90s were very intensive, were very strong, and there's been very good research. There's a lot of very good local organizations that have been involved in the implementation and an intervention since the beginning. And the U.S. government and U.S. private institutions and universities have partnered with the local organizations. And I think it all together have been doing a very good job of addressing some of the issues that we know permit the transmission of the disease.
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MARTIN: Well, like, for example, what? Are there specific groups that you've worked with, specific populations that you've targeted for this intervention? Who are they?
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Ms. TIMYAN: Some of the core - as we call, the core transmitter groups are the commercial sex workers. I think early on there were some very good and there still are some very good programs to promote condom use and to promote education of clients and education of partners of the commercial sex group. Another early on element of the transmission was unsafe blood supplies and strong efforts by the Haitian Red Cross to improve the blood supplies, so that that is no longer a transmission element. And then other programs are working with the youth, you know, that has a very high youth population. Youth leaders are trained in peer education and are working with their peers on prevention messages and safe sex messages and all those things have worked quite well.
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MARTIN: Haiti still ranks high among Western nations in terms of HIV infection rates. Do you think that you and others working in this field can get the rates down even lower, and how?
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Ms. TIMYAN: I do believe we can get the rates down lower, and I'll tell you one of the reasons why. With the recent increased funding that the U.S. government and the global fund for AIDS out of Geneva has provided to Haiti for care and treatment. Because don't forget, now that we are now identifying increasing numbers of the HIV-positive persons in this country and providing them treatment - and when you are identifying bigger and bigger percentages of the people that are positive, you can actually target them with interventions or to encourage them not to be transmitting the disease - with, you know, encouraging condom use, encouraging safe practices among couples where one is positive, one is negative, and then really increasing our efforts to prevent the transmission of HIV from mother to child when a woman is pregnant.
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So there are some very, very specific prevention strategies that get more and more effective as you find out who is positive in the country, I mean, identify all the positive people, yes.
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MARTIN: And Judith, finally, a recent report found that HIV/AIDS cases jumped 22 percent here in Washington, D.C. - this nation's capital - since 2006. Do you think there's anything that public health officials and other officials here can learn from how Haiti has handled the disease?
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Ms. TIMYAN: I don't know too much about the whole social context and the whole transmission context of the HIV rate in D.C., but I will tell you that there is one important element of how we have been addressing, or the Haitians have been addressing, the HIV/AIDS here, and that is with a holistic approach - providing a full range of services from, of course, the health care and the ARV treatment. Also, social, psychological, nutrition, legal counseling and accompaniment or being with that person and their family to take their drugs. And I think that holistic approach really has a very positive effect on, not only the care of that person and the family, but also would reduce the transmission rates.
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MARTIN: Judith Timyan is the senior HIV/AIDS adviser for the U.S. Agency for International Development in Haiti. She joined us by phone from her office in Port-au-Prince. Judith Timyan, thank you so much for speaking with us.
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Ms. TIMYAN: You're welcome.

On one hand, Haiti has been successful in reversing its HIV/AIDS epidemic which preserves lives, families, and communities. But as you say, there are other public health issues, water/sanitation chief among them, that are major challenges as well. I dont think other public health issues have been neglected, just that HIV/AIDS is the only disease for which the international community has made available the level of funding needed to make progress.

This is good news indeed. My only concern is whether this success has been achieved at the expense of investment in other very important public health issues (drinking water qality for instance).