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).