For years the medical and international aid communities were under the erroneous impression that the poor could not be counted on to take medications on a timely and consistent basis like those living in developed countries. Well, it appears that we can finally put the final nail in this misconception, and confidently state that it does not matter if you are rich, poor, black, white, South African or Haitian, if life-saving medicine is made available, people will take them when and in the amount they are supposed to. This was reiterated in today’s Miami Herald, which ran an article entitled “Amid unrest, Haiti gains in fight on AIDS.” While the article illustrated the ability of rural Haitians to take HIV medication on a consistent basis, rarely missing doses which could lead to mutation of the disease, it also reminded us that while Haiti has made great strides in HIV prevention (lowering HIV prevalence among adults from 6% to 2-3% in a decade) now is not the time to become complacent.

Some unsettling issues brought up in the article include:

- The description of patients who become distraught when they learn that they do not have AIDS. The health care provided to those with AIDS is so superior to other diseases, that it is quickly becoming the one disease that Haitians can find sufficient treatment. It is great that HIV treatment is available, but when people start being disappointed that they don’t have the disease, we have to examine what inequalities exist in the country’s health care system.

- Most of the HIV treatment dollars went directly to a handful of nonprofit healthcare groups, largely bypassing government agencies. While development dollars MUST go to the organizations that are the most proficient and effective in delivering care, government agencies should be brought into the process in order to learn how good organizations work. Haiti is currently being carved out by development organizations, with government health agencies unable to provide any type of unification among those providing care.

- Life expectancy in Haiti is 53 years for men and 56 for women. One child in eight dies before the age of 5. Simply pathetic and inexcusable.

- Without a road, patients can’t get to the clinic. Another reminder that health care does not exist within the vacuum of the clinic or health care system. Attack the diseases first, but remember that sustainable health care requires us to think in a more holistic approach. We need to start by putting the band aids on the bullet holes, but some day we’re going to have to take the guns away.

Haiti and the organizations that are working there are doing a great job at combating the spread of HIV, but we must not become complacent in addressing the other issues presented in this article. We’ve made great strides, but there is still work to be done.

Chris Schron