HIV/AIDS, Public Health

A New Approach is Needed for HIV/AIDS Treatment in Haiti

Published in Woy magazine 

At 28 years old, Mariette is a young energetic woman caressing hopeful dreams for her child. She mourns the death of her husband, who recently passed away from AIDS (Acquired Immuno Deficiency Syndrome). Also infected by the HIV virus, she regularly receives a triple-drug therapy at the Justinien Hospital at Cap-Haitian. Regularly, Mariette and her daughter make the 45 minute trip from her hometown Limbé to Cap-Haitian to receive treatment. Like Mariette, many HIV-infected patients living in areas around Cap-Haitian travel to reach the Justinien Hospital for regular biological and clinical follow-ups.

Mariette is one of the lucky few able to benefit from antiretroviral treatments. While antiretroviral drugs have been available in industrialized countries since 1996, it was not until 2002 that Haiti received a substantial donation from the Global Fund to Fight AIDS, Tuberculosis and Malaria which led to the first treatment programs by two organizations fighting the disease on the field since its early days. In that same year, the World Health Organization released guidelines for the treatment of HIV/AIDS for the first time in history.

Despite such tremendous progress, not every infected patient could benefit from therapy immediately after diagnosis, mostly because of the high cost of treatment and the lack of health insurance. As noted by United Nations Program on HIV/AIDS, “by 1998, while 95 percent of people with HIV were living in poor countries, almost none had access to antiretroviral therapy, which then cost $12,000 to $16,000 a year per patient.” Among other reasons, it seems that this is how the World Health Organization determined patients’ treatment eligibility because it was simply too expensive to provide medication to everybody; so they prioritized the patients who were in more advanced stages of the disease, those who were much sicker. Therefore, it was not until Mariette became very sick that she was finally admitted to the hospital and was declared eligible for drug therapy in accordance to the 2010 guidelines, which are currently used in Haiti. This delay, from the diagnosis time to the start of her treatment, increased the risk of transmission in addition to other health consequences. Unfortunately, this is currently the story of millions of other HIV-infected people.

However, to decrease the spread of HIV/AIDS and ultimately eliminate it by 2020, scientists are planning a bolder strategy, named “test-and-treat”. The suggested strategy entails the initiation of therapy immediately after a positive HIV test, regardless of the biological and clinical parameters, as it used to be. Regarding this new approach, a recent publication on the medical journal The Lancet stated that: “Instead of dealing with the constant pressure of newly infected people, mortality could decrease… Transmission could be reduced to low levels and the epidemic could go into a steady decrease towards elimination.” As of this writing, test-and-treat represents the core strategy in WHO guidelines for HIV treatment, published in September 2015, 13 years after the original publication. If the Haitian government works to apply this as part of the national plan to eliminate HIV/AIDS in Haiti, more people like Mariette can start therapy sooner than she did and will have a higher chance of survival, without passing the virus to another generation.

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Today, Haiti is at a crucial point in the history of the 30 year-old pandemic, but faces many challenges to achieve the desired goal. In order to meet the gigantic promises of test-and-treat, the Haitian government must work towards a sound reinforcement of the healthcare system with a focus on the people by preventing the massive exodus of qualified health professionals. The fight against discrimination and stigma must become a priority, because every man’s life is valuable no matter his status in society. The number of testing centers in Haiti must increase for early detection.  The government needs to establish adequate cooperation with international partners in order to have available drugs for every infected patient. And most of all, we must continue to educate the youth about this virus. Marie-Ange, Mariette’s daughter is only twelve years old. However, Mariette ensures that she transmits her knowledge and experience fighting HIV to her young daughter. At the end of the day, as the sun began to retreat, Mariette boarded another tap-tap with her daughter to rejoin their community in Limbé. Because of the antiretroviral treatment, Mariette continues to hope.

 

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HIV/AIDS, Public Health

HIV/AIDS and Discrimination: A wrestling history

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As I was completing a two month internship in Brussels, I surprisingly noticed that my coworkers knew little to none about Haiti and its troublesome yet tremendous history. Their rare assertions turned around the political instability and discriminating facts pertaining to the HIV/AIDS epidemic evolving in the country since at least three decades. As a matter of fact, the HIV virus (isolated by Robert Gallo and Luc Montagnier in 1983) has originated in West Africa and spread to humans since the early 20th century. Since the very first years of this 30 years-old pandemic, discriminating ideas have travelled the world and survived until today, even among the most academically educated people. Looking at the history of the deadly disease, I’ve come to realize how the fight against social and ethnic discrimination has led to outstanding progress towards a better future.

The year 1981 marked an astonishing turning point in human history. On June 5 of that year, the Centers for Disease Control and prevention (CDC) published a report of five cases of a rare lung infection known as Pneumocystis carini pneumonia (PCP) among gay men in Los Angeles, USA. In New York and California, cases of a rare cancer, Kaposi’s sarcoma, were also reported to the CDC in the same period, leading to a total of 270 cases in the USA, by the end of the year. The general press prompltly used the terms “gay related immune deficiency” and “gay cancer” to describe the new disease and suggest a link between homosexuality and the disease.

On 1982, among the cases reported to the CDC, 34 were Haitians residing in the USA and eleven in Haiti. This discovery has led the CDC to conclude that being Haitian was a separate risk-factor for the newly spread disease and coined the term “4H disease” to point out male homosexual, heroin users, hemophiliacs and Haitians as at-risk groups. With such a denomination, it was the beginning of an unprecedented discrimination era based on sexual orientation and ethnicity. In a study published in 2010, it is stated that the HIV discrimination against Haitians resulted in the devastation of Haiti’s fragile economy.

The discrimination had serious consequences in regards to the spread of the disease. People with symptoms suggestive of the newly identified syndrome lived by fear of rejection, quarantine or violence. Until today, discrimination remains a challenge when it comes to treating the disease. It is a common factor contributing to delayed treatment in HIV cases, even in developed countries. It also impairs the public health strategies dedicated to test at-risk populations and control the epidemic. Therefore, the fight against AIDS has always been tightly linked to the fight of discrimination. At the time of “4H disease” there was a social, cultural and scientific (because of a poor understanding of the new syndrome) barrier which threatened the proper management of the epidemic.

100.000 Haitians protested in NY against FDA policy on blood donation Photo credit: @carelpedre twitter account. April 20, 2015 @ 7:55 AM

100.000 Haitians protested in NY against FDA policy on blood donation
Photo credit: @carelpedre twitter account. April 20, 2015 @ 7:55 AM

In this context, an unexpected event happened in the United States. On 1983, a New York doctor was threatened with eviction from his building for treating HIV patients. It led the Lambda legal group and Gay Men’s Health Crisis to file and win the first AIDS discrimination lawsuit in the USA. And, in July, the U.S. Congress enacted the Americans with Disabilities Act (ADA) which prohibits discrimination against individuals with disabilities, including people living with HIV/AIDS. Even though discrimination against gay communities persists today, this was a shining light spread upon the entire world regarding the necessity of banning stigma.

Years later, in New York, home of the largest Haitian diaspora community, 100.000 Haitians assembled and marched on April 20, 1990 in protest against a decision of the CDC forbidding Haitians and sub-Saharan people to donate their blood to blood banks. As reported by the New York times, Dr. Jean Claude Compas, said, “This policy is on the basis that Haitian blood is dirty, that it is all infected with the HIV virus. The decision is based not on sexual preferences, but on nationality, ethnicity.” Placards mentioned: “We’re proud of our blood,” and, “Let’s fight AIDS, not nationality.” Following this protest, a Food and Drug Administration (FDA) advisory committee voted to urge the CDC to abandon their policy based on exclusion.

100.000 protesting in NY against FDA policy on blood donation Photo credit: @carelpedre twitter account. April 20, 2015 @ 7:55 AM

100.000 protesting in NY against FDA policy on blood donation
Photo credit: @carelpedre twitter account. April 20, 2015 @ 7:55 AM

There is no doubt that in every corner of the world, discrimination against HIV infected people of any social category and ethnicity has been fought with vigor. In the light of the essential principles which guide humanity, AIDS is regarded today as a chronic disease and infected people ought to be cared for with the utmost dignity. To repeat the words of Ambassador Deborah L. Birx, “We won’t see an end to the epidemic as long as people living with HIV/AIDS feel unsafe and are forced to the fringes of their communities” The two major events described in this article have helped the world acknowledge how critical the battle for human rights has been in insuring a better future for all. Haiti is experiencing a declining prevalence since 1990. In this era of globalization, it can only be great news for the world. But this success is fragile and our common effort is required to sustain it. Share this paper in order to raise awareness on the need for inclusion and respect of all human rights no matter their health status.

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