Global Health, Public health concern, Social Issue

On the shades of violence in Haiti

When we first moved to our current neighbourhood ten years ago, the sides of our impasse was occupied by poorly maintained shrubs and houses isolated from each other. Only one car could manage to go through a narrow path left between the trees. Acquaintances often quipped about us living in such a remote place, hardly accessible and sometimes dangerous, given the numerous cases of kidnapping that had occurred there in the past. Indeed, the main avenue was not even fully concreted and huge potholes spread along the road. But ever since the earthquake hit, people from diverse and unknown backgrounds have settled on unfenced lands nearby, slowly changing the settings. Retail sale of clairin, a popular alcoholic cocktail, has flourished since then and round the clock gambling also attracts many young unemployed. Gun related and gender specific violence were quickly added to the picture, outlined by injuries, addiction and mental health issues.

Over time, we got used to the times when drunken men cause inconvenience and to the days when quarrels over money or marriage issues block access to our home. But as an extreme example of how unchecked violence has spread, three young men were recently found dead on the streets, killed by heavy gunfire heard during the night. Surprisingly when it comes to violence, young people seem to be the most vulnerable. Violence claims the lives of 200,000 young people per year worldwide and represents the 7th cause of death in Haiti.

The disastrous political context of the country during the last decades has shaped the minds towards believing that violence is inevitable. Not only have people engaged in violent acts for the smallest rewards, but many accustomed to political turmoil think of violence as a substantial part of their daily life. The general public and the policy makers consider violence more as a banal indicator or trend, going up and down but never as an issue plaguing their own personal and community health. In our communities, the trivialization of violence is in fact, the result of inaction which results in more violence, repeating a vicious cycle and accumulating into increased cases of serious injury, chronic diseases and perhaps lowered life expectancy.

The popular culture has long encouraged violence against women through apologies of machismo and the objectification of women. It goes without saying that despite women’s rights activists’ campaigns, they remain the largest target of verbal and physical violence. Misogynistic words being too often valued and praised, they somehow abound in the media, accompanied by degrading images of women and hateful mocks. Even in my youngest years growing in Cap Haitian, the tendency to disregard women and LGBT communities’ values had already been deeply rooted in most boys my age. So it was not surprising that, as a medical intern in Cap-Haitian decades later, I couldn’t keep count of the cases of gender-related violence registered in the emergency service. There were even cases where serious burns were the consequence of such domestic violence.

Besides the factors mentioned above, structural violence seems an even more important cause of physical violence. The lack of education, unemployment, social and economic inequalities, exclusion, gender-based, racial or religious discrimination and poverty among other factors stand as complex mechanisms preventing many people from defining and fully realizing themselves. In the countryside, the absence of an efficient mean to uphold justice leaves enough space for violent conflicts over land tenure, often leading to deaths. Although there are no excuses to violence, it is rooted in a highly unequal society, which leaves very little opportunities through decent jobs and an environment to realize one’s potentials. As a matter of fact, the World Health Organization referred to concentrated poverty, easy access to alcohol, drugs and guns and weak governance as main risk factors for youth violence. And as far as we know, the daily lives of most occupants of cluttered neighborhoods in Haiti consist of much of these factors.

Although the population may rejoice in the brutal murder of robbers, these acts may not be more than a Band-Aid on a deep wound, if the core problems remain unaddressed. Perhaps it would be useful to keep engaging all communities proactively in order to expel the idea that violence is normal and inevitable in Haiti. Communication should counter the idea that the situation is acceptable today simply because it was worse 12 years ago, because no level of violence is suitable. It will be mandatory, to teach or keep reminding our communities the fact that women are equal to men both in their body and their mind. School children should be taught that violence makes orphans and leads to many health consequences. If young people are offered the opportunity to play a role in their country’s path to development, if they are able to support their families with dignity and respect for others’ property, it will certainly make a difference and that is definitely a worthy investment for the future.

Cluttered neighborhood

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HIV/AIDS, Public Health

HIV/AIDS and Discrimination: A wrestling history

wrestling

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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