Amid multiple crises, Haiti’s efforts to fight HIV continue as best they can

Recently, many Americans have been outraged to see images of Border Patrol agents on horseback fending off Haitian immigrants from crossing the Rio Grande River from Mexico to the United States by lashing their horses’ reins in their face like whips. The invocation of haunting images of 19th-century slave hunters caused an uproar, leading the Biden administration to say the Border Patrol would no longer use horses.

One thing many observers did not know was that many Haitians trying to cross the border did not come directly from their island nation. They had already been living in Brazil and Chile since the earthquake devastated Haiti in 2010 – and decided to leave recently because the COVID pandemic made jobs there scarce.

Another thing that lost a lot of onlookers was that border patrols hunting down Haitians were just the latest episode in a long history of US mistreatment of Haiti and Haitians. Haitian-American writer Edwige Danticat pointed out in the New Yorker in the wake of Fury of the Horses that during the early 1990s, the United States used the Guantanamo camp before 9/11 to detain Haitians who had fled their country after a military coup in 1991. The coup (some of whose leaders had been trained by the states) toppled the coup. United States or on CIA salaries) by the first democratically elected president, Jean-Bertrand Aristide. The Obama, Trump, and Biden administrations have supported the corrupt and brutal regimes in Haiti. The violence-torn country is awash in American-made weapons.

In short, the United States continues to prevent Haitians from seeking relief in the United States from the violence and instability of their country in which America has played a major role.

On the other hand, in an example of how the United States sometimes works to alleviate crises in other countries, it has treated HIV in Haiti through its global AIDS relief program, PEPFAR, and its participation in the global relief program, the Global Fund. Both programs allocated significant funding to systems that provide treatment, care, and other services to the nearly 150,000 Haitians living with HIV — the largest such number in the Caribbean.

PEPFAR alone, since it began in 2003, has pumped hundreds of millions of dollars there, supporting a network of HIV/AIDS clinics and service nonprofits across the island nation. The 2020 PEPFAR report found that Haiti has high rates of people with HIV being diagnosed, treated, and undetectable — all good things — yet the rate of those not receiving care outnumbers those who receive it. Thus, only “modest gains” have been made towards reaching the numbers that would effectively end the HIV epidemic there.

And it was all before 2021, when Haiti — the poorest country in Latin America and the Caribbean, with about two-thirds of its population living on less than $2 a day — was in trouble. This includes the assassination of its embattled president, Jovenel Moss, in July, which plunged the country into social and political chaos. Then, in August, an earthquake that killed more than 2,200 people was followed by more devastation than Tropical Storm Grace.

Despite these upheavals, HIV/AIDS advocates there say the biggest barrier to services has been the COVID pandemic. Just a week after the assassination, Haiti, lagging behind many countries, finally received half a million doses of the Moderna COVID vaccine from the United States, but recently, the country is still second only to the world in terms of the percentage of the population fully vaccinated. – less than 0.1%.

Soeurette Policar, executive director of ODELPA, which works with HIV/AIDS nonprofits across Haiti and leads those groups’ monitoring of HIV clinics across the country against discrimination and stigmatization by staff. “When we first noticed COVID here, it was like I had leprosy – so people with HIV were avoiding going to hospitals to get their medication for fear that people would think they had COVID.”

Since then, Polekar says, more people with HIV have returned to care, sometimes motivated by home visits from social workers. “We’ve all struggled not to lose the great progress we’ve made here in terms of adherence to HIV treatment,” she says. “Now we have people going back to health centers after being away for six months.”

According to Eva Stead, acting in-state director of the New York City-based Nonprofit Housing Business Program in Haiti, the quality of services for people living with HIV has improved and even remained the same throughout the country’s problems due to nonprofit organizations. HIV Centers Surveillance Programme, a model that has been adopted by African countries.

“This has given us data on where we need to do more to provide appropriate services, including education about HIV itself, so patients know what they are facing, and making sure health centers have social workers on hand,” Steide says. To support patients, especially when first starting treatment. In a poor country like ours, low-paid employees often show their frustration on patients.” This, Steide says, is something the monitoring program, officially called the CSO Observatory, is alerting to.

The program revealed huge disparities in HIV care across this country with an area of ​​just over 10,000 square miles and 11.4 million people. “Some centers are really models, taking care not to separate HIV patients from the rest of patients, making them identifiable and vulnerable to stigma,” Steide says. “But others are just disasters.”

She says that typical behavior in a poorly performing center may include employees who freely and unnecessarily disclose the status of HIV-positive patients to other employees. They’ll say, ‘Be careful of this guy – he has AIDS. “At one center, she says, a staff member scolded a patient saying, ‘I’m not the one who gave you HIV — you got it yourself.'”

Stead and Polikar say the primary problem is the absolute poverty of many people living with HIV. “They’re homeless and unemployed, without proper nutrition, and if you don’t have a job, you can’t support yourself,” Stead says. She adds that the PEPFAR DREAMS programme, which was created to provide educational and vocational support to young women at high risk of HIV infection in PEPFAR beneficiary countries, is only available in more than half of Haiti’s 10 regional departments.

“We need more income-generating activities for people living with HIV,” Stead says. “We’re not talking about millions of dollars – just money to start a small business.”

Another fundamental problem in Haiti is the persistence of discrimination in the country towards gays and transgender people – two groups in the country that are severely affected by HIV. “Religion is very prevalent here,” says Stead of Haiti, which has a population of 96% Christian, mostly Catholic due to its French colonial history. However, she says, “It’s a slow process, but people here are learning to live with it [gay and trans people]The LGBTQ community is getting stronger and less fearful, especially when they’re in public groups.”

In fact, she said, there was a festival held in the L’Artibonite section in late September, which attracted over 10,000 people, most of whom were gay and transgender people. “The crowd didn’t attack them, and they enjoyed the show,” she said proudly.

Polecard says the need to improve security in Haiti is critical. Right now, she says, gangs are in control of most of the country, sometimes making it difficult for people to get to hospitals and other essential destinations.

It was echoed by Charles King, CEO of Housing Works, who makes several trips a year to Haiti where there are two Housing Works clinics as part of its program in Haiti. After the earthquake devastated the country’s southern peninsula, he and others hired police to escort them there from Port-au-Prince to deliver tents and hygiene kits to partner organizations because the road was controlled by gangs.

“There were times when it wasn’t safe to go more than two miles from the airport,” he says. When a gang invites violence in the streets, everything is shut down and it is very difficult for everything, including the economy, to function. It is not at all clear when the next elections will take place.”

Stead says that given Haiti’s chronic turmoil, she wishes the US would treat Haitian immigrants more humanely by giving them a chance to obtain asylum rather than detaining them at the border and deporting them to Haiti by plane, as the US recently did with Title 42. Trump-era policy, which Biden has continued it, denying border-crossing and asylum hearings, as dictated by international law, arguing the COVID public health emergency.

“For the past 30 years, we’ve gotten used to nature, our politicians, and foreign powers,” Steide says. “No wonder everyone flees. Everyone wants a place to live in dignity and safety. If the conditions here were right, Haitians would be here. We are a beautiful country with good food and good people. But when you have so many things that hinder opportunities, what do you think people will do?” We are strong, resilient, hard-working people — so give us humane choices.”

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