World AIDS Day, observed December 1st, is an opportunity both to call attention to the continuing challenges to end infections globally, and in the case of Haiti, to shed new light on the link between poverty, the prevalence of HIV/AIDS and other diseases, and the need for deep and coordinated efforts across the issues. (Photo credit: Fonkoze)
Outside of sub-Saharan Africa, the Caribbean has the highest prevalence of HIV/AIDS infections globally, a fact that too often seem to fly below the radar of both regional governments and the international community. Haiti, which shares the island of Hispaniola with the Dominican Republic, has the most cases overall — an estimated 130,000, out of a population of just under 11 million. Approximately 74,000 of infected Haitians are women and 9500 are children, 14 years and under.
The impact of the disease on women, and the consequence of so many orphaned children, is one more factor complicating the country’s efforts toward economic and social stability, and poverty eradication. Approximately 59 percent of Haitians live in poverty and almost one-quarter in extreme poverty, close to 40 percent do not know how to read or write, and only one in four have access to a toilet. Such conditions erect serious barriers to appropriate care and containment of infectious diseases.
The scale of HIV/AIDS and other infectious diseases in Haiti are both a contributor to, and a consequence of individuals and communities living in poverty. The burden of disease is exacerbated by unmet challenges in the health system overall: inadequate infrastructure, human resources, and funding. However, progress against HIV/AIDS and tuberculosis (TB) — one of the leading killers of people living with HIV — demonstrates how a coordinated and well-funded systematic health response can succeed.
Second to political instability, natural disasters have long been Haiti’s most (un)predictable obstacles. In 1963, Hurricane Flora killed 3500 people; in 2008, approximately 800 died following hits from four storms; and, on October 9 of this year, Hurricane Matthew took another 800 lives, reports say.
Haiti’s worst natural disaster by far was the earthquake of January 12, 2010. The strongest in the western hemisphere in more than 200 years, the quake killed more than 200,000, displaced millions, and devastated the capital, Port- au-Prince. As if that were not enough, in the wake of the earthquake, U.N. peacekeepers from Nepal (where cholera is endemic) carried the bacteria to Haiti (where cholera is not) and triggered an epidemic that, so far, has infected more than 800,000 Haitians and killed more than 10,000.
Compared to the immediacy and visibility of high impact natural disasters, chronic poverty and diseases like HIV/AIDS have become one with the landscape in Haiti — parts of its normal reality that are not “news” anymore. World AIDS Day, observed December 1st, therefore, is an opportunity both to call attention to the continuing challenges to end infections globally, and in the case of Haiti, to shed new light on the link between poverty, the prevalence of HIV/AIDS and other diseases, and the need for deep and coordinated efforts across the issues. The disproportionate number of women affected indicates, as well, the need for more focus on women’s empowerment and on their reproductive health needs.
Haiti, to its credit, is making progress toward containing and treating HIV/AIDS and other infectious diseases like TB, despite these difficulties. HIV prevalence has more than halved from 3.9 percent in the early 1990s to 1.8 percent currently, fewer pregnant women are testing positive, and many of the infected are on antiretroviral drugs.
A review of the country’s National Strategic Plans for TB and HIV by the ACTION partnership found that the country’s approach is strong, well-coordinated, and in full compliance with national policies that are grounded in recommendations from the World Health Organization. Haitian organizations, the report highlights, were among the first to demonstrate the efficacy of TB-HIV integration in 2001, and the Haitian government rolled out its strategic plan in 2002. It notes the work of private clinics, such as GHESKIO Centers and Zanmi La Santé, which provide fully integrated TB and HIV services, free of charge. A 2016 grant from the Global Fund, awarded in April, will finance "expansion of coordinated services, access to x-ray and GeneXpert diagnostics, nutrition and transportation support for patients and trained community health workers," a great stimulus for even more improvements.
External funding has been critical to Haiti’s successes, given its own budgetary constraints. However, it is also a marker of vulnerability since continuity is never guaranteed and amounts can fluctuate without warning. The United States President's Emergency Plan for AIDS Relief (PEPFAR), for example, has been a significant and increasing source of funds, providing more than $28 million in FY 2004, nearly $51.8 million in FY 2005, $55.6 million in FY 2006, $84.7 million in FY 2007, and approximately $100 million in FY 2008. This year, allocation dropped to $77 million.
Overall conditions suggest that Haiti’s problems are soluble but more resources are needed to address broad issues of poverty, prevent people from contracting HIV/AIDS, reduce the number of people who die from it, and eliminate stigma for those who live with it. These are critical steps, if the sustainable development goal of ending the epidemic by 2030 is to be attained.
 UNAIDS. (2016). HIV and AIDS estimates (2015). Retrieved from http://www.unaids.org/en/regionscountries/countries/haiti.
 Haiti Partners. (2015, November 18). Haiti statistics: Haiti by the numbers. [Web log post]. Retrieved from https://haitipartners.org/about-us/haiti-statistics/; and World Population Review. (2016). Haiti Population 2016. Retrieved from http://worldpopulationreview.com/countries/haiti-population/.
 Basu, M. (2016, October 5). Haiti: a nation sadly familiar with hurricanes and earthquakes. CNN. Retrieved from http://www.cnn.com/2016/10/04/world/haiti-disasters/.