HIV/AIDS in Haiti

AIDS in Haitians was first recognized in 34 Haitians living in the United States in 1982. In the same year eleven individuals in Haiti were suspected to be HIV infected. From 1983 to 1987, the virus spread quickly through the population mostly through heterosexual sex, as HIV infected cases attributed to homosexuals or bisexuals went down from 50% to less than 1%. == Prevalence ==

In Haiti, the three groups where HIV/AIDS is most prevalent are men who have sex with men, sex workers, and prisoners, with prevalence rates of 18.2, 8.4, and 4.3 respectively. The recent declines in HIV infection rates are most notable in urban areas, and have been attributed to significant behavioral changes, including decreased number of partners, decreased sexual debut, and increased condom use. Other explanations for the recent trends include AIDS-related mortality and improvements made in blood safety early in the epidemic. However, continued political instability, high internal migration rates, high prevalence of sexually transmitted infections, and weakened health and social services persist as factors with potential negative impacts on the epidemic. == Risk factors ==

According to a 2010 study, one major risk factor for HIV infection in Haiti, especially in women, is lower socioeconomic status. Similar trends from related studies have also been seen in other developing nations with gender disparities, such as Malawi, Rwanda, Kenya, Ghana, Democratic Republic of Congo, Zambia, and Uganda. Another vulnerable group is adolescents and young adults. For females, risk factor groups include those who have low levels of education, live away from their parents, have been married, or have had a child. For males, factors indicative of HIV infection are intravenous drug use and sexual debut with an unknown individual. For both genders, young adults who are less aware of HIV and its transmission through risky behavior are more likely to be infected, and amongst females, those who talked more openly about HIV infection and testing were less likely to be infected. Finally, having sexual contact with unfaithful partners, having an STI, especially syphilis, and not using condoms are all additional risk factors that affect both genders. == Economic impact ==

On the national level, HIV causes damage to the Haitian economy because the individuals most affected by the epidemic are the young adults that contribute the most to the country's economy. At the start of the epidemic, Haiti's tourism and export industries suffered when Haitians were classified as an HIV risk group. According to Jean Pape, the head of the largest Haitian HIV research center, Haitian products could no longer be sold in the US and tourism, which was the basis of the Haitian economy, declined drastically. HIV infection in a parent can lead to the loss of one source of income which in turn leads to malnutrition, lack of access to education for the children, and increased risk of child labor. The cost of healthcare is another burden on the family. From a 1997 study involving 600 households from Côte d'Ivoire, Burundi, and Haiti, households with at least one HIV infected family member spent nearly twice the amount on healthcare (around 10.6%) compared to families without HIV infected individuals, decreasing household consumption in other areas. The HIV treatment also on average took up 80% of the entire family's healthcare budget. Even after the death of the HIV infected individual, the household never completely returned to its original level of consumption. == HIV treatment and prevention ==

Nearly 75% of HIV treatment in Haiti is sponsored and overseen by the NGOs Partners In Health and Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in collaboration with the Haitian Ministry of Health. Starting in 1997, the clinic made post-exposure prophylaxis (PEP) available to women who suffered from rape and HIV health workers who had occupation injuries. In late 1998, individuals with long term severe opportunistic infections were offered antiretroviral therapy as opposed to only being allowed to treat their symptoms for free. For those infected with the more life-threatening tuberculosis, anti-tuberculous therapy was prioritized over ART. HIV positive individuals displaced due to the earthquake often live in substandard conditions in tent cities, decreasing their immunity and increasing their susceptibility to infection or progressing to AIDS. The large concentration of HIV positive individuals in confined tent cities also increases the risk of HIV transmission within the smaller community of individuals. However, the overall structure of the HIV treatment system has largely remained intact and the majority of HIV infected patients continue to receive access to antiviral therapy while the nation rebuilds the rest of its healthcare system. Other challenges to the HIV treatment and prevention efforts in Haiti include more recent events, such as Hurricane Matthew, the cholera outbreak, and additional refugees arriving from the Dominican Republic, the limitations on the human and financial resources the NGOs can provide, and the fluctuating level of cooperation from the Haitian government. == The Haitian connection controversy ==

The Haitian connection controversy is the debate regarding the origins of the HIV virus in Haiti and the United States and whether or not HIV was spread into the US by Haitians or into Haiti by Americans. The controversy began in 1982, when the CDC noted that 34 cases of immunodeficient patients were Haitian. Dr. Jacques Pépin, a Quebecer author of The Origins of AIDS, stipulated that Haiti was one of HIV's entry points to the United States. In July 1960, when Belgian Congo gained independence, the United Nations recruited Francophone experts and technicians from all over the world to assist in filling administrative gaps left by Belgium. In his 1990 book AIDS and Accusation, Paul Farmer refutes the idea that Haiti was an HIV entry point to the USA. Referencing an epidemiological study on the prevalence of sarcomas associated with HIV/AIDS contraction, Farmer suggests that Cambronne's plasma business occurred before identifiers of HIV infection were recorded in Haiti, indicating that the disease did not arrive in Haiti until at least the late-1970s. In a 2007 study, 5 HIV isolates from different regions were compared on the molecular level. By comparing the number of mutations present in different strands of HIV found from patients from Central Africa, the United States, and Haiti, the results predict that the Haitian strain of the virus is the genetic midpoint between the strains found in Central Africa and the United States, and that the virus traveled from Haiti to the United States about 3 years after it reached Haiti. Regardless of origin, the consequences of HIV/AIDS in Haiti were severe. The disease spread rapidly throughout Haiti, infecting thousands. ==See also==