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#4732: AIDS EPIDEMIC ADDS TO TRAGEDY IN HAPLESS HAITI (fwd)
AIDS EPIDEMIC ADDS TO TRAGEDY IN HAPLESS HAITI
By Alfredo S. Lanier Tribune Staff Writer
PORT-AU-PRINCE, Haiti -- For all their misfortune, the 34 orphans
living at Rainbow House are the lucky ones. They have lost one or both
parents to the AIDS epidemic in Haiti, and 28 of the children, from
infants to 6 years old, have tested positive for the virus that causes
AIDS.More than an orphanage, Rainbow House is a symbol of the deep and
continuing ravages of the disease in Haiti, whose AIDS epidemic has been
eclipsed by the country's political and economic turmoil. As the only
operation of its kind in a country with an estimated 190,000 AIDS
orphans, many HIV-positive, Rainbow House is a remarkable but
minuscule oasis in the bleak landscape of the AIDS epidemic.
Located in the hilltop suburb of Boutelliers, above the polluted mayhem
of Haiti's dilapidated capital,Rainbow House occupies a mansion once
owned by the family of Michelle Duvalier, wife of former dictator
Jean-Claude "Baby Doc" Duvalier. The house was looted by mobs after
Duvalier's overthrow in 1986, during a nationwide orgy of vengeful
destruction known as the dechoukaj that targeted anything connected to
the former dictator. Five years ago, the Haitian government gave it to a
Canadian and Haitian couple rent-free. They rebuilt it and set up
Rainbow House.David, a toddler, seems to instinctively relish his
relative good luck. The 2-year-old runs up to visitors laughing, with
his arms in the air, demanding to be picked up.He was turned over to
Rainbow House at 3 months. His mother died of AIDS and his father, a
farmer with a large family, didn't know what to do with him.David, who
is HIV-positive, was plagued with ailments including skin infections and
intestinal parasites. "We thought he would die," said Danielle
Reid-Penette, the Canadian half of the couple who founded Rainbow House.
"We generally don't take children that are that sick, but my husband and
I decided to take him anyway." David's lucky streak continued when Dr.
Jane Buss,an infectious disease and AIDS specialist from Middletown,
Conn., and two other American doctors visited.Moved by the plight of the
children, the doctors offered to supply three of them with the
latest--and enormously expensive--drugs that are keeping hundreds of
thousands of AIDS patients alive in the U.S. and Western Europe, but are
virtually unavailable in Haiti.
David was one of the three.
It's a really tough decision, because you don't want to start someone on
the drugs unless you can guarantee they'll continue to get them," Buss
said. In addition to the orphans at Rainbow House, there are an
estimated 335,000 adults infected with HIV in Haiti, between 5.4 percent
and 7.7 percent nationwide, according to 1998 figures by the Policy
Project of Haiti.While not as catastrophic as the crisis in sub-Saharan
Africa, where some countries report infection rates as high as 36
percent of the adult population, Haiti's AIDS problem is by far the
worst in the Western Hemisphere. By comparison, in 1998, the infection
rate in Western Europe was .25 percent, .56 percent for North America,
according to the World Health Organization.About 300,000 Haitians had
died of AIDS by 1998,according to the Policy Project, or between 100 and
150 people daily--quite a toll for a country with a population of about
7 million.The AIDS toll has reduced life expectancy in Haiti from 61
years to between 47.4 and 51 years,according to the Policy Project.
Taboos and denial
Unlike Western nations that have been able to contain the spread of the
disease through public education campaigns and expensive medical
treatments, Haiti is still at the starting gate in its fight against
AIDS. Factors such as cultural taboos and a national denial of the
problem hamper efforts to control the disease, but none as much as the
abject poverty and endless political crises that beset the country.
Haiti was unwittingly pushed center stage when the AIDS epidemic first
broke in the early 1980s. Along with homosexuality, intravenous heroine
injection and hemophilia, being Haitian--the so-called 4-H
Club--suddenly became a "risk factor." Such stigmatization was swift and
disastrous.Between 1980 and 1983, the tourist industry, one of
Haiti's largest sources of foreign revenue, all but collapsed.
Some doctors say religious beliefs that blame AIDS on curses and evil
spirits make public debate difficult. That may be changing, thanks to a
middle-aged, middle-class woman, Esther Boucicault, from the small town
of St. Marc, 30 miles from Port-au-Prince. Her husband died of
AIDS six years ago. About 18 months ago, Boucicault announced
publicly that she is HIV-positive. The reaction was mostly astonishment.
After she spoke to one group of teenagers in the capital, many initially
heckled her.The image of a respectable-looking woman and their
notions about people with AIDS just didn't jibe. By the time she
finished, there was silence in the auditorium. Her campaign has helped
lift the veil of shame and secretiveness.Simultaneously, or perhaps
spurred by Boucicault's efforts, a number of support groups for people
with AIDS have sprung up throughout the capital--including one for
gays. At Rainbow House, some of the children attend the local parochial
school, and Reid-Penette said one of her missions is to disseminate the
message that "with some minimal precautions, it is safe to live and play
with children with HIV." Ultimately, it is Haiti's perpetual political
chaos and dismal poverty that have prevented the development
of a full-scale attack on AIDS.The outbreak of the epidemic coincided
with the waning hours of the Duvalier dictatorship in the mid-1980s and
the subsequent game of musical chairs at the presidential palace. The
overthrow of Jean-Bertrand Aristide in 1991 was followed by three years
of military dictatorship and a U.S.-led invasion to put him back in the
presidency. Political squabbling since 1997 has immobilized the
government, cut off virtually all international assistance and prevented
the implementation of any effective nationwide policies to deal with
AIDS or much of anything else.Studies have found that AIDS likely
spread to the countryside during the reign of terror imposed by the
military after Aristide's first term, when young men--many of them
infected--fled the capital. The rate of infection in Port-au-Prince
remains at least twice that of rural areas.
`Poverty and ignorance'
If there is central factor that drives Haiti's AIDS epidemic it is the
country's poverty and miserable health conditions. "This is not a
Haitian disease but a disease of poverty and ignorance," said Dr. Arthur
Fournier, associate director for community health at the University of
Miami School of Medicine, who also runs a training program for family
doctors in the Haitian town of Cap Haitien. For instance, in tests his
students have run at orphanages in Haiti, half the children tested
positive for exposure to tuberculosis, which is also the leading
opportunistic disease to attack those with AIDS. But the latest
retroviral medications, the so-called "drug cocktails" that have slashed
the mortality rate of HIV-positive people in the U.S. and Western
Europe, are all but non-existent in Haiti. The main reasons are the
cost--about $1,000 a month--and the state-of-the-art medical monitoring
required. "We treat opportunistic infections but can't act on
reducing viral loads because we have very little access to the
medicine," said Dr. Gabriel Thimothe, who has a private practice and is
executive director of Haiti's Ministry of Population.He estimated that
only 3 percent to 4 percent of people with AIDS have access to the
newest drugs.It's very hard to see people dying because they have no
access to the medicine, sometimes I try to get the drugs for them,"
said Thimothe, who has treated 200 people with AIDS. "I try not to feel
angry. Most of the time I just feel powerless." According to Norberto
Martinez-Cuellar, a Colombian doctor who heads the Panamerican Health
Organization mission in Port-au-Prince, the cost of treatment and
monitoring is so prohibitive that it would take the entire national
budget for the next 10 years to properly fight Haiti's AIDS epidemic.
"You can't isolate AIDS from its economic and social context," he said.
"The main reason that countries in Africa and Haiti have the highest
rates of HIV and AIDS is the enormous levels of poverty, illiteracy and
social exclusion."Despite that, Martinez-Cuellar added that some
prevention and education programs are making inroads. Condom use,
despite its connection to prostitution in the minds of many
Haitians, has increased to about 30 percent among sexually active males.
Fournier said there are signs that the rate of new infections in Haiti
may even be leveling off.
Medication and hope
Meanwhile, the Panamerican Health Organization and the World Health
Organization have set up a hot line to answer questions about AIDS
transmission. The line has been flooded, mostly by calls from
young people. This summer, the organization also plans a cross-country
caravan, featuring live bands and pop artists, to spread the gospel of
safe sex and AIDS prevention. Yet for those already infected with HIV,
access to First World medications is the only hope. A pact announced in
May between the UN and five of the world's leading drug makers to help
poor countries buy the latest AIDS drugs at reduced cost
may help Haiti. According to Thimothe, wider availability of AZT
would have the greatest effect in preventing mother-to-child
transmission, the type that infected the 28 children at Rainbow House.
Such what-ifs generally don't seem to discourage Reid-Penette, who has
launched an outreach program to help 93 children with AIDS who are still
living with their families in the neighborhood around Rainbow House. She
provides food, medical attention and money so they can attend school.
Still, remembering the deaths of nine of her charges--especially that
of little Emmanuel--makes Penette pause. "He had a rough life," she
said. "His grandmother had left him at the door of a radio station
downtown last February. We couldn't let him die in the street and took
him in. But at age 8, he didn't want to live any more. He died asking
for his grandmother."