8502: AIDS: Haiti's First Lady Mildred Aristide addresses UN panel discussion (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: MKarshan@aol.com

UNITED NATIONS SPECIAL SESSION ON HIV/AIDS
PANEL DISCUSSION
IMPLICATIONS FOR POVERTY REDUCTION:
IMPACT OF HIV/AIDS 
STATEMENT 
BY
MILDRED ARISTIDE
FIRST LADY OF THE REPUBLIC OF HAITI
NEW YORK
JUNE 26, 2001

?EVERYONE HAS TO LIVE?

Last month, when President Aristide launched the initiation of Haiti's 
five-year strategic plan for a government-led national response to HIV/AIDS 
pandemic, he anchored his remarks in the fundamental truth that ?everyone has 
the right to live.?

Everyone has the right to live.  The 35 million people worldwide living with 
HIV/AIDS; the 260,000 people living with the disease in Haiti.

This panel necessarily opens a host of issues about the interrelatedness of 
HIV/AIDS, poverty, gender inequality and development.  The fight against 
AIDS, must both in theory and in practice, be also a fight against poverty 
because we know if you live in poverty you are likely to be poorly educated, 
to be malnourished, to suffer inequality if you are a women, to have less 
access to basic medicines and healthcare.  And these are the conditions that 
facilitate the spread of HIV/AIDS.

Yet in Haiti the fight against AIDS and the fight against poverty; are being 
dangerously treated like two separate and distinct fights.  Urgently needed 
resources to decrease a 53% illiteracy rate, build needed infrastructure, 
reform and modernize a decrepit healthcare system, and create potable water 
distribution systems are being withheld, while we are told that there is 
?money for the AIDS fight.?  There is only one fight: the fight against 
poverty that has contributed to the 90% HIV/AIDS infection rate in the 
developing world.  The more we understand this and simultaneously on all 
fronts of this battle, the more effective we will all be in this one fight.  

Despite limited resources, Haiti has been able to mount a defense against 
AIDS.  They include an aggressive prevention campaign, a program to prevent 
against mother to child transmissions, the launching of a trial vaccination 
program, and a limited anti-retroviral drug treatment for people with HIV.  
These efforts deserve to be amplified and expanded to the national level.  
While the cure for AIDS still eludes us, anti-retroviral therapy life to the 
victims of AIDS.  If indeed everyone has the right to live, then victims of 
AIDS necessarily have the right to this drug therapy.  Esther Boucicaut, a 
member of our delegation who is here with us is living testament to the life 
sustaining value of this treatment.

Haiti knows what it must do.  The Ministry of Health in close partnership 
with NGOs active in the treatment and prevention of HIV/AIDS have come a long 
way from the early dark days of this disease when Haitians were branded a 
high risk category of AIDS on the now infamous 4-H list -- Haitian, 
homosexual, hemophiliac and heroin users and in 1993 when Haitians were among 
the political refugees otherwise eligible for political asylum were denied 
asylum because of their HIV status.  However, despite these efforts being 
deployed today, Haiti finds itself first among the nations of the Caribbean 
impacted by HIV/AIDS.

At present the national incidence of HIV infection stands between 4.5% and 
6%, with approximately 30,000 new cases being reported every year.  Since 
1988, 300,000 Haitians have died from AIDS.  Today 5 Haitians die from AIDS 
every one-hour.  163,000 children have been orphaned by this killer disease.

But the greater tragedy is that AIDS appears to be on a continuum of 
infectious diseases plaguing Haiti.  Tuberculosis, measles, diarrhea, 
pneumonia, tetanus -- exacerbated by malnutrition -- are still killing people 
in Haiti. Haiti's vulnerability and the vulnerability of other poor countries 
to these diseases, HIV/AIDS and infectious disease have far reaching causes.  

We are living the catastrophic results of the introduction of the HIV virus 
onto a healthcare tableau that is a breeding ground for the virus.  With 92% 
of all the adults, 97% of all women, and 98% of all children infected with 
HIV living in the developing world, we know that poverty is a co-factor of 
AIDS.  Therefore if we want to effectively address AIDS, we must address the 
other indices of poverty.

But today in Haiti international financing for Haiti has been frozen 
notwithstanding the AIDS pandemic which the international community labels 
the greatest crisis of the 20th century.  

A very word on why: a dispute about the method of calculation used to 
determine second round electoral races for 8 senate seats.  This electoral 
crisis has wrongly been allowed to snowball into a political crisis.  And as 
a result, international aid has been suspended.  Eight million Haitians, 
260,000 victims of a fatal, debilitating disease are being punished.  

As the resolution to this political crisis has been offered by the government 
it must trigger the release of funds -- funds to implement the government's 
program rooted in the principle of investing in people.  It is a program that 
seeks to provide education, health, and access to Haitians in the 
countryside, those they call moun endeyo (people outside) who have been 
historically excluded from the political and social life of the nation.

The declaration that will be signed by the member States during the course of 
this special General Assembly specifically states that helping countries 
alleviate poverty and achieve sustainable development will strengthen their 
national capacity to combat HIV/AIDS.  And that the HIV/AIDS challenge cannot 
be met without new and additional resources.  It is time that new and 
additional resources be made available to Haiti.  

HIV/AIDS is impoverishing Haiti.  The cost of care over the average 7-year 
span of the disease totals $182,000,000.  Annual funeral costs for each of 
the 125 people with AIDS who die daily total approximately $11,406,250.  HIV 
positive patients occupy 10-50% of an already limited number of hospital beds.

Seventy-five percent of Haitians infected are in their prime working age 
years.  And in Haiti up to 60% of the working population is involved in the 
informal sector that offers no social safety net.  The death of a family 
breadwinner is devastating.  

The growing prevalence of HIV/AIDS among women in Haiti is particularly 
ravaging because of the central role women play in the economy.  And, as 
heads of 30% of all households a death may mean the break-up of families, 
children are pulled out of school and are orphaned.  It is no coincidence 
that the rising tide of HIV/AIDS has been accompanied by the rising tide of 
street children, predominately in our capital.  

The goals of the 5-year strategic plan that Haiti will begin to prepare has 
been set: reduce the HIV/AIDS infection rate by 33%, reduce the level of 
sexually transmitted disease by 50%, and reduce mother to child transmission 
by 50%.  The approach is multi-sectoral, under the leadership of our Ministry 
of Health with the close collaboration of NGOs active in the treatment and 
prevention of HIV/AIDS and activist Haitians living with HIV/AIDS.  

Haiti has targeted interventions on all three modes of HIV transmission: 
sexual contact, mother to infant and blood.  The political will and the 
technology are there.   What is missing are funds to expand these programs to 
the national level. 

Strategies on prevention of course include aggressively marketing the use of 
condoms; the sale of male condoms in Haiti has jumped from 2 million in 1990 
to over 11.6 million in 2000; education on the disease and how to prevent 
infection; the use of telephone hotlines; and caravans of artists partaking 
in regional campaigns in the countryside to warn against AIDS and disseminate 
information directly to the population.  

About 30% of HIV-infected mothers will give birth to children who are also 
infected.  If the goal of this treatment is the survival of children, the 
mothers must remain alive and healthy.  At the very least, these mothers must 
be first on line to receive the anti-retroviral drug therapy.  

Transmission of HIV by blood or by blood products was the major mode of 
transmission of HIV in women in early 1980s. As a consequence, the Ministry 
of Health closed the commercial blood bank which usually paid donors and put 
the Haitian Red Cross in charge of ALL blood banking operations in Haiti.  
Haiti is one of the few countries in the world with ONE institution in charge 
of ALL blood banking operations.  

Additionally, the GHESKIO Center in Haiti has taken a lead role with Brazil 
and Trinidad in a trial vaccination program.  Forty volunteers at low risk to 
become infected with HIV have enrolled in the program.  The present objective 
of this study is to determine if whether Haitians who have low nutritional 
status, and high infectious burden can develop an immune response comparable 
to that observed in more ?healthy? populations in developed countries.

Partners in Health, a Boston based health and social justice organization 
operates a hospital in a remote mountain village in Haiti's Central Plateau.  
They are able to provide the ?cocktail? of expensive anti-retroviral drugs 
for HIV/AIDS patients free.  This is followed up with regular medical 
checkups.  Through a medical strategy called ?directly observed treatment? 
local men and women living in the mountains surrounding the hospital are 
trained as health care workers who watch patients take their drugs.  

But as one HIV positive woman said in a recently published article, ?I go to 
the doctor and all I get are these prescriptions.  But they don?t give me 
food.  They don?t give me money to buy this medication.  I can't eat medicine 
and I can?t feed it to my children.? 

While a comprehensive package necessarily involves: 
-   Vaccine development;
-   Aggressive prevention through education and barrier methods;
-   Development of new prevention tools that do not depend on male 
approbation;
-   Effective therapy for those already sick including aggressive detection 
and     treatment of opportunistic infections and, in a subset of patients, 
highly active   anti-retroviral therapy;
It also means a renewed effort not only to understand how poverty and gender 
inequality increased risk of HIV but also a strategy to address these growing 
inequalities.

A comprehensive HIV package is necessarily a social justice package.

Thank you.