13913: Craig-Article: AIDS crisis in Haiti worsens despite cheaper drugs (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Dan Craig <dgcraig@att.net>

AIDS crisis in Haiti worsens despite cheaper drugs

By Tim Collie
STAFF WRITER
Posted December 1 2002

PORT-AU-PRINCE, Haiti -- The world's nations have pledged billions to fight
AIDS and the cost of life-prolonging drugs have plummeted, but help still seems
far off for this poor nation, where the epidemic first emerged two decades ago.

At the Sisters of Charity clinic, tired, gaunt men propped up by their wives
and families arrive each day suffering from tuberculosis, pneumonia and other
diseases that ravage their immune systems. Those who can walk are often given
medicine and sent on their way. The worst find a place in the beds recently
cleared of the dead.

"If there are 10 men who come, seven or eight of them will test positive for
the HIV virus," said Brother Thomas Pulickal, the missionary who runs the
clinic, which sits on the edge of vast slum called Cite Soleil. "A year ago, it
was more like six out of 10. The number of people with the virus is growing,
and we're trying to help them, but it's very, very difficult. You give them
medicine but many of them don't take it for long, or don't return to get more."

The men who lie on the open-air clinic's 47 cots represent the backbone of the
working poor in this country. Many are bus drivers, day laborers and fishermen.
Some are ex-soldiers, whose positions of power gave them sexual access to needy
women. Most are in their late 20s and 30s, though many look far older.

"I had a wife, but when I became sick and couldn't earn any more, she left me,"
said Gerald Ulyses, 35. "I was here for a month, then left to go back to work.
Then my stomach just swelled up, and back here I've come. I don't really have
anybody to help me here -- my father and mother died. My wife is now sick,
too." Holding up a small paper cup with cookies, he offers them to a visitor.
"I can't really eat anything anymore, you might as well have them," he said. "I
just want to be well and work again. Any work. But I can't even really stand."

Today is World AIDS Day, designated by the United Nations to recognize the
estimated 42 million people infected with the disease, which has killed at
least 20 million people as it enters its third decade. As part of that
observation, the South Florida Sun-Sentinel recently returned to Haiti to
revisit some of the places and people profiled in a special section on AIDS in
the Caribbean published last year.

Very little has changed in the past year. While more people are receiving the
drug cocktails that prolong life, their numbers are minuscule compared with
growing numbers of infected. Programs to help others are expanding, but the
pace is very slow and the money needed to expand them still is not in place.

The situation in Haiti reflects conditions in many of the hardest hit countries
around the world, where most of the infected don't even know they carry the
deadly virus. A report released last week by the United Nations says the plague
is growing exponentially, and likely will infect an additional 45 million
people in the next eight years if prevention and treatment programs costing at
least $10 billion are not implemented.

The poorest country in the Western Hemisphere, Haiti's population of 8 million
has the highest HIV infection rate in the world outside of sub-Saharan Africa.
It was here, in the early 1980s, that AIDS appeared in such numbers that health
officials stigmatized Haitians by singling them out as a risk group with
hemophiliacs, homosexuals and intravenous heroin users -- the notorious 4H's.

The nation's dire poverty, the lack of basic health care, sewage systems,
drinkable water and good roads has hindered efforts to stem the spread of the
disease. Political disarray, which sent hundreds of thousands of infected
refugees fleeing urban slums into the countryside, widened the deadly swath of
AIDS during the 1990s.

Compounding the disaster is the plague's cascading effect through families,
villages and the island's economy. Often carried by the highest earning males
-- truck drivers, soldiers and traveling salesmen -- AIDS in Haiti has left
women and orphaned children fending for themselves. The disease has now reduced
adult life spans by at least five years, from 51 to 46, according to health
experts, essentially erasing a century of medical progress.

Few of these survivors even know they have been infected with the HIV virus
that causes AIDS. And many don't want to find out because of the stigma
attached to the disease, say local doctors. If the disease continues to spread
in Haiti, many think it eventually will erase entire villages as it has in
southern Africa, where the family breakdown is fueling a regional famine.
According to the Central Intelligence Agency, Haiti's population is contracting
because of AIDS-related fatalities.

"I've been sick ever since my husband died, but you know, I really can't afford
to go to a doctor," said Lucette Riviere, 33, whose husband, Odres Victor, died
of AIDS-related tuberculosis last year shortly after being profiled in the
Sun-Sentinel. "I've got six kids to take care of, and I used up all our money
to send one to the hospital."

After her husband's death, his family turned their backs on her. A
sister-in-law who owns the unfinished cinder-block house where Riviere lives
has boarded up one side of it, pushing the mother and her children into a
single room.

"There just isn't enough money for me to worry about myself," she explained. "I
got a loan to start a small business on my own, but that money's gone now on
medicine. At some point, you just give up and hope God will provide. What I
want most is to get the two oldest through school so maybe they can get jobs
and help out."

Claudy Petit-Homme, 20, has seen the disease wipe out his entire family. He has
been sick for nine months and cannot walk from his bed at the Sisters of
Charity clinic. He has lost so much weight that his legs have shriveled to the
bone.

"They have given me the medicine now and I'm starting to feel better,"
referring to anti-retroviral drugs. "I just wish my family had got some. First
my father got sick and died. No one knew why. Then my mother, and then my
stepfather. My sister is sick, but she doesn't come here. I'm not sure where
she has gone.

As the family fell, neighbors began to turn on them. One night, someone burned
down their house.

"I really think that house was haunted anyway, seeing what happened there," he
added.

An estimated 300,000 Haitians have died of the disease since 1980 -- by far the
largest toll in either the Caribbean or Latin America. More than three-quarters
of the Caribbean region's 440,000 cases are in Haiti.

"Haiti has by far the highest prevalence rate in the Caribbean -- about 6
percent of the adult population," said Peter Piot, the head of UNAIDS, the U.N.
agency that leads global efforts to fight the epidemic. "It's got very poor
infrastructure, certainly not the strongest government. These are all factors
that hinder the response to HIV/AIDS."

Haiti is scheduled to receive one of the first multimillion-dollar grants from
the Global Fund to Fight AIDS, Tuberculosis and Malaria -- the independent
agency created by the United Nations and funded by the United States and other
nations to fight the disease in the most troubled countries.

The price of drugs also has come down, lending hope for care to many. In the
United States, these AIDS drug "cocktails" can cost up to $15,000 a year. But
under international pressure, drug companies have lowered their costs to as low
as $350 a year for generic versions. Despite this huge price drop, only 230,000
citizens in low- to moderate-income nations are taking the drugs, and most of
them are in Brazil, according to the United Nations.

Many small treatment programs in Haiti are showing signs of success, Piot said.
One such program, administered by Harvard physician Paul Farmer in the
country's remote Central Plateau, is successfully treating about 200 people
with life-prolonging anti-retroviral drugs backed by extensive counseling.

Successful treatment involves far more than dispensing medicine in Haiti. Few
people here own automobiles, making travel back and forth to a clinic extremely
difficult. The medicine itself can cause nausea, headaches and occasional
vomiting, which prompt many to quit taking it. Finally, it must be taken with
regular meals, a luxury for many here who survive on extremely small portions
of food.

At the Sisters of Charity clinic, doctors began handing out medicine earlier
this year on a case-by-case basis. But many of those who received the pills
didn't return to continue the treatment. Others refused to take them but
continued coming even as they got sicker. The clinic doesn't have enough
employees to launch follow-up visits into homes.

"It's gotten to the point where we have to decide who we give the medicine too
--who's the most likely candidate to use it," explained Rick Frechette, a
Catholic priest who has spent more than a dozen years offering medical care in
the slums of Port-au-Prince.

"Out of 40 people we've given medicine, only 18 are on it now. The rest either
didn't return or after a dose or two, stopped taking it. That's not good, but
it's the best can do now under these conditions," he added. "You have to accept
the limitations here."

Tim Collie can be reached at tcollie@sun-sentinel.com or 954-356-4573.
Copyright (C) 2002, South Florida Sun-Sentinel