14800: Karshan: Feb. 7, 2003 Issue Papers: The AIDS Crisis and Health Care (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: MKarshan@aol.com

February 7, 2003 Issue Papers:  The AIDS Crisis and Health Care

THE AIDS CRISIS
AND HEALTH CARE

HISTORICAL CONTEXT

-   The AIDS crisis appears on a continuum of infectious diseases plaguing
Haiti.  After World War II when the World Health Organization began reporting
on health conditions, the chief cause of death among infants was
gastroenteritis, measles, tetanus and TB.  Malnutrition was widespread.  By
1981 when the first cases of AIDS began to arise, the major causes of
childhood death in Haiti continued to be diarrhea, pneumonia and tetanus.

-   Once cases of this still mysterious disease appeared in Haiti, Haitians
were included in the now infamous list of 4-Hs -- homosexual, hemophiliac,
heroin user, Haitian -- as carriers of the disease.  Haitians lost jobs in
the service industry and were barred from certain forms of employment.

-   But the stigmatization raised the level of consciousness about AIDS.  In
the late 1980's the Haitian community in the U.S. organized one of the
largest anti-AIDS rallies in front of the New York offices of the Center for
Disease Control to demand that Haitians be dropped from the list.

-   On the medical and scientific front, the early
    stigmatization of Haitians led doctors in Haiti in the early 1980s to
document case studies of patients presenting symptoms of AIDS.  In 1982 the
GHESKIO Center emerged as the first AIDS research and treatment center.  Many
of the first medical journal articles which helped forge a greater
understanding of the HIV virus were based on data collected in Haiti.

-   In Haiti, as in other countries suffering from the AIDS pandemic, the
lack of clean water, sanitation, education and infrastructure has contributed
to exacerbating the crisis.
STATISTICS

-   Haiti's  national  HIV/AIDS  infection  rate  is
    between 4½ to 6%, with rates as high as 13% in rural areas, giving Haiti
the highest HIV infection rates in the Western Hemisphere.

-   There are approximately 300,000 Haitians living with HIV/AIDS.

-   Haiti has the highest tuberculosis infection rate in the Western
Hemisphere.

-   There are 1.2 doctors, 1.3 nurses and 0.04 dentists per 10,000 Haitians,
mostly concentrated in the capital.

-   40% of the Haitian population is without access to primary health care.

-   The child mortality rate is 80 deaths per 1,000 births.

-   Average life expectancy is 49.6 years.


THE IMPACT OF THE EMBARGO
ON HEALTH CONDITIONS

-   On  July 21, 1998,  the  Haitian  government
    and the IDB signed a $22.5 million loan for Phase I of a project to
"decentralize and reorganize" the Haitian health care system.

-    The funds would be used to construct low-cost community health centers,
train community health agents, and purchase medical equipment and essential
medicines.  The ultimate objective of Phase I  was to reduce the high infant
mortality rate, reduce the high juvenile death rate and reduce birth rates.


-   This health loan, as well as close to $150 million in humanitarian loans,
has been blocked by a U.S. led embargo against Haiti.

-   Dr. Paul Farmer, medical director of a private health facility in Haiti's
Central Plateau that treats patients infected with HIV/AIDS, tuberculosis and
other diseases, reports that "the aid embargo has in effect rendered the
Ministry of Health incapable of reviving the national network of clinics and
hospitals."  Dr. Farmer's facility, which is normally equipped to receive no
more than 35,000 visits per year, last year saw 200,000 ambulatory patients.
He attributes this rise to, "dramatically diminished ability of the
public-health system to respond to the needs of the Haitian people.  The
Ministry of Health, the only institution with a mandate to serve the entire
population, has been strapped by financial constraints."

-   Last year, Dr. Bill Pape, co-founder of GHESKIO, wrote to the IDB
president urging that the health loan be released because, "a battle against
AIDS is directly linked to the reorganization of the health system."

-   Assistance through the NGO sector is simply not enough and is no
substitute for a comprehensive public health policy.  In its 2001 newsletter,
the Haitian Health Foundation, a non-profit U.S. organization receiving funds
from USAID working in Haiti wrote, "the number of villages that we serve has
grown from 15 to 92 with a population that now stands at more than 200,000.
Despite this dramatic increase, USAID has failed to keep pace."

-   Despite this position taken by leading NGO healthcare providers, a recent
U.S. Senate delegation to Haiti confirmed that the U.S. will continue its
policy to block funds directly to the Haitian government.



EFFORTS

-   The government of Haiti has centered its national health program on
improving maternal and pre-natal health conditions.  The School of Mid-wifery
was renovated and reopened, as well as the maternity wards of eight public
hospitals.

-   An aggressive campaign to vaccinate children against measles, rubella,
polio and other childhood diseases is in place.

-   The government of Haiti's cooperation with Cuba has led to the expansion
of the number of physicians in areas of the country with no doctors and the
training of upwards of 400 Haitian medical students.

-   On the HIV/AIDS front, Haiti was one of the first countries to sign a
Grant Agreement with the Global Fund for AIDS, Malaria and Tuberculosis.  The
two-year grant for $17,945,045 million will finance a broad sector of private
and public expert AIDS/care providers in the prevention, testing and
treatment of AIDS.

-   Ground breaking drug treatment to full blown AIDS patients is underway at
a hospital run by Partners in Health in a very poor community in Haiti's
Central Plateau.

-   Haiti is part of an important 3-country HIV/AIDS trial vaccination
program.

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