16368: Karshan: Anthony Lake Op Ed in Miami Herald, August 10, 2003 (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: MKarshan@aol.com

Miami Herald [Op-ed], Posted on Sun, Aug. 10, 2003
Young AIDS victims in Haiti need a new plan
By ANTHONY LAKE

Some good news for the people of Haiti, who receive so little:
The U.S. government has announced a  multimillion dollar
program to fight HIV/AIDS there, focused on preventing the
transmission of the  disease from mothers to children. The
announcement should be applauded. But another step should
be taken, as well -- to achieve its greatest impact, the program
should include direct funding for the  Haitian Ministry of
Health. Our current policy toward Haiti would preclude that.

Why change this policy? Let me begin with a scene vivid in
my memory. It was a moment in which I  learned that my heart
could both be lifted and broken at the same time.

A group of us from the U.S. Fund for UNICEF were visiting
HIV/AIDS projects in Haiti. At every  stop, we were strangely
exhilarated by the courage, competence and high morale of all
the workers  we met -- doctors, technicians, counselors and
others who were fighting to preserve life in the midst of
constant death.

We spent a few hours at the Arc en Ciel orphanage, where
some 40 kids receive wonderful care.  Taking our hands, they
showed us their rooms. The echoing sound of their laughter
was wonderful. As  they put on an ebullient dance
performance, I was particularly drawn to one little girl, smaller
than the  others. Her occasional frown of concentration as she
tried but often failed to stay in step reminded me  of my own
struggles to keep up when I was her age. Her smiles were thus
all the more engaging. The  spirits of the children were
inspiring.

The heartbreak was this: Almost all the children at Arc en Ciel
are not only orphans. They themselves  are infected by the
HIV virus. According to the blood tests done shortly before
our visit, the little girl I  was watching should already have
died. She may have died by now. And worse: Only a tiny
fraction  of the tens of thousands of AIDS orphans in Haiti can
get such care. And each year, some 5,000  Haitian babies are
born infected, joining an estimated 300,000 other Haitians
who live with the virus --  and will probably die from it.

Yet, surprisingly, given the dismal social, economic and
political situation in Haiti, experts are looking  at its
HIV/AIDS programs as a source of some hope in the global
fight against this scourge. Overall  infection rates in Haiti are
actually in decline. And our UNICEF group saw two
programs, in  particular, that help explain why.

The GHESKIO Centers, under Dr. William Pape, are jointly
supported by the Ministry of Health,  Cornell University and
local sponsors. They treat tens of thousands of patients a year
and offer free  testing. The prospect of treatment helps
persuade pregnant women to get tested -- and then, if the  tests
are positive, to take the drugs that can prevent transmission of
the disease to their unborn babies.

In the central plateau, the celebrated Dr. Paul Farmer is
proving that first-rate medical care is possible  even in the
poorest circumstances. Supported by his home university,
Harvard, and foreign donors, his  Partners in Health project is
saving thousands of lives while training and employing local
personnel.

Combining drug therapies and an effective outreach program,
it is a model of what could be done in  poor regions
throughout the world. But only if such programs can be
replicated in Haiti and beyond.  Not an easy challenge. Pape
and Farmer cannot be cloned. Their programs rely heavily on
donated  resources, especially medicines. And support from
Cornell and Harvard, as well other donors, cannot  easily be
duplicated.

This brings us to the central issue: U.S. and international
policies toward Haiti. For the best way to  expand the success
of these programs is through a public/private partnership. This
can best be  achieved if the Ministry of Health, one of the
more-effective Haitian ministries, is fully involved. Yet  (with
some rare exceptions) it is subject to the U.S. prohibition
against our aid going directly to the  Haitian government.

To put pressure on the government for the political gridlock in
Haiti, American aid (which recently is  actually increasing)
flows through nongovernmental organizations. The health
ministry, thus, is  supported indirectly. (It should be noted that
our ambassador there, Dean Curran, has also taken a  strong
personal interest in HIV/AIDS programs, including some
effective fund-raising for the Arc en  Ciel orphanage.) But the
near total ban on direct aid to the Ministry of Health cannot be
justified in  either practical or moral terms.

In a practical sense, the Ministry of Health is the only
institution with reach to replicate local successes  throughout
Haiti. We need to build its capacity to do so. And in any case,
the ministry is not as  sensitive politically, as, say, those
dealing with police matters or public works.

So how can we justify undercutting our initiative on
HIV/AIDS by continuing this ban on direct aid to  such a
crucial institution? Let the aid flow there, requiring full
transparency so that we may know it is  not misused. Not only
for the sake of efficiency in how our dollars are spent, but for
the sake of all the  Haitian babies who will otherwise come
into the world with three strikes against them. For the sake of
some future child who could have hope, unlike the little girl I
met at Arc en Ciel.

Anthony Lake was national security advisor to President
Clinton (1993-1997) and special envoy to  Haiti (1997-2000).