23986: (news) Slavin: Doctor dispenses hope to HIV/AIDS patients in Haiti (St. Pete Times 122604) (fwd)

[Bob Corbett <corbetre@webster.edu>]

from: jps390@aol.com

http://www.sptimes.com/2004/12/26/Worldandnation/Doctor_dispenses_hope.shtml

Doctor dispenses hope to HIV/AIDS patients in Haiti

Despite poverty and political turmoil, renowned physician Jean W. Pape persists, making headway against the disease.
By DAVID ADAMS, Times Latin America Correspondent
Published December 26, 2004

PORT-AU-PRINCE, Haiti - Dr. Jean W. Pape is a rare commodity in a country racked by gang violence and political intolerance - a success story.

The internationally renowned physician, who is Haitian, runs one of the oldest HIV/AIDS research institutes in the world.

It's also one of Haiti's best kept secrets.

"We keep a low profile," said Pape, interviewed in his office at the GHESKIO laboratory and research center, located along a potholed road in a gang-infested stretch of the capital's waterfront.

"We don't get involved in politics. We're focused on the health of the Haitian people."

Pape is one of numerous people, both Haitian and foreign, quietly dedicated over many years to improving living conditions in a country that often confounds the best intentions.

Whether working with AIDS patients, orphans or slum kids, together they represent hope in a country of failed state institutions. Pape's achievements are especially noteworthy given the extraordinary resources he has brought to bear in one of the most challenging fields of medical research.

"He's very visionary, and Haiti needs visionaries," said Matthew Brown, Haiti director for the U.S. Centers for Disease Control and Prevention, which works closely with Pape. "In many ways Haiti is leading the way for (HIV/AIDS) treatment. It's something people don't know about Haiti, and it's amazingly good news."

Pape's international reputation stretches from the White House to top universities and drug companies trying to find a cure for the disease. He is considered one of the world's leading AIDS authorities, with numerous accolades and publications in medical journals. In 2002, he was awarded France's coveted Legion d'honneur, for "his contributions to the improvement of the health of the Haitian people and the people of the world."

A distinguished-looking man with a gray goatee, Pape divides his time between Haiti and the United States, where he is a professor at Cornell University.

He began studying AIDS in the late 1970s, after graduating from Cornell's medical school. He had come home to investigate diarrhea in infants, but he discovered a strange infection was killing adults, too.

Pape ended up creating the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infection, or GHESKIO Centers. (GHESKIO refers to an early name for what would become known as AIDS.) Pape persuaded the Haitian Health Ministry to provide a building with free rent, electricity and one telephone line.

The center remains in a dangerous area of downtown, dubbed "Kosovo" by locals. But Pape refuses to place armed guards outside.

"We have never felt insecure here," said Pape, whose friends call him Bill. "People say I'm crazy, but I have been here since 1979 and we have not lost a pencil. The people know that this is their place and the care is free."

AIDS hit Haiti early - and hard. And GHESKIO took on the battle almost single-handededly.
The infection appeared to be so prevalent in Haiti that U.S. health officials at the CDC went so far as to list Haitians among four high risk groups, along with homosexuals, hemophiliacs and drug users.

In 1986 the CDC removed Haitians from the list after research by Pape and others showed the disease was sexually transmitted.

Early on, Pape's team discovered that 49 percent of women with AIDS had received blood transfusions from largely unregulated commercial blood banks. He persuaded the Ministry of Health to shut them down. Today all the country's blood banks are run by the Haitian Red Cross.

Pape continued to study the disease while training Haitian doctors and nurses to treat patients who trickled into his clinic. Getting over Haiti's sexual taboos was difficult at first. Men were embarrassed to seek treatment.

In the early years, Pape treated 2,000 to 3,000 patients a year. But as the infection spread, along with word of the free care offered at GHESKIO, more people began to come forward - male and female. Last year GHESKIO saw 23,000 new patients, with a 17 percent HIV infection rate. That is expected to rise to 25,000.

>From 1993 to 2003, the percentage of adults infected with HIV dropped sharply from 6.2 percent to 3.1 percent. The infection rate in infants born to women with AIDS has also dropped from 30 percent to 8 percent in recent years.

After struggling for years with limited resources, GHESKIO's work is suddenly taking off, thanks to a radical shift in U.S. funding for HIV/AIDS treatment.

When Bush administration officials began looking into a new health initiative, Pape was one of four experts from around the world invited to the White House to give a briefing. Officials were seeking reassurance that drugs known to slow the advance of the disease - known as antiretroviral therapy - could be successfully used in the developing world.

Pape argued that the drugs could make a huge difference.

"We were drilled with questions for four hours until they were fully convinced," Pape recalled. "They were concerned that ART drugs would not be stolen and sold on the U.S. market."

Officials also wanted to know if patients could be persuaded to stick with the treatment long enough to be worthwhile.

In February last year, the White House announced the President's Emergency Plan for AIDS Relief, a five-year, $15-billion government initiative. Under the plan Haiti was due to receive $20.3-million in 2004 to support prevention and care. Pape is impressed with the speed of its implementation.

"I've never seen anything move so fast," Pape said. "I've worked in the U.S. a lot and know how things work there."

Support is also being channeled to rural areas in Haiti through another project, Partners in Health, led by Dr. Paul Farmer, a former Brooksville resident.

An estimated 30,000 Haitians would be eligible for antiretroviral therapy. But until this year only 1,800 received it. With cash to pay for expensive drugs, GHESKIO, PIH and its sister sites are now able to treat more than 3,000 patients with antiretrovirals. The goal is to increase that to 3,800 by March 2005, and 25,000 by 2007.

With new support from the United States and the United Nations Global Fund, Pape is busy expanding his work across the country to 26 provincial centers. This has helped enormously to boost laboratory capacity and clinical testing and counseling for HIV/AIDS patients, in partnership with the Haitian Ministry of Health and other local groups.

In all, he is planning 100 sites nationwide, all staffed with doctors and nurses trained by GHESKIO.

U.S. officials are full of admiration for Pape and his team. "Now we have a unique opportunity to expand the good work of GHESKIO," said Brown, the CDC Haiti director. "For 22 years they have been combating this disease with very limited resources. Now we can help them take it beyond the walls of their clinics."

GHESKIO is among a few centers conducting U.S.-backed HIV-AIDS vaccine trials to test a new drug produced by the pharmaceutical giant Merck. Tests will start next month at a renovated former school next door to GHESKIO.

Scientists hope the drug will provide a breakthrough. While they have so far not been able to prevent the occurrence of HIV infection, they believe the new vaccine could block, or delay, the development of AIDS in infected people.

GHESKIO's success has come in the midst of worsening political and economic conditions. Haiti is the poorest country in the Western Hemisphere. An estimated 75 percent of its 8.5-million people live on less than $2 a day, according to the United Nations.

Pape credits a succession of Haitian governments, despite their many faults, for recognizing the importance of AIDS.

In particular he cites Haiti's former First Lady Mildred Aristide, for taking special interest. "She was a real advocate for the AIDS cause," he said.

But when an armed rebellion erupted earlier this year against President Jean-Bertrand Aristide, Pape refused to take political sides. Instead, he prepared for the worst.

The uprising disrupted public services and many private business were shut down.

But operations at GHESKIO were never interrupted, thanks to its contingency plan. Staffers set up a network of warehouses stocked with drugs, dividing the capital's 2.5-million inhabitants into sections. Patients were given a phone card with a number to call to get their drugs.

Pape says you have to be a practical thinker in medical research. "It's our duty to identify problems and solutions," he said.

It's a philosophy that many wish could be extended across the board in Haiti.

"It's not easy to work, or live, or do anything in a dirt-poor joint like Haiti," said Chris Barratt, head of health programs in Haiti for the U.S. Agency for International Development. "But Bill Pape showed it can be done."

© Copyright 2003 St. Petersburg Times. All rights reserved

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J.P. Slavin
New York
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