Haitian Child

Haitian Child

Saturday, November 24, 2012

HIV in Haiti

Almost a third of a century has passed since AIDS secured a top spot as one of the medical scourges of the twentieth century. In Canada, a diagnosis of HIV is no longer a death sentence and some, I suspect, presume the disease is something like polio, an historical infection that we no longer need to be concerned about. In Haiti this is certainly not the case. Even in Canada the infection continues to be a health care challenge.

T4 cell (green) infected with HIV (red) courtesy of Medscape

In the early 1980's the Center for Disease Control in Atlanta, Georgia, in a moment of glibness, determined that AIDs was a problem in homosexuals, hemophiliacs, heroin users, and Haitians. This played well for the press but did not tell the real story. Sadly, Haiti was labeled as a member of the "4 H club," and this stigma has stayed.

Haiti, however, has done better than most under-developed countries to prevent infection with HIV. Pro-active preventative efforts reduced the prevalence rate from 9.4% in 1993, to 3.7% in 2003, and to 1.9% by 2009, the year before the earthquake. About 120,000 people in Haiti are infected with HIV and of these, 61% of the adults are women. There are about 12,000 children with HIV.

Courtesy of Partners in Health (PIH) and other groups, antiretroviral treatment (ART) is available free and in 2011, this group alone provided ART to about 6,300 individuals in Haiti. However, PIH understands that while lifesaving, the medications are not the real answer, and that without housing, water, food, and psychosocial support, the problem will not be solved. To paraphrase a Haitian proverb, to provide medicine alone is like asking someone to wash their hands and then dry the hands in the dirt.

The cost of the medications has been an obstacle but after worldwide pressure from a variety of important groups, the phamaceutical industry has reduced the cost of ART from several thousands of dollars a year to less than $150.

A recent New England Journal of Medicine article about HIV in Haiti (Severe et al, 2010;363:357-65) reported that earlier treatment with ART, when the CD4+ counts are 200 to 350 per cc (higher than current criteria to start treatment) resulted in a 75% reduction in death and a 50% reduction in the incidence of tuberculosis. Wow! The authors estimated that the cost for 2 years of ART in this group of individuals is about $400 per person.

Next month in Haiti, I expect to see children with the infectious complications of HIV and AIDS. I will have my clinical eyes open and my gloves on.

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