The Caribbean region has the highest HIV prevalence outside of Africa, with an estimated 2 percent of adults seropositive, 85 percent of whom live in Haiti and the Dominican Republic. The epidemic is concentrated in young adults and is transmitted mainly through sexual contact, with perinatal transmission rising in some areas, particularly in Haiti. A 1998 study estimated that the HIV infection rate in Haiti is 6 percent in urban areas and 4 percent in rural areas, making Haiti the hardest hit country in the Caribbean region.
Health sector funding by major bilateral and multilateral international agencies has been reduced or discontinued in Haiti, despite a growing epidemic and increasing national determination to respond to the epidemic. In Fiscal Year 2002, the U.S. Agency for International Development (USAID) will reduce its overall funding from $50 million to $35 million, affecting the Mission’s population, health, and nutrition activities. A team of consultants was asked to review and assess USAID’s current HIV/AIDS portfolio in Haiti in May 2001.
The assessment team found significant accomplishments, including a high level of awareness of HIV among the population and the establishment of a national condom social marketing program. However, protected sex is not widely practiced, and multiple sexual partners are common. The team was struck by a growing commitment to confront the challenges of ignorance and discrimination, poor health systems, lack of access to care and support, and an absence of political will.
The launch of a new national strategic planning process by the Ministry of Health gives rise to hope that policy guidance and funding commitment will follow. The national plan acknowledges the direct linkages between sexually transmitted infections (STIs), HIV, and other infectious diseases, such as tuberculosis (TB). It will become operational by the end of 2001.
Responding to the generalized HIV/AIDS epidemic in Haiti requires a dual approach: providing decentralized prevention and care services throughout the country while ensuring extra coverage of high-risk settings or “hot spots” where transmission is most rapid. The team recommends that USAID pursue two mutually reinforcing strategies: a departmental approach to expanding access to counseling and services and developing a second generation of messages on prevention, safe sex, human rights, and care and support for the afflicted, and an increased focus at the national level on vulnerable or high-risk communities most in need of services.
In the development and implementation of these strategies, related issues of commodity security, funding, and program and donor coordination will have to be addressed. The team recommends a partnership between the public and private sectors to expand access to counseling and services, develop a second generation of messages on prevention, safe sex, human rights, and care and support for the afflicted, and increase focus at the national level on vulnerable or high-risk communities most in need of services.
The team also recommends that USAID support the national strategic planning process and provide funding for the implementation of the national plan. Additionally, USAID should work with other donors and partners to ensure that funding is coordinated and that resources are used efficiently. The team emphasizes the need for a sustained commitment to addressing the HIV/AIDS epidemic in Haiti and recommends that USAID continue to support the national response to the epidemic.
The assessment team was struck by the commitment of the Haitian government and civil society to addressing the HIV/AIDS epidemic. The team notes that the launch of the national strategic planning process and the establishment of a national condom social marketing program are significant steps towards addressing the epidemic. However, the team also notes that much work remains to be done to address the challenges of ignorance and discrimination, poor health systems, lack of access to care and support, and an absence of political will.
The team recommends that USAID work with the Haitian government and civil society to address these challenges and to ensure that the national response to the epidemic is sustained and effective. The team also recommends that USAID support the development of a comprehensive plan to address the HIV/AIDS epidemic in Haiti, including a plan for prevention, care and support, and treatment.