Haiti has the Western hemisphere's highest HIV rate: an estimated 6 percent of adults are infected. The current political crisis threatens to fuel the epidemic by undermining treatment programs as well as studies of what prevention methods work best.

Raul Boyle, UNAIDS' Haiti coordinator, and others say the crisis could worsen the epidemic in several ways. Roadblocks have disrupted shipments of food and medicine, and doctors worry that treatment interruptions will build resistance to medications. Anarchy and violence will likely lead to higher rates of rape. To feed their families, women in isolated areas may be driven to form partnerships with soldiers or truckers -- alliances that, in other parts of the world, have helped spread HIV, said Ruth Berggren, an AIDS specialist at Tulane University-New Orleans.

MARCH, a group with which Berggren works, uses mobile clinics to deliver food and medicine to 175,000 women around the central city of Mirebalais. MARCH runs a network of "accompagnateurs," paid support workers who visit the homes of women with AIDS. Though roadblocks have forced MARCH to cancel some clinics, Berggren said accompagnatuers still travel on foot to remind people to take their medicine.

After looting and violence in Port-au-Prince forced the closing of the country's oldest AIDS hospital, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), doctors switched to a contingency plan and consulted with patients by phone. GHESKIO is one of the main recipients of Haiti's $67 million grant from the Global Fund to Fight AIDS, TB and Malaria; the money allowed it to open 20 clinics around the country last year and pays for the distribution of antiretrovirals to 1,800 patients. Some of this reaches poor people in central Haiti through a network of clinics run by Harvard University-based Partners in Health.

GHESKIO's director, Jean William Pope, said he hopes the US administration will follow through with plans, announced just six days before President Jean-Bertrand Aristide fled the country, to send more money to AIDS programs in Haiti.

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