Haiti: The Intersection of Race, Poverty and HIV

A Doctor Describes the Impact of an Epidemic on His Homeland

In the early 1980s, before HIV had been identified or AIDS was officially named AIDS, one poverty-stricken nation was thought to be the epicenter of the disease that was wreaking havoc on the lives of gay, white men abroad.

In an effort to identify high risk groups for this mysterious plague, the United States Centers for Disease Control and Prevention (CDC) placed Haitians on their list of "H's", alongside homosexuals, heroin injectors and hemophiliacs. In fact, early studies even suggested that HIV had originated in Haiti, and that people of Haitian descent carried a particular trait that gave them a predisposition for the disease.

The infant mortality rate in Haiti is the highest in the Americas and life expectancy, at approximately 52 years, is the lowest in the Caribbean. This small, famine-stricken nation also holds the title for the second-lowest per capita caloric intake in the world, with an average household income of $230 per year. As a result of such poor living conditions, crime, violence and prostitution became the way of life for many within the lower class majority.

In the late 1970s, inexpensive vacation packages drew many tourists to the Caribbean, to Haiti in particular. It is thought by many that the high prevalence of sex trade that took place between citizens trying to survive in their homeland and tourists seeking a better vacation yielded a plethora of sexually transmitted diseases, including what we now know as HIV.

In an effort to obtain a better understanding of the effects of such a dramatic series of events on an already fragile people, I sought out the wisdom of Dr. Fritz Lolagne, who was once a private practitioner in Haiti.

Dr. Lolagne and I became fast friends during an interview I conducted with him for TheBody.com, a comprehensive HIV treatment education Web site. He was a recipient of their 2005 HIV Leadership Award for his work in prevention education at the Center for Multicultural Wellness and Prevention in Orlando, Florida.

I credit him for being the first person to truly open my eyes to the extent of devastation that Black people, and not just those in America or in Africa, but Black people all over the world are experiencing from AIDS.

"For people who live in poverty," says Dr. Lolagne, "there are very few options for entertainment, so sex becomes a big deal. People can't go to the movies or watch television or listen to CD's, so what do they do for recreation? They have sex.

"The number one mode of transmission for HIV in Haiti is reported as heterosexual contact," he explains. "In my own private practice, largely due to our culture, not many people would admit to being gay or to having sex with anyone of the same sex. Homosexuality is completely taboo in Haiti."

Although the people of Haiti live in great denial and silence about the existence of homosexual behavior, the exact opposite is true for Haitians about their HIV status.

"The people of Haiti feel that if they spread the word, they can garner support and, therefore, their fight will be much easier," says Dr. Lolagne. "Hiding creates stigma and stigma creates separation. Our situation is far too intense to isolate anyone."

It is estimated that nearly 5 percent of the population in Haiti is infected with HIV (15 times the rate of infection in the United States). According to Dr. Lolagne, achieving adequate healthcare for the masses is a task that appears to be virtually impossible. "Our resources are very limited. We have some great people there doing some really great things, but I am afraid that it just isn't enough."

A dispute between the administration of Haiti's president, Jean-Bertrand Aristide, and the small non-Haitian coalition of powerful entities that oppose him have caused some $500 million in approved international loans and grants to be blocked. "There are resources available," Dr. Lolagne says in desperation. "But it appears, at times, that for one reason or another, the entire world has turned a deaf ear to cries of the people of Haiti."

One major effort that Dr. Lolagne speaks highly of is Zanmi Lasante (Creole for Partners in Health), located in Cange, Haiti. Zanmi Lasante is headed by Paul Farmer, an American doctor from Harvard Medical School. Aside from providing healthcare to more than 1,500 Haitians living with HIV, Zanmi Lasante also runs schools, makes sure that the local water is safe to drink, and helps to provide jobs for hundreds of people.

Partners in Health has been successful in reducing the cost of antiretroviral therapy down to $1,000 per year per patient from about $10,000 (roughly the average cost for anti-HIV medication in the U.S.). Amazingly, they have also been able to ensure, through private donations from non-governmental agencies, that all of their patients who are in need of medication receive it.

But even with such great progress being made, there remains a huge deficiency in overall healthcare in Haiti, especially for those living with HIV. At times, there are literally hundreds of people who sleep outside of the Zanmi Lasante clinic, awaiting their turn to see a doctor. And because clinics such as this only exist in urban areas throughout the country, the devastation brought on by the epidemic in rural areas is magnified.

"I am really saddened at times by what I see when I return home," Dr. Lolagne says. "I try to gather as much knowledge and material as I can so that I can share it with my colleagues back in Haiti."

Dr. Lolange strongly believes that the road out of poverty and disease for the people of Haiti is paved with education. "When people are poor or sick or hungry, education is the furthest thing from their minds," he explains. "We must somehow provide them with the resources they need to educate themselves and take control over their own destiny."

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