Out of the Spotlight, the Quiet Spread of HIV in Haiti

'There is no control of the HIV situation,' said Reginald Dupont.
"There is no control of the HIV situation," said Reginald Dupont.

What Liesl Gerntholtz remembers most about Haiti in the early days after the quake was the darkness. In camps set haphazardly around the country, night came suddenly and electricity was sparse.

"If you walked around the camps, you wouldn't need me to explain to you why it's dangerous," she said.

In July, in the flurry of media coverage surrounding the six-month anniversary of the quake, there was a lot of discussion about the country's most obvious problems. Critics have assailed the slow movement of financial aid into the country. By one estimate, workers have cleared less than five percent of the rubble.

But some worry that another, more hidden problem is quietly bubbling in Haiti: The spread of HIV.

The board of the Interim Haiti Recovery Commission, the international body charged with routing Haiti's recovery, meets today for the second time. On its agenda: Deciding which multi-billion dollar donations go where. Major topics include funding a back-to-school program, debris removal and agricultural development. What's missing is serious talk about how to stave off HIV infections in a nation that has worked arduously to reduce its HIV rate from a staggering six percent in 2001 to 2.2 percent in 2007.

Gerntholtz, director of the Women's Rights Division at Human Rights Watch, visited 15 camps in Haiti in February. In Parc Jean Marie Vincent alone, she documented four gang rapes. "This currently isn't getting the kind of attention that it should be," she said.

Part of the problem is that unlike rubble and dollars, the spread of HIV is invisible and difficult to quantify. Haiti's mechanism for measuring sexual violence was knocked out after the quake. But studies have already shown that disasters often prime a region for the spread of HIV.

In the wake of the 2004 Asian tsunami, researchers sponsored by Oxfam interviewed about 1,000 people in 30 tsunami-affected communities in India. They found that in 10 of the 11 encampments studied, HIV-vulnerability (measured in terms of activities such as condom use) rose in the disaster's aftermath.

The report concluded that post-disaster trauma, combined with life in makeshift encampments, had triggered changes in sexual behavior. Normal standards of conduct where unenforceable in the temporary camps. Alcohol use and extramarital relations rose as survivors fought stress, boredom and grief. Commercial sex flourished.

Progress at Risk

Erick Louis, Liony Accélus, Reginald Dupont and Esther Boucicault are leaders at four grassroots AIDS service organizations throughout the country. All are members of PHAP+, a coalition urging the Haitian government to formulate a comprehensive post-quake AIDS plan.

This is what they reported in interviews in late July: Sexual violence was already high in Haiti, which did not criminalize rape until 2005. In the camps, it abounds. Electricity is unreliable, and the blanket of darkness that settles each night can be dangerous for women. Condoms often reach the country, but actual distribution is sporadic. Camps are crowded. Some people still sleep out in the open. To meet basic needs, many resort to transactional sex.

Single women with no means of providing for themselves are most vulnerable to infection.

"There is no control of the HIV situation," said Dupont, the program coordinator at SEROvie, the country's largest organization serving gay and transgender people with HIV.

Partners in Health, one of the largest nongovernmental health care providers in Haiti, has worked vigorously to both prevent gaps in HIV/AIDS treatment and ensure that prevention methods are put in place. After the quake, it moved about 200 employees into four of the camps in and around Port-au-Prince, setting up health clinics -- some specifically for women -- and training workers to find people who may need treatment. Between January and June 30, it tested nearly 16,000 people in those four camps for HIV. Six hundred and fifty-seven came up positive.

The organization's director of communications, Andrew Marx, worries that even this might not be enough. Some aid money is getting into the country, he said, but very little has gone to Haiti's Ministry of Public Health and Population.

"Haiti was quite a remarkable success story in reducing the [HIV] prevalence rate," he said. "And the earthquake has disrupted the lives of patients, put more people at risk, and disrupted the health system, and there is certainly a risk that we'll see that progress slow -- or even temporarily go into reverse."