Part I: For my final project on health in Haiti I intend to look at HIV/AIDs and how this disease impacts the country. In 2018, there were about 160,000 people in Haiti living with HIV/AIDS, a majority of those people being adults with less than 10,000 being children under 15 years of age putting the adult prevalence rate at about 2% of the Haitian population (UNAIDS). In 2018 alone, 7300 people were infected with HIV and 2700 people died from it (UNAIDS). While 67% of people infected with the disease know their status, as HIV positive, that leaves more than 30% of those infected without knowledge of their status (UNAIDS). The peak of HIV prevalence was in the 1990s with a rate of about 8% (Koenig et. al, 2010). 

Combatting the prevalence in Haiti has been a widespread effort in the country. Antiretroviral therapy (ART) was introduced in the mid-1990s as a drug to treat HIV and is now used throughout Haiti as one of the primary forms to help those with HIV positive status (Hammer, 2011). ART is also being used as a prevention method for those who are not HIV positive as well as a way to prevent mother to child transmission for HIV positive women who are pregnant (Koenig et al, 2010). Prior to using ART as a prevention of mother-to-child transmission up to 27% of infants of HIV positive mothers contracted HIV from their mothers compared to 1% just years after the drugs introduction (Koenig et al, 2010). Prevention also includes education to Haitians on HIV risk factors, safe sex practices and access to condoms (Koenig et. al, 2010). While this preventative education is beneficial, many are still partaking in sex without condoms, increasing the likelihood of infection. 

Prevention efforts have been incredibly successful in Haiti but still have a long way to go in being accessible to all. The main problem cited with preventative care is inaccessible to the poorest in Haiti. Non-governmental organizations are working to expand care to rural and urban groups in need in order to fill the public health gap such as Partners in Health (PIH) in rural areas and the Haitian Study Group on Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO) in urban areas (Koenig et al, 2010). Poverty not only restricts access to medical care but also impacts day to day activities such as safe drinking water, adequate sanitation facilities, shelter, food, and violence that all exacerbates their situation (Malow et al., 2010). Another aspect that impacts medical care is natural disasters. Haiti is ripe with hurricanes and tropical storms that are bound to get worse with the continuation of climate change making it impossible for people to seek care sometimes regardless of their class status.  

Part II: Public health wise, HIV stands to impact the lives of many if it goes untreated. Combatting this issue from a public health perspective means providing care to people throughout the country which can be quite difficult as well as expensive (Koenig et al, 2010). ART drugs have decreased prevalence but this is not the end of the issue, natural disasters, drug resistance and sustainability are possible barriers to continue to provide care. 

Culturally, there are aspects to this health concern as well. HIV stigma is very widespread in Haiti preventing many from seeking the healthcare they need or educational prevention (Malow et al, 2010). The topic is so stigmatized people avoid talking about it. Another cultural aspect of this disease goes back to historical discrimination Hatitans faced when the disease was discovered. HIV was first discovered in the US and Haiti. The disease became known as the “4H disease” affecting Haitians, hemophiliacs, heroin users, and homosexuals. This targetting of Haitans lead to discrimination and heavily impacted their economy stimulating groups such as GHESKIO to take action to understand and treat the disease (Koenig et al, 2010). Stigma as well as a history of discrimination based on this disease adds to the understanding of HIVs impact on Haitians. 

Hammer, S. M., (2011). Antiretroviral Treatment as Prevention. The New England Journal of Medicine, 365, 561-562.doi: 10.1056/NEJMe1107487

Koenig, S., Ivers, L.C., Pace, S., Destine, R., Leandre, F., Grandpierre, R.,… Pape, J.W. (2010). Success and challenges of HIV treatment programs in Haiti: aftermath of the earthquake. HIV Ther., 4(2), 145-160. doi:10.2217/hiv.10.6. 

Malow, R., Rosenberg, R., Lichtenstein, B., Devieux, J.G. (2010). The Impact of Disaster on HIV in Haiti and Priority Areas Related to the Haitian Crisis. J Association Nurses AIDS Care, 21(3), 283-288. doi:10.1016/j.jana.2010.02.002.

UNAIDS. (2019). Country Factsheets Haiti. Retrieved from https://www.unaids.org/en/regionscountries/countries/haiti.