Haiti has one of the highest adult HIV prevalence ratings outside of Africa. With about 2% of its adult population being HIV positive, this disease heavily impacts day to day life in Haiti (UNICEF, 2012). Comparatively, Haiti ranks far higher in the adult prevalence of HIV than other nations such as the United Kingdom at 0.16% (Kirwan et al 2016). Not only is this disease a deadly autoimmune disease, it distinctly impacts women and children due to cultural and economic factors. The HIV crisis in Haiti is one rooted in a history of colonization, lack of resources and gendered advantages. To accurately assess this crisis, I will look at this health issue through the critical lens to investigate who benefits from the epidemic, who is hurting, and what is being done. Additionally, this topic demands one to look at specific Haitian culture as well as the environment to understand how this issue is exacerbated as well as how gender plays a vital role in this crisis.

Analyzing this health issue in the critical anthropological perspective is important because through the process of learning about Haiti I have noticed that many power imbalances have led to the situation the country is in and this is exactly what the critical perspective evaluates (Critical). Incorporating how certain people have benefitted from Haitian suffering is crucial to understanding my health issue. As I analyze the country, one of the most important aspects is poverty and inequality something that is commonly addressed through a critical perspective (Leatherman & Goodman 2011). When researching, I found that many anthropology scholars utilize critical theory to incorporate how social and political situations have enabled the spread of HIV (Schoepf 2001). This paper will ultimately look at who is benefitting and who is suffering from this crisis, or who benefitted from situations that enabled this crisis. 

To understand the geopolitical situation Haiti currently has, one must acknowledge its history as a colony, an occupied nation, and one that has had a large amount of international involvement in its economy and the private sector. French colonization has heavily impacted Haitian life. Haiti was a colony of France until 1804 when the enslaved Haitians revolted against the French and earned independence (Schuller, 2012). In the wake of independence, the French demanded a massive payout to recognize Haiti as an independent country. At the time, this was was crucial to the Haitian state’s legitimacy due to the composition of their country being freed slaves in a time when slavery was still very vital to many economies (Schuller, 2012). To pay off this debt for state recognition, Haiti took out massive loans from the French and spent over 120 years paying it off through about 80% of their tax income. This debt made it so the Haitians were unable to build proper infrastructure and thus an economy during a time when other independent nations were thriving and “modernizing” (Shuller, 2012). On top of this, the United States (US) invaded (1915) and occupied Haiti until 1934, while controlling their finances until 1947 (Ramachandran & Walz 2015). The US occupation took control of the finances, keeping it away from the Haitian people, installed puppet governments, that favored light-skinned people, therefore, injecting racial tensions, and incorporated capitalism and private ownership heavily (Schuller 2012). This history is important to understand because it lays the political and economic groundwork for Haiti, this system of Western countries utilizing the nation set back infrastructure, independence, economic empowerment, and created racial tensions while disregarding autonomy for Haitians. This contextual history allows beginning to understand who was profiting off the resources in Haiti for hundreds of years instead of that economic power going back to Haitian people.

Economic power over Haiti doesn’t stop there. It is crucial to also understand how the international aid system locks Haiti into binding economic contracts that privatize professions and takes power away from the government under the guise of economic assistance. By the 1970s, more than 70% of the government’s money came from international assistance and while this seems like a philanthropic thing for countries like the US to do, in reality, the money is oftentimes a loan with a high-interest rate or it comes with strings attached, meaning the money can only be spent in certain ways allowing foreign countries to dictate what happens in Haiti to benefit themselves (Ramachandran & Walz 2015). This kind of investments in Haiti do not go to the Haitian people but typical go toward helping improve the private sector enabling an increased wealth inequality. Most of the landowners in Haiti do not actually live in Haiti, therefore, they extract money from the Haitian economy (Schuller 2012). With resources not going to the people and private economy growing to enable offshore investors to prosper, it is no wonder that almost 60% of its population below their national poverty line and about a quarter of their population in extreme poverty which is defined as making less than $1.90 a day (The World Bank 2012). 

This may seem like a lot of historical and economic talk instead of focusing on the HIV crisis but it is crucial to understand this information to contextualize why resources are so lacking that there are only 2 doctors for every 10,000 people in Haiti (Schuller 2012). Poverty is so rampant that most people spend up to 30% of their income on food, have difficulty finding drinking water, and lack proper sanitary facilities (Schuller), let alone preventative care items such as condoms to avoid the spread of sexually transmitted infections (STIs) such as HIV. 

The history of the disease also adds a cultural backdrop to the stigma surrounding the disease. Haitians faced massive discrimination, primarily from the United States, 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 (Malow et al, 2010). This discrimination made stigma about the disease incredibly high, keeping people from discussing prevention, how to seek healthcare and talking about the disease in general. The US stigmatized this disease and blamed in Haitian people, using their power as a Western-nation to control the discourse about the disease thus creating a stigma that disables people from talking openly about the disease. 

The gendered aspect of this disease is deeply connected to economic inequality and power. Haiti does not provide free education, therefore, many families have to make the choice of which children they can send to school if any. This leads to many uneducated women and girls in the country (Schuller 2012). Lack of education gives women less of an advantage to seek economic empowerment forcing them to resort to rely on men and turn to things such as sex work. Rates of condom use are very low because men have power in the sexual relationship due to the economic power that they hold over women (Hempstone et al, 2004). Women fear to negotiate their demands when it comes to sex due to their lack of economic power. When women cannot negotiate condom use, the potential to contract STIs, or more specifically, HIV, goes up. Women also lack the ability to negotiate the sexual encounter, in general, leading to a high rate of sexual violence against women. One study has shown that 54% of rural Haitian women have experienced forced sex (Hempstone et al, 2004). Younger and younger women are utilizing sex as a way to economic benefits, typically teenagers seeking older males with money (Hempstone et al, 2004). Women contract diseases often from men giving them opportunities to survive when women lack education. Women then often pass this disease to their children. Women who are HIV positive and pregnant can give their children the disease if they are not given antiretroviral therapy (Koenig et al, 2010). Using this therapy treatment is promising, but when there is a massive shortage of medical professions and income to spend on medical needs, many women end up passing the disease onto their children. In these situations, men benefit from being able to sexual control women but ultimately, Western nations who pump money into the Haitian economy to control their efforts win by continuing a cycle of disease and poverty that continues Haitian dependence. 

The geographical location and environment in Haiti exacerbate poverty that constricts resources and economic empowerment. Climate change has increased the severity of tropical storms for the nation. Haiti has experienced two major natural disasters in the last ten years, one being the massive earthquake in 2010 to strike the capital, Port-au-Prine leaving 220,000 deaths and over 300,000 people were injured (Danquah et al., 2014). This disaster left Haitians struggling, resorting to make-shift shelters out of plastic tarps, inadequate restrooms, and even trading sex for food (Scheuller, 2012). Additionally, Hurricane Matthew that hit Haiti in 2016 devastated infrastructure, and vital resources that people needed to survive (Cook & Beachy, 2018).  The country is still reeling from both of these disasters that massively destroyed the infrastructure that the country had. This added to the international aid sent to the country, tying itself back to the economic control over the country when Western nations either loan money, with high-interest rates, or they give money with strings attached leading donors to either make money or control the nation. 

Current efforts to prevent the spread of HIV in Haiti comes from prevention and education programs as well as a medical intervention. Prevention efforts have been incredibly successful in Haiti but still, have a long way to go in being accessible to all. Preventative care is often inaccessible to the poorest in Haiti, especially rural populations. 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). While both PIH and GHESKIO are run by Haitians, they are heavily tied to Western research institutions for funding, putting the control over the organizations in Western hands (Koenig et al, 2010). On top of combating rural inaccessibly, these organizations have to navigate cultural stigma around the disease cited above. Heterosexual intercourse being the main form of transmission (Koenig et al, 2010), prevention education is focused on how to stop transmission during intercourse. This primarily comes from education about condom use but still has a long way to go. According to PIH, only 35% of Haitians between age 15-24 accurately described how to prevent the transmission of HIV (“Sir Richard’s” 2012). Condom shortage is also a problem within Haiti, and global companies with a mission to eradicate the shortage have chipped in. Sir Richard’s donated 500,000 condoms to PIH. Yet again, this is another example of Western organizations, governments, or companies investing in the crisis frequently for their own gain. 

This issue needs to continue to be looked at in a critical framework, as well as the HIV crisis worldwide. We have the knowledge to prevent transmission and educate populations to stay safe yet many nations with colonial backgrounds and heavy international aid have staggering rates of HIV patients. Additionally, work on how women are impacted by a disease transmitted through sex is important. As noted, the power within a relationship to determine sexual intercourse is tied to economic power and in a country that monetizes education, women are left behind economically leaving them far less agency in the bedroom. I believe that the crisis actually benefits Western donors and that enabling Haitians to have the autonomy to build infrastructure and prevention efforts independently would not benefit Western powers as it does now. Overall, the critical perspective asks “who benefits and who suffers?” (Critical) and in this case, Western powers benefit over economic and political control while Haitians suffer from the disease, lack of resources, and natural disasters. Economic empowerment to the country and its people (both men and women), urban and rural, would enable autonomy but as we have seen, the country has been dependent or indebted since colonial times. 

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