Episcopal Medical Missions Foundation
Making A Difference
HIV/AIDS in Haiti
Between 1990 and 2000 the population of Haiti increased by 18%. Last year for the first time since census figures became available, the population of Haiti actually declined. This is explained in part by the HIV/AIDS epidemic in Haiti, the subject of an address by The Rev. David Mc Neeley, M.D., to the attendees at the EMMF 4th annual conference “Adventures in Episcopal Medical Ministries.” Dr. Mc Neeley told the audience that in Haiti one out of sixteen people between the ages of 15 and 49 have AIDS. Thirty thousand people died of AIDS last year in Haiti, and those orphaned by the epidemic have risen to an unmanageable 200,000. With funding from EMMF Dr. Mc Neeley has developed a long-range program to address the AIDS problem as it affects pregnant women and their offspring. He began by surveying attendees at antenatal clinics and learned that about 4% of Haitian mothers were carriers of HIV. He knew that the virus was spread from mother to infant and that without effective therapy the child was destined to develop AIDS. Once AIDS is fully developed the virus is difficult to eradicate without the administration of multiple anti-viral drugs that are expensive and out of the reach of most individuals in third-world countries. Dr. Mc Neeley, Professor of Infectious Diseases at Cornell University, and an expert in the use of anti-viral drugs in children, also knew that if these medications are given at the time of birth, most infants would not acquire the virus. The cost of this life-saving treatment is a very small fraction of the annual cost to treat an adult with AIDS.
Access to health care and information about HIV/AIDS is not supported in Haiti by the kind of public health system enjoyed by most developed countries. In rural areas the prevalence of HIV is as much as twenty times greater than in other parts of the country where these services are available. Dr. Mc Neeley, who led the development of the Episcopal/Presbyterian hospital of St. Croix in Leogane and who was its medical director for 10 years, was familiar with the difficulties in disseminating accurate information about health care in general and HIV/AIDS in particular to the remote villages of Haiti. His approach to the problem was to institute the World Health Organization’s (WHO) Community Health Worker Program, a curriculum designed to provide a knowledgeable lay person in remote villages where there are no health care professionals. With these health care workers and midwives distributed throughout Haiti, pregnant women could be tested for HIV. Once identified as HIV positive they could be brought to the hospital for their delivery and the treatment of their babies.
Dr. Mc Neeley described the plans that have been set in place to utilize the community health workers (CHWs) to implement the search for pregnant HIV positive Haitians. It was important to integrate the HIV rogram into the whole of the maternal and child health services already conducted by the CHWs and to incorporate the services of obstetricians, pediatricians, nurses, nutritionists and clergy when available. A training plan and strategy for the CHWs was written and clinical guidelines were adapted. The villages of Cabaret and Delmas were selected as the initial implementation areas. A permanent AIDS Information Center was dedicated where information was available daily, the testing for HIV was conducted and the follow-up maintained.
For the 2003-2004 period a number of initiatives are planned. Community-based support groups and programs for HIV positive women will be instituted. Antenatal care services will be strengthened for pregnant women. Information will be provided about the risks of unprotected sex. Counseling about safer sex and the prevention of infection will also be provided.
A copy of the presentation on HIV/AIDS in Haiti can be obtained by clicking the link below. The presentation is in MS PowerPoint format.
Primary Health Care for Perinatal and Childhood HIV Infection in Developing Countries
Episcopal Medical Missions Foundation: Making a Difference in Haiti
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