Profamil’s driver Alix pulls supplies out of the rubble Image: Paul Carrénard, Profamil

Although Haiti once had the highest rate of HIV/AIDS outside of sub-Saharan Africa, the Caribbean nation had seen a recent decrease in infections. Once lumped into what some called the US Centers for Disease Control and Prevention’s ‘4-H club’ of risk factors—homosexuals, hemophiliacs, heroin users and Haitians—the country’s HIV incidence plunged from 6.1% of adults in 1993 to 2.2% today. But the 12 January earthquake that shattered the lives of Haitians and destroyed more than half of the AIDS clinics in Port-au-Prince could threaten to reverse this progress.

Profamil, an affiliate of the International Planned Parenthood Foundation (IPPF), saw two of its clinics in Port-au-Prince and Jacmel reduced to rubble in the quake. After the disaster, it organized mobile health units that provided basic health care and HIV prevention services to the temporary shelters in and around both cities. Even so, “the distribution chain is uneven because of the chaos,” says Carmen Barroso, IPPF’s director for the western hemisphere, who worries that antiretrovirals and contraceptives are not getting to all those who need them.

The Gheskio clinic, among the oldest non-governmental organizations working in HIV/AIDS care in the world, was back up and running within 24 hours of the quake. All the walls around both Gheskio’s downtown Port-au-Prince site and the satellite campus near the airport were destroyed, but many of the clinical buildings, which were mostly single story constructions with light, corrugated iron roofs, only sustained minor structural damage. This allowed the center, which provides antiretroviral therapy to more than half of all patients in Haiti, to maintain HIV care and attend to the thousands of newly homeless people who camped out on Gheskio’s three-acre downtown property.

“I was utterly amazed by how rapidly they were able to reorganize, regroup and get right back to their mission,” says Kenneth Hover, a structural engineer at Cornell University in Ithaca, New York, who travelled to Haiti a week after the quake to assess the safety of the Gheskio buildings.

Thanks to a disaster contingency plan developed in the event of a political upheaval or hurricane, HIV/AIDS patients in Haiti had two weeks worth of extra drugs; Gheskio staff also carried extra supply. This reserve ensured continuous treatment until an emergency shipment of drugs from the US President’s Emergency Plan for AIDS Relief arrived one week after the quake. Around 65% of Gheskio’s 7,000 patients on antiretroviral or tuberculosis drugs are now receiving their medications at the main clinic in Port-au-Prince; another 15% are going to four designated satellite sites throughout the city; approximately 20% of patients remain unaccounted for (New Engl J Med).

Looking ahead

Displaced Haitians camping on Gheskio’s downtown campus Image: DVIDSHUB via Flickr Creative Commons

As citizens continue to flee the disaster-stricken capital, Gheskio is also providing technical support to help 26 rural clinics across the country provide life-saving drugs. “We are doing what we can to make sure that as people move out to the provinces they are connected to those sites,” says Rebecca Heidkamp, a graduate student in nutritional sciences at the Weill Cornell Medical College who was working at the Gheskio clinic when the earthquake struck and has now returned to New York.

The day after the quake, four New York-based AIDS groups formed a coalition to fund and operate two damaged clinics in Port-au-Prince and one in St. Marc. A day later, Charles King, president and CEO of coalition member Housing Works, an organization tackling both AIDS and homelessness, was on a plane with the first shipment of drugs.

Jesus Aguais, executive director of Aid for AIDS, another coalition member that collects antiretrovirals from HIV-positive North Americans who have excess unexpired meds, says that his organization has collected enough donations to continuously treat around 1,000 people. He has also had discussions with an Indian generics manufacturer to obtain more doses. “Our role is to fill in the gaps,” Aguais says. “What we’re trying to do is avoid treatment interruption,” which can lead to drug resistance.

But just because HIV-positive Haitians have access to antiretrovirals doesn’t guarantee that they will maintain their treatment regimen, warns Maeve McKean, a legal fellow at the International Community of Women Living with HIV and AIDS and at the Center for Health and Gender Equity in Washington, DC. “If people don’t have food they won’t take the drugs because it makes them so violently ill,” she says.

What’s more, McKean adds, because of the economic insecurity many women desperate for food and shelter are likely to resort to sex work or stay in unhealthy relationships, which will further erode gains made in stemming the tide of HIV. “There’s at least been a set back of five years,” she says.