AIDS in Haiti Poor Education And Social Taboos Make Tracking the Disease Difficult

by Anne-christine d'Adesky

The effect of AIDS in Haiti continues to be devastating. Since the first AIDS cases were reported in 1978-9, the country has suffered from severely negative press reports calling AIDS a "Haitian disease" and warning visitors to avoid the island as a vacation spot. More significantly, AIDS is exacting a heavy toll on Haitians. Lack of money, proper health care, and public education about AIDS has resulted in people dying in less than six months after a diagnosis of AIDS or AIDS-Related Complex (ARC).

Until three years ago, the government's response to the crisis was to avoid or deny it, since any public attention might be seen as giving legitimacy to those suggesting a tourist boycott. Today, both the private and public sectors are awakening to the grave threat the disease poses for residents of the capital, Port-au-Prince, and for those living in the countryside, where health care and education are, at best, mediocre.

"The government has changed its policy and is starting to talk about AIDS," said Dr. Jean-Claude Compas, head of the Haitian Coalition on AIDS in New York (Native 139). "But I don't think anything is being done to combat the disease. The situation right now is terrible, and it is going to get worse," he predicted.

The first probable AIDS case in Haiti was diagnosed through an autopsy in 1978, according to a report in the New England Journal of Medicine (Vol. 309, Oct. 20, 1983) by the Haitian Study Group on Kaposi's sarcoma and Opportunistic Infection (GHESKIO). The group, formed in 1982 and led by Dr. Jean W. Pape, studied 61 AIDS and ARC patients to determine how the disease originated in Haiti and how it was being spread. They found that a small but significant number of men with AIDS reported bisexuality-two of 12 men with KS (17%); three of 24 men with ARC (13%); two of 10 men with probable ARC (20%). Those figures were limited, however, by a heavy social taboo about homosexuality, wherein the "approach to questions of a personal

Haitian officials at road check point. nature [concerning sex or drug abuse] was not standardized." Two other risk factors, blood transfusions and prostitution, were found to be possible sources for AIDS infection. Five out of 25 patients (20%) with ARC have received transfusions from one and onehalf to six years prior to diagnosis, among them two women. None of the nine women with KS or ARC reported engaging in prostitution, but a host of venereal diseases were reported in the overall study group. Drug abuse was not reported by any patient.

Other Factors

Statistically, the relatively low percentage of AIDS cases being either bisexual or blood transfusion patients suggests that other factors might have influenced the spread of AIDS in Haiti. GHESKIO's report showed that eight of 30 patients (27%) had a history of malaria, while other infectious agents endemic to Haiti were also present. Elsewhere, various researchers have suggested a link between the so-called "AIDS virus" and malaria, African Swine Fever Virus (ASFV) and other tropical disease viruses.

A recent report in The Lancet (September 7, 1985) found that, "HTLV-III retrovirus

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antibody reactivity was associated with malaria and immune complexes in healthy Africans." This held true for all three HTLVIII retroviruses. The report suggested that malaria and HTLV-III "May share environmental factors," and listed mosquitoes and cow parasites as common sources for viral transmission.

TheASFV/AIDS lkink remains a highly controversial theory, since it indirectly implicates the U.S. government. In 1979, just prior to the large outbreak of AIDS in Haiti, the U.S. government sanctioned the slaughter of native pigs in Haiti who had contracted African Swine Fever, then replaced the pigs with am American breed that fed only on expensive U.S. grain. Proponents of the ASFV/AIDS link point to the timing of the two epidemics, noting that "striking similarities" exist in terms of symptoms, like fever, immune suppression, and skin lesions comparable to KS (Native 64-65). If the theory is true, it could seriously harm the U.S. pork industry, which exports a high quota of pork products.

Within Haiti, AIDS/ARC is largely an urban disease, concentrated in a suburb of the capital called Carrefour, a center for male

Ellen B. Neipris

Over 100 people attended a benefit held December 2 at One If By Land for the AIDS Resource Center, Inc. (ARC). The evening was hosted by playwright Harvey Fierstein and entertainers included comedian Robert Altman, Ruby Rims, and singer Roz Winter. The organizer of the benefit, Buddy Noro, hoped the dinner would raise much-needed money and "put ARC on the map." ARC provides financial assistance, housing, and pastoral, bereavement and spiritual counseling to people with AIDS. Twenty-one people currently reside in ARC shelters, and the organization plans to accommodate 60 more in the near future.

10 NEW YORK NATIVE/DECEMBER 23-29, 1985

AIDS News

and female prostitution, GHESKIO reports show. Patients come from a range of socioeconomic backgrounds. In a study of 48 patients, 32% had an annual income of less than $150, and 33% earned $150-$1,000 annually. Today, a majority of Haitians survive on $100 annual income (Cancer Research, Vol. 45, September, 1985). The median age for AIDS patients is 32; most are men, although "now it is almost 33%-39% female patients in Haiti," Compas states. The women were infected either by sexual contact or blood transfusion, he surmises. He adds that many Haitian mên had several girlfriends, just as husbands had mistresses, and that prostitution was common in Haiti "for economic reasons."

Due to malnutrition and "very mediocre public health care, the average poor Haitian already suffers from immune suppression and is therefore "more vulnerable to pneumonia, tuberculosis, diarrhea and parasites which characterize opportunistic infections related to AIDS," Compass stresses. He added that many suffer "itching all over the body."

Throughout Haiti, there are about a dozen doctors treating AIDS patients. The very sick attend public hospitals in Port-au-Prince, which lack the facilities to give proper care to AIDS patients, Compas explains, although even at Canape Vert, a private hospital, they overcrowded with AIDS patients. "Those who can pay come to the U.S. to get treated," says Compas, "but most just die. The number one concern for most Haitians in not AIDS anyway. It's how to eat."

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"Blood Banks Spread Disease"

Another danger is the lack of proper procedures at certain medical facilities. "The blood is not being screened for anything," Compas told the Native, "not for syphilis, hepatitis, or AIDS, except for the Red Cross, where it is properly screened." Compas called the central Banque du Sang (Blood Bank) "a source of diseases." Lack of screening means that it is virtually impossible to document or trace the number of donors or recipients of a particular virus.

So far, public education about AIDS has had little effect on prostitution, but it has enlightened Haitians about their sexual activities and attitudes. "I was amazed by some of the stories I was told by Haitians," says Compas, "such as one couple who had sex several times a day with boys they paid. Before AIDS, nobody talked about it." He assumed that such sexual practices would decrease as public education increases and as the social muzzle around such topics as homosexuality and bisexuality is removed.

Last month, a private business company raised $15,000 in donations from well-to-do Haitians toward AIDS care. GHESKIO is assisted by government and outside sources, like Cornell University Medical Center. Funds for research are available, and many foreign researchers are or have been studying AIDS in Haiti, including the Centers for Disease Control. As yet, however, "no experimental drugs are being tried in Haiti," Compas says, which means Haitians aren't benefiting from the millions of dollars being given to such projects.

By now, it has been shown that AIDS is

not yet on the scale of certain African countries, the U.S., or Brazil. In Haiti, the real-

ity of AIDS is that no one really knows how many AIDS/ARC patients are among those who think they suffer from the ravages of hunger; without blood screening, the AIDS, ASFV, or any other infectious virus might be infecting the general population; should the virus spread to the countryside, the chances of it killing a large percentage of that population is high; and finally, without outside assistance, the Haitian government will not be able to cope with this crisis. This is the second of two articles.