Haitians left out
A lot of recent attention has focused on the failings of the reconstruction efforts in Haiti since the devastating earthquake which hit in January 2010. There is little doubt that many of the criticisms are well founded. A large portion of the funds promised for the reconstruction efforts has simply never materialised. The largest proportion of the money went to multilateral agencies, and big well connected NGOs. A much smaller proportion went to the Haitian government - around 13% - and even less directly to Haitian NGOs – with some estimates as low as 0.4%.
In fact, it is reported that Haitian organisations were often not taking part in meetings to discuss reconstruction. They could be unaware of the meetings, did not have the necessary ID passes to access the UN compound, or simply did not have sufficient staff capacity to spend long hours in these discussions. At worst, the meetings were being held in French or English, and not being translated into Creole, thus excluding sole speakers of Haiti’s main language.
Despite the shortcomings in the humanitarian response, it is clear that for many people living in the country, the challenges they face in their daily lives stem back long before this most recent crisis. A lack of housing, adequate sanitation, education, healthcare are longstanding issues for many Haitians.
Facing stigma and discrimination
For people living with HIV, or groups most at risk to infection, this situation is compounded by the discrimination and stigma they face in their daily lives. In many cases, the fear of discrimination blocks access to even the most basic services they require and the stigma still surrounding HIV means that securing a job or livelihood becomes even more of a challenge.
People living with HIV in Haiti generally rely on the support network that their family and community can provide, given that that universal healthcare and social security is far from being a reality. Nevertheless, the stresses placed on Haitian society following the earthquake meant that families and communities became increasingly disjointed.
In some cases, people living with HIV struggled to access the medications they needed as they were displaced from their home areas and a huge strain was placed on health services. Furthermore, resources and focus shifted towards new emerging health issues, seen to be more pressing, such as sanitation and the outbreak of cholera. Given what has already been widely reported on very high rates of transactional sex, sexual exploitation and sexual violence in Haiti after the earthquake, the apparent absence of attention paid to HIV is becoming alarming.
Addressing an HIV crisis
Very little new data on HIV in Haiti has been published since the earthquake, yet past experience in other fragile contexts shows that following such a crisis, the HIV prevalence rates can rise rapidly if attention to HIV prevention is not adequately paid.
Health infrastructure was severely disrupted and damaged following the earthquake and significant gaps still remain. As with the general reconstruction efforts, the HIV response since 2010 has been dominated by international assistance, rather than locally led responses, and it is likely that this response will not be sustainable. As such, it is vital that an effective coordinating mechanism for the national HIV response is re-established in order to make sure that all needs are being met. This should involve international stakeholders, but crucially also Haitian actors, both government and civil society. In this way, the HIV response can complement wider efforts to strengthen Haiti’s health sector in general.
Community led responses
The Alliance Linking Organisation in Haiti, Promoteurs Objectif ZeroSIDA (POZ), has supported the creation and development of associations and networks of people living with HIV for several years. It has provided training to develop the skills needed to run independent organisations, and in some cases funding and support with infrastructure.
At the forefront of the work of POZ, people living with HIV are involved in peer outreach work, providing education, advice and support. They organise support groups which are crucial to encourage people to access the medical care they require and to adhere to treatment. These groups are also an important space for people to rebuild their social support networks. POZ also reaches out to groups who are particularly vulnerable to HIV, such as men who have sex with men.
For the HIV response in Haiti to be successful, particularly in the complex reconstruction period, it is imperative that it focuses on building the long-term capacity of civil society. Moreover, people living with HIV themselves need to be fully part of the civil society response in order to help ensure that human rights, care, support and prevention programmes are restored, not just in the post-earthquake setting, but well into the future as well.
Thomas Dunmore Rodriguez is senior programme officer at the International HIV/AIDS Alliance.