HIV epidemic casts devastating shadow

High infection rates taking their toll on Caribbean nations

June 19, 2001|By Tim Collie, South Florida Sun-Sentinel.

BAINET, Haiti — A cool breeze blows as the body of Jean David Droitdieu, carried down steep rocky trails on the shoulders of men chanting an almost cheery dirge, approaches his mother's house.

There's a faint smell of rum in the air--it's what has fueled the men during their grueling, four-hour hike from the nearest road in southeastern Haiti. The men lumber up a bank into a remote village of white stone homes known as Galette Mousambe.

The chanting ends, replaced by a long, pitiful shriek as the mother sees the corpse of her eldest son. Soon, dozens of friends and family join in a single violent wail that seems to fill the entire valley.

As one more life claimed by AIDS, this 28-year-old's death will be something less than a statistic. It joins countless other deaths, officially unrecorded, but mounting on a scale at which experts can only guess as the epidemic sweeps through the Caribbean.

"This was a good man, a very respectful guy," Junior Droitdieu, the dead man's brother, said as villagers console his mother. "He worked hard, took care of his family."

AIDS epicenter for region

Now entering its third decade under the brunt of the epidemic, Haiti is the epicenter in the Caribbean's struggle with AIDS. This desperately poor nation has the largest number of cases in a region with one of the world's highest infection rates.

During the last two decades, an estimated 300,000 Haitians have died of the disease, making it by far the largest toll in either the Caribbean or Latin America. An estimated 87 percent of all AIDS cases in the Caribbean are occurring on the island of Hispaniola, home to Haiti and the Dominican Republic, with a combined 15.8 million inhabitants.

Overall, at least 390,000 adults and children in the region are living with HIV, the virus the causes AIDS. The real number could be higher--well over 500,000 people--because many countries lack the resources to even count the sick.

In spite of efforts by several international health agencies, the infection rate is increasing. There are now twice as many new HIV infections occurring as there are AIDS deaths, leading to fears of a higher death rate in the years to come.

Epidemic is expanding

The epidemic is expanding with the help of migration, tourism, sexual liaisons and a cultural resistance to sex education and programs advocating condom use. It is taking advantage of small, transient communities, fragile island economies and weak public health systems that are ill-equipped to halt the spread.

But the stigma attached to the virus--the taint of adultery, illicit sex and drug use--has crippled efforts to curb its spread. Many of the sick fear for their jobs and families if their illness is discovered, while the young and seemingly healthy who think they are immune from HIV continue its spread.

Stopping the disease is more than just a question of simple biology. A new generation of medicine exists that could save lives, but it is mostly out of reach in impoverish countries like Haiti.

"The biggest problem is medical care. There really isn't any public medical care," said Jean Saurel Baujour, a leading AIDS activist in Haiti. "There is no national reference center. Not even the most basic statistics are really being kept.

"It's a long fight. It's a lonely fight. Many of us are going to die," added Baujour, who has HIV. "We know that. But we can help change things for the sons and daughters that follow us."

Ill-equipped doctors

Doctors, who in poor areas charge about $1 for office visits, are ill-equipped to deal with sickness as debilitating as AIDS. Though many doctors advertise the availability of HIV tests, they usually don't give them until a patient is showing symptoms of full-blown AIDS, health workers said. When they do test, the doctors often don't even tell their patients they have tested positive.

"What we find out is when we tell the patient, they tend to die sooner," said Dr. Michel Thomas, who has a small practice in Cite Soleil. "They just lose hope. The stigma is so great here against AIDS, you just tell them they have TB or another opportunistic infection."

In Haiti, officials with the UN Joint Program on HIV/AIDS estimate that as many as 330,000 of its 7.6 million inhabitants are infected with the AIDS virus--12 percent of the urban population and 5 percent of rural inhabitants.

But as large as its problem is, Haiti is not the only country seriously threatened by the epidemic. In the Bahamas, 4.1 percent of adults are infected with the virus. AIDS is now the major cause of death among young men between the ages of 15 and 44 in the English-speaking Caribbean. In some parts of the Spanish-speaking Dominican Republic, it has become the leading cause of death among women in the same age group.

More alarming, some experts said, is the increase of infection among expectant mothers. In Haiti and Guyana, 7 percent to 8 percent of pregnant women are HIV-positive, a staggering rate that suggests the scale of contagion.