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Final Report for the
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Introduction The poorest, most densely populated country in the western hemisphere, Haiti has the region's most advanced HIV/AIDS epidemic. The early emergence and high prevalence of this new syndrome in Haitians was perplexing, ultimately leading researchers to identify "Haitians," as a group -- along with "Homosexuals, Heroine users, and Hemophiliacs" (the "Four H's of AIDS" in early conceptualizations) -- at high risk for the disease. Such a broadly constructed risk category as "Haitians" bespeaks the enigma that surrounded the emergence of AIDS, from which developed undue scientific speculation about AIDS in Haiti. Unaware of the epidemic's global dimensions and only partially knowledgeable of the disease's transmission patterns, some researchers at the time theorized about "the Haiti connection" to explain its mysterious and unsettling appearance in the U.S. Inevitably, this indiscriminate speculation and risk group categorization had the unfortunate effect of initially stigmatizing a whole country and an entire population of US immigrants1. Hampering any immediately constructive reaction to this new public health threat, the early discourse of AIDS in Haiti was one of blame and counter-blame. A visitor to Haiti today, however, who is unaware of this recent history might be hard pressed to accept that the response to AIDS in Haiti had such an inauspicious debut only 15 years ago. Today, what is apparent is a frank public recognition and discussion of sexual risk and preventive behaviors, popular appeals from public figures for compassion and support for AIDS patients and their families, and whole communities engaged in the constructive work of prevention. Haiti's AIDS control efforts, in fact, stand out in their public prominence, their multi-sectorial base, and in the diverse but collaborative contributions from groups and individuals representing all spheres of Haitian life: private and public; popular and professional; religious and secular; international, national, and local. The history of AIDS in Haiti, therefore, has special significance. The sharp contrast between the implication and stigmatization characterizing the initial response to AIDS and the collaboration and compassion that is in evidence today, makes the example of Haiti an especially apropos venue for the field of public health to take stock of what has been learned and accomplished in the short 15 years since the AIDS epidemic was first recognized. AIDSCAP in Haiti also has special significance. A coup d'état in 1991 threw the Haitian government into chaos, rendering the National AIDS Control Program completely dysfunctional. The economic sector was also severely impaired and violence was widespread. Donor agencies withdrew their development assistance to Haiti in protest against the coup government. Through AIDSCAP, however, USAID continued to support NGO-based AIDS prevention in the country. Throughout most of the AIDSCAP project period Haiti was enduring major political and economic crisis. During this time and by default (as the only major AIDS prevention activity in the country), AIDSCAP assumed many of the responsibilities of the national program, including coordinating and funding activities, providing technical assistance to specific intervention projects, and conducting high visibility AIDS awareness and advocacy campaigns. The present-day vigor of AIDS prevention and control efforts in Haiti is due to USAID's commitment to AIDS prevention in the country despite the political circumstances, in addition to the dedication of AIDSCAP and NGO partners to carry on in the adverse conditions that existed during the project. Endnotes
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