The devastation caused in Haiti by last week’s earthquake seems to have no limit. As governments and international aid groups work to meet basic
needs for food, water, medicine and shelter, others must
work to stave off what could be another awful legacy of this natural
disaster–an acceleration of the HIV and AIDS epidemic among Haitian women.
Narrowly focusing on the devastation at hand, without simultaneously addressing
underlying factors which do and will heighten women’s’ vulnerability to HIV in
emergencies, will lead to tragic consequences in the long run.
Even before the earthquake, rates of HIV infection were
already high in Haiti, accounting for the most serious HIV epidemic in the
Caribbean. In addition, women represent 60 percent of the 120,000 people known to be infected with HIV in Haiti.
In this and many other ways, Haiti resembles sub-Saharan Africa much more than it does
its Caribbean neighbors. The small island nation is one of the
poorest in the world. A majority of Haitians live on less than
two dollars a day, and life expectancy hovers around 58 years.
The dislocation and displacement that have resulted from the
earthquake create the perfect recipe for an increase in HIV infections.
First, just as there is insufficient access to food and water, access to HIV care, treatment and prevention has been interrupted or limited. The
health infrastructure in Haiti, what little there was before, has been decimated. Second, gender inequalities become exacerbated during an emergency and thus women and
girls are at greater risk of exposure to sexual and gender-based violence and
exploitation increasing their risk of contracting sexually transmitted infections, including HIV.
Even in stable times, women and girls are
biologically, socially and economically more at risk than men to contracting
HIV and other sexually transmitted infections. In an emergency situation, such as
the one that has engulfed half of Hispaniola, these vulnerabilities are
amplified. Limited access to
health services means that something as simple as a condom may not be
available. Where not exposed to
direct violence, the chronic shortage of basic goods often pushes women and
girls into survival behaviors that put them at risk of acquiring HIV. This is
especially true among displaced populations where normal safety nets, including
access to friends and family, are absent.
Despite the links between emergencies and HIV vulnerability,
addressing these risk factors generally is not seen as a priority. Relief
operations tend to focus on meeting the basic needs of shelter, water, food and
palliative care. There is no doubt that it is difficult to think in the
long-term when there is so much suffering in the "here and now."
However, not prioritizing HIV and the needs of those living with HIV now is short-sighted and threatens not only to lead to increased disease burdens in the future but to perpetuate the spread of drug-resistant strains of HIV that can more easily transfer from one person
to another.
When an HIV-positive person takes anti-retroviral drugs it reduces
the amount of virus in their body, making them both healthier and less
contagious. However, if the medication is stopped or taken
sporadically, the virus is given the opportunity to mutate, able to reproduce itself in the presence of anti-retroviral drugs. If
drug-resistant strains spread in Haiti, it would likely reverse much of
the progress made in the country on HIV to date and significantly compromise the
country’s ability to control the spread of the disease.
The reality is that the money, support and aid pouring into Haiti
could all be in vain if, once the cities are rebuilt, and lives restored HIV
rates are no longer at 2.2 percent but triple that. In working with
Haitian people, including those already living with the disease, humanitarian
organizations must consider a broader definition of basic needs. Food,
water, and shelter are critical.
But these must be supplemented by efforts to provide safe shelter for
women and girls, offer protection from gender based violence, and dramatically increased access to
reproductive health services. The risk of sexual violence should be taken into
account in organizing temporary shelters. In addition, displaced
Haitians must be given the opportunity to be active participants in relief
efforts, including women in the process of deciding the best ways of meeting their own needs.
While many of these practices are self-evident and are already
incorporated into the policies of aid agencies and international bodies, the
pressure to consider these as secondary priorities is tremendous. Even though
we do not see it, Haitian women’s vulnerability to HIV is increasing daily,
occurring as it often does, as a backdrop to a natural disaster. Aid
agencies and the Haitian government must work to meet not only the needs that
can be seen today, but provide for prevention, care and support to reduce the
tragedy of tomorrow.