After the Earthquake: Haiti's HIV/AIDS Infrastructure Is Devastated

Haiti must now rebuild from the catastrophic 7.0 earthquake it suffered on January 12. Most of its citizens lack access to basic health care services, and the nation will have to reconstruct hospitals and clinics.

But the conditions may be even more disastrous for an already vulnerable community: Haitians living with HIV/AIDS. Many of the clinics that were destroyed were HIV/AIDS clinics, and many of their staff members were killed. According to reports, almost no one seems to have access to antiretrovirals (ARVs).

Much-Needed Services Are Gone

Haiti's HIV/AIDS caseload is dramatic. UNICEF estimates that 5.6 percent of the pre-earthquake 15- to 49-year-old population was HIV-positive, including about 19,000 children. HIV/AIDS is the nation's leading contagious cause of death, making the loss of AIDS services particularly dangerous.

SEROvie, Haiti's largest organization serving gay and transgender people with HIV, was devastated, reports The Advocate. The majority of the staff were killed. Director Steven La Guerre describes the chaos: "We were having our usual support-group meeting on a quiet Tuesday afternoon when the worst happened. The sound is unforgettable. I can't even describe the horror as the ceiling and the wall started to fall."

"At least half of Port-au-Prince's AIDS clinics appear to have been destroyed," says Charles King, CEO of Housing Works, the New York City-based AIDS service organization (ASO) that finds housing for people living with HIV/AIDS. King traveled to the disaster zone to deliver ARV medication and supplies. His blogging offers a compelling snapshot of post-earthquake life for people with HIV/AIDS.

In one dispatch, he writes, "On the way to the airport, we passed CEPOZ, an HIV/AIDS clinic and support center. The two-story building was completely flat. Anyone who was there when the quake struck never had a chanceā€¦.We later passed a second AIDS clinic. This one is still standing but clearly not for long."

AIDS Clinic Becomes "Tent City"

Founded in 1982, GHESKIO (Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections) is Haiti's leading HIV research and training center. Its two campuses, both located in Port-au-Prince, suffered structural damage, but most of the staff have been accounted for. After the disaster, the center opened its gates and became a field hospital and tent city for thousands.

Jean William Pape, M.D., GHESKIO's director, told NBC Nightly News, "We have no choice. They lost their only home and their hope." Dr. Pape also told NBC that approximately 5,000 people were living at the main campus, which could shelter twice that many and perhaps even more.

An Emergency Plan Pays Off

Dr. Pape hopes to coordinate medical services and HIV care with local providers. "We need to know how many hospitals are working, how many operating rooms they have," he says.

There is some good news. GHESKIO has been providing lifesaving ARVs to hundreds of HIV-positive patients. The center had a hurricane-emergency plan in place, and it remains "fully operational"--even with the influx of thousands of residents--administering up to 900 ARV doses daily.

Medications Remain Scarce

But the people GHESKIO is reaching are just the tip of the iceberg. Up to 50 percent of Haiti's estimated 130,000 HIV-positive citizens are on ARVs. Nobody knows how many patients cannot get to their meds.

"Antiretroviral drugs are extremely scarce," UNICEF says. Missing doses can cause blood levels of the virus to surge, which could lead to treatment resistance and may increase the person's ability to infect others. Many are leaving Port-au-Prince for rural areas, which will also disrupt treatment.

The dire situation also means that people are more likely to engage in risky behavior and "survival sex." "People don't stop having sex because there was an earthquake," notes Housing Works' King, who was asked by Haitian ASOs to bring "as many" condoms as possible.

AIDS Orphanages in Peril

Pregnant women and infants are also at considerable risk. The closing of so many hospitals makes it more difficult for HIV-positive pregnant women to receive their meds--and increases the chances that their fetuses will become infected.

It's been difficult to find reliable information about the country's AIDS orphanages. One of the larger facilities, Kay Angel (Kreyol for "Angel House"), located in Jacmel in southern Haiti, was hard hit by the quake. (A Flickr album documents the town's destruction.) Luke Montgomery, one of the orphanage's founders, reported that all of its charges made it out alive but were now on the streets "surrounded by rubble with no food, water, blankets or medicine. Two are handicapped and cannot walk."

Building a Bridge to the Future

With every tragedy there are opportunities. International ASOs are helping to rebuild Haiti's HIV/AIDS infrastructure. One example: Housing Works is raising funds to build an HIV/AIDS clinic in Port-au-Prince. (Broadway Cares/Equity Fights AIDS has already donated a generous $25,000.)

"There are many people in Haiti who are determined to save as many lives as they can and to rebuild their own country," says King. "We are making this commitment for the long haul."

Rod McCullom, a writer and television news producer, blogs on Black lesbian, bisexual, gay and transgender news and pop culture at rod20.com.