23 May, 2005
NEW YORK ? Internationally recognized experts on HIV/AIDS assessed the grim realities facing the two countries which share the island of Hispaniola, and laid out elements of an agenda for bilateral cooperation at the Batey Relief Alliance?s III International Conference, ?HIV/AIDS in the Dominican Republic and Haiti: A Bilateral Challenge,? held April 30 at Columbia University in collaboration with Barnard College and the Columbia University International Family AIDS Program. Click HERE to view images of the conference.
Together, the Dominican Republic and Haiti account for 85% of the AIDS cases in the Caribbean. Their shared border means that any hope of reducing the deadly toll of the HIV virus depends on the sharing of information and the search for collaborative solutions. According to the United Nations 2004 Report on the AIDS Epidemic, the overall HIV/AIDS prevalence rate is 2.3% in the Dominican Republic and 4.5% in Haiti. HIV/AIDS rates are 5% or more in the bateyes, rural communities in the Dominican Republic?s sugar cane fields, which house Haitian migrant workers, Dominico-Haitians, and Dominicans. There is significant migration and movement from one end of the island to the other, as well as a high level of tourism from other countries around the world, making HIV/AIDS a significant cross-border issue for the Dominican Republic and Haiti.
“Realistically the two populations are much closer than many think when dealing with commerce or migration. The cross-border mobilization alone is ground for a swift response with a serious binational effort for HIV/AIDS prevention and control,? said Ulrick Gaillard, CEO of the Batey Relief Alliance.
The panelists identified the following realities of HIV/AIDS in the Dominican Republic and Haiti:
? Overall HIV/AIDS surveillance is poor, especially on binational aspects of transmission, but excellent models have been used selectively and could be replicated across the island.
? The epidemiology in rural and urban areas differs greatly, although HIV/AIDS is worse in the Dominican Republic?s rural areas while urban areas in Haiti are the ones that bear the brunt of the epidemic.
? Testing needs to be extended to broader populations in both countries.
? The high interaction of sex workers with foreign clients points highlights a global aspect to the epidemiology of HIV/AIDS in the Dominican Republic and Haiti.
? Women now represent about half of those infected in the Dominican Republic, as is the case around the world. Since sexual violence and power play a large role in the transmission of HIV, empowering women must be a key component of prevention efforts.
? AIDS affects business productivity through its devastating toll on the working-age population. Because it brings together a large captive audience, the workplace is a good venue for education and treatment initiatives. Though businesses are open to such efforts as a way to fight the virus that is hurting productivity and profits, most lack the knowledge to implement such programs on their own.
? AIDS has left behind a huge orphan population, including 163,000 in Haiti alone.
? The link between poverty and HIV/AIDS is unmistakable, not only in terms of people lacking the resources for medical care, but also because it pushes so many people into the sex trade as a last resort for economic survival.
? People living with HIV/AIDS should be given a voice in human rights and anti-discrimination campaigns.
? Condom use is very limited.
? Dominican efforts are sometimes hampered by the perception that HIV/AIDS is limited to the Haitian migrant population.
? The marginalized population (60% or more Dominicans) living in the impoverished bateyes of the Dominican Republic has the highest rate of HIV/AIDS (5% or more) in the country, and yet receives very little attention in education, prevention and treatment.
The panelists offered the following binational solutions and opportunities for collaboration:
? The integrity of blood banks must be ensured.
? Employment of an accompagnateur, who visits patients daily to make sure they take their medications, can greatly increase compliance and reduce the likelihood of anti-retroviral drug resistance developing.
? The number of doctors as a percentage of the population is abysmal in Haiti.
? Fighting HIV/AIDS requires a holistic approach that also involves attacking broader issues that affect health and the environment: housing, malnutrition, and deforestation.
? Social support networks make the difference between survival and death.
? There is a continued urgent need for low-cost drugs and laboratories.
? Further training of health personnel is needed.
? Public-private sector partnerships are essential to ensuring delivery of services.
? Pregnant women must be engaged to prevent the transmission of HIV to their unborn children.
? Assistance to the Dominican border hospitals to find solutions for providing care to Haitian patients.
? Kreyol language training and educational materials for Dominican hospital and NGO staff.
? There is a real need for health referral systems for migrant workers.
? Joint campaigns are important for immunization and detection of tuberculosis, which frequently accompanies HIV/AIDS.
? Joint meetings between NGOs and government health authorities can help to coordinate efforts.
? The involvement of the medical and business communities is crucial to joint efforts.
? There is a dire need to secure a steady supply of and financing for inexpensive medications and testing.
? Binational efforts must be based on mutual respect and reciprocity.
? Microenterprise and other economic empowerment efforts can help to break the vicious circle of poverty and AIDS, especially for women.
Stephen Nicholas, M.D., Director of Pediatrics, Harlem Hospital Center, and Director, International Family AIDS Program, described successful efforts to treat and prevent pediatric AIDS in New York City, and the initiative to adapt that approach to the Dominican Republic.
Assessing HIV/AIDS in the Dominican Republic and Haiti were: Alan Berkman, M.D., Dominican Republic Project Leader, Columbia University Department of Epidemiology; Mark Padilla, MPA., SocioMedical Sciences Department, Columbia University; Gessy Aubry, Haiti Country Director, SMARTWORK; Julio Soto, M.D., Ph.D., Directeur Scientifique, Centre de Coop鲡tion Internationale en Sant頥t D鶥loppement.
Describing bilateral responses to HIV/AIDS prevention were Jean William Pape, M.D., Director of GHESKIO, Haiti; Professor of Medicine, Cornell University, New York City; Keith Joseph, M.D., Columbia University Division of Infectious Diseases and Partners In Health. Both spoke on National Efforts in Haiti. Panelists addressing National Efforts in the Dominican Republic were Consuelo Beck-Sague, M.D., Medical Director and Senior Pediatrician, Family AIDS Program; Ed Wood, Chief Operating Officer, the Clinton Foundation HIV/AIDS Initiative; and Raymond Thertulien, M.D., Ph.D., Medical Director, Batey Relief Alliance.
The final panel raised challenges and gave examples of innovation in HIV/AIDS prevention: Elizabeth Beachy, Dominican Republic Country Representative, PSI; Antonio de Moya, Office of the Executive Director, COPRESIDA; Santo Rosario, Executive Director, COIN; and Jon D. Erickson, PhD and Patricia F. Erickson, DVM, both of Batey Libertad Coalition and the University of Vermont.
Michele Wucker, Senior Fellow at the New School University?s World Policy Institute and author of Why the Cocks Fight: Dominicans, Haitians, and the Struggle for Hispaniola, moderated the discussions.
Sita Frederick performed Bitter Suite, a dance work exploring colonial and contemporary sugar production in the Dominican Republic and conceptions of Dominican identity. Danny Shaw read a poem on the shared traumas of the Dominican and Haitian Diasporas.
The Batey Relief Alliance (BRA) is a not-for-profit humanitarian aid entity that unites local grassroots organizations, government agencies, universities and the international community in a strategic partnership to help create a productive and self-sufficient environment for poor marginalized populations in the Caribbean. Toward this end, BRA Dominicana is actively involved in addressing the socio-economic ills facing thousands of children, their families and others languishing in the bateyes, urban and rural slums and the frontier zones of the Dominican Republic and Haiti ? by raising public awareness ? facilitating thoughtful dialogues ? and delivering services in primary health care, HIV/AIDS prevention/education, child development, domestic violence, improved water and sanitation, shelter reconstruction, micro-credit projects, legal aid and education. For more information about BRA, visit our website at www.bateyrelief.org.
Photo credit: Jon Anderson
