In post-quake Haiti, rebuilt AIDS clinic treats more patients
By Anastasia Moloney, Reuters Alertnet, September 5, 2012
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PORT-AU-PRINCE (AlertNet) - Tucked away in the Haitian capital is one of the world's leading AIDS treatment and research centres. A clean, tightly-run clinic provides an oasis of calm and order in stark contrast to the crowded, rubbish-strewn streets outside its guarded gates in downtown Port-au-Prince.
Set up 30 years ago, the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections - or GHESKIO - suffered $10 million-worth of damage in the massive earthquake that rattled Haiti in January 2010. The disaster destroyed parts of a clinic, a hospital for tuberculosis (TB) patients and research laboratories across GHESKIO's several sites. And, it has taken until now for the centre to get back on track.
"We have almost rebuilt everything. We have caught up with lost time," GHESKIO Director, Dr Jean William Pape told AlertNet in an interview at the centre's headquarters, near the grassy grounds that served as a makeshift field hospital in the aftermath of the quake. "We are also seeing more patients now than pre-quake times," he added.
Over the decades, tens of thousands of Haitians living with TB and HIV/AIDS have relied on GHESKIO for free, life-saving treatment.
With the help of Haiti's ministry of health and Cornell University in the United States, Pape set up GHESKIO in 1982. He and other Haitian doctors had observed an increase in the number of adults in the Caribbean country mysteriously falling ill and dying from previously treatable diseases such as diarrhoea and Kaposi's sarcoma - a rare type of cancer that can affect the skin and internal organs.
These observations were published a year later in a seminal study that described AIDS before the acronym even existed. As such, GHESKIO was the first institution in the world exclusively dedicated to fighting HIV/AIDS.
"The word AIDS then did not exist. It was coined much later," Pape said. "We published in the New England Journal of Medicine the first cases of AIDS in a developing country. Our patients presented either with Kaposi's sarcoma or opportunistic infections," the Haitian-born doctor explained. "Ninety percent were males and about half had tuberculosis. We had a feeling that this was going to be important."
GHESKIO went on to publish more ground-breaking research, including a paper dispelling an early theory that Haitians were more at risk of catching the AIDS virus than other populations. "I think what unified us most was the fact that the world almost was against us early on. AIDS then was known as the 'four H' disease - homosexuals, heroin addicts, haemophiliacs, and the fourth H being the Haitians," Pape said. "This was a huge mistake. We published data that shows Haitians had the same risk factors as anybody else," said the U.S.-educated doctor, who is also a professor at Cornell University?s Weill Medical College in New York.
In 1996, GHESKIO's research also helped show that AIDS could be transmitted through heterosexual contact. "When we reported the rapid shift from a homosexual population to the heterosexual population nobody seemed to believe it could occur so quickly. But it did," Pape said.
More recently in 2010, following GHESKIO's clinical research on antiretroviral therapy for HIV patients, the World Health Organisation changed its guidelines on its treatment protocol for HIV patients.
Key care provider
Today, GHESKIO provides around 500 TB patients free treatment every year, making it the largest provider of TB care in the Caribbean nation. It also gives free HIV/AIDS services to around 140,000 children and adults every year, including counselling, HIV testing, antiretroviral therapy and nutritional supplements. Despite GHESKIO's reach, HIV treatment coverage in Haiti reaches less than half of those in need, according to UNAIDS.
GHESKIO's focus on preventing mother-to-child transmission of HIV, ensuring a safe blood supply, and AIDS prevention campaigns - including raising awareness about safe sex and condom use - have all helped to lower Haiti's HIV prevalence rates. Today, 2.2 percent of Haiti's adult population is living with HIV, down from 6.2 percent in 1993, Pape said.
"You are not going to die anymore"
Providing HIV patients with free antiretroviral drugs is one thing. However, making sure patients take the cocktail of powerful antibiotics over a course of six months or more when they are supposed to, and correctly, is quite another challenge.
It's a problem Pape and his team are constantly striving to solve. When a patient fails to pick up drugs or misses a medical appointment at the clinic, says Pape, GHESKIO's electronic records system alerts a field worker to visit the patient's home. Patients can also ring a hotline and speak to a doctor. Also, every TB and HIV patient is given an extra two-week supply of medication, an initiative that helped save lives in the chaos following the earthquake.
"In Haiti, there have always been problems of some kind, so we had to develop a contingency plan," Pape said, referring to the nation's troubled history of social unrest and political upheaval.
But perhaps more importantly, patients are given hope. "It's team work," Pape said. "The counsellor, lab technician, field worker and nurse, all of them are involved in indicating to the patient - 'First of all, you are not going to die any more. Now you can think about living and about finding some work. Give us a little time, give us two to three weeks of taking your medicine daily and we'll change your life'."
Pape is now overseeing the building of a new hospital for GHESKIO's TB patients, set to finish in May 2013, after its TB hospital was destroyed in the earthquake.
While GHESKIO is rebuilding, though, Haiti in general is still struggling to recover from the earthquake. "The country has not yet rebuilt. It's going to take some time before the country as a whole can catch up," Pape said.
"But we are a resilient nation, a resilient people and I think that we will be able to go back and do better than what we were doing before the earthquake," he said.