Amy Bracken
PORT-AU-PRINCE, Nov 30 2006 (IPS) – For a rare dose of optimism, stop by the oldest private HIV research centre in the world. Fight your way through the chaotic, filthy streets of downtown Port-au-Prince, through a crowd of men, women and children awaiting care, and you ll find Dr. Jean William Pape, smiling in a crisp white medical cloak.
Pape, the director of Gheskio, which he co-founded in 1982, has good news to report. Studies show that Haiti s HIV rate is less than half what it was in 1993. And today an estimated 10,000 people are on anti-retroviral medication, with funds coming in for double that. In a poor and deeply divided country, public, private and international sectors have come together to fight a horrific epidemic, and made progress.
But the decades of hard work by Haiti s HIV researchers and activists are bumping up against a strong countervailing force: deep-seated gender inequality.
Studies show that despite an overall decline in HIV, figures are grim for women and girls. In a just-released report, UNAIDS puts Haiti s sero-prevalence rate at 2.2 percent for adults nationwide (compared with 3.1 percent widely reported for 2003), but it says there is no evidence of a decline among rural women.
And Pape himself reports what he calls a somewhat disturbing finding: One-third of Haiti s HIV cases are in the country s western region, which includes Port-au-Prince, and most of them are among women. Among girls nationwide, the Ministry of Public Health reported this year, the HIV rate is twice that of boys.
Pape says the explanation is simple. I think that it s not difficult to understand, he told IPS. Women are faithful to one man, but the man is not, so that same man may have contact with 10 or more different women, and he is bringing the infection to his partner.
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As for the gap between boys and girls: [That s] essentially because [girls] are being offered money or goods or whatever by adults, so clearly we are seeing that girls are much more vulnerable.
Because of this power imbalance, one cannot expect women to be the decision-makers when it comes to protection from HIV, says Steeve Laguerre, Catholic Relief Services HIV/AIDS programme manager for Haiti. We still need to target men to address this rate for women. It s difficult for [a woman] to suddenly change the habits she s used to having with a particular man. We need to work with that man.
More than 60 percent of Gheskio s patients are women, and workers there see the effects of gender inequality every day. Gheskio psychologist Nathalie Coicou works with pregnant women who have tested positive for HIV. She says most of her clients were infected by an unfaithful partner.
Women don t have the power to negotiate [about protection], even if they know the men are with other women, she told IPS in French. It s economic dependence, and dependence in that she has less power to make decisions.
Coicou says she urges infected women to use protection with the men who infected them because re-infection can further harm their health. But clients consistently say the men refuse.
And it gets worse. Lately, Coicou has had to suspend her work with pregnant women because her caseload has grown so heavy in another category: rape victims.
When Gheskio opened its sexual violence victim services unit in 2000, it received 10 rape victims for the entire year. Each year since then, the number has climbed, reaching 300 in 2005. And in recent months, the number has surged, with an average of 10 per day over the last month, mostly from gang-controlled slums. Gheskio workers believe the general and recent increase of visits reflects a broader incidence rather than more people knowing to come to the centre for help.
Several organisations provide rape victims with sexual violence kits , assembled by UNFPA, which include prophylactic antiretrovirals, but many victims don t realise such a thing is available.
Coicou says some victims also don t realise that it wasn t the man s right to rape them. Others are reluctant to press charges because they are afraid of reprisals or because they have no faith in Haiti s justice system. And they are founded, their fears, Coicou said. Much of the time legal proceedings lead to nothing.
Dr. Marie Deschamps, Gheskio s secretary general, is tired of seeing rape victims sit in the halls of the centre, afraid to go home because their aggressors are on the loose. We feel we are in a boat going nowhere, she says. But Deschamps has joined forces with other medical and legal workers to form a women s consortium to help the government address violence against women.
In a meeting of HIV research and outreach organisations held at Gheskio this week, the groups agreed that their work must focus more on the problem of rape by increasing personnel, training and public awareness.
For the broader, societal reasons that women are more vulnerable to HIV, experts are discussing other solutions.
To Coicou, the reasons for high rates among women and girls are two-fold: a greater biological susceptibility and a cultural notion about gender dynamics learned early in life. She sees education as the way to address the latter.
Dr. Pape talks about addressing gender inequality on the level of medical advances. We really need to empower women, he said, describing a vaginal gel scientists are trying to develop to fight HIV. This would give them the power to protect themselves.
But Pape also recognises the importance of hope. Discussing ways to protect the most vulnerable in the population girls living on the street he says the rates are diminished when they are given shelter, but the problem isn t solved. Until those kids can really have a future, where they can see clearly where they are going, I think it s going to be very difficult.
