Maintaining HIV health services in the wake of disaster
01 Apr 2015 by Jean Thomas Nouboussi, HIV, Health and Development Team, UNDP Global Fund Programme, Haiti
In 2010, Haiti suffered an earthquake with devastating consequences. 225,000 people died and 1.5 million people were displaced. There was 10 million cubic meters of debris, 30 of the 49 hospitals in the country were ruined, and 80 percent of schools and 60 percent of the government structures were destroyed. With very little infrastructure left, the internally displaced people were settled in 1500 camps in the metropolitan areas. What happened to us in Haiti has been referred to as the largest urban disaster in modern history.
The humanitarian effort following the earthquake was extraordinary, with much global attention and donor support. However, there was little funding and planning for the HIV response and to address gender-based violence. These needs had not been integrated into the larger humanitarian work, despite the fact that Haiti has the highest burden of HIV in the Caribbean region. Incidences of rape in the internally displaced camps were high, young people were turning to sex work for economic reasons, and the rates of HIV and TB transmission increased.
Haiti had been receiving Global Fund grants since 2003, but the weakened systems and capacities after the earthquake challenged their implementation. UNDP was invited to be the interim Principal Recipient of the Global Fund grant, but working with about 40 sub-recipients from the government and civil society.
We at UNDP used the opportunity of the Global Fund programme to integrate HIV into the broader humanitarian effort. We needed to ensure that the people displaced by the earthquake - including key populations such as sex workers, men who have sex with men, and the youth - were able to access and benefit from HIV services in a consistent and sustained way. Through face to face or small group interaction, we managed to reach 200,000 female sex workers and men who have sex men with HIV prevention interventions; we set up more than 20 youth-friendly HIV prevention and treatment centers across the country; and we supported 6,000 orphans and vulnerable children from HIV affected families to attend school.
By 2014, 40 percent of the 62,786 people receiving anti-retroviral treatment are able to do so through UNDP supported Global Fund grants; over 350,000 people accessed voluntary counseling and HIV testing services annually; and over 30 million condoms have been distributed.
Linking the Global Fund programme with the post-earthquake efforts was a major factor in the stabilization of HIV prevalence in Haiti. Without it, the numbers of people infected with HIV would have been considerably higher. It is also a lesson for us that even in the midst of a colossal crisis such as the one we endured in Haiti, it is important that there are contingencies to ensure that health services are maintained.