Haiti: Access to treatment for HIV or AIDS, including support from the public or private sectors, as well as from international organizations; treatment by society of people with HIV or AIDS, especially when they seek treatment and including cases where these people are members of a sexual minority (2016February 2019) [HTI106236.FE]

Research Directorate, Immigration and Refugee Board of Canada, Ottawa

Information on access to HIV or AIDS treatment in Haiti was scarce among the sources consulted by the Research Directorate within the time constraints of this Response, and the Research Directorate drew its information mainly from two sources: the Haitian government and the UN.

1. HIV/AIDS in Haiti

According to sources, the number of people living with HIV in Haiti is estimated at 150,000 (Haiti Dec. 2018, 37; UN 2017). According to Haitian government data, HIV prevalence among adults aged 15 to 49 was estimated at 2.1 percent in 2016 (Haiti Nov. 2017, 30) and at 2.0 percent in 2018 (Haiti Dec. 2018, 37).

HIV prevalence among “men who have sex with men” (MSM) was estimated at 12.9 percent in 2014 (Haiti Dec. 2018, 37). A report on a mission to Haiti in 2017 organized by the French Office for the Protection of Refugees and Stateless Persons (Office français de protection des réfugiés et apatrides , OFPRA) with the participation of the National Court of Asylum (Cour nationale du droit d’asile , CNDA) states that [translation] “studies conducted by [the] SEROvie [Foundation] (Fondation SEROvie ) [1] reveal that the HIV prevalence rate is 12.8% among MSM” (France 2017, 67). According to the Haiti page on the UNAIDS website, the prevalence of HIV among gay men and other MSM, who are among the key populations most affected by this disease, is 18.2 percent (UN n.d.a).

In its March 2016 report on the national AIDS situation, the Haitian government notes that the HIV epidemic in Haiti is [translation] “generalized” in nature, but that HIV prevalence in 2016 is comparable to that observed in 2006, which indicates that it is stabilizing (Haiti Mar. 2016, 12). In a progress report published in 2018 on the HIV situation in Haiti, based on data from January to December 2017 available from the national Monitoring, Evaluation and Surveillance Interface (MESI) [2] database, the Haitian government mentions a [translation] “decline” in the epidemic (Haiti 2018). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response. UNICEF reports that Haiti [translation] “continues to be the country where [HIV/AIDS] prevalence remains the highest in the world, outside the African continent” (UN n.d.b).

2. Access to HIV/AIDS Treatment
2.1 Statistics on the Number of AIDS-Related Deaths

According to the UN team in Haiti that met on World AIDS Day, on 30 November 2016, [translation] “AIDS-related deaths [have decreased] by 49% since 2008” (UN 30 Nov. 2016). The UNAIDS website page on Haiti currently states that since 2010, AIDS-related deaths have decreased by 24 percent in Haiti (UN n.d.a). The Haitian government reports that the estimated number of AIDS deaths in 2016 was 4,200 and the overall AIDS mortality rate was estimated at 42 per 100 000 people (Haiti Nov. 2017, 30). According to UNAIDS, 4,700 people died of AIDS in Haiti in 2017 (UN 2017, 1).

2.2 Statistics on HIV/AIDS Treatment Coverage

In November 2016, UNAIDS reported that the [translation] “number of HIV-positive people receiving medical treatment in Haiti more than doubled from 2010 to 2015 (over 82,500 to date)” (UN 30 Nov. 2016). In its March 2016 report, the Haitian government states that antiretroviral treatment coverage is 45.9 percent (Haiti Mar. 2016, 21). According to UNAIDS, in 2016, about 55 percent of people living with HIV (PLHIV) in Haiti had access to antiretroviral therapy (UN n.d.a). According to the December 2018 Bulletin de surveillance épidémiologique VIH/SIDA of Haiti’s Ministry of Public Health and Population (ministère de la Santé publique et de la Population , MSPP), 103,400 people were receiving antiretroviral treatment in Haiti as of 30 September 2018, which included, among those affected, approximately 65 percent of adults, 74 percent of women over 15 years of age, 50 percent of children and 70 percent of pregnant women (Haiti Dec. 2018, 37).

The Global AIDS Monitoring 2018report, which is based on data collected from the MESI database between January and December 2017, states that 67.3 percent of people living with HIV are aware of their status, 58 percent of people with HIV are aware of their status and are receiving antiretroviral treatment (at the end of 2016), and that 39 percent of people are aware of their status on antiretroviral treatment and have viral suppression (Haiti 2018).

2.3 Services and Treatments Available

According to the December 2018 MSPP Bulletin de surveillance épidémiologique , 177 health institutions offered HIV testing services across the country; 145 health institutions offered the comprehensive mother-to-child transmission prevention package; and 165 health institutions offered antiretroviral drugs (Haiti Dec. 2018, 37).

According to the March 2016 national situation report, many organizations are involved in the fight against HIV/AIDS in Haiti: [translation] “in 2014 and 2015, the Haitian HIV/AIDS Program, as it is currently configured[,] was implemented by 25 networks” (Haiti Mar. 2016, 39). Of these, according to the same source, 14 provide prevention, diagnosis, care and treatment services (Haiti Mar. 2016, 39). The same source reports the following:

[translation]

All networks and the 10 [departmental health directorates] are responsible for ensuring that care, which is provided at the 170 [voluntary screening]/[mother-to-child transmission prevention centres] of which 135 are [antiretroviral care centres], is of high quality, and they must do their best to improve care accessibility and continuity for patients in their service areas. (Haiti Mar. 2016, 39)

In its December 2017 Bulletin de surveillance épidémiologique , the Haitian government presented the GHESKIO [Haitian Research and Study Group on Kaposi’s Sarcoma and Opportunistic Infections (Groupe haïtien de recherche et d'études sur le sarcome de Kaposi et des infections opportunistes )] centres, [translation] “a Haitian non-profit institution” fighting AIDS:

[translation]

Currently, two centres, [the National Laboratory and Research Institute (Institut national de laboratoire et de recherche)] and [the Institute of Infectious Diseases and Reproductive Health (Institut des maladies infectieuses et de la santé de la reproduction )] serve the population of the Ouest Department and 25 other [public] and private sites are part of the MSPP/GHESKIO network to increase access to services and improve prevention and care services for patients and families affected by HIV/AIDS and related diseases. (Haiti Dec. 2017, 29)

According to the same source, [translation] “30% of active patients in Haiti are monitored through the [GHESKIO/MSPP] network” (Haiti Dec. 2017, 30).

In the December 2018 Bulletin de surveillance épidémiologique , the MSPP notes the example of the Catholic Medical Mission Board (CMMB), which [translation] “works with sixteen (16) health institutions, including thirteen (13) denominational and three (3) public ones, spread over five (5) geographical departments: Nord, Artibonite, Ouest, Sud and Les Nippes” (Haiti Dec. 2018, 25).

2.4 Barriers to Accessing Care

UNICEF reports the following on its Haiti webpage:

[translation]

The weakness of the Haitian health system is one of the main obstacles to universal access to health care. Access to services, both for geographical and economic reasons, is one of the major challenges in a country where 60% of the population lives in rural areas with only one doctor per 67,000 inhabitants. (UN n.d.b)

Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

2.5 National HIV/AIDS Programs

The MSPP states the following in its March 2016 report:

[translation]

In Haiti, considerable efforts have been made and a national policy [has been] defined and implemented. It is reflected in the national response to the dynamics of HIV infection through the development of the Strategic National Multisectoral Plan (Plan stratégique national multisectoriel , PSNM), which provides broad guidelines for interventions at all levels. For example, the care of PLHIV that was provided by two institutions that had [antiretrovirals] in 2004 is currently covered at 140 sites that provide [antiretroviral] services across the country to more than 60,000 patients. (Haiti Mar. 2016, 49)

The UN Secretary-General, in an October 2017 report on the United Nations Stabilization Mission in Haiti (MINUSTAH), notes the following:

[UN English version]

Building on the reductions attained in the number of new HIV infections and AIDS-related deaths, the Ministry of Public Health and Population approved the national multisectoral strategic plan on HIV and AIDS for 2018-2023, formulated by the national AIDS programme in conjunction with national and international partners. The plan is aimed at eliminating HIV in Haiti by 2030. (UN 5 Oct. 2017, para. 27)

According to the MSPP Bulletin de surveillance épidémiologique , the national [Haitian AIDS] response for 2030 has three objectives:

[translation]

95% of people living with HIV are aware of their status, 95% of all HIV-infected people tested receive sustainable antiretroviral treatment, 95% of people receiving antiretroviral treatment have a permanently suppressed viral load. (Haiti Dec. 2018, 7)

2.6 Contributions and Participation of Foreign Agencies and Funding for HIV/AIDS Programs

In its March 2016 report, the Haitian government states, [translation] “[UN] agencies provide the [National AIDS Program (Programme national de lutte contre le sida , PNLS)] with technical and financial support but carry out interventions in coordination with other HIV/AIDS civil society organizations and [service delivery points]” (Haiti Mar. 2016, 35). These agencies are UNESCO, the International Labour Organization (ILO), MINUSTAH, UNICEF, UNDP, the Pan American Health Organization of the World Health Organization (PAHO-WHO), and the UN Population Fund (UNFPA) (Haiti Mar. 2016, 35-38).

Sources indicate that Haiti received financial aid from the US through the President’s Emergency Plan for AIDS Relief (PEPFAR) (iciHaiti.com 13 July 2018; Loop Haiti31 May 2017). PEPFAR reports that 200,091 people in Haiti received antiretroviral therapy through this program between 2004 and June 2018 (US 18 Oct. 2018).

A November 2017 article in the Haitian newspaper Le Nouvelliste , published during the third Latin American and Caribbean Forum on HIV/AIDS, which took place in Haiti, states the following:

[translation]

After 14 years, Haiti depends entirely on international aid to fund its AIDS programs … . All the programs receive support from [PEPFAR] and the Global Fund, which are reducing their contributions each year. (Le Nouvelliste 7 Nov. 2017)

Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

3. Treatment by Society of People with HIV or AIDS When They Seek Treatment

Information on how society treats people with HIV or AIDS when they seek treatment was scarce among the sources consulted by the Research Directorate within the time constraints of this Response.

In its March 2016 report, the Haitian government indicates that obstacles and challenges to HIV prevention include [translation] “stigma and discrimination” faced by PLHIV (Haiti Mar. 2016, 31). The same source notes that there are in Haiti

[translation]

well-documented cases of people living with HIV/AIDS who experience stigma and discrimination and who are denied services because of their HIV status in the workplace, in education and health care, and even in communities where there are PLHIV. (Haiti Mar. 2016, 48-49)

The news website HaïtiLibre quotes statements made by Haiti’s Protector of the Citizen (Protecteur du citoyen ) at a conference hosted by the Association of Haitian Women Infected and Affected by HIV in December 2018:

"Stigma, discrimination and exclusion at work are frequent cases that infringe the rights of PLHIV. The rights of people affected by the virus, such as non-discrimination, housing, care, social security, and assistance and well-being, are violated. They are subject to disqualification and they must also endure the hostility of their community and work." (HaïtiLibre 5 Dec. 2018)

The same source also points out that “there is a great legal vacuum in terms of protection of their rights” (HaïtiLibre 5 Dec. 2018). Furthermore, the US Department of State’s Country Reports on Human Rights Practices for 2017notes that the law in Haiti does not prohibit discrimination based on HIV-positive status (US 20 Apr. 2018, 27-28).

Two sources report the results of a 2012 population survey on public attitudes towards people living with HIV: UNAIDS states that 57.7 percent of adults responded in a poll that they would refuse to buy vegetables from a shopkeeper or vendor if they knew that the person had HIV (UN 2017, 6); US Country Reports 2017 states that 61 percent of women and 55 percent of men reported discriminatory attitudes towards people living with HIV (US 20 Apr. 2018, 22). Furthermore, in 2016, the Haitian government stated the following regarding people needing treatment:

[translation]

[Stigma and discrimination] also undermine prevention efforts because people, fearing the reactions of others, are afraid to find out whether they are infected so that they may seek treatment. [Stigma and discrimination] lead people who are at risk of infection and some of those who are affected to continue engaging in unprotected sex because they think that changing their behaviour will raise suspicion about their HIV status. (Haiti Mar. 2016, 49)

However, the same source states that increasing access to HIV treatment is [translation] “one way to combat discrimination and stigma” and that “support groups have proliferated in health care facilities to foster greater acceptance of the disease and to reduce denial, another perverse effect of stigma and discrimination” (Haiti Mar. 2016, 49). A July 2017 UN report further notes that [UN English version] “[with UN] support, the Ministry of Health conducted a nationwide poll in support of eliminating stigma and discrimination relating to HIV” (UN 12 July 2017, para. 25). Information on the results of the survey could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

3.1 Sexual Minorities

In an article on HIV/AIDS care in Haiti following Hurricane Matthew in fall 2016, UNAIDS reported the following:

[UN English version]

Community leaders say marginalized groups, including gay men and other men who have sex with men [MSM], transgender people and sex workers, are even more vulnerable in these circumstances. Based on a preliminary assessment conducted by [NGOs] in the areas most affected by the hurricane, stigma and discrimination has become a barrier to some people in need of assistance. (UN 2 Nov. 2016)

Following a mission to Haiti from 26 March to 7 April 2017, OFPRA reported that, with regard to people in Haiti who experience discrimination on the basis of their sexual orientation, [translation] “for homosexual people with HIV, the discrimination is twofold” (France 2017, 67).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

Notes

[1] The SEROvie Foundation is a Haiti-based organization that provides psychosocial support to men who have sex with men (MSM) living with HIV/AIDS in five regions of the country, assisting more than 3,500 people (Fondation SEROvie n.d.).

[2] The Monitoring and Evaluation Surveillance Interface (MESI) is [translation] “an online database system that can be accessed by sites across the country with minimal infrastructure and technology … and that enables sites to regularly post their own data”; it “reduces the cost of data collection and makes real-time data available for decision-making [and] serves as a central repository for HIV, epidemiological surveillance, family planning, maternity care, HIV case reporting and community data” (Haiti Apr. 2012, 38).

References

Fondation SEROvie. N.d. “About Us.” [Accessed 22 Feb. 2019]

France. 2017. Office français de protection des réfugiés et apatrides (OFPRA) with Cour nationale du droit d’asile (CNDA). Rapport de mission en République d’Haïti - du 26 mars au 7 avril 2017 . [Accessed 20 Feb. 2019]

Haiti. December 2018. Ministère de la Santé publique et de la Population (MSPP). Bulletin de surveillance épidémiologique VIH/SIDA, No. 19 . [Accessed 21 Feb. 2019]

Haiti. 2018. “Country Progress Report - Haiti .” Global AIDS Monitoring 2018. [Accessed 21 Feb. 2019]

Haiti. December 2017. Ministère de la Santé publique et de la Population (MSPP). Bulletin de surveillance épidémiologique VIH/SIDA, No. 16 . [Accessed 20 Feb. 2019]

Haiti. November 2017. Ministère de la Santé publique et de la Population (MSPP). Bulletin de surveillance épidémiologique VIH/SIDA, No. 15 . [Accessed 25 Feb. 2019]

Haiti. March 2016. Ministère de la Santé publique et de la Population (MSPP). Déclaration d'engagement sur le VIH/sida - Rapport de situation nationale . [Accessed 21 Feb. 2019]

Haiti. April 2012. Ministère de la Santé publique et de la Population (MSPP). Déclaration d’engagement sur le VIH/sida, UNGASS - Rapport de situation nationale, Haïti, mars 2012 . [Accessed 26 Feb. 2019]

HaïtiLibre. 5 December 2018. “Haiti - Social: People Infected with HIV, Stigmatized and Marginalized .” [Accessed 19 Feb. 2019]

iciHaiti.com. 13 July 2018. “Health: 90,000 Haitians Receive Treatment for HIV .” [Accessed 20 Feb. 2019]

Loop Haïti. 31 May 2017. Obed Lamy. “Plus de 100 millions pour lutter contre le SIDA en Haïti .” [Accessed 19 Feb. 2019]

Le Nouvelliste. 7 November 2017. Edrid St Juste. “Sida‐Haïti : Qu’adviendra‐t‐il si les bailleurs se retirent .” [Accessed 25 Feb. 2019]

United Nations (UN). 5 October 2017. Security Council. Rapport du Secrétaire général sur la Mission des Nations Unies pour la stabilisation en Haïti . (S/2017/840) [Accessed 19 Feb. 2019]

United Nations (UN). 12 July 2017. Security Council. Rapport du Secrétaire général sur la Mission des Nations Unies pour la stabilisation en Haïti . (S/2017/604) [Accessed 25 Feb. 2019]

United Nations (UN). 2017. UNAIDS. “Haiti 2017.” Country Factsheets. [Accessed 25 Feb. 2019]

United Nations (UN). 30 November 2016. United Nations in Haiti. “Les personnes séropositives sous traitement en Haïti ont plus que doublé depuis 2010 .” [Accessed 20 Feb. 2019]

United Nations (UN). 2 November 2016. UNAIDS. “Assurer le retour des services de prévention et de traitement du VIH en Haïti après le passage de l’ouragan Matthew .” [Accessed 19 Feb. 2019]

United Nations (UN). N.d.a. UNAIDS. “Pays - Haïti.” [Accessed 20 Feb. 2019]

United Nations (UN). N.d.b. UNICEF. “Haïti - VIH/SIDA - Les défis .” [Accessed 20 Feb. 2019]

United States (US). 18 October 2018. President’s Emergency Plan for AIDS Relief (PEPFAR). Haiti. [Accessed 25 Feb. 2019]

United States (US). 20 April 2018. Department of State. “Haiti.” Country Reports on Human Rights Practices for 2017 . [Accessed 19 Feb. 2019]

Additional Sources Consulted

Oral sources:Caribbean Vulnerable Communities Coalition; Doctors of the World Canada; GHESKIO centres; Haiti – Ministère de la Santé publique et de la Population, Protecteur du citoyen; Haitian Global Health Alliance; OXFAM-Québec – Haïti; professor in the women’s studies program at an American university whose interests include sexual minorities in Haiti; sociology professors at a Quebec university whose interests include Haiti; UN – UNAIDS Haiti.

Internet sites, including:Amnesty International; ecoi.net; Factiva; Freedom House; Human Rights Watch; International Crisis Group; UN – Refworld, World Health Organization.