«Right now, the main challenge is finding the patients, because many have moved due to insecurity,» said Carmen Jean, UNHCR coordinator in Bon-Repos
The 41-year-old HIV-positive woman hastily fled Canaan in September 2023. Gang leader Jeff (Kanaran) Larose had been controlling the area where she had been living for about a decade.
«I could only take my identification documents, a few clothes, and a backpack,» said the tile professional and beauty product seller to AyiboPost.
Temporarily housed in Delmas at the premises of «Gipa Network Haiti,» a nonprofit organization dedicated to promoting the rights of people living with HIV, this mother of five, four of whom are also HIV-positive, found medication there to take care of herself and her children.
Hundreds, if not thousands, of other HIV-positive citizens who fled gang violence are not as fortunate, several healthcare professionals revealed to AyiboPost. The woman personally knows other HIV-positive individuals who are sleeping on the streets and struggling to continue accessing medication.
«I could only take my identification documents, a few clothes, and a backpack.»
Expressing her distress, she stated, her gaze averted, «I feel sad and guilty because I have nowhere to go, and I bear the weight of having children who did not choose to live in this situation.»
Gang attacks in February 2023 in Port-au-Prince knocked out 11 of the 32 centres in the UGP-MSPP/PEPFAR network providing life-saving HIV-AIDS care, according to a medical source interviewed by AyiboPost.
The precarious context of these «crisis centres» raises serious fears that new infections could rise in the near future, jeopardizing «significant progress» in the fight against HIV in Haiti — where new infections and deaths from the disease were reduced by 21% and 75% between 2010 and 2022respectively.
According to a December 1, 2023 press release from the United Nations Integrated Office in Haiti (BINUH), HIV prevalence was estimated at 1.7% among adults aged 15 to 49.
Since late February 2024, gangs have been attacking, looting, burning, and maintaining pressure on various institutions in the metropolitan center of Port-au-Prince, including hospitals.
The precarious context of these «crisis centres» raises great fears about an increase in new cases of infection in the near future.
At a standstill since last March, patients and staff at the Hospital of the State University of Haiti (HUEH) have deserted the area around Rue Monseigneur Guilloux, controlled by bandits.
For example, the malfunctioning of the HIV monitoring site there is forcing some HIV-positive patients to seek treatment at the La Paix University Hospital in Delmas 33, or at a new site in Turgeau.
Read also: Haiti: hospitals overwhelmed by events
La Paix University Hospital, home to an HIV service delivery site for hundreds of HIV-positive patients, including 93 children, is losing sight of these patients during the spike in gang violence.
«At our site, there are about 120 patients who are unaccounted for, including two children,» says Keisha Elisma, coordinating physician for infectious diseases at La Paix Hospital.
During the unrest, three patients at the hospital under medical supervision were murdered. Two others died when their treatment was interrupted because they had to leave Port-au-Prince, officials said.
Most of the patients, usually coming from areas such as Carrefour, Gressier Tabarre, Bon-Repos, Sarthe, Cabaret, Arcahaie, Saint-Marc, Cap-Haïtien, and Jacmel, can no longer go to the hospital to get medicine.
At our site, there are about 120 patients who are unaccounted for, including two children.
In Croix-des-Bouquets, several patients’ homes were abandoned when health workers arrived on the scene to try to supply them with medication.
Forced to leave their homes, some patients went to provincial cities, the Dominican Republic or the United States of America.
Due to the closure of a site at the Haitian Group for the Study of Kaposi Syndrome and Opportunistic Infections (GHESKIO) Center and the Hospital of the State University of Haiti (HUEH), La Paix Hospital receives an average of ten of these patients per week, to refer them to nearby drug providers.
On March 4, acts of vandalism followed by looting were perpetrated on the grounds of the Saint-François de Sales Hospital on Rue Chareron.
Meanwhile, the Hospital Carrefour-Feuilles Sanatorium has been closed since the Grand Ravin gang’s bloody offensive on the population of Carrefour-Feuille, in August 2023.
Read also: Carrefour-Feuilles: Sanatorium hospital seeks refuge for scattered tuberculosis patients
The insecurity also affects other hospitals in the metropolitan area such as the Bon Repos Community Referral Hospital (HCR – Croix des Bouquets), the Dr. Ary Bordes Hospital in Beudet and the Croix-des-Missions Health Centres.
Vandalized in February 2023, the UNHCR site in Bon-Repos—an area asphyxiated by the Canaan gang led by a man named Jeff—was cooperating with the Croix-des-Missions centre to continue its activities at times.
But in January 2024, the institution was forced to merge with the Croix-des-Missions Health Centre, given the situation in Bon-Repos.
Forced to leave their homes, some patients went to provincial cities, the Dominican Republic or the United States of America.
Today, the Croix-des-Missions site remains impenetrable due to the erection of barricades and insecurity.
This has once again forced officials to open a satellite centre in Caradeux to continue assisting HIV-positive patients, despite the obstacles.
«At the moment, the major problem is finding the patients, because many have moved due to insecurity,» says Carmen Jean, coordinator of the UNHCR in Bon-Repos, which has merged with the Croix-des-Missions centre.
The two centres, which respectively have 624 and 334 patients affected by HIV, receive «about 50 follow-up visits per month, during this crisis period,» the doctor in charge of the site told AyiboPost. This differs from normal periods when the establishment would receive this many patients in the course of a day.
Read also: Haiti in danger: insecurity pushes specialized doctors to leave the country
The insecurity that has reigned in Croix-des-Bouquets for about 5 years has overwhelmed surrounding hospitals. Residents are deserting the area controlled by the «400 Mawozo» gang, led by kingpin Wilson Joseph, alias Death Without Days.
Most of the patients at the Croix-des-Bouquets health centre fled after the area was vandalized in 2022.
«This is slowing down our activities in caring for HIV-positive patients, because we can’t reach them in some areas,» says an HIV programme manager at the Croix-des-Bouquets health centre. He asked for anonymity because he was not authorized to speak on behalf of the institution.
For this site of more than a hundred patients, whose «operations depend on the climate of the area,» the decrease in the number of patients is alarming.
«We have recorded a drop of more than 50% in the number of visitors to the centre,» continues the doctor, who also points out that these patients who are out of treatment can become a vector of transmission.
Currently, the major problem is finding patients, as many have moved due to insecurity.
The GHESKIO network’s largest centre, located at the Bicentenaire, has been closed since the kidnapping for ransom of Dr. Douglas Pape, son of the centre’s co-founding physician, William Pape.
One of the largest HIV monitoring networks, with more than 20,000 patients, the GHESKIO centre is also facing the problem of patients dropping out of treatment at its various sites.
«There are an estimated 3,000 patients who have not been seen or have moved to the provinces,» says Dr. Bernard Liautaud, one of the centre’s founding members.
Despite the situation, GHESKIO’s activities continue through other locations in Carrefour, the Military Hospital, Ruelle Berne, etc.
In view of the growing insecurity, staff at the GHESKIO centre in Bicentenaire have been relocated to a new site, the Institute of Infectious Diseases and Reproductive Health (IMIS), located on the road from Tabarre to Chateaublond.
An estimated 3,000 patients who have not been seen or have moved to the provinces.
The situation in the country is putting pressure on medical staff.
«To operate in a context like this, it takes willpower, because employees also live in high-risk areas,» says Keisha Elisma, a doctor at La Paix Hospital.
Follow-up with these patients continues through phone operators, social workers and travelling agents at fixed points.
The Bon-Repos centre, for its part, mobilizes its team even beyond working hours and days.
«We are doing everything we can,» said Carmen Jean, head of UNHCR in Bon-Repos, who also explained that the centres in the area and Croix-des-Missions are trying to establish a connection with those in the provinces, where the patients are going.
At the Caradeux centre, there is a decrease in the stock of medicines, but the staff does not hesitate to provide them to patients for several months in case they decide to leave the area.
According to figures from the platform, «Monitoring, Evaluation and Integrated Surveillance» (Mesi), from January to March 2024, the population of HIV patients at the UGP-MSPP/PEPFAR network’s 13 sites in the West was 12,915.
This monitoring platform, developed in 2004 under the leadership of the MSPP and the PNLS, reported 8,388 people with a high viral load who could transmit the virus.
Cover image: A medical specialist performs a laboratory test. | © freepik
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