ORT-AU-PRINCE, Haiti ? Hope is an elusive commodity here. But Dr. Jean W. Pape has found enough of it to confront one of the world’s highest AIDS rates.
He has managed to slow the epidemic here, one of the worst outside Africa, by nimbly adapting his medical techniques to the country’s political upheaval, withering poverty and crumbling infrastructure.
Dr. Pape has been so successful, in fact, that the world is now recognizing the work he and others have done by making Haiti the first country in the Western Hemisphere to receive a grant from the new, United Nations-initiated Global Fund to Fight AIDS, Tuberculosis and Malaria.
In awarding Haiti $25 million, international officials called the treatments and methods devised at the Gheskio Centers, which Dr. Pape directs, and other clinics a model for how poor countries with few resources can combat AIDS, and the tuberculosis and diarrhea that often attack people with the disease.
“Haiti’s work has shown conclusively that you cannot use a lack of infrastructure as an excuse not to treat patients,” said Anil Soni, adviser to the fund’s executive director. “We want to show you can adapt what is being done in poor settings to stabilize patients. That is a lesson for the world.”
The award carries a double distinction, since it is going to a network of clinics like Gheskio in a consortium that includes the Haitian government itself.
Although direct foreign aid to the government has been frozen because of a political deadlock, the award is seen as a much-needed injection of money at a time when government-run clinics have decayed.
The funds will increase treatment and prevention in a country where more than 250,000 people are infected by the virus, out of a population of about seven million. Last year, AIDS claimed 30,000 lives.
“We are using this project to say you can’t do such a program by ignoring public facilities,” Dr. Pape said. “We still have the greatest presence of H.I.V. outside of Africa. What is important is we have been able to control this epidemic in a place that people usually talk about as being in chaos.”
Gheskio has had impressive results fighting severe diarrhea with antibiotics, has developed methods of diagnosing sexually transmitted diseases and has found some less expensive drug combinations to treat AIDS.
It and other private groups use funds provided by foundations and foreign governments to buy the medicines, which are priced far beyond the reach of most Haitians. The Global Fund grant will provide medication for about 1,200 more people.
The United Nations Development Program and the Sogebank Foundation, the philanthropic branch of Haiti’s leading bank, will manage the funds, which are expected to arrive this month and to be used over a two-year period.
Mr. Soni said the arrangement aimed to maximize efficiency and nurture cooperation between the public and private sectors. If it works, the fund could eventually provide Haiti as much as $67 million over five years, he said.
Haiti’s Health Ministry will receive about $1 million to help develop its planning ability and to coordinate the various projects.
“AIDS is not a political problem,” said Dr. Henri Claude Voltaire, the minister of health. “It is a public health problem that affects all of society. The vision is clear, we need a strategy that includes everyone.”
Mr. Soni said the government had shown its willingness to work with other sectors of the often-fractious society as it convened a series of meetings to discuss how to fight AIDS. The chairwoman is Mildred Aristide, wife of President Jean-Bertrand Aristide.
“The money is going to be used mostly by nongovernmental organizations not despite the government, but because of the government, which sat down with them to submit the proposal,” Mr. Soni said. “We did not get an application saying, `Give us a lot of money and we’ll do what we want.’ We got an application that said, `Give the money to organizations that will make the best use of it and keep us accountable.’ “
Although the country faces a host of problems with water and electricity as well as public health and poverty, a number of clinics have managed to flourish.
Paul Farmer, a founder of Partners in Health, which runs a clinic in the Central Plateau town of Cange, said that although the vast majority of Haiti’s AIDS patients live in areas where advanced laboratory tests are unavailable, doctors have relied on simpler blood tests and detailed medical histories to determine who is most in need of medication.
His group, which will receive part of the grant, sends health educators to villages to visit patients and help them to stick to their medical regimen. It has also sponsored educational programs, including video presentations and informal public talks, to increase awareness of the disease and how to avoid it.
Dr. Pape’s group now plans to train staff from government clinics as part of his project’s activities financed by the Fund. He is confidant that with enough resources, the country can hold the line on the disease until a vaccine is discovered.
And maybe, they can teach the politicians something, said Rene Max Auguste, a businessman with a foundation that helps Dr. Pape.
“The Global Fund process was easier then the political process,” Mr. Auguste said. “It showed us we can work together. What is the other choice?