Caribbean HIV fight struggles for funds Lower infection rates mean help is harder to come by

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December 1, 2006



(12-01) 04:00 PST Cinco Casas Bateye, Dominican Republic -- In halting Spanish, Amelia Cayo describes her antiretroviral treatment, counting with precision the number of pills she takes three times a day.

"I feel better since I started the pills, and you can be sure I will keep taking them," Cayo said in this impoverished rural community in the central province of Monte Plata.

Cayo, 53, who is part-Haitian and a Creole speaker, is one of 43 AIDS patients receiving free antiretroviral therapy from a clinic sponsored by Bateye Relief Alliance Dominicana, a nongovernmental organization. She and other descendents of Haitian sugarcane workers are part of an estimated 200,000 residents of the bateyes -- migrant worker communities adjacent to the mostly now-fallow sugarcane fields. Before the opening of the center early this year, the estimated 3,000 bateye residents here received little or no medical attention. Among the country's 200,000 bateye inhabitants, 5 to 12 percent are HIV-positive, according to government studies.

Government researchers say 78 percent of HIV infections are transmitted through heterosexual sex.

While the Dominican Republic has managed to keep its AIDS rates from rising in the last decade -- a countrywide 1.1 percent HIV-prevalence rate, according to the Health Ministry -- it has been slow to reach the 88,000 people affected by the virus. Only 3,500 people are currently taking drugs, according to local health experts.

Like most other countries in Latin America and the Caribbean, the Dominican Republic has not faced a severe epidemic, yet progress in this region has been slow, with a few exceptions. At the end of last year, the Caribbean's HIV/AIDS-prevalence rate of 1.6 percent was the second highest in the world, after sub-Saharan Africa, according to the United Nations Program on HIV/AIDS, known as UNAIDS, and the World Health Organization. Haiti and the Dominican Republic account for about 75 percent of those cases.

The Dominican Republic shares the island of Hispaniola with its poorer neighbor Haiti, which despite years of political instability has made strides in lowering its prevalence rates and distributing antiretroviral pills to more than 7,000 patients. In the late 1990s, Haiti had a prevalence rate of 6 percent, which has dropped to about 2 percent due to increased condom use, health officials say. Haiti is the only country in Latin America and the Caribbean to see a notable drop in its HIV-prevalence rate, according to the United Nations.

By the end of 2006, the number of people in Latin America and the Caribbean with HIV will be almost 2 million, 210,000 more than in 2004, according to UNAIDS. By 2015, the region is expected to have nearly 3.5 million people living with the virus.

The Bateye Relief Alliance Dominicana, which provides free medical services in the bateyes, gets its funds from former President Bill Clinton's foundation, Lions Club International Fund and other charities. Alliance Executive Director Maria Virtudes Berroa says sugarcane workers have been systematically excluded from the public health system because of racial, economic and social discrimination.

Even though the Dominican national HIV-prevalence rate is relatively low, many health workers say it has remained virtually unchanged since 2002, and fault the government for not having a coordinated plan to provide antiretroviral medicine to the poor.

"Sometimes it's easier to work in a country that has almost no health infrastructure, like Haiti or parts of sub-Saharan Africa, than a country that has some, like the Dominican Republic," said Keith Joseph, a doctor with Partners in Health, a nongovernmental organization that also works in Haiti, Latin America, Russia and Africa.

Joseph says health officials in many countries are slow to acknowledge the seriousness of the HIV epidemic and then resist offers of assistance. He says the Dominican Republic has also been hampered by corrupt health officials, who pocket money destined for AIDS programs and mismanaged international funding entities.

According to Tony De Moya, a member of the Presidential Commission on AIDS, the Dominican government has always put more emphasis on prevention, while working with sex workers and gays to promote condom use.

"But the commitment has not yet translated into major support for AIDS prevention and treatment in the (health) budget," De Moya said. Antiretroviral therapy "has increased, but we rely on the Clinton Foundation and Global Fund" to fight AIDS, he added.

Ulrick Gaillard, chief executive officer for Bateye Relief Alliance in New York, says AIDS funds are increasingly drawn to sub-Saharan African and other regions that boast far higher numbers of people infected with the virus.

"Funders can't get quite the same bang for their buck in the Caribbean as they can in Africa," said Gaillard. "I'm concerned that we may not be able to continue to work if they stop funding us."

The Bateye health group has already lost USAID funding in education and prevention programs for 30 bateye communities when the project ends next May, according to Gaillard.

"At this point, we're only reaching a tiny portion of the people with AIDS in the bateyes," Wendy Valdez, a physician in the Cinco Casas bateye. "It would be disastrous if we had to stop."



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