What about people with HIV in disasters?

When an earthquake struck Port-au-Prince, Haiti in 2010 the scale of the disaster was evident. Three and a half million people were affected by the quake, an estimated 220,000 people died and more than 300,000 people were injured. One and a half million people became homeless. However, it was harder to see the effect the earthquake had on people living with HIV, who became invisible in the aid response.

HIV was quickly forgotten as a national priority in the face of more pressing emergencies. Yet in Haiti, an estimated 120,000 people are living with HIV and 13,000 of these are under 14. Only two thirds of all these are said to know their HIV status. There are approximately 87,000 AIDS orphans.

Effects of the earthquake on HIV organisations

When the quake happened, national organisations working on HIV issues suffered major losses, losing staff and often their premises. POZ, an Alliance Linking Organisation, works in Haiti to reduce the impact of HIV through community mobilisation. POZ lost its buildings in Port-au-Prince, its administrative centre and the Centre d’Espoir, the place where clients came to receive services. Given that these were rented premises, they were not able to reconstruct the buildings because they had no land. Rent prices elsewhere increased dramatically. SEROvie, Haiti's largest organisation serving gay and transgender people with HIV, was also devastated by the quake and its premises destroyed.

In the aftermath of the disaster, the Alliance coordinated with other British NGOs to try and establish initial communication and coordination with POZ. After a few days, the Alliance heard news that POZ Senior management team and most programme staff had survived, although some of them were seriously injured. Most were without any housing, and had limited access to water or food. Communications were still very fragile with no electricity in most areas. 

Fewer than 40% of people living with HIV had accessed antiretroviral therapy sites.

HIV services in the aftermath

In many cases, HIV services were being provided in the yards of health centres or hospitals, or under a tent. Antiretroviral (ART) and tuberculosis drugs were out of stock in some places. Within a short period following the earthquake, the Ministry of Public Health and Population and UNAIDS estimated that fewer than 40% of people living with HIV had accessed antiretroviral therapy sites.

The collapse of infrastructure affected people living with HIV’s access to food, water, essential medication, psychosocial services and safe spaces. The usual support centres and safe spaces had been demolished; the majority of hospitals destroyed and those that were available were overwhelmed with injured people. Most of the structural damage happened in the three departments (Ouest, Sud-Est and les Nippes) that accounted for nearly 60% of people living with HIV. Community support mechanisms were broken or severely strained.

POZ’s effort to provide support

POZ organised itself to provide support to people living with HIV and others who sought out their services. It placed trained community leaders and champions into the camps to work with people at high risk of getting HIV and worked as closely as possible with the organisations in charge of the camps, particularly in relation to sexual assaults and rapes.

POZ did not receive any funds from the international appeals. This is not surprising given a report by the United Nations Office of the Special Envoy for Haiti , which says that less than 0.6 % of funding from bilateral and multilateral donors was estimated as given directly to Haitian organisations and businesses since the earthquake. But nevertheless, POZ diverted some funds to emergency issues through negotiation and good relations with donors.

What did we learn?

From this experience in Haiti and elsewhere, we have learnt that the international community needs to pay more attention to HIV prevention and treatment issues when they respond to emergencies and deliver aid. International humanitarian non-governmental organisations (NGOs) may be armed with staff and money, but they do not have specialists to work with the key groups of people at risk of HIV such as men who have sex with men, transgender people and sex workers. POZ was not prepared for the disaster and the long-term changes it brought to the country. It is vital for local organisations to be included in relief and construction efforts as they have the best access to the people who need help the most. When disasters happen, more coordination is needed between international and local organisations to try to meet the pressing needs of people living with HIV and others who may be at risk.