Getting to Zero: HIV by the numbers


  • 25 million: number of deaths caused by HIV/AIDS since 1981
  • 2.5 million: number of HIV-related deaths averted by antiretroviral treatment (ART) in low- and middle-income countries (LMICs) since 1995
  • 34 million: number of people living with HIV worldwide at the end of 2010
  • 3.4 million: number of children under 15 years living with HIV
  • 68%: percentage of HIV-positive persons living in sub-Saharan Africa
  • 2.7 million: number of new HIV infections worldwide in 2010, a 21% decrease from 1997
  • 50%: worldwide percentage of HIV-infected persons who aware of their status
  • 96%: reduction in sexual transmission of HIV between serodiscordant partners with antiretroviral therapy observed in the HPTN052 trial
  • 61%: percentage of new HIV infections in the United States occurring among men who have sex with men (MSMs) as of 2009
  • 44%: percentage of new HIV infections in the United States occurring among Blacks as of 2009
  • 2%: Adult HIV prevalence in Baltimore city in 2009; adult HIV prevalence in Haiti in 2009
  • 5%: Adult HIV prevalence in Baltimore zip code 21205, directly northeast of the Johns Hopkins medical campus, in 2009; adult HIV prevalence in Gabon in 2009
  • 37.5%: HIV prevalence among MSMs in Baltimore city; the proportion of new HIV infections among MSMs in Baltimore has increased to nearly the same levels as in 1985
  • 76.9%: percentage of HIV-infected MSMs in Baltimore city who are unaware of their status
  • 312: Median CD4 count at HIV diagnosis in the Baltimore-Towson metropolitan area (current guidelines recommend initiating ART at CD4 counts 350-500)
  • 6,411: Number of HIV-positive people in the United States currently on AIDS drugs assistance program (ADAP) waiting lists
  • 6.65 million: number of HIV-infected people currently receiving ART in low- and middle-income countries
  • 3.3 million: number of people currently receiving ART through Global Fund grants
  • $2.2 billion: unfulfilled pledges to the Global Fund to fight AIDS, TB and Malaria
  • 2: number of countries (USA and UK) that have honored their pledges to the Global Fund
  • ZERO: number of new grants that will be awarded by the Global Fund for the next two years in response to budget shortfall; UNAIDS goal by 2015 (0 new infections, 0 discrimination, 0 AIDS-related deaths)

Peacekeeping Gone Awry

Source: CNN.com

In her talk, Dr, Emilie Calvello expressed consternation about the multiple NGOs that flooded Haiti in the wake of the earthquake and the lack of partnership and cooperation with the local Haitian healthcare providers. She particularly emphasized that the willingness to help was not enough—we must help in the right way. This includes understanding the cultural perspectives of the Haitians as well as engaging their abilities to improve the crisis at hand.

This week, we saw how even in a disaster situation, we must view those we aid as “co-producers” of health, no matter how strong the impulse is to see them as helpless and suffering. In the aftermath of the earthquake in Haiti and the resulting destruction of public infrastructure, an epidemic of cholera has swept the nation with an equally dangerous wave of chaos. Now, reports have emerged that Haitians are violently protesting against UN peacekeepers. At first glance, this seems ludicrous. How can people protest against the malicious spread of bacteria? What good could come from fighting the “peacekeepers” that are there to help?

With a critical eye, however, it is clear that this cholera epidemic has only served to open the floodgates for the tension and mistrust that had festered between the Haitian population and the foreign occupiers. The situation is complex. The spread of cholera is a public health crisis, but we must realize that all diseases are socially, culturally, and politically grounded. Many Haitians from the slums, mistakenly but understandably, view the cholera treatment centers as hotspots for spreading the disease. Upcoming elections in Haiti are suspected to be the motivations for the cholera-related riots. It is almost overwhelming to comprehend and assess it all. Nevertheless, it is a necessary exercise, as disaster response has spiraled into a nationwide epidemic and now to political unrest. From this compounding crisis, we see the increasing urgency of appropriate international interventions, lest we face the unintended consequences of our supposed altruism.

“The true test is in the doing”

I apologize if this is more of an emotional response than an intellectual one, but that was my state of mind while I was watching Dr. Calvello speak–my reaction to the images and narratives that she presented was almost entirely visceral. Only now, after just returning from a three-day conference on health and development in Haiti (which included a panel on the disaster response), am I able to really begin to sort through some of the issues that Dr. Calvello spoke about and think about them rationally.  That discussion, however, will come in a later entry.

After having lived in Haiti for nine months prior to the earthquake (which included several extended trips to Port-au-Prince) and having known people who were affected (and lost) that fateful day in January, I found it incredibly challenging to process the photos that flashed across the smart-board: My mind raced with each building in ruins that appeared in the background and with each dead body that lay motionless on the ground.  Was I really there, in a sterile classroom, looking remotely at these hellish scenes of places I strolled through casually but 20 months before? My physical and experiential detachment seemed both painful and absurd.

Disjointed memories flooded my head, each seeming totally discordant, even surreal, given the content of the slides and my present location.  Surprisingly (or not), I had managed to almost completely avoid such photos since the quake, aided by my remote setting at my field site in South Africa at the time of the catastrophe and by a protective need to repress the temptation to let the event consume me, given my distance from Haiti and relative powerlessness to do anything beyond helping translate ‘SOS’ texts over the Internet (the vast majority of which contained no actionable information).

I remembered the first time I saw the Haitian National Palace.  A Haitian friend, Rigot, looked over at me as it came into view–”It’s the one building in Haiti that is beautiful,” he stated, indifferently.  I quickly snapped a photo (below–it now looks like this):  It was a beautiful building, especially with its dramatic gray backdrop, and for a moment my heart began to fill with pride for Haiti.  My brain quickly took over, however, and I started to pose questions.  What business did the government have with such an edifice when over 30,000 children under five were still dying on an annual basis?  Which elected official was foolish enough to believe that he actually deserved to live in such a place, given the total dysfunction of Haiti’s public institutions?

In the end, my cynical nagging subsided and I remained transfixed by the French Renaissance structure, a vestige of Haiti’s enduring connection to and bizarre reverence for its colonial oppressor.  How such a building could coexist undisturbed with the bullet-riddled walls of Cité Soleil just minutes away was completely beyond me, but its presence seemed to signify hope at the time; a hope that one day Haiti would elect a president deserving of such a regal place of residence.

*  *  *  *  *

One of the greatest challenges for me has been how to process my time in Haiti and how to think of it and speak about it going forward. To the detached observer, Haiti is nothing short of a train-wreck: earthquakes, hurricanes, floods, riots, food insecurity, malnutrition, HIV, voodoo, child slaves, bloody coups d’état, mud cookies, and now cholera–these are all themes we come across associated with Haiti in the press. The result of a “pact to the devil” made by Haitians long ago to escape slavery, according to Pat Buchanan. Even veterans of Haiti (and diasporic Haitians themselves) tend to dramatize, falling into the same hackneyed phrases (“tortured,” “cursed,” and “beleaguered,” are favorites) and reductive portraits of the country that do not bear it justice.  A single story emerges: Haiti is destined for failure, and we might as well cut our losses.

It’s true, Haiti has not been able to catch a break.  When things don’t seem to be able to get worse, they often end up defying your expectations.  Haitians and ‘Haiti-philes’ have learned to expect the worst while hoping for the best–optimism in Haiti can sometimes seem like a cruel joke. That said, the Haitian people have proved their resilience time and time again, and their strength in the face of overwhelming challenges does not cease to inspire.  Haiti has overcome many obstacles, and I have no doubt that it will be able to get through this one.

My memories of Haiti are not all depressing.  Nor are the vast majority of the Haitians I came to forge relationships with depressed.  I am tired of reading the same dozen stories on Haiti in the news and listening to the same tired old cliches.  It is time to create a new narrative.  If there is any event that has the power to disrupt the inertia that has held Haiti down for so long, it should be this past calamity.  However, the international community still has a very long way to go towards empowering Haiti and Haitians to effect such a change, and many initial pledges on behalf of foreign governments remain unfulfilled.

There’s a proverb in Creole: lawouze fè banda tout tan solèy pa leve. Literally, it means “the dew shows off as long as the sun hasn’t come up.”  Figuratively, it translates to “the true test is in the doing.”  It is time for us, as a global community, to finally live up to our commitments and our moral duty as fellow inhabitants of this world and take definitive action on Haiti in partnership with the country’s population.

Haiti Cholera Death Toll Tops 900

It’s just getting worse…

Photo courtesy BBC News

I’m hoping that someone (ahem, Alex Harding) who knows a lot more about water safety, contamination, and cholera than I do will weigh in, but I just had to note the utter TRAGEDY of this situation. Cholera is so easily treatable with antibiotics and oral rehydration therapy. But this, coming atop the devastation of the earthquake and Haiti’s lack of resources, is way beyond the country’s management capacity. More than 14,000 people have been hospitalized, and the death toll continues to rise.  What can we do?