Dr. Jean William Pape, Weill Cornell Medical College and Les Centres GHESKIO, Haiti, discusses The Caribbean Response to HIV Amidst Natural Disasters. Photo Credit: Steve Shapiro/2011 Caribbean HIV Conference

By Vania Andre

For 33 years, Dr. Jean William Pape has quietly led some of the most comprehensive AIDS research in the world. Unlike researchers affiliated with mainstream global health agencies like the World Health Organization (WHO), Pape’s work, which includes being the first to identify H.I.V / AIDS in the developing world, has remained mainly unrecognized by the general public.

However, with the reconstruction of his tuberculosis treatment center, which collapsed in the 2010 earthquake, Pape’s accomplishments in the fight against AIDS have resurfaced alongside his groundbreaking work with tuberculosis treatment.  On Mar. 23, Pape and members of his organization GHESKIO, will inaugurate the research center’s new multi-drug-resistant tuberculosis (MDR-TB) facility in.

The GHESKIO’s state-of-the-art hospital will provide tuberculosis patients with long-term housing as they receive medical treatment.

Based out of Port-au-Prince, GHESKIO, a French acronym for “The Haitian Study Group on Kaposi’s Sarcoma and Opportunistic Infections,” was the first institution in the world dedicated exclusively to AIDS research.

“We started our work before we recognized what AIDS was,” Pape said. Under the Duvalier government, no one wanted to hear about AIDS. It was a shameful disease that no one thought would become a pandemic.

In 1983, GHESKIO published its first scientific paper on AIDS in the developing world. At the same time, the CDC categorized Haiti as a risk factor in contracting the disease alongside drug addicts and gay men.

Chemists working for the NGO GHESKIO fill bottles of bleach in the lab on the GHESKIO grounds in Port-au-Prince. With CDC support, GHESKIO is distributing bleach as a way to fight cholera across Haiti. February 2013
Chemists working for the NGO GHESKIO fill bottles of bleach in the lab on the GHESKIO grounds in Port-au-Prince. With CDC support, GHESKIO is distributing bleach as a way to fight cholera across Haiti. February 2013

Stigmatization of a people

AIDS first emerged in Haiti at the same time it surfaced in the United States during the late 1970s.  Haiti, a country that was at the time, and still is, marred by political and economic instability, had little defense set in place to combat the onset of the pandemic.

When the disease was found in Haitian immigrants living in the U.S., there was a general disbelief within the community about whether a disease that seemed to only manifest in gay men and drug addicts was indeed being contracted by Haitians. By 1982, the CDC named Haitians as an official risk factor.

We were unfairly placed in the “4H club,” Pape said. “Heroin addicts, homosexuals, hemophiliacs and Haitians were named as the four risk factors in contracting AIDS.” After the CDC named Haiti as a risk factor, Pape and his GHESKIO colleagues published the first comprehensive description of AIDS in a tropical resource-poor setting in 1983 in the New England Journal of Medicine. Their research found Haiti had the same risk factors as Americans and heterosexuals.

The CDC’s classification of Haiti as a risk factor severely hurt the country’s tourism industry, at a time when tourism was the backbone of the Haitian economy. Chartered flights and cruise ships stopped arriving to Haiti’s shores, while hotel staff was laid off as visitors stopped appearing.  The CDC argued the rate of AIDS cases among Haitians was high enough to warrant the classification, however Haitian researchers and politicians claimed the labeling racially motivated.

While Haiti was pinpointed as the AIDS capital of the world, the diseases actual prevalence was across the shores of the island.

At the time, Puerto Rico had the highest concentration of AIDS cases, Pape said. In one interview with a reporter from NBC, Pape made an attempt to discuss the AIDS crisis in Puerto Rico, but the reporter “didn’t want to talk about that.”

A changing landscape

“Make no mistake about it – HIV may well be with us into the future, but the disease that it causes need not be,” Hilary Clinton said in a 2012 speech on Worlds AIDS Day, “advances in science and technology have now made it possible for the next generation to be AIDS free.”

In the early 1980s, some researchers within the Western medical community believed Haiti was a lost case, Pape said. They assumed the epidemic would kill the number of people it has to and eventually stabilize itself.

Now more than two decades later the prevalence of HIV and the number of people contracting the disease has gone down significantly. According to the latest statistics from UNAIDS Haiti’s AIDS prevalence is 2.1 percent, down from 9.4 percent in 1993.

With the support of the Ministry of Health GHESKIO has accomplished major feats in AIDS research and treatment. The research center “identified contaminated blood transfusions as a major mode of HIV transmission in 1985, and then worked with the Haitian Government to place the Haitian Red Cross in total control of blood banking.

“In 2005, GHESKIO documented the success of antiretroviral therapy (ART) in a resource-poor setting, and in 2010, GHESKIO published ART treatment initiation criteria, which prompted the WHO to change international guidelines.”

The work done at GHESKIO led to a reduced rate of HIV transmission from mother to child, with a reduction from 27 to 5 percent in 2009.

“The progress made in curbing AIDS shows the tremendous effort that was done by Haiti as a country,” Pape said. “We were stigmatized as an AIDS country, but our progress is a beautiful example of what we can do when motivated to fight together.”

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