Making a difference in Haiti. Can-do doctors confront the agonies of health care desparation in Haiti.
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Characteristics of the acquired immunodeficiency syndrome (AIDS) in Haiti.
To identify the characteristics of the acquired immunodeficiency syndrome (AIDS) as it occurs in Haiti, we studied 61 previously healthy Haitians who had diagnoses of either Kaposi's sarcoma (15), opportunistic infections (45), or both (1) established in Haiti between June 1979 and October 1982. The first cases of Kaposi's sarcoma and opportunistic infections in Haiti were recognized in 1978-1979, a period that coincides with the earliest reports of AIDS in the United States. We do not believe that AIDS existed in Haiti before this period. The types of opportunistic infections and the clinical course in Haitians with Kaposi's sarcoma and opportunistic infections were similar in most aspects to those in patients with AIDS in the United States. The median age of Haitians with Kaposi's sarcoma and opportunistic infections was 32 years, and 85 per cent were men. The interval between diagnosis and death was six months in 80 per cent of the patients. Diarrhea was the most common reason for seeking medical attention in patients with opportunistic infections. Lymphopenia and skin-test anergy were observed in 86 and 100 per cent of patients, respectively. Potential risk factors (bisexual activity or blood transfusions) were identified in 17 per cent of male and 22 per cent of female patients. Demographic information suggests that patients belonged to all socioeconomic strata of Haitian society.
Acquired Immunodeficiency Syndrome↗
AIDS in Haiti.
The first cases of AIDS in Haiti were recognized in 1978-1979, a period that coincides with the earliest reports of AIDS in the United States. Current data are consistent with the hypothesis that AIDS originated in Africa, came to the United States and Europe, and subsequently was introduced into Haiti by either tourists or returning Haitians. The seroprevalence of HIV among healthy sexually active adults in Port-au-Prince, Haiti, is approximately 10%. This rate of HIV infection is threefold that observed in rural areas. The highest prevalence rates were observed in female prostitutes (53%) and in the male and female spouses of AIDS patients (55%). The types of opportunistic infections and the clinical course in Haitians with AIDS were similar in many respects to those in patients with AIDS in the United States. Important differences were noted in the prevalence of specific opportunistic pathogens in Haiti. It resembled observations on these infections in Africa. During the past 4 years, there has been a progressive decrease in the percent of patients reporting bisexuality and blood transfusions, and an increase in those reporting either a spouse with antecedent AIDS, prostitution, or none of the aforementioned activities. In 1986, heterosexual transmission probably accounted for over 70% of AIDS cases.
Acquired Immunodeficiency Syndrome↗
Biomphalaria glabrata in Haiti.
Biomphalaria glabrata, an intermediate host for Schistosoma mansoni, was first reported in Haiti in 1891 at one location in the Départment du Nord and in 1977 it was reported at several sites in one additional watershed. Our study identifies two additional locations each on a different watershed plus a third possible site. A wide but discontinuous distribution of the snail on the north coast of Haiti is confirmed (no autochthonous infections with S. mansoni have been reported). While there are many possible explanations for this discontinuous distribution, a role for the competitor Thiara granifera in shaping the current distribution of B. glabrata is suggested. The incursion of B. glabrata into Haiti is not recent but at the same time is not expanding.
Animals↗
Antituberculous drug resistance in central Haiti.
To determine the prevalence of antituberculous drug resistance in Haiti, we conducted a 1-yr survey in a central district. From a bacillary positive (smear and/or culture positive) case rate of 80/100,000, there were 282 patients from whom Mycobacterium tuberculosis was cultured. Each isolate was packaged and delivered to Canada where speciation and drug susceptibility testing were performed. Reported resistances are those using the proportions method (Laboratory Center for Disease Control, Ottawa, Canada). Resistance to one or more drugs was found in 22% of isolates. Age was the most important predictor of resistance in Haiti; resistance rates for age groups less than 14, 14 to 29, 30 to 44, greater than or equal to 45 were 8, 19, 22, and 31%, respectively. In patients not known to have received antituberculous drugs in the past, resistances were isoniazid (19%), streptomycin (5%), ethambutol (2%), ethionamide (2%), rifampin (1%). We conclude that antituberculous drug resistance is prevalent in Haiti, especially in older age groups, and that in persons with no known antituberculous drug use in the past, resistance to isoniazid is significant.
Adolescent↗
Impact of human immunodeficiency virus type 1 on tuberculosis in rural Haiti.
We conducted a case-control study to determine the relative and attributable risk of HIV seropositivity for bacillary-positive (smear and/or culture) pulmonary tuberculosis in Haiti. There were 274 patients with tuberculosis and an equal number of control subjects. Antibodies to HIV were present in 67 (24%) patients and eight (3%) control subjects. Odds ratios suggested that the risk of pulmonary tuberculosis was 15.7 times as great (95% confidence interval, 4.8 to 5.0; p less than 0.05) in patients 20 to 39 yr of age who were HIV-seropositive than in HIV-seronegative patients. In contrast, the relative risk in those 40 to 59 yr of age was elevated (3.0 times), though not significantly (lower 95% confidence interval, 0.8). In the 20- to 39-yr age group, 31% of tuberculosis was attributable to HIV infection (95% confidence interval between 23 and 39%). HIV-seropositive and HIV-seronegative patients did not differ with respect to sputum smear positivity. HIV-seronegative patients were twice as likely to be infected with resistant organisms, though this was not significant. We conclude that HIV infection is a major risk factor for pulmonary tuberculosis in young adult residents of Haiti. This, together with the fact that similar proportions of HIV-seropositive and HIV-seronegative patients were potentially infectious, suggests that without vigorous counteraction tuberculosis will become a greater problem for Haiti.
Acquired Immunodeficiency Syndrome↗
Perceptions and practices relating to condom use among urban men in Haiti.
This report is based on a survey conducted in 1986-87 of sexually active adult male residents in a low-income community of Port-au-Prince, Haiti. The objectives were to investigate knowledge of and attitudes toward condoms; to evaluate the effectiveness of the existing condom distribution program; and to obtain information that can be used in the design of strategies to increase condom acceptance and use among men throughout Haiti. A final sample of 706 sexually active adult male residents in stable unions, including a specially drawn sample of male partners of condom acceptors, were interviewed in their homes. Although condoms are almost universally known, they are rarely used. The majority felt that the responsibility for family planning should be borne by the woman. Whereas condoms may be of limited popularity for family planning purposes in Haiti, it should be determined whether they might be more acceptable as an effective means of controlling the spread of AIDS and other STDs.
Adolescent↗
Health for all: a surgical model in Haiti.
The need for health services, healthpower, and university participation is evident in Haiti, West Indies. The Hospital Albert Schweitzer in Haiti has a reputation for quality health care and a large volume of tropical disease that is worth experiencing. Health volunteers and university personnel are treated well and receive room and board in pleasant houses on the hospital complex. One becomes involved quite quickly in the active practice of medicine at the hospital and the necessity to read is facilitated by an excellent library. Reaching out to others and helping them achieve healthier lives is a direct form of hope for the future of the world. One can see that this makes a difference in one's own lifetime. To promote health for all it is important to promote changes in university training and research objectives that include interest in and concern for the scientific and educational problems associated with health for all. The Hospital Albert Schweitzer has always had these concerns and universities such as Yale have sent their surgical residents for one- to three-month rotations as part of their surgical training program. The residents are supervised by a board-certified general surgeon. Medical universities that participate in the global strategy of health for all could be allocated a greater number of residency training positions. To inquire further about the Hospital Albert Schweitzer write to Dr. Michel Jean-Baptiste, Medical Director, Hospital Albert Schweitzer, P.O.B. 1744, Port-Au-Prince, Haiti, West Indies.
Female↗
Cancer in Haiti 1979-84: distribution of various forms of cancer according to geographical area and sex.
Haiti exemplifies all of the problems of developing countries: poverty, hunger, reduced longevity, and an illiteracy rate of more than 75%. It is, therefore, not surprising that so little attention has been given to late-onset chronic diseases, particularly cancer. The results of a special survey of cancer cases first diagnosed in 1979-84 are presented, with relative proportions of cancers by site, according to age, sex and geographical area of origin (coastal vs. mountain). The major cancers recorded were: stomach and intestine, primary hepatic (especially in males), cervix, penis, and Kaposi's sarcoma (KS). There were 18 cases of KS, all of which occurred among AIDS patients. Among males, hepatic cancers accounted for a significantly larger percentage of cancer cases in the mountain vs. coastal origin group, while the reverse was true for penile cancer and KS. These preliminary data on cancer in Haiti are discussed with particular reference to dietary factors (for cancers of stomach, intestine, liver and cervix). The clarification and confirmation of these possible relationships between diet and cancer should provide an opportunity to elucidate environmental factors as causes of cancer.
Adolescent↗
Hôpital Albert Schweitzer and the Republic of Haiti.
The Hôpital Albert Schweitzer was established near the village of Deschapelles in Haiti in 1956 by Dr. and Mrs. William Larimer Mellon of Arizona. The hospital currently has 162 acute care beds and provides inpatient and outpatient services to a district of about 160,000 people. In 1983, visits to the hospital and its dispensaries totaled 39,163. Since its founding the hospital has evolved into a tertiary care facility but has also established primary care programs through seven satellite dispensaries. Health agents and midwives play an important role in the hospital's field programs. Outreach programs concentrate on health and nutrition education, immunizations, supplementary food programs, tuberculosis screening, oral rehydration for infants with diarrheal diseases and cord cutting clinics for the prevention of neonatal tetanus. This paper describes the principal causes of morbidity and mortality in this area of Haiti, the functioning of the hospital and both its medical and non-medical programs. The latter include agricultural irrigation and well digging projects, and wood working, weaving and ceramic facilities to encourage local artisans.
Community Health Services↗
Allocation of family resources for health care in rural Haiti.
A household survey of 230 episodes of infant and child illness in rural Haiti was analyzed to identify sociocultural and environmental factors that determine allocation of family resources for health care. The analysis tested the hypothesis that expenditures of time and money would vary according to expectations about the prognosis for the disease in question, the age and sex of the child, the household composition and family structure, and seasonal fluctuations in weather and financial resources. The results show that these factors are significant predictors of resource allocation, although they do not always produce the kind of influence that was hypothesized. The findings emphasize the importance of cultural and ecological variables, as well as of purely medical and economic factors, in understanding family response to illness. The importance of nonmonetary resources (such as the free time available to adult family members) in that response is also indicated. The study has methodological and practical implications for Haiti and other areas.
Adolescent↗
Risk factors associated with AIDS in Haiti.
A total of 121 acquired immunodeficiency syndrome (AIDS) patients diagnosed in Haiti were studied between June 1979 and December 1983. Risk factors were identified in 65% of 34 patients evaluated in a standardized manner since July 1983 and included: bisexuality, 38%; blood transfusion, 21%; and intravenous drug abuse or a spouse with AIDS, 6%. These risk factors were reported by only 20% of the 85 patients studied between June 1979 and June 1983. AIDS patients also reported more frequent parenteral injections prior to the onset of their illness than control subjects (e.g., siblings, friends, sexual partners). Heterosexual activity among female AIDS patients was also greater than in their female controls. It was concluded that, in contrast to the experience reported among Haitians with AIDS in the USA, risk factors are present among most patients with AIDS in Haiti.
Acquired Immunodeficiency Syndrome↗
Assessment of Leptoconops bequaerti as a potential vector of Mansonella ozzardi in Haiti.
Experimental studies in Bayeux, Haiti showed that the biting midge, Leptoconops bequaerti, is capable of supporting the complete development of Mansonella ozzardi but only on a very limited scale. This suggests that the species may not be involved in the natural transmission cycle despite its abundance and pestiferous nature in certain areas of Haiti. A midge-holding container is described which markedly enhanced the survival of engorged L. bequaerti in the laboratory.
Animals↗
The acquired immunodeficiency syndrome in Haiti.
Two hundred twenty-nine patients in Haiti with the acquired immunodeficiency syndrome were studied between 1979 and 1984. The clinical spectrum of the syndrome in Haitians was similar in most aspects to that in patients with the disease in the United States. However, in contrast to findings in the United States, accepted risk factors (bisexuality, blood transfusions, intravenous drug abuse) were identified in only 43% of Haitian patients. Patients in Haiti with and without these risk factors were similar to each other but differed from age- and sex-matched siblings and friends in the number of heterosexual contacts and receipt of intramuscular injections. These latter activities were commoner in patients than in their siblings and friends, and represent potential modes of transmission of infection with the human T-lymphotropic virus type III.
Acquired Immunodeficiency Syndrome↗
Duodenal ulcer in rural Haiti I. Clinical features. II. Gastric secretory studies.
I. In a study of 100 duodenal ulcer patients in rural Haiti, pyloric obstruction was present initially in nine per cent, but later developed in an additional 20 per cent. This high incidence of obstruction is similar to that observed in other tropicla populations in Africa and India. II. Standardized tests for basal and stimulated acid secretion in a small group of duodenal ulcer patients in rural Haiti were not elevated. The implication of the study is that either the test must be modified for different populations or the role of acid secretion in the pathogenesis of the disease questioned.
Adolescent↗
Tuberculosis, poverty, and "compliance": lessons from rural Haiti.
Tuberculosis (TB) is the leading cause of death among rural Haitian adults, and TB control in Haiti is widely acknowledged to be a failure. The causes of both the endemicity of TB and the failure of attempts to address it are briefly reviewed before data from a study conducted in rural, central Haiti are presented. Members of one group of patients with active TB were given free medical care; members of a second group were given free care as well as financial aid, incentives to attend a monthly clinic, and aggressive home follow-up by trained village health workers. Comparing the two groups shows significant differences in mortality, sputum positivity after 6 months of treatment, persistent pulmonary symptoms after 1 year of treatment, average amount of weight gained, ability to return to work, and cure rate. The roles of human immunodeficiency virus and cultural factors are also examined. When adequate nutrition and access to free care were assured, drug-dependent and patient-dependent factors were shown to be of secondary importance in determining treatment outcome. Based on these data from a small, community-based TB-control project, the authors conclude that high cure rates can be achieved if the primacy of economic causes of TB is acknowledged and addressed.
Acquired Immunodeficiency Syndrome↗
Nutritional assessment of children in drought-affected areas--Haiti, 1990.
From January through June 1990, a drought occurred in the Caribbean nation of Haiti. To determine whether the nutritional status of young children had been affected by drought-related reductions in food supply, in September 1990 a nutrition survey was conducted in the five departments most affected (Nord-Ouest, Nord, Nord-Est, Artibonite, and Centre) of Haiti's nine departments.
Child↗
Prevalence of HIV infection and high-risk activities in Haiti.
The prevalence of antibodies to human immunodeficiency virus (HIV) was determined in the relatives, friends, and sex partners of AIDS patients in Haiti and in other unrelated Haitian population groups. Among contacts of AIDS patients, HIV seroprevalence was highest among sex partners of the opposite sex (55%) and lowest among female relatives and friends (9%) of female AIDS patients. Male relatives and friends of male AIDS patients had a seroprevalence rate of 19% and also had a history of multiple heterosexual partners and frequent contact with prostitutes. The HIV seroprevalence rate among unrelated groups of Haitian adults ranged from 2% in rural healthy adults to 22% among tuberculosis patients to a high of 49% among Haitian prostitutes. This seroprevalence pattern suggests that HIV infection is widespread in Haiti and that heterosexual activity plays a major role in transmission.
Bisexuality↗