PORT-AU-PRINCE -- Jean Rejane Geralda's main problem isn't receiving her AIDS medications -- she hasn't missed a dose -- it's putting some sort of roof over the head of her daughter, Shara.
Geralda, like hundreds of thousands across post-earthquake Haiti, has been unable to obtain even a basic tent or tarpaulin from relief agencies. As the rainy season approaches, Geralda sleeps on an uncovered mattress with her newborn child in the back yard of her quake-damaged home.
``My bed is right on the ground,'' Geralda said, a situation in stark contrast to her AIDS-related medical care, where ``I am able to get everything I need.''
Geralda's situation highlights the fact that AIDS care in Haiti, by some measure, has rebounded faster from the Jan. 12 earthquake than the country as a whole. But the post-quake conditions still present prevention challenges -- threatening what had been steady progress for a nation that accounts for half of all AIDS cases in the Caribbean.
In recent years, Haiti's battle to reduce that number was a quiet success story. U.S.-backed AIDS programs brought the incidence of the disease down from 10 percent to 2.2 percent at the time of the Jan. 12 earthquake. Though restoring these programs has proved easier than providing shelter to the 1.3 million people left homeless by the quake, international health organizations still worry that the disaster has dealt a severe blow to AIDS treatment and prevention efforts.
Prevention is a challenge in the tent cities. At the city's largest encampment, where an estimated 45,000 crowd the site of an old military airport, the occasional free Condom distribution is not enough, said Dr. Kobel Dubique, who coordinates a clinic there.
A three-pack of condoms in Haiti costs about 15 gourdes -- less than one dollar -- but that's still more than many quake-battered Haitians can afford. ``We need to be distributing more condoms,'' Dubique said. ``And free. Free, free, free.''
Dubique said security in the tent cities must also be strengthened, as there have been at least four confirmed rapes at the camp where he works. One woman was raped twice. Camp dwellers themselves have organized into security details to reduce crime, but these security ``patrols'' are unarmed.
Refugee International's Emilie Parry, back from a recent visit to Haiti, warns that the impromptu settlements around the city present great risks.
``There's no lighting,'' she said. ``Women are being attacked sexually and otherwise . . . they feel very vulnerable.''
On a positive note, doctors and administrators boast that they were able to restore services to nearly all HIV/AIDS patients receiving antiretroviral treatments within days of the quake. At the GHESKIO clinic, Dr. Serena Koenig reports that all but 5 percent of the 14,000 patients on antiretroviral drugs before the quake were continuously being treated.
Of the rest, she said, the Haiti Ministry of Health and doctors at the clinic believe some died and the others are in the countryside, where they are eligible to continue their drug therapies.
SUPPLY IN PLACE
HIV/AIDS treatment avoided interruption because, according to the U.S. Centers for Disease Control's Dr. Steven Harris, there was already a three-month supply on the island. Moreover, the U.S. program had sponsored an electronic database of AIDS patients -- a rarity in Haiti's Ministry of Health -- which allowed for greater ease in tracking the patients after the disaster.
Clinics that were destroyed or damaged shifted to tents or other temporary quarters. At the General Hospital in Port-au-Prince, where Geralda receives care for both herself and her newborn, blue and white tents service about 50 HIV/AIDS patients per day.
That's down from the pre-quake norm of 80 per day, but the number of returning patients is continually growing. By next week, the hospital plans to have its in-house computer-tracking system up and running again and should be able to better pinpoint those patients that have gone missing.
Meantime, Geralda receives free medicine at the CDC-sponsored facility. Giralda hadn't planned on getting pregnant -- she says she was practicing safe sex -- but with the help of AIDS medications that she took during pregnancy and now administers to her newborn, there's a good chance that the child can avoid contracting the disease.
``I get very good care here,'' she said.