The First Lady Visits Haiti

On March 13 and 14 Laura Bush will travel to Haiti and Mexico to visit U.S.-supported projects on healthcare and education. This visit will reinforce administration efforts to help with the global HIV/AIDS epidemic and the assistance that has come from the global AIDS initiative, the President’s Emergency Plan for Aids Relief (PEPFAR). (The Mexico visit will focus on a new U.S.- Mexico partnership for breast cancer.) The first lady’s visit comes at a time when greater attention is being placed on the impact that HIV/AIDS is having on women and girls. Gender is an essential component in the fight against the global AIDS epidemic, and PEPFAR has made progress in implementing gender strategies. Whether these can be sustained in Haiti will depend on an ongoing U.S. commitment to the program, a comprehensive approach to girls and women’s education, and support for the more than 163,000 children that are AIDS orphans.

Q1: Why is Haiti the focus of this visit?

A1: Haiti is the poorest country in the Western Hemisphere, ranked 153 in the human development index. The average life expectancy is 53 years. UNAIDS estimates that there are 190,000 people living with HIV, in a population of 8 million people; of this total, 180,000 are aged 15 and older; and of this group, 96,000, or a little over half, are women. The national HIV/AIDS prevalence rate is about 3.8 percent, though many believe it is closer to 5.4 percent. The government of Haiti spends only $32 per capita for health services on its population. It is dependent on external assistance for any type of HIV/AIDS programming.

Q2: Why is HIV/AIDS prevention and treatment so critical in Haiti?

A2: AIDS is destroying the development potential in Haiti. Not only is it putting young women at risk, but it is also undermining the base of human capital, one of Haiti’s most abundant resources. After more than 14 years of turmoil, Haiti was on the verge of state failure, but the more recent effort since 2004 to reestablish democratic governance in Haiti has made progress in stabilizing the country. The UN Stabilization Mission in Haiti (MINUSTAH) is working on a peacekeeping mission that addresses not only security, but also development. This mission is up for renewal in October 2008. The United States has an interest in preventing failed states, which is part of its national security strategy, and seeks engagement with Haiti on a wide range of governance and development agenda items. Haiti also shares the island of Hispaniola with the Dominican Republic. There is great potential for cross-border transmission of the disease, given the porous nature of the border and the large number of economic migrants.

Q3: What is the government of Haiti doing to complement international support?

A3: Haitian president René Préval has worked with international donors, and especially the United States, to address the AIDSepidemic. Prime Minister Jacques-Édouard Alexis gave AIDS a high national profile. Prevention and treatment were part of a national strategic planning process over the last few years. The real challenge, however, is how to integrate the demands of healthcare with other urgent needs in Haiti—security, justice, and stimulating the economy. What remains unclear is how the government, which has so little resources, can sustain drug treatment and AIDS prevention programs if international support is reduced. It will take the commitment of the United States, the United Nations, and other donors to prevent backsliding on one of the hemisphere’s most pressing health crises. Haiti remains a fragile political environment.

Johanna Mendelson Forman is a senior associate at the Center for Strategic and International Studies in Washington, D.C.

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