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Success Seen Treating AIDS in Haiti

STEVE INSKEEP, host:

We have good news this morning from a place where there's often nothing but bad news about AIDS. Haiti is the poorest country in the Western Hemisphere. It's the one with the worst HIV problem, and it's one of two places we are visiting on this World AIDS Day. Worldwide, an estimated 40 million people are infected with HIV; 90 percent of them are in the world's poorest countries, which is why the news from Haiti may be especially significant. Here's NPR's Richard Knox.

RICHARD KNOX reporting:

Not so long ago there was heated debate about whether the world's poorest people with AIDS should be given the triple-drug treatment that's turned HIV infection into a manageable disease in rich countries. The drugs are expensive and they have to be taken every day without fail. Political pressure brought the price of drugs down and shamed rich nation governments into putting up money for treatment.

Today comes the most solid evidence yet that it's paying off. It's a study in the New England Journal of Medicine on the first thousand people given triple-drug therapy in Port-au-Prince, Haiti. Before treatment, only 30 percent of Haitians with AIDS were alive a year after their diagnosis. With treatment, the survival rate tripled to nearly 90 percent among adults and teen-agers. Nearly 100 percent of treated children were alive a year after starting the drugs.

Dr. Charlie Gilks of the World Health Organization says the Haitian study is a major vindication of treatment advocates like him.

Dr. CHARLIE GILKS (World Health Organization): It's a reminder to people who doubt that a simple strategy to deliver antiretroviral therapy can result in really excellent results at one year.

KNOX: Results like this: Nearly 80 percent of Haitian patients had no detectable virus in their blood after a year on treatment, and their HIV-ravaged immune systems were rebounding just as well as patients treated in Boston or Baltimore.

Dr. BILL PAPE (Cornell University): What it shows is that we're able to have comparable results as the best academic centers in the US.

KNOX: Dr. Bill Pape is a Haitian doctor on the faculty of Cornell University. He leads the treatment project in Port-au-Prince. He says Port-au-Prince, with its squalor, malnutrition, violence and desperate poverty, is about as challenging a place to test HIV treatment as anywhere on the planet.

Dr. PAPE: The population is poor, the population is not educated, and they lack everything that you can think of. And it is possible to make it work there, so I think if it works in Haiti, it's stimulus to make it work in other places as well.

KNOX: The Haitian project had to be creative to make treatment work. They hired people with HIV who were doing well on treatment to counsel and inspire new patients. They handed out food to AIDS patients and their families. They gave patients telephone calling cards to keep in touch. Dan Fitzgerald, a Cornell doctor who works in Port-au-Prince, says political turmoil sometimes prevented patients from coming in for their appointments.

Dr. DAN FITZGERALD (Cornell University): If that week there's a political riot or there's violence in the streets and they physically can't get to the clinic because of the violence, then they can't refill their medicine.

KNOX: If the clinic staff knew trouble was brewing, they sometimes gave patients an extra week or two of medicine. At times they had to find another way.

Dr. FITZGERALD: If they knew a patient lived in a certain neighborhood, they would bring the medicine home with them and then send a message to the patient and say, `Come by my house instead of going to the clinic.'

KNOX: The results aren't measured only in soaring survival rates and excellent laboratory results, but in dramatic returns to good health. Dr. Pape recalls one terribly wasted man who first came to the clinic by ambulance.

Dr. PAPE: And three months later he was asking me for a job as a driver. That's exactly what we see. They are gaining weight, they have confidence in life, and they are asking for jobs.

KNOX: Pape is confident that within two years, virtually everyone in Haiti who needs triple-drug treatment can be getting it if the international aid holds up.

Richard Knox, NPR News. Transcript provided by NPR, Copyright NPR.

Since he joined NPR in 2000, Knox has covered a broad range of issues and events in public health, medicine, and science. His reports can be heard on NPR's Morning Edition, All Things Considered, Weekend Edition, Talk of the Nation, and newscasts.