When an HIV diagnosis is surprising

PIH/ZL's program to prevent mother-to-child transmission of HIV provides HIV-positive mothers with formula, bottles, and the accessories needed to sanitize the bottles and provide potable water for the formula. The program has helped to bring the mother-to-child transmission rate to less than 2 percent in the Central Plateau of Haiti.

As staff at Partners In Health (PIH) and its sister organization Zanmi Lasante (ZL) begin providing care to Port-au-Prince’s urban population, they are seeing different medical needs than those of the rural populations they’ve primarily worked with throughout the last two decades. Not all of these conditions are earthquake related; some reflect the dearth of adequate medical care for the poorest of the poor living in Port-au-Prince prior to the earthquake. 

Last week, a critically ill 5-year-old child arrived at the PIH medical facility in Port-au-Prince. Although staff there had treated many critically ill children, this boy was different--when examined, he tested positive for both HIV and tuberculosis (TB).

Though it is not rare to find children who are infected with these diseases in Haiti, the U.S. Government estimates 120,000 Haitians are living with HIV, the staff of PIH and ZL were very surprised.

“[We don’t see these cases in our catchment area] at 5 years old!” said Cate Oswald, PIH's Program Manager for Psychosocial Support and Mental Health.

For the past two decades, PIH/ZL and its partners at the Ministry of Health have run comprehensive programs for HIV and TB in the Central Plateau and Artibonite Valley, several hours outside Port-au-Prince. PIH/ZL first began its voluntary HIV/TB counseling and testing program in 1986. In the Central Plateau, where in 1995 PIH/ZL became the first clinic in Haiti to offer antiretroviral drugs free of charge to all HIV-positive women to prevent mother-to-child transmission of HIV, the transmission rate has fallen to less than 2 percent. These programs have made it extremely rare to find young children, like this 5-year-old boy, who have not been previously diagnosed.

The PIH/ZL staff began providing care in Port-au-Prince shortly after the earthquake struck on January 12. In addition, many displaced people are leaving the devastated capital city to seek medical care in PIH’s more established rural catchment areas. This massive reverse urban migration suggests that PIH's HIV and TB programs in the Central Plateau and Artibonite Valley will soon be taking on changing public health needs--including more undiagnosed HIV/TB pediatric cases.

At present, the boy’s condition is still critical. “He's still hanging on, [we] had to give him an immediate blood transfusion and oxygen--he's so weak,” said Cate. PIH/ZL has also put him on both antiretroviral drugs and tuberculosis medications.