Article

Understanding the reasons for decline of HIV prevalence in Haiti

E M Gaillard¹, L-M Boulos², M P André Cayemittes³, L Eustache⁴, J D Van Onacker⁵, N Duval⁵, E Louissaint⁵ and G Thimoté⁵

Edited by N Walker, H Ward and R Miller

¹ The POLICY Project/Futures Group International, Port-au-Prince, Haiti
² Centre d’Évaluation et de Recherche Appliquée (CERA), Port-au-Prince, Haiti
³ Institut Haitien de l’Enfance, Port-au-Prince, Haiti
⁴ The POLICY Project/Futures Group International, Port-au-Prince, Haiti
⁵ Ministère de la Santé Publique – UCC, Port-au-Prince, Haiti

Correspondence to:
Correspondence to:
E M Gaillard
PO Box 1314, Port-au-Prince, Haiti; egaillard{at}msn.com

Objectives: HIV sero-surveillance rounds and projection estimates suggest a decline of HIV prevalence among pregnant women and the general population in Haiti. This study aimed to evaluate the decline of HIV prevalence and understand the reasons for the decline.

Methods: Following an epidemiological analysis, three mathematical models were used to re-create the national epidemic, calculate HIV incidence, and confirm the decline of HIV prevalence. Declining trends in prevalence data were compared with observed trends in behavioural data.

Results: HIV progressed rapidly from initial infection to AIDS and death, with people dying twice as fast as in developed countries. With the rapid progression of the disease and the early intervention efforts in securing the blood supply, prevalence among commercial sex workers and blood donors peaked in the late 1980s followed by a decline in the mid-1990s in the general population. The observed decline among pregnant women and in the general population was confirmed after controlling for confounding variables. The Haitians are well informed: there is an increase in condom use with occasional partners at last contact and in abstinence and fidelity, and a decrease in the number of occasional partners. However, the age of sexual debut is lower and the proportion of sexually active youth has increased.

Conclusions: There is evidence of decline in HIV prevalence among pregnant women, specifically among pregnant women living in urban areas and pregnant women 25 years and older, but not among pregnant women living in rural areas and pregnant women 24 years and younger. Although many factors have acted in synergy to halt the AIDS epidemic in Haiti, the main reasons for decline seem to point to mortality and blood safety intervention efforts in the early stages of the epidemic.

Abbreviations: AIDS, acquired immune deficiency syndrome; BSS, Knowledge and Behavioral Surveillance Surveys; DHS, Demographic and Health Surveys; EPP, Estimation and Projection Package; FCSW, female commercial sex worker; HIV, human immunodeficiency virus; STI, sexually transmitted infection

Keywords: Haiti; modelling; prevalence; incidence; decline

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