UN embargo fuels Aids catastrophe in Haiti: 'Four in five slum boys infected'

THESE are items not covered by the international embargo. They are three-packs of condoms called Pante, which is creole for Panther. And just now we are handing out a few samples to young men gathered in a dusty square in Jacmel, a once- prosperous port on the southern coast of Haiti.

Some spin on their heels and giggle in embarrassment, but everyone accepts these little gifts. They know what they are. A huge billboard advertises them on the other side of the square. 'Pa Pran Gol', reads the slogan against a picture of a Pante packet and of a goalkeeper blocking a football heading for the net. 'Don't take a shot.'

Giving away the condoms is easy. But Steve Chapman, who works for the Washington- based Population Services International (PSI), is pleased by the encounter, because these men seem at least to have got the message about condoms being important. 'Maladie,' one of the group replies quickly. 'It is for the maladie.' Yes, Mr Chapman confirms, it is for the sickness - Aids.

Years of suffering and death have brought a tragic familiarity with the disease, even in this town more than 150km south of the capital, Port-au-Prince. When it was first documented here by American researchers in 1983, locals dubbed it in creole diare masisi - 'faggots' diarrhoea' - or, more tellingly still, '4-H' (katrach) - a compression of the four categories of people thought then to be alone in carrying the HIV virus: haemophiliacs, homosexuals, heroin users and Haitians.

Today, the continuing political turmoil is further impeding efforts to control the disease. The 1991 military coup that overthrew Jean-Bertrand Aristide prompted an exodus of his supporters from the slums of the capital to the countryside. Many took HIV and Aids with them. There is virtually no care for those who have the disease and any campaign to contain it - including Mr Chapman's condom distribution effort - is made almost impossible because of communication and travel difficulties. Adding to the deprivation is the international embargo.

According to studies by the Cornell University Medical Centre of New York, which operates a research clinic in Port-au-Prince, about 10 per cent of Haiti's sexually active population either has Aids or HIV that usually develops into it. In some groups, the rates are higher. As many as four in five of the young boys who crowd the capital's slums may be infected.

Though it cannot be proven, it is possible that Aids first came here from the country that leads the international sanctions effort against it - the United States. In the 1980s Port-au-Prince was a mecca for gay holiday-makers from Miami and New York.

Today, if Haitian refugees seeking asylum in the US test positive for HIV antibodies they must find an American sponsor willing to guarantee payment of medical bills to have any hope of admission.

'I think it a reasonable hypothesis that it was imported into Haiti from the United States,' says Dr Warren Johnson, who heads the Division of International Medicine at Cornell and oversees the university's work in Haiti.

Dr Johnson considers unlikely the once-popular theory that the virus was brought from West Africa by Haitian workers who were sent there by Jean-Claude 'Baby Doc' Duvalier, before his flight from the country in 1986.

Noting the worsening conditions under which the battle against Aids must be fought, Dr Johnson calculates that in the Baby Doc era, the Haitian government allocated about dollars 3 per person per year for health care. 'Now it has deteriorated to the point where it is almost nothing. And that in part is because of the international embargo,' he says.

When Haitians die of Aids, it is usually without dignity in the shacks of city slums or hidden in the hills. Mr Chapman, meanwhile, feels at least he is easing the suffering. Contracted by USaid, the US government development agency, PSI is working to distribute condoms by offering them at subsidised low prices - less than 7 cents for a pack of three - to any Haitian who can retail them. These are especially operators of the lottery - borlette - stalls that dot the country, and which offer tiny cash prizes based on draws made each night on the New York lottery. Between September 1992 and October 1993 3.9 million packs were sold.

Dr Johnson acknowledges the campaign, but believes it will not be enough to save this country from the disease. 'I believe it has helped some, but in a situation like this if you were to calculate the number of condoms you would need to really make a difference, it would simply be astronomical.'

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