Haiti: Combating the Negative Implications of Linking AIDS and Haiti

• The Association of Haitian Physicians Abroad (AMHE) responds to Worobey study, November 7, 2006The Association of Haitian Physicians Abroad (Association des Médecins Haitiens à l'Etranger or AMHE) has reviewed the recent article by Thomas Gilbert and colleagues, reporting a phylogenetic analysis of archival blood samples collected from five early recognized AIDS patients at Jackson Memorial Hospital in 1982-1983.

• The study authors identify these five patients as Haitians who left Haiti after 1975. This article has several important limitations and does not provide any scientific breakthrough. Before a detailed critique of this paper, AMHE would like to point at the following remarks in methodological biases that may explain some of the study findings. First, the bias in selection of early samples of HIV among Haitians is quite obvious. The investigators chose a convenient sample under the unproven assumption that all these Haitian immigrants acquired HIV infection in Haiti. They obviously ignore that the clinical course of these patients perfectly fits the natural history of HIV/AIDS. No culturally-sensitive epidemiological investigation has ever been conducted of these initial Haitian immigrants presenting with HIV infection at Jackson Memorial Hospital in Miami. Therefore, the assertion that they contracted HIV in Haiti is presumptuous and not based on facts. Moreover, no archival samples from Haiti are included in the phylogenetic analysis and this constitutes a serious flaw. We do not know either how many samples of the pandemic clade B might have come from Haitian subjects, which raises the prospect of misclassification.

• Second, the authors do not adequately report on some of their methods and results. For example, they do not specify clearly the number of sequences for which there was uncertainty as to which subtype they belonged to; neither do they try to replicate their results by sequencing other HIV genes. While computer simulation techniques and phylogenetic analyses are important to our understanding of biological evolution, the application of these methods with such serious methodological limitations does not prove unequivocally the origin of the pandemic clade B subtype in the United States.

• Because these findings lack scientific validation, we need to raise questions about the motives of the authors; their paper not only does not advance our knowledge of the HIV epidemic but it continues with a dangerous precedent of victimizing an ethnic group with flimsy data. Needless to say that such half truths have been very harmful to the country and its people. The hasty classification of Haitians as a group at risk for HIV more than 20 years ago can be considered as a cloud hanging over good scientific practice. It destroyed the tourist industry in Haiti; its citizens have since been suffering from the social stigmata of presumed carriers of dangerous germs even though that classification was finally removed by the CDC.

• We are also afraid that such mishandling of data can have the unintended consequence of the refusal of Haitian patients to participate in research studies at American Universities for the fear that they will be used as guinea pigs in the furtherance of biased scientific protocols and conclusions. That would be the saddest of ironies for we all need good science to help us all against this calamity. La Science sans conscience n'est que ruine de l'âme

• Christian Lauriston, MDPresident of the Central Executive Committee of AMHE.

Action Plan by Stanley Lucas
October 30, 2007

A University of Miami study http://www.haitivisions.com/docs/pdf/Worobey_PNAS.pdf was recently publicized linking the introduction of AIDS into the US with Haitian immigrants. Not only is the study false, but it perpetuates this cultural stigma and association of Haiti and AIDS. We need to address these allegations quickly and efficiently so that they do not have a chance to sink further into the psyche in the US and do further damage to the reputation of Haiti. The following is a simple 3-step action plan to immediately address this issue. -------------------

PHASE I:
DO THE RESEARCH
In the next two days, we need to gather information and data in order to factually combat the charges. I suggest we turn to the following sources for data to help shape our message: ---------------------------------------------------------

Haitian Community in the US

· The association of Haitian doctors living in the United States should take a leading role on this issue. The association should convene a special meeting to outline their plan to combat these claims. Specifically, they could: a) Collect data on the studies of virus HIV in Haiti to help combat the claims that Haiti was the “stepping stone” into the US; and b) solicit the support of Johns Hopkins and Cornell University', which have best the team of AIDS researchers in Haiti and works in collaboration with Dr. Reginald Boulos of the CDS and Dr. Jean Pape of Gheskio.-----------

US Organizations

· USAID should have a lot of data on this issue given their extensive program to combat AIDS in Haiti (note: President Bush made a $51 million grant this year to fight AIDS in Haiti).

· Dr. Paul Farmer can be of assistance to us in fighting this propaganda. He can help the group prepare a strategy to answer the study. I wa told that he is in the process of writing a rebuttal. --------

PHASE II:
DEVELOP THE MESSAGE
Using the information collected, in the next three days, we need to develop a succinct and powerful message that includes the following elements:

Haiti was not the stepping stone for the spread of AIDS into the US. (backed up with facts from prominent experts).

In fact, these types of studies appeared almost 20 years ago. The Haitian Community in the US was outraged at the allegations and launched an incredible protest. As a result, the CDC came out publicly and confirmed that AIDS was not brought to the US by Haitian immigrants.

There are many programs that help combat the spread of AIDS in Haiti. (cite USAID program and any others). However, more can be done. Much is done in Africa through the Clinton Global Initiative and Bono’s One campaign, but little attention is paid to Haiti, a country that is so close to the US.

Haiti, as the poorest country in the Western Hemisphere, is facing many challenges. Unfortunately, much of the news coverage is centered around attacking a country that is already in dire straights. Rather than conducting studies that result in staining the reputation of 8 million people, couldn’t this money be spent to help build up the country of Haiti? ------------------------------

PHASE III:
ADVOCACY AND GETTING THE WORD OUT!
Encourage the Haitian Government to engage the US Government on a Strategy and Message Dissemination

· Haitian Members of Parliament should request the support of their counterparts in the US Congress in getting the word out. Specifically, the Congressional Black Caucus should have an interest in defending Haiti and its reputation.

· The Haitian Minister of Health should contact his American counterpart at the CDC to express concern and work together to establish a strategy to counteract this.

· The Preval Administration should engage the Haitian Embassy to answer these allegations. A Washington PR firm is on retainer to the Government of Haiti and should be engaged to help develop and disseminate the message.

Get the Word Out Through As Many Channels As Possible

· Engage Journalists in the US: Jacqueline Charles of the Miami Herald and Labbe of Washington Post are both supportive of Haiti and will be willing to get out the message.

· Engage Haitian Journalists and Radio Stations: The Haitian radio stations in the US should work with credible Haitian American Associations to get the word out on their radio programs.

· Encourage Celebrities and Other Well Known Personalities to Speak Out: Celebrity attention can raise the profile of the issue with certain segments of the population and often draw media attention. Evelyne Danticat (Haitien writer in the United States), Wyclef Jean (artist), Patrick Gilles (Chrysler designer), Dr. Dalmacy and others should be engaged.

· Protest at the University of Miami: Students and Haitian Americans should raise the profile of this issue by protesting this study and the release of factually incorrect information. ----------------------------------------------
AIDS/HAITI: WASHINGTON D.C. ADVOCACY PLAN
By Stanley Lucas: centurionlucas@gmail.com

Dear Friends and Colleagues: As I'm sure most of you are aware, another study has surfaced linking Haitian immigrants to the introduction of AIDS in the US. The study was conducted by professors at the University of Miami and the University of Arizona. Clearly, the results of this study put a stain on Haiti's reputation in the US and make things more trying for Haitian immigrants. You may recall that several years ago, a similar study was put forth and the strong negative reaction from the Haitian community prompted the US government, namely the Center for Disease Control, to come out and denounce the findings. I believe we again need to take action and raise awareness of this issue within the US government. Having Haitian leaders visit Washington to raise this issues and provide the facts to the US officials will go a long way in accomplishing that goal and protecting and defending Haiti's image. To that end, if you are interested in considering a trip to DC to help get out this message, I would be more than happy to help arrange meetings with the appropriate officials, including the Center for Disease Control, the Department of Health and Human Services, Members of Congress, and others. We need to strike fast and efficiently on this topic before this misinformation has a chance to sink into the psyche of Americans and US officials. I believe your involvement would be greatly helpful on this front. I would strongly encourage you to make the trip -- it is certainly a worthy cause! I look forward to hearing from you soon. Regards
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