An Alternative Model for the Provision of Services to HIV-Positive Orphans in Haiti

The Joint United Nations Program on HIV/AIDS estimates that there will be 25 million AIDS orphans by the year 2010,¹ a fact that is placing strains on usual responses to orphanhood. This paper describes the approach adopted by a not-for-profit organization, Caring for Haitian Orphans with AIDS (CHOAIDS), that provides comprehensive care to HIV-positive orphans in a family-centered environment in Haiti. CHOAIDS addresses the physical, emotional, and educational needs of the children while integrating them in their communities and providing employment to HIV-positive women. The paper describes the challenges faced by CHOAIDS as it transitions from an emergency-response initiative to a full-fledged not-for-profit agency.

The Care of AIDS Orphans in Haiti

In Haiti approximately 3.8% of adults ages 15–49 are HIV-positive² and 5,000 children are born infected with HIV.³ At 670 per 100,000, Haiti’s maternal mortality rate is five times the average for Latin America and the Caribbean.⁴ Moreover, the estimated infant mortality rate is 60/1,000 live births,⁵ with a large proportion of these deaths potentially related to AIDS. The number of AIDS orphans continues to increase at alarming rates, leading the government to create a number of institutional orphanages. In 2002, there were 191 orphanages registered with the Chambre de l’Enfance Nécessiteuse Haïtienne (CENH), an organization focused on improving the quality and management of Haiti’s orphanages.³ These institutions house at least 200,000 children, a much higher number of orphans and vulnerable children (OVC) living in orphanages than in most countries with similar HIV/AIDS prevalence rates.³ Due to limited budgets, orphanages in Haiti often operate at maximum capacity and provide only the most basic services of food, shelter, and medical care. Institutional orphanages are often unable to provide personalized care to children. More importantly, very few of them address the needs of AIDS orphans who are themselves HIV-positive.

A Family-oriented Model of Care

What follows is a description of the work of CHOAIDS, a not-for-profit organization that seeks to provide an alternative model of care for HIV-positive AIDS orphans in Haiti. This organization recognizes that the care of HIV-positive orphans not only requires meeting survival needs, but also restoring a sense of family and of individuality for each child. CHOAIDS originated in response to an emergency situation involving a 13-year-old HIV-positive girl who had been abandoned at a local hospital and had no source of material or social support. This initiative quickly grew into an agency that provides services to a small group of orphans in a family-oriented setting.

Children involved in CHOAIDS are identified through the two main providers of HIV/AIDS medical care in the capital city of Port-au-Prince: Groupe Haitien d’Étude du Sarcome de Kaposi et des infections Opportunistes (GHESKIO) and Grace Children’s Hospital (GCH). These two institutions provide most of the needed medical care, including antiretroviral treatment (ART) to the children. Since its creation in 2003, CHOAIDS has cared for 19 HIV-positive orphans between the ages of five and 16. The provision of family-oriented care that emphasizes individual attention requires that only a small number of children be served. At the time of this writing (July 2009), nine children (three boys and six girls) are receiving services from CHOAIDS.

CHOAIDS hires HIV-positive women as caretakers for the children entrusted to it. This approach is intended to provide motherly care for the children and, at the same time, to improve the caretakers’ health and economic well-being. A stable job is a major asset in a country where the unemployment rate is 70%,⁶ and where there are very few, if any, opportunities for HIV-positive people. In addition, informal conversations with the women suggest that they also feel empowered and valued as trusted caretakers who have a role in day-to...