Diógenes Pina

BARAHONA, Dominican Republic, Oct 14 2006 (IPS) – Ansi, Luisa, Sofía and Oveña lost their father to AIDS last year in this Dominican Republic town near the border with Haiti, after he was bedridden for six months. Their future looks dim as their mother was also infected with HIV by her husband.
The children, between the ages of two and nine, spend much of the day with Carmela Pie, their grandmother. They laugh and play, unaware that Oveña, the youngest, could suffer the same fate as their father. Some of her tests are still pending.

Supporting four children alone is difficult, the grandmother tells IPS. Life is too hard, she says, combing Oveña s hair. I don t know what s going to happen to this family.

Carmela s grandchildren are going through the same experience as 33,000 girls and boys in the Dominican Republic who have lost one or both of their parents to AIDS. And another 3,000 children are living with HIV, the AIDS virus, in this country of 8.5 million.

The Dominican Republic is located in the second worst-hit region in the world after sub-Saharan Africa: the Caribbean.

At the end of last year, the Caribbean s HIV/AIDS prevalence rate stood at 1.6 percent, with some 330,000 cases, according to the 2006 Report on the Global AIDS Epidemic, published by the Joint United Nations Programme on HIV/AIDS (UNAIDS).
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Neighbouring Haiti is the biggest cause of concern, as it has an adult prevalence rate of 3.8 percent, compared to 1.7 percent in the Dominican Republic.

Ansi, Luisa, Sofía and Oveña were born in the Dominican Republic but their parents are Haitian. Barahona, 205 kilometres southwest of the capital, Santo Domingo, where they live with their mother and grandmother, is less than 100 kilometres from the border that divides this Caribbean island shared by both countries.

The economy of this area of 179,900 people revolves around a sugar mill built in 1916. Local residents also earn a livelihood growing plantains and other crops, or extracting gypsum and salt.

Nearly 65 percent of Barahona residents are poor, according to the report on Focalisation of Poverty in the Dominican Republic, released this year by national authorities and the United Nations Development Programme (UNDP).

As a sugar-producing area, Barahona is surrounded by factories with bateys , or barracks-style sheds that house the sugarcane cutters, most of whom are Haitian.

The proximity to Haiti is associated with the high level of the disease in Barahona, Lidia García, head of the Comprehensive Healthcare Unit at the regional Doctor Jaime Mota Hospital, told IPS. Although there are no precise statistics, it is estimated that the prevalence of HIV in the bateys may be as high as six percent.

Many locals get involved in relationships with people from Haiti, and that increases the likelihood of infection, García said.

In an attempt to respond to the problem of orphaned children, on Sep. 29 the authorities presented a national policy for the protection and improvement of living conditions of children and adolescents who are orphaned and vulnerable because of HIV/AIDS.

It contains eight main areas of action, including support for families, equal opportunities for education and effective healthcare and sex education.

The policy was drawn up in the context of the global campaign launched last year by the United Nations Children s Fund (UNICEF) and UNAIDS, to intensify actions on behalf of the more than 15 million children worldwide who have been orphaned by the disease..

Halting the spread of AIDS is one of the Millennium Development Goals (MDGs), adopted by the international community in 2000 as a platform to combat inequality and poverty around the world.

The Dominican policy is the result of an inter-institutional process led by the Presidential Council on AIDS and the National Council on Childhood, with the support of the National Institute of Health and UNICEF, said Humberto Salazar, executive director of the presidential AIDS council, during the presentation of the document at the government palace.

There now remains the challenge of making the strategies proposed by this policy document a reality, with effective interaction between government, civil society, the private sector, churches, and all who are fighting the epidemic, said Tad Palac, UNICEF representative in the Dominican Republic.

The officials say they intend to ensure access by mothers or fathers to effective prevention and treatment services to prolong their lives, in order to lower the levels of risk for children and adolescents in families with HIV, before the death of one of the parents eliminates the protection they provide for their children. But no concrete measures or budgetary allocations have been announced.

According to official figures, 2,490 Dominicans required antiretroviral drugs for an advanced stage of the disease in 2005, and they represented 26 percent of all patients who needed antiretroviral therapy, which reduces the virus load in the body and prolongs life.

Juan Alberto Pie, the father of the four children, died in April 2005 at the age of 39. Responsibility for the family fell to Luisa, his wife, who now goes to the market every day to sell used clothing and shoes to support her children. She is 27, and she knows she is HIV-positive.

The grandmother, 69, does not want to even think about what lies ahead. I m too old to work, she says, looking at her calloused hands. She recalls her days in the fields, shrouded against the sun, planting pigeon peas and beans to raise her three children.

I can only look after them for a while, now, I m not strong enough to do everything for them, she says. She shakes her head and says I can t, I can t I don t know what I ll do.

In 2004, 7,900 people died of AIDS in this country, and the health authorities are starting to consider the disease as the primary cause of death in adults of reproductive age.

The government s national policy document states that the conditions of structural poverty in Dominican society limit the response capability of the community and of the families themselves. HIV/AIDS becomes a family tragedy as a result of the high cost of primary health care, and because of the institutional weaknesses in the country s health system.

Forty-two percent of the Dominican population lives below the poverty line, and in some areas 31 percent of the people live in extreme poverty, according to the Focalisation of Poverty report.

Carmela Pie lives with her daughter and grandchildren in a slum neighbourhood, in a tin and cardboard shack with a dirt floor. I need help with the children. I m old, she says. Who knows what will happen to them in the future when their mother and I aren t around any more.