RESUMO
This article reviews human immunodeficiency virus (HIV) infection in Haiti. The evolution of the epidemic in Haiti, its spread from urban to rural areas, its varied clinical manifestations, and the attitudes of Haitian people toward HIV infection provide important lessons on understanding and managing this infection in a developing country. The heterosexual spread of HIV, particularly among the poor, is well-documented as is the role of other sexually transmitted diseases along with tuberculosis. Coinfection of HIV and tuberculosis have led researchers to study the effects of six-month supervised intermittent tuberculosis therapy both in controlling tuberculosis and slowing the progression of HIV. Various surveys and discussion groups about acquired immunodeficiency virus knowledge and beliefs demonstrate a large deficit in HIV education despite campaigns to educate the population. The great impact of HIV disease on morbidity and mortality in Haiti indicates that a great deal of work still needs to be accomplished and demonstrates the frustration in fighting the infection in countries with inadequate resources and infrastructure. Advances in HIV vaccine research seem to be the most promising option for developing countries such as Haiti.
Assuntos
Infecções por HIV/epidemiologia , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Haiti/epidemiologia , Humanos , Incidência , Masculino , Gravidez , Fatores de Risco , Distribuição por Sexo , Taxa de SobrevidaRESUMO
BACKGROUND AND OBJECTIVES: This article documents the history, politics, and economics that have contributed to a health care delivery crisis in Haiti and why family medicine will be crucial for the recovery of Haiti's health care. Since the United Nations intervention, there has been some improvement in health conditions. However, the embargo and political turmoil left little infrastructure on which to build. Developing family medicine, one of the priorities of the Ministry of Health, will reverse traditional forces that favor emigration and specialization and will provide the country with well-trained physicians who can treat most of the common health problems of Haiti. These common preventable and treatable problems are now contributing to short life expectancy and high infant mortality. While the ultimate responsibility for Haiti's health rests with Haitian health professionals, the country has an immediate need for international humanitarian assistance, particularly for general medical care.
PIP: With its 7 million people inhabiting an area the size of the state of New Jersey and with average annual per capita income of $225, Haiti is the poorest and most densely populated country in the Western Hemisphere. 85% of children in rural Haiti have clinical evidence of malnutrition, the infant mortality rate is 94/1000 live births, the maternal mortality rate is 4.5/1000 live births, life expectancy is 55 years, and there are rapidly growing rates of tuberculosis, malaria, and AIDS. Much of Haiti's health crisis is tied to the country's recent troubled political and economic past. That past has disrupted Haiti's health infrastructure to such an extent that Haitian people routinely suffer with, and often die from, readily preventable and treatable illnesses. Haiti's health care infrastructure cannot be rebuilt without humanitarian support and technical assistance from the international community. The authors explain the history, politics, and economics which have contributed to the health care delivery crisis in Haiti and why family medicine will be crucial for the recovery of the country's health care. The development of family medicine will check certain elements which favor emigration and specialization, and will provide the country with well-trained physicians who can treat most common health problems in the country.
Assuntos
Atenção à Saúde , Medicina de Família e Comunidade , Haiti , Humanos , Cooperação Internacional , PolíticaRESUMO
Thirty-six patients with AIDS and culture-proven nontuberculous mycobacteriosis were compared to 20 patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis with regard to clinical signs, symptoms, and diagnostic methods. Patients with nontuberculous mycobacteriosis were more often younger and homosexuals, while patients with tuberculosis were usually Haitian-American or users of intravenous drugs. A majority of patients with tuberculosis presented with fever and weight loss. These symptoms were seen in approximately 50 percent of the patients with nontuberculous mycobacteriosis. A distinct syndrome of dyspnea, chills, hemoptysis, and chest pain was seen in a significant minority of patients with nontuberculous mycobacteriosis. Lymphadenopathy was seen almost exclusively in patients with tuberculosis. Pulmonary sources (expectorated sputum or bronchoscopy specimens) were the most common source of diagnosis in both groups. Patients in both groups in whom the diagnosis was obtained from pulmonary sources frequently had negative chest x-ray films on presentation. Cavitary disease was absent from both groups.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium/etiologia , Infecções Oportunistas/etiologia , Tuberculose Pulmonar/etiologia , Adulto , Fatores Etários , Broncoscopia , Feminino , Haiti/etnologia , Homossexualidade , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Fatores de Risco , Escarro/microbiologia , Transtornos Relacionados ao Uso de Substâncias , Tuberculose Pulmonar/diagnóstico , Estados UnidosRESUMO
Twenty Haitian patients, hospitalized from 1 April 1980 to 20 June 1982, had Pneumocystis carinii pneumonia, central nervous system toxoplasmosis, esophageal candidiasis, cryptococcosis, disseminated cytomegalovirus, progressive herpes simplex virus, chronic enteric coccidiosis, or invasive Kaposi's sarcoma. Ten patients died. Opportunistic infections were frequently multiple and were recurrent in three patients. In seven patients disseminated tuberculosis preceded the other infections by 2 to 15 months. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. At least three patients probably acquired the syndrome in Haiti. Lymphadenopathy was common. Seventeen patients tested had anergy, and 18 had lymphopenia. Monoclonal antibody analysis of peripheral-blood T-cell subsets done on 11 patients showed a marked decrease in T-helper cells and an inversion of the normal ratio of T-helper cells to T-suppressor cells. This syndrome among heterosexual Haitians is strikingly similar to the syndrome of immunodeficiency described recently among American homosexuals.