Haiti

The humanitarian crisis in Haiti is exacerbating the vulnerability of people living with or affected by HIV, particularly women, girls, and key populations. The situation has deepened existing inequalities, and multiplied the risks faced by marginalised communities. In the face of this adversity, UNAIDS continues to work with partners to ensure that people living with or affected by HIV have access to life-saving HIV services, including treatment and prevention services.

For example, in the West Department, over 50,000 people are receiving antiretroviral treatment and are at high risk of disruption. HIV prevention and health care services also face disruption. The recent violence continues to leave thousands of families traumatized. Thousands of people now find themselves unsafe and exposed to all types of risks. Displaced people and vulnerable populations need emergency aid and safe, protected spaces.

"Communities already at risk of HIV in Haiti have been made even more vulnerable, and people living with HIV are facing greater challenges in accessing treatment and care", said UNAIDS Regional Director for Latin America and the Caribbean, Luisa Cabal. "Together with all the United Nations agencies, and with partners, UNAIDS is advocating for safe and unhindered humanitarian access, and the protection health facilities and health workers."

The situation in Haiti is dire, with over 5.5 million people in need of assistance, including more than three million children. The World Food Programme has noted that around 1.4 million Haitians are "one step away from famine." The UN Humanitarian Coordinator for Haiti has noted that the humanitarian response plan is only six percent funded. Less than half of the health facilities in Port-au-Prince are functioning at their average capacity, and there is a pressing need for safe blood products, anesthetics, and other essential medicines.

In the face of these challenges, UNAIDS and its Cosponsors, together with the United States President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Observatory of Civil Society for HIV/TB/Malaria are supporting Haiti’s National AIDS Program.

UNAIDS has been working with the Ministry of Health and Population Unit for Management of Health Emergencies to support HIV treatment delivery. This support includes programmes to provide a broad package of support to affected communities. For example, together with the United Nations High Commissioner for Refugees (UNHCR) and in collaboration with the Organisation de Développement et de Lutte contre la Pauvreté (ODELPA), UNAIDS supports girls and women who are survivors of gender-based violence by training community leaders and granting empowerment funds for women and men's income-generating activities.

"We are working to ensure that people living with HIV have continuity of antiretroviral treatment as well as access to essential needs, especially including the most vulnerable people across the most affected areas," explains Christian Mouala, UNAIDS Country Director for Haiti. "UNAIDS remains committed to not let the humanitarian crisis disrupt the progress that has been made in the HIV response.  The United Nations stand together to support the people of Haiti."

At Refuge des Femmes d'Haiti, a small women's community-based organization in the commune of Croix-des-Bouquets, Port-au-Prince, Martha Norcimè, a 34-year-old pregnant woman from the nearby commune of Delmas, completes her training in sewing and macramé—a form of textile produced using knotting techniques.

She is part of a group of vulnerable women deeply affected by the gang violence and warfare that has impacted several areas of the capital since early 2022. Most of her peers came from Croix-de-Bouquets. All of them—including women with HIV—living in challenging circumstances, who have seen their livelihood completely disappear throughout these past two years as violence rose.

"I will soon give birth to my first child. I used to sell food and cleaning products that I was buying on the Haitian-Dominican border between Jimani and Malpasse, and I was then selling in markets in the city and in my neighborhood,” recalls Martha. “But I could no longer continue, given the blockade of the North city entry controlled by armed gangs. So many women traders are raped, kidnapped, or robbed by them."

In the fall of 2022, a joint UN project coordinated by the UNAIDS Country Office in Haiti, with participation from UNFPA, UNDP, and UNICEF, has been launched in partnership with Refuge des Femmes d’Haiti and with the support of FOSREF, a Haitian non-governmental organization. The goal is to support women and girls living this daily reality by empowering and giving them the tools to remain healthy and overcome the feminization of HIV in Haiti.

Haiti’s significant gains made over the past decade in controlling its HIV epidemic are now under threat, particularly in the capital, where a third of the 11.8 million Haitians reside. The brunt of an ongoing socio-economic and security crisis triggered by the assassination of former President Jovenel Moïse in July 2021 is borne by adolescent girls, young and adult women.

The feminization of HIV has long been a feature of the Haiti pandemic with HIV prevalence for females at 2.3%, compared to 1.6% among men. Still, the continuing multi-faced and profound crisis, fueled by such levels of violence, is exposing thousands of women to HIV infection.

In October 2022, a joint human rights report published by the United Nations Integrated Office in Haiti (BINUH) and the Office of the United Nations High Commissioner for Human Rights (OHCHR), entitled Sexual violence in Port-au-Prince: a weapon used by gangs to instill fear denounced collective rape by gangs in the capital as a weapon of war. In May 2023, research conducted by the Global Initiative Against Transnational Organized Crime in Cité-Soleil, another impoverished commune in Port-au-Prince deeply hit by gang activity, found that 80% of the women and girls who participated in the study had been victims of one or more forms of gender-based violence by one or multiple perpetrators.

"We work closely with UN Agencies to support women, victims of violence, make them financially independent and thus reduce the feminization of HIV, sexual and gender-based violence and maternal and neonatal mortality," says Novia Augustin, President of Ref-Haiti, and of the Federation of Women Organizations for the Equality and Human Rights (FEDOFEDH). "Difficulties are several, but the biggest is insecurity and the lack of financial resources. My motivation comes from our results: When I look at the satisfaction on the faces of the women we have accompanied, the recognition they show, I tell myself that it is worth it, despite all the difficulties encountered and the risks incurred."

Martha recalls how Novia opened the door to her for intensive training every day from 8 a.m. to 4 p.m. At the time, she was already pregnant. And despite the pregnancy-related fatigue, she did not miss a single day of class. “I can sew skirts, bonnets, blouses and even sandals!" she says proudly. "But I can't do anything now because of this crisis. Sometimes I even miss my pre-natal appointments with the doctor just because I am afraid to go out."

Besides training, Ref-Haiti also included discussions  on HIV risk and prevention, gender-based violence, sexual and reproductive health, family planning, and cholera. The awareness-raising activities targeted women beneficiaries and hundreds of young girls of other affected communes.

"We are working to support an integrated health response for women and girls so severely affected by gang violence and by socio-economic inequality”, says Christian Mouala, UNAIDS Country Director for Haiti. “We are proud of women-led local organizations such as Refuge des Femmes and their immeasurable efforts to support women to overcome the challenges they face."

All photos by UNDP Haiti

Imagine being widely blamed for tragedies that befall your country. Earthquakes. Hurricanes. Floods.

Now imagine being excluded from disaster response efforts because of this.

Lesbian, gay, bisexual and transgender (LGBT) people in Haiti face profound prejudice. Discrimination often undermines life chances. Education and employment opportunities erode. Even accessing healthcare can be difficult.

Founded in 1999, the SEROvie Foundation pairs health promotion for the LGBT community with human rights advocacy and socioeconomic empowerment. Today the organization operates projects in nine geographical departments.

UNAIDS supports SEROvie to ensure that the needs of key population communities are addressed during disaster responses. This intervention ensures people living with HIV continue to receive HIV treatment and have timely access to aid. Beyond the emergency phase, beneficiaries get support to resume generating incomes and reintegrate into their homes. They also receive psychosocial support to cope with grief and trauma.

In 2016 SEROvie founded the J.C Ménard Clinic in Port au Prince. This clinic serves LGBT people and other key populations including female sex workers and their clients. Here SEROvie has distilled more than two decades' experience in providing health and social support into a complete service package.

With the assistance of several collaborators including the U.S. Agency for International Development (USAID), J.C Ménard offers a range of free-to-user services addressing gender-based violence, stigma and discrimination, family planning and HIV prevention, including PrEP. It also provides HIV, STI and TB treatment and care. 

At the in-house laboratory, technicians manage both diagnostics and treatment monitoring. They track individual journeys from positive test to viral suppression. Over the last year the clinic provided facility-based HIV testing for 6,000 people and supported HIV treatment management for over 1,500 clients. Apart from dispensing patients' medicines, the clinic coordinates with other treatment facilities to ensure there are no stockouts and drugs do not expire.

Social workers conduct individual assessments to determine clients' needs. Psychologist, Darline Armand says the most important moment in her work is the first interaction after someone has been diagnosed.

"They need to feel safe," she says.

Peer Supervisor, Gregory Jacques, explained that the clinic employs both peer education and peer navigation as strategic approaches. Educators engage clients about relationships, risk and safety, providing accurate information. Navigators are themselves people living with HIV who walk others through the treatment and care process.

"The thing that makes a difference is that they know you are just like them," one navigator explains.

In the community room clients learn about health and relationships through fun activities. This is also where they meet for support groups and dialogues.

The Monitoring and Evaluation team measures programme performance with painstaking detail. They track everything from the number of people living with HIV identified through index testing to the number of sensitization sessions conducted with Voodoo priests. Over the past year more than 15,000 people received awareness-raising messages on HIV, GBV, stigma and discrimination from the clinic. Over 1,500 people benefit from comprehensive HIV care and treatment services while more than 1,500 are on PrEP.

Steeve Laguerre, SEROvie's co-founder, reflects on the organization’s journey with both awe and clarity.

"The services we provide are entirely determined by the needs of the people we serve," he says. "We seek funding that aligns with their demands. The work is always client-driven." 

This client-centred approach is valuable for the wider Caribbean. According to the 2022 Global AIDS Update, In Danger, last year four of five new infections in the region were linked to key population communities and their sexual partners. At the same time, most of the funding for regional combination prevention activities with key populations comes from international sources. 

“Community-led strategies for patient care help reduce late diagnosis and loss to follow-up while improving treatment outcomes,” said Dr. Christian Mouala, UNAIDS Country Director for Haiti. “These approaches must be adequately resourced and integrated into the national response.” 

“I have not been taking my meds for seven months,” said Carla Joseph (not her real name), a transgender woman living with HIV in Haiti. “I need a reliable, direct place that will not ask me for a referral letter … to get back into care.”

She is speaking to one of Haiti’s community-led monitoring (CLM) field officers from the Civil Society Forum Observatory, who over the past year have been working to learn more about how to connect diagnosed people to treatment and ensure that those already in care are better served.

“During the monitoring we met many clients waiting for their turn to be consulted and get their drug refilled,” said Elisabeth Jacques, a Community-Led Monitoring Field Coordinator. “Shouldn’t the services be at the best day and time for the patient?”

UNAIDS is supporting the community-led monitoring work being conducted by Haiti’s Civil Society Forum Observatory. Community-led monitoring is an accountability mechanism to improve people’s access to HIV services and the quality of care they experience. The process is led and implemented by communities of people living with HIV, key populations and other vulnerable groups.

This initiative is part of a coordinated effort by partners, including the Ministry of Public Health and Population and the United States Government through the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It aims to maintain and expand access to HIV services for Haiti’s estimated 150 000 people living with HIV, including 30 000 who are not yet aware of their status.

In its first report, the Civil Society Forum Observatory called attention to the need to improve client-centred services by extending service hours and reducing waiting times. It has also recommended an increase to six months for the supply of antiretroviral medicines dispensed to stable people living with HIV. Additionally, the community-led monitoring exercise unearthed a need to improve treatment literacy related to the concept of U = U (undetectable = untransmittable).

“We should build the capacity of civil society to do this sensitization work. They are more familiar with the clients. When someone is lost to follow-up, community members know how to speak to them and encourage them to come back. If we empower the community through community-led monitoring we can have a better handle of what’s going on,” said Soeurette Policar, the Coordinator of the Civil Society Forum Observatory.

The Head of HIV Prevention at the Ministry of Public Health and Population, Steve Mc Allan Smith, welcomed the recommendations. “Community-led monitoring will tell us how services are being rendered in the community and how people are experiencing those services from a client perspective. This approach will tell us how to tailor interventions to the specific needs of the patients. It will also help us address testing issues. But mostly it will help us retain people in care. Reaching the targets is really good,” he said. “But maintaining them long-term is what we are going for.”

Over the past year, the country has contended with intersecting crises. One month after the assassination of its president, Haiti endured a devastating earthquake, followed by a tropical storm. Worsening organized crime and an epidemic of kidnappings have had dire implications for the daily life of Haitians. In recent months a fuel shortage has made it even more difficult for people and organizations to conduct their affairs. And all this under the spectre of COVID-19.

Poverty, gender-based violence and the discrimination faced by people living with HIV and key population communities undermine people’s ability to stay on treatment. The challenging socioeconomic and security context only makes things worse. According to PEPFAR data, almost 8000 Haitians came off HIV treatment last year.

However, as the UNAIDS Country Director for Haiti, Christian Mouala, noted, Haiti was able to successfully implement multimonth dispensing of antiretroviral medicines to 88% of people on HIV treatment during COVID-19. This was thanks to coordinated efforts under the leadership of the Ministry of Public Health and Population and the collaboration of many stakeholders, including Haitian civil society.

“The people and health system here are resilient and adaptable,” Mr Mouala said. “At this time community leadership must become even more central to developing and implementing strategies to ensure people enjoy the best possible HIV, health and social support services.”

In 2001, Micheline Léon felt unwell. The then 33-year-old mother of three journeyed from her home in the small town of Corporand in central Haiti to a clinic in Cange. There she was diagnosed with HIV and tuberculosis.

Fortunately, three years earlier an organization called Zanmi Lasante—Haitian Creole for Partners in Health—had launched the HIV Equity Initiative. (Zanmi Lasante is the sister organization of the United States-based nonprofit health-care group Partners in Health.) This was one of the first projects in the world to effectively deliver antiretroviral therapy in poor, rural settings.

Twenty years later, Ms Léon is one of 2000 community health workers called accompagnateurs in the Zanmi Lasante network. Multiskilled teams of accompagnateurs are the link between patients and health facilities. They are also part of all HIV Equity Initiative discussions regarding patient care, treatment and social support.

Community health workers live in the areas where they work. They help to ensure that patients recover and stay healthy. Their main roles include medicine distribution and home visits, as well as linking people to care. They accompany patients to clinics and track those who have missed appointments. During the COVID-19 pandemic, the accompagnateurs were key to Zanmi Lasante’s care and treatment work. The home-based care and contact tracing skills refined in response to HIV are now being used for COVID-19.

Zanmi Lasante has a holistic approach to care that includes social services such as providing accommodation, food and transport. Community health workers help to coordinate all the support needed. They also serve the wider community by running educational campaigns on topics such as mental health and sexually transmitted infections.

Critically, the accompagnateurs empower and inspire people to take charge of their own health. Ms Léon is a role model within reach. Since starting treatment she has stayed adherent to it and her HIV viral load has remained undetectable since she began receiving viral load tests in 2017. She owns a small fruit and poultry business and sometimes spends time in Port au Prince, where she has a new grandson. She takes part in various group activities at the Zanmi Lasante site in Cange, including support groups, viral load classes and mothers’ clubs.

“The psychosocial support I received from Zanmi Lasante made me realize that my diagnosis was not a death sentence and I could go on and live a healthy and fulfilled life,” Ms Léon said.

Another stalwart Haitian HIV programme employs a community health approach. GHESKIO, the Haitian Study Group on Kaposi’s Sarcoma and Opportunistic Infections, was founded in 1982, the year before HIV was formally discovered. It is the world’s oldest HIV organization and has conducted research and provided clinical care over the past four decades.

GHESKIO has leveraged a community-based model to help Haiti respond to HIV and other public health crises. When the COVID-19 pandemic reached the country in March 2020, GHESKIO reinforced an existing programme—Distribution of ART in the Community—to ensure that clients living with HIV were provided with a three-month supply of medication. From a small room at the National Solidarity Association (ASON), a team packages medicines into plastic bags and pours over their client list. If a person is unable to come for their medicines, they’ll receive a home delivery.

GHESKIO also strengthened training activities for their multiskilled community health workers. In this way they provided social support for patients as well as home care for cases that did not require hospitalization.

“Our Community Unit played an essential role in the acceptance of new COVID-19 treatment centres in the impoverished, crowded slums,” said GHESKIO’s Program Coordinator, Patrice Joseph. “In collaboration with the Ministry of Health, we have strengthened contact tracing, case investigation and outbreak management for COVID-19.”

One of the newest community health workers is CV, a 35-year-old mother of three from Village de Dieu, a slum south of Port au Prince. She herself survived COVID-19. When she began feeling ill a community health worker accompanied her to get tested. Following five days at GHESKIO’s COVID-19 hospital, a community team conducted home visits to ensure her full recovery.

Now she works as a greeter at GHESKIO. She is also a GHESKIO community health agent, encouraging patients to come to scheduled visits. CV supports community sensitization around COVID-19 prevention by promoting sanitation and educating people about the importance of COVID-19 vaccination.

“I don’t take one day for granted,” she said.

At the GHESKIO (Groupe Haïtien d'Étude du Sarcome de Kaposi et des Infections Opportunistes) clinic in Port au Prince, Haiti, a young woman learns that she is HIV-positive. Along with counselling, she is offered immediate enrolment into a treatment programme at the facility.

Same-day treatment initiation is among the approaches Haiti has used to turn the tide on its HIV epidemic. HIV prevalence among adults is now 1.9%, down from a high of 3.2% in the mid-1990s. According to government statistics, of the estimated 154 000 people living with HIV, 89% know their status. Ninety-three per cent of diagnosed people are on antiretroviral therapy and 87% of people who are on antiretroviral therapy are virally suppressed. Over the past decade, deaths due to AIDS-related illnesses fell by 63% in the Caribbean country.

These achievements are the result of collaboration between the Government of Haiti, civil society and international development partners.

But they are also due to considerable donor investment. The vast majority of total HIV expenditure in Haiti comes from international sources.

The UNAIDS Country Office for Haiti is currently supporting the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Ministry of Public Health and Population to conduct the Sustainability Index and Dashboard (SID) exercise in Haiti. This is a tool completed every two years to sharpen understanding of countries’ sustainability landscapes and inform HIV investment decisions. Through the exercise, stakeholders assess national HIV responses from the point of view of sustainability and across four thematic areas. This is Haiti’s fourth SID. 

“The impressive gains Haiti has made over the past decade can be compromised in the future by overreliance on external funding. UNAIDS is pleased to support the Ministry of Public Health and Population along with PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria through this exercise to build a more sustainable response,” said the UNAIDS Country Director for Haiti, Christian Mouala.

UNAIDS will continue to work together with the national leadership, PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, civil society and other key partners of the HIV response to ensure that national interventions are equitable. The focus is on reaching the most vulnerable communities through coordinated programming and implementation and consistent inclusion of people living with HIV and key populations, including in humanitarian contexts.

The Executive Director of the Unit for the Control of Infectious and Transmissible Diseases (UCMIT), Pavel Desrosiers, noted that the SID exercise is crucial to identifying weaknesses in the current HIV response.

According to Hamfrey Sanhokwe, the PEPFAR Coordinator for Haiti, the SID also helps donors, “Measure progress on programmatic and financial sustainability and focus efforts for an optimal HIV national response.”

The optimum participation of all HIV stakeholders is key to the process. “People living with HIV were represented in and contributed to all the thematic meetings during the week and the exchanges were productive,” said Maria Malia Jean, a representative of the Haitian Federation of the Associations of People Living with HIV (AFHIAVIH).

The results of Haiti’s 2021 SID will be finalized and validated by all stakeholders before the end of October. HIV stakeholders will then be able to visualize and focus on areas that need further strengthening, while noting the successes they have worked so hard to achieve.

“Haiti has achieved much progress in the fight against HIV; however, efforts must be sustained and increased to ensure that targets are achieved by 2030,” said the Director-General of the Ministry of Public Health and Population, Lauré Adrien.

GENEVA, 8 July 2021—UNAIDS is shocked and saddened by the assassination of Jovenel Moïse, the President of Haiti, during an attack by gunmen at his private residence. It also sends its sincere hopes that the First Lady, Martine Moïse, will recover from the injuries that she sustained during the incident.

“My thoughts are with the family of President Moïse at this incredibly difficult time,” said the UNAIDS Executive Director, Winnie Byanyima. “I sincerely hope that the First Lady will recover from her injuries. She is a strong friend to UNAIDS and a staunch champion in the response to the HIV epidemic, both in Haiti and across the region.”

Ms Moïse, above left, has chaired Haiti’s Global Fund to Fight AIDS, Tuberculosis and Malaria Country Coordinating Mechanism since 2017 and is a close ally of UNAIDS. She is also a member of the Spouses of Caribbean Leaders Action Network and champions its work around the Every Woman, Every Child initiative in Haiti. Among Ms Moïse’s priorities are combatting violence against women and girls, teen pregnancy and human trafficking. She also supports the agenda to prevent and eliminate mother-to-child transmission of HIV.

In June, Ms Moïse spoke on behalf of the Caribbean Community at the United Nations General Assembly High-Level Meeting on AIDS.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Haiti’s first safe house for transgender people opened last week. Kay Trans Ayiti launched with the snip of a red ribbon and cheers from a circle of activists and residents. The group took turns taking pictures between bobbing pink and blue balloons tied to the veranda.

The triumphant moment came during a tough time. Asked how transgender people have fared in Haiti during COVID-19, home founder Yaisah Val was emphatic. “When the rest of the population has a cold, the trans community has pneumonia. Just imagine that with the hunger, poverty and meagre resources in Haiti, we are always on the outside,” she says.

In many ways, Ms Val is not as shut out as the people she serves. Haiti’s first publicly open transgender woman introduces herself as a mother of two and a wife. She has a degree in education and clinical psychology. She was a teacher and school counsellor before becoming a full-time community mobilizer, activist and gender identity spokesperson. During what she calls her stealth years, she was easily accepted as a woman.

Born in the United States of America to Haitian parents, she has had the benefit of a stable home, supportive teachers and a wildly loving grandmother.

“If you are going to be a sissy you will be the best sissy there is because you are mine,” her granny told her when she was a boy named Junior.

This is an anomaly. According to the United Caribbean Trans Network, transgender people in the region are far less likely to be supported by family, complete their secondary education and be employed. They are more likely to be homeless, to sell sex to survive and to face extreme violence. All this sharply increases the community’s HIV risk. A recent study found that transgender women in Haiti had an HIV prevalence of 27.6%—14 times higher than the general population.

But notwithstanding her “privileged” life, Ms Val’s 47-year journey has been fraught.

From when she was two or three years old she knew she was a girl. The gender policing from relatives was immediate and incessant: “Straighten up that boy. You can’t let him grow up like that.” At seven she was admitted to Washington Children’s Hospital with self-inflicted wounds to her genitals. Puberty was, “hell … a lot of confusion and self-hate.”

About 20 years ago she became herself during the Haitian Carnival. She braided her hair, slipped into a dress and boarded a loud, colourful tap-tap bus with her friends. One man flirted. He called her pretty and opened doors. She felt like Cinderella.

“That boy eventually found out and beat me within an inch of my life,” Ms Val remembers. “Whether you are upper class or middle class or on the streets, as long as you are trans it does not matter. Once you disclose, all respect is gone … you are just this thing. That one word disarms you of all humanity in people’s eyes.”

Transitioning offered a sort of freedom, “I was living and being seen as who I am, who I had always been.” But the fear of being assaulted or excluded made her identity a stressful secret. Old boyfriends did not know she was transgender until she came out years later. She only disclosed to the man who would become her husband after they had lived together for a year and were on the brink of getting married.

“I don’t recommend people do that,” Ms Val says again and again, referring to transgender people hiding their gender identity from romantic partners. “It can be violent. It can be dangerous.”

In her case it worked out. Her partner decided that she was the same person he knew and loved. Three years ago, the story repeated when she disclosed to her children.

“I was just surprised,” her son, Cedrick said. “I was shocked in a good way. They’d slowly started educating me over the years, so I understood what it meant. Ever since then the whole mother/son bond went to a new level for both of us. It filled in all those gaps. Now everything made sense, like her childhood stories.”

Coming out to those closest to her has opened the floodgates to activism. In 2016, Ms Val became the first person in Haiti’s history to publicly identify as a transgender person. She has been a key partner for UNAIDS Haiti and the island’s lesbian, gay, bisexual, transgender and intersex (LGBTI) people organizations. Last year she participated in a national dialogue on LGBTI rights. Together with her husband she started taking in homeless transgender people. That paved the way for Kay Trans Ayiti, which now houses 10 transgender people. Fundraising is under way for a programme of psychosocial support, hormonal replacement legal advice and job training. One of their employment initiatives is a food cart. Some of their residents are living with HIV. They are supported to remain adherent to their antiretroviral treatment.

Ms Val knows first-hand how terrifying it is to access sexual and reproductive health care as a transgender woman. She recalls the experience of going to a gynaecologist in Haiti to get a check-up related to her vaginoplasty. The doctor did not understand what “transgender” meant. That visit ended with the gynaecologist calling other doctors to gawk.

“I was a YouTube channel, a Google page … anything but a human being. I was upset. I was crying. This is why transgender people do not access health care! We have a lot of transmen with gynaecological issues who make herbal treatments rather than go to the doctor,” Ms Val says.

Her group, Community Action for the Integration of Vulnerable Women in Haiti (Action Communautaire pour l’integration des Femmes Vulnerable en Haiti, or ACIFVH), is working with two HIV clinics to sensitize health-care providers. Combatting the ignorance and conservatism is a tall task. Even after educational sessions some doctors and nurses have tried pushing their religious views on the trainers.  

“I was lucky not to be hindered by transphobia and discrimination,” Ms Val reflects. “Imagine if I did not have a supportive grandmother, an education and opportunities. I would not have been the person you see now.

“If you throw a seed on concrete it is not going to thrive. Being trans is not the problem. It is the reaction people have to it:  throwing them on the streets, not letting them work, not taking them into schools. We need to have a place in society. It is hard. It will take a while. But someone has to start.”

Charlot Jeudy, the President of Haiti’s lesbian, gay, bisexual and transgender (LGBT) community organization Kouraj, was found dead at his home in November. Investigations into the circumstances of his death are ongoing. UNAIDS remembers Mr Jeudy as a fearless campaigner for human rights.

In the aftermath of the devastating earthquake in 2010, the people of Haiti worked to overcome the loss of homes, businesses, public services and more than 100 000 lives. But amid the shared trauma and determination, a harmful narrative emerged.

Some people began to blame the masisi—a derogatory Haitian Creole term for gay men. They thought that the disaster was a divine punishment for the sins of the LGBT community. Members of sexual and gender minorities found themselves subject to intensified exclusion and abuse. Human rights organizations documented cases of LGBT people being denied access to emergency housing, food, health care and work. There were also reports of physical assaults and homophobic rape.

Rather than accept the situation, Charlot Jeudy decided to act. He created Kouraj, which means courage in Haitian Creole. In the struggle for equal rights, Kouraj emphasized the importance of community empowerment and aimed to inspire pride and confidence among LGBT people.

“We wish to put forward an alternative discourse on homosexuality in Haiti because for too long only homophobes have discussed our reality and proposed their own interpretation,” Mr Jeudy said in 2011.

Over the next eight years, Kouraj evolved to offer community training, legal and psychosocial services and sexual health education. It became one of Haiti’s leading advocates for ending discrimination against LGBT people and has played a key role in resisting the introduction of discriminatory laws.

The organization was aptly named. Its members have contended with verbal abuse and death threats. Three years ago, it had to cancel a festival to celebrate the Afro-Caribbean LGBT community after numerous threats of violence. According to friends, Mr Jeudy resisted their pleas to leave the country at the time. In response to a spike in reports of anti-LGBT street violence last year, he worked with the United Nations on a project to promote tolerance and equal rights.

John Waters, Programme Manager of the Caribbean Vulnerable Communities Coalition, paid tribute to Mr Jeudy’s leadership.

"I have watched Charlot Jeudy grow from a young, impatient and impassioned activist into a thoughtful, strategic leader, capable of using human rights not as a sword, but as a shield,” said Mr Waters. “He won over the hearts and minds of others to create allies. Mr Jeudy has left a huge gap in human rights work in the Caribbean. He raised the bar for those who must now follow in his footsteps.”

Mr Jeudy was also an active civil society representative on the body that oversees the management of Haiti’s response to HIV, tuberculosis and malaria.

“Under Charlot Jeudy’s leadership, Kouraj was a model partner,” said Fritz Moise, Executive Director of the Foundation for Reproductive Health and Family Education. “His death is a big loss for the response to HIV in Haiti.”

UNAIDS has added its voice to the expressions of grief and also paid tribute to the leadership of Mr Jeudy.

“Charlot Jeudy exemplified the power of communities to be the voice for the voiceless and to make meaningful change in people’s lives,” said UNAIDS Country Director for Haiti, Mame Awa Faye. “This World AIDS Day we celebrated the power of communities to make a difference. Mr Jeudy did just that.”