The HIV infection rates in our area are about 2% to 2.5% based on local testing data in this region. HIV continues to be a big health topic.
AIDS Education
The Clinic's AIDS educational activities began in 2000 and have been underway ever since. Initially, Anita and Michael simply began talking to junior and senior high classes at Episcopal Schools in the area. In time, private and public schools were also included. In 2003, community-wide educational activites began and continue today.
Hundreds of volunteer community health promoters are involved with HIV prevention activities on the community level as well as one-on-one activities. A unique group of health promoters has dedicated its efforts to reaching people whose behavior places them at high risk of acquiring HIV or sexually-transmitted disease (STD's): those people on the streets looking for sex. These health promoters go to the places where people congregate looking for sex in order to distribute infomation and condoms, to answer questions, to make informal presentations, and to otherwise promote sexual health. They work on the streets from 10 PM until 2-3 AM on Friday and Saturday nights about twice a month.
HIV/AIDS Treatment
Prior to 2006, there was no treatment within the Province for people with HIV. We began to transport people to a center in La Romana (about 30 miles east) and get them enrolled there for care.
Eventually, several centers (funded by the Clinton Foundation) opened in this Province; Clínica Esperanza y Caridad was one of those centers. The Clinic has registered more than 400 patients (11 of whom are children). The Clinic's unit operates colaboratively now with the Dominican public health HIV/AIDS services system, relying on integrated public and private financing. The Dominican government has expressed the intent to assume costs for HIV care for those who cannot afford it. However, governement processes tend to be slow and politically unpredictable. Consequently, the Clinic sitll depends upon private funding and donations at this point.
The overall benefit to the community (including antiretroviral medicines distributed and other resources that the unit can leverage) is estimated to have a worth of more than 1.1 million US dollars.
Confidential HIV Testing and Counseling
The confidential HIV testing and counseling unit opened in 2003. Over the years, the HIV positive test results have averaged consistently about 5% among people with an unknown HIV status coming to the unit. Over the years, the unit has perfromed thousands and thousands of HIV tests (more than 2,300 HIV tests during 2009). The 'background' HIV rate in pregnant women seems to be about 2.3% in our area. We have consciously tried to 'enrich' our testing population with those more likely to have a positive test result through the Clinic's health promotion activities.
Social Services
The population that the Clinic serves are predomnately poor people. People with resources tend to go to private centers in Santo Domingo, Puerto Rico, or the USA. For the poor people living with HIV/AIDS, the infection simply adds another challenge and impoverishing factor to their lives.
Malnutrition was recognized early on as a problem for people infected by HIV here as well as for their families and children. Over the years, the Clinic's HIV/AIDS program has provided whatever nutritional support was available to those who needed it the most. Other forms of social assistence (such as school supplies and clothing) as also provided when we have the resources. Transportation to come for medical care and appointments may also be critical to a successful treatment outcome.
Some indicated medicines and laboratory tests fall outside of the public health assistence network. We also try to help offset these expenses for patients when funds are available.
The Clinic also partners with Esperanza Internacional, a Christian economic development organization, in a program of micro-loans to enable people living with HIV/AIDS to start small-scale businesses.
HIV Support Groups
The Clinic has provided the means for people living with HIV/AIDS to oragnize support groups. There are currently two HIV support groups running. Things have changed over the years, but the challenge of living with AIDS is still a bit easier with peer support. Duirng 2010, these groups increased their independcnce and autonomy including the development of their own treatment literacy and adherence programs as well as encouraging HIV testing.