The paradox of Haiti has grown more extreme in recent years—a beautiful Caribbean country suffering from severe economic and political instability. During the past decade, Haiti’s precarious conditions have been exacerbated by a military invasion, an economic embargo, and continued chaotic governance. Through it all, PSI/Haiti has persevered to provide access to affordable, quality health products and information.

The 1991 coup d’état in Haiti left the public health system incapable of addressing the country’s myriad health needs. Today, Haiti is the poorest and least-developed nation in the Western Hemisphere and has the region’s most alarming health statistics. A combination of the highest birthrate in the Caribbean, a fertility rate of 4.8 children per woman, and short birth spacing has resulted in poor maternal and child health as well as an annual population growth rate of 2.1 percent. If current trends continue, Haiti’s population will nearly double in the next 30 years, from 7.5 to 14 million people.

Haitian families are in severe need of reproductive health programs that reduce the risk of unwanted pregnancies and sexually transmitted infections. Haiti has been particularly vulnerable to the AIDS epidemic, with HIV rates approaching 10 percent of the total population. This situation severely affects the health of HIV-positive individuals and their families, and has dire economic implications for the country’s future.

Throughout the past tumultuous decade, PSI/Haiti’s social marketing program has continued to deliver messages of abstinence, fidelity, and safer sex practices, as well as millions of quality, affordable condoms. Even during the economic embargo, when essential household goods and gasoline were in short supply, PSI was able to double condom sales in Haiti. Total sales of PSI’s KAPOT PANTÈ condoms reached almost 60 million by the end of 2000. This brand is now available nationwide in over 3,000 traditional and non-traditional retail outlets, including bars, pharmacies, market stalls, general stores, and clinics. The product has become well known throughout the country: today, over 75 percent of sexually active Haitians are aware of PANTÈ and the protection provided by condoms against HIV/AIDS.

PSI/Haiti’s innovative communications activities educate people and motivate prudent behavior. Ninety percent of Haitians who are HIV positive acquired the infection during adolescence or early adulthood. Therefore, educational messages targeted at youth fill an especially urgent need. Club Cool, a project developed and largely carried out by young people, publishes a bi-monthly magazine for youth dedicated to HIV prevention and reproductive health messages. Club Cool also trains adolescents to educate their peers and communities about HIV and pregnancy prevention. Other PSI programs focus on women, who account for 50 percent of AIDS cases in Haiti. Traveling forums called Koze Famn ("women talk" in Creole) visit urban neighborhoods and rural areas to explain HIV/AIDS, contraceptive choice and family planning. Ambyans Reyalite sessions introduce commercial sex workers in urban centers to PSI/Haiti’s new Reyalite female condom.

Another key health intervention by PSI/Haiti is the promotion and marketing of hormonal contraceptives, to expand Haitian women’s access to and use of reversible contraceptives. PSI distributes Confiance, a three-month injectable contraceptive, and Pilplan and Minigynon, low-dose oral contraceptives, throughout the country. In fact, PSI is responsible for over 25 percent of all modern contraceptive use in Haiti.

Hand-painted murals identify a sales outlet carrying PANTÈ condoms.

In the area of children’s health, PSI/Haiti launched a project to lower the number of childhood deaths from diarrhea-induced dehydration. Haiti has among the highest infant mortality rates in the Americas—74 deaths per 1,000 live births—as well as a rate of 131 deaths per 1,000 children under the age of five. Research shows a high level of public understanding that oral rehydration therapy is critical to protecting children’s health, but access to affordable treatment is limited and many Haitian families do not know how to use oral rehydration salts (ORS) properly. To alleviate this severe health problem, PSI’s project strategy includes: national distribution of its ORS brand, Sèl Lavi; behavior change communication activities for caregivers; training of NGO health workers, pharmacists and vendors in ORT and social marketing of ORS; and promotion of related healthy behaviors, such as continued breast-feeding and increased liquid intake.

A variety of donors have played integral roles in the success of PSI’s health programs in Haiti. Funding from the governments of the Netherlands, the United States and Japan, as well as from the United Nations Population Fund, UNAIDS and the World Bank, has made the implementation of PSI’s innovative strategies possible. Private funders have also played a significant part in guaranteeing continuous reproductive health services during years of crisis in Haiti. These private donors include the Erik E. and Edith H. Bergstrom Foundation, the David and Lucile Packard Foundation, the William and Flora Hewlett Foundation, the Turner Foundation Inc., the Summit Foundation, the Westport Fund and the Bingham Trust.

PSI has received several awards in recognition of its achievements in Haiti and its commitment to the Haitian people. In 1995, PSI/Haiti received the Pan American Health Organization’s Marco Aguayo Prize for "scientific quality and programmatic impact." In 1998, PSI/Haiti was honored with the United Nations Population Fund’s first Dr. Emmanuel Ade Award for its contribution to international family planning.

In Haiti as in other countries in turmoil, reaching the people in greatest need means enduring difficult political and economic circumstances. PSI/Haiti will continue to work and get results in this challenging environment, delivering lifesaving health products and healthy-behavior communications to the Haitian people.

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