By Sarah Fort

The women, all of them rape sur­vivors, belong to the Com­mis­sion of Women Vic­tims for Vic­tims, or KOFAVIV, a com­mu­nity rape-crisis orga­ni­za­tion try­ing to call atten­tion to the plight that too many Hait­ian women face. In Sep­tem­ber 2006, 150 mem­bers of the group marched through the streets of the Hait­ian cap­i­tal, black masks rep­re­sent­ing the silenc­ing they feel and the anonymity of their masked attackers.

Since KOFAVIV began in 2004, the orga­ni­za­tion has coun­seled more than 1,000 rape vic­tims in Port-au-Prince. That’s only a frac­tion of the Hait­ian women who have been vic­tim­ized. Accord­ing to a sur­vey reported in the August 2006 issue of The Lancet, an esti­mated 35,000 women and girls were sex­u­ally assaulted in Port-au-Prince dur­ing the 22 months of the interim gov­ern­ment that fol­lowed the ouster of Pres­i­dent Jean-Bertrand Aris­tide in early 2004. Three per­cent of all female sur­vey respon­dents reported sex­ual vio­lence; half of the vic­tims were minors. Hait­ian women’s rights activists say that many of the women they coun­sel have been left to cope not only with phys­i­cal and psy­cho­log­i­cal scars, but also with HIV infec­tions trans­mit­ted by their attackers.

Haiti’s HIV/AIDS infec­tion rate of 3.8 per­cent among peo­ple ages 15 to 49 is already the high­est in the West­ern Hemi­sphere, and pub­lic health experts and human rights activists warn that rape is threat­en­ing to spread HIV even more virulently.

In a coun­try where poverty and polit­i­cal insta­bil­ity allow rapists to escape pun­ish­ment, sex­ual assault has long been not just a ran­dom crime but also a delib­er­ate weapon of polit­i­cal and social oppres­sion. Yet now, accord­ing to KOFAVIV activist Malya Vil­lard, Hait­ian women’s knowl­edge of con­tract­ing HIV through con­sen­sual sex actu­ally has put them at even greater risk, because if they attempt to refuse sex, they might be raped. “In the working-class areas, women have learned about HIV, so men are forc­ing them,” she says. “The guys have in their mind that they are the com­man­der of the woman. That’s why they force.”

Scant fund­ing for women’s security

The link that can be made between HIV/AIDS and sex­ual assault in Haiti is a dif­fi­cult prob­lem for the President’s Emer­gency Plan for AIDS Relief (PEPFAR), the Bush administration’s five-year, $15 bil­lion effort to com­bat HIV/AIDS in devel­op­ing coun­tries. As one of PEPFAR’s 15 “focus coun­tries,” Haiti received more than $28 mil­lion in U.S. aid in 2004, $51.8 mil­lion in 2005 and $55.6 mil­lion in 2006.

Debate in the United States has zeroed in on the sex­ual pre­ven­tion plan that PEPFAR endorses. The Absti­nence, Be Faith­ful, and cor­rect and con­sis­tent Con­dom use, or so-called ABC, approach is derided by those who pro­mote the use of con­doms for cater­ing to faith-based inter­ests and by sup­port­ers of absti­nence and fidelity approaches for pro­mot­ing sex­ual activ­ity through con­dom distribution.

One par­tic­u­larly con­tro­ver­sial com­po­nent of the ABC approach is the ear­mark that Con­gress passed in 2003 requir­ing that at least two-thirds of sex­ual trans­mis­sion pre­ven­tion funds sup­port absti­nence until mar­riage and fidelity pro­grams in each of the focus countries.

As KOFAVIV project coor­di­na­tor Anne Sosin said, “ABC works in a con­text where women are able to exer­cise their sex­ual rights, but women in Haiti are vic­tims of a wide range of vio­la­tions. Many of the vic­tims of KOFAVIV who are HIV-positive con­tracted the virus through rape.”

The stigma attached to rape means that it’s rarely reported. When it is, too often noth­ing is done. Accord­ing to Sosin, there has been only one suc­cess­ful pros­e­cu­tion of a rape case in Haiti in 2006.

In recent years, in the absence of law and order in Haiti, women and girls have become easy tar­gets for the gangs that rule the streets. “They are ter­ror­iz­ing the pop­u­la­tion, using rape as a way of reg­u­lat­ing com­mu­ni­ties,” said Nadine Puechguir­bal, the U.N.‘s senior gen­der adviser to its sta­bi­liza­tion mis­sion in Haiti. Gangs have moved into female-headed house­holds where they won’t be challenged.

“Police aren’t able to pro­tect civil­ians against gangs,” an offi­cer in CIMO, Haiti’s spe­cial police, admit­ted to the Inter­na­tional Con­sor­tium of Inves­tiga­tive Jour­nal­ists (ICIJ). He said secu­rity has always been used as a polit­i­cal tool in Haiti, and that most police sta­tions don’t even have a patrol car, or gas for one. The gangs are bet­ter equipped, he said, and have more firepower.

Cather­ine Mater­nowska, a pro­fes­sor of anthro­pol­ogy and social med­i­cine at the Uni­ver­sity of Cal­i­for­nia, San Fran­cisco, who has con­ducted research in the coun­try over the past two decades, says the street vio­lence in Haiti has increased since 1986 with the unrav­el­ing of the bru­tal Duva­lier dic­ta­tor­ship. The more efforts there were to enforce democ­racy and the people’s move­ment, she said, the more repres­sion there was and rape began to be used polit­i­cally. Rape con­tin­ues to be used by gangs to claim turf or to repress cer­tain populations.

Most Hait­ian women don’t have the option to leave.

Vio­lent attacks leave long-lasting effects

Yolette Jeanty is the direc­tor of Kay Fanm, a Hait­ian group that works with women who are vic­tims of domes­tic violence.

Behind the high walls of the shel­ter where she works, Jeanty says she tries to refer women infected with HIV to clin­ics or hos­pi­tals for med­ical ser­vices. Med­ical care is nec­es­sary, she says, because more cases are very vio­lent. Many times, rapists use sharp metal instru­ments attached to them­selves to assault women. Most vic­tims of those kinds of attacks can’t bear chil­dren and “usu­ally have long-term hem­or­rhag­ing,” she said.

Vio­lent attacks put Hait­ian women at much greater dan­ger of HIV infec­tion than con­sen­sual sex. Accord­ing to Dr. Paul Zeitz, exec­u­tive direc­tor of the Global AIDS Alliance, “There are bio­log­i­cal, cul­tural and eco­nomic fac­tors that make women more sus­cep­ti­ble. Women are bio­log­i­cally at risk because the HIV virus can more eas­ily pen­e­trate vagi­nal mucus dur­ing inter­course. The cells are frag­ile and brit­tle. In addi­tion, ulcer­a­tive STDs [sex­u­ally trans­mit­ted dis­eases] are an impor­tant co-factor in facil­i­tat­ing the spread of the virus.”

Also, gang mem­bers com­mit­ting these crimes are more likely to be infected. Rapists are part of a high-risk group in Haiti that is ill-informed about HIV and has no incen­tive to get tested. They don’t know their HIV sta­tus, and, accord­ing to Sosin, they are often dis­crim­i­nated against by social ser­vices for being young men from poor neighborhoods.

Other faith-based groups from the United States, includ­ing World Vision and World Con­cern, are receiv­ing funds to dis­sem­i­nate the absti­nence and be faith­ful mes­sages to youth through church and com­mu­nity groups.

Repeated requests to the U.S. gov­ern­ment for an inter­view to respond to these con­cerns were denied.

The start of sev­eral absti­nence and fidelity pro­grams in Haiti were delayed as a result of secu­rity con­cerns. World Vision and World Con­cern held off ini­ti­at­ing their pro­grams because of inad­e­quate secu­rity. PEPFAR staff even moved from their U.S. Agency for Inter­na­tional Devel­op­ment (USAID) offices here to a hotel in Miami for sev­eral meet­ings. Other meet­ings with out­side part­ners were held in Hotel Mon­tana, high up in the hills of Port-au-Prince and far from the com­mu­ni­ties being discussed.

Amer­i­can Red Cross receives more than $7 mil­lion in PEPFAR fund­ing for its HIV pre­ven­tion pro­gram in Haiti, Tan­za­nia and Guyana. Judi Har­ris, the health del­e­gate for the

Har­ris’ pro­gram teaches a cur­ricu­lum called “Together We Can”. Although the con­tract Amer­i­can Red Cross signed spec­i­fies that the 10– to 14-year-olds they work with be taught the “Absti­nence” and “Be Faith­ful” com­po­nents of the ABC approach, and that absti­nence is the key mes­sage, Har­ris said the cur­ricu­lum is being adapted for the younger pop­u­la­tion to fit the Hait­ian context.

Yet, accord­ing to a recent arti­cle in Social Sci­ence and Med­i­cine, some U.S. and Hait­ian doc­tors have expressed con­cern about the way HIV/AIDS pre­ven­tion is being taught. “The stan­dard for­mat for pre­ven­tion edu­ca­tion for HIV infec­tion and other STDs may have very lim­ited util­ity in set­tings where forced sex and severe eco­nomic vul­ner­a­bil­ity are so fre­quent as to be ordi­nary. For exam­ple, a woman who is try­ing to prac­tice ‘safe sex,’ or absti­nence, may actu­ally place her­self at greater risk of phys­i­cal and/or sex­ual vio­lence,” it says.

Some signs of progress

Across the road from Cite de Dieu is GHESKIO (Le Groupe Hai­tien d’Etude du Sar­come de Kaposi et des Infec­tions Oppor­tunistes), the nation’s lead­ing HIV/AIDS research orga­ni­za­tion and clinic. Behind a wall and past a secu­rity guard who serves pri­mar­ily as a direc­tor of traf­fic is a large open build­ing and a long line of peo­ple wait­ing for ser­vices in the hot sun. Inside, Dr. Jean William Pape, the ami­able direc­tor and founder, says that GHESKIO cen­ters see many vic­tims of rape and that he rec­og­nizes that absti­nence as a pre­ven­tion strat­egy is not pos­si­ble in most cases.

GHESKIO, which received a $2 mil­lion U.S. grant for HIV/AIDS treat­ment and lab­o­ra­tory infra­struc­ture in 2005, is one of the few PEPFAR-funded orga­ni­za­tions in Haiti that treats women who have been raped. The orga­ni­za­tion works in con­junc­tion with the Hait­ian Min­istry of Pub­lic Health and Pop­u­la­tion and pro­vides post-exposure pro­phy­laxis, a pow­er­ful dose of anti­retro­vi­ral drugs that may pre­vent a rape vic­tim from devel­op­ing an HIV infection.

In addi­tion, as of August 2006, along with the Min­is­ter for Women’s Affairs, GHESKIO planned to launch the country’s first 24-hour hot­line for vic­tims of sex­ual vio­lence and to staff sev­eral cen­ters where women could come for help. Pape hopes to link GHESKIO’s rape patients with advo­cates who will help the patients get gov­ern­ment ser­vices and advise them on nav­i­gat­ing the Hait­ian court system.

And there are other ways that U.S. fund­ing could help Haiti deal with its problems.

Farah Tanis, the co-founder of Dwa Fanm, says that the coun­try needs help in strength­en­ing its law enforce­ment and jus­tice sys­tems, so that police and courts would pros­e­cute the offenders.

Fifty-five mil­lion dol­lars in U.S. aid money has been appro­pri­ated for women’s jus­tice and empow­er­ment pro­grams in sev­eral African coun­tries, includ­ing South Africa, Kenya, Zam­bia and Benin. Money has yet to be appro­pri­ated for this pur­pose in Haiti. PEPFAR’s Moloney-Kitts says it’s true that staff mem­bers were forced to move from their USAID offices to a hotel in Miami for sev­eral meet­ings due to secu­rity, and she rec­og­nizes that, “[In Haiti], we need an effec­tive depart­ment of jus­tice and some rule of law,”

But Puechguir­bal, from the U.N. mis­sion, says an addi­tional prob­lem in Haiti is that “women don’t trust the police because some­times they are the abusers.”

There are some signs of progress. In 2005, Haiti finally changed its archaic rape law, at least tem­porar­ily, when a pres­i­den­tial decree ordered that sex­ual assault be rec­og­nized as a crime and not only as an assault against honor. But to become per­ma­nent, the law needs to be passed by the newly elected Hait­ian Parliament.

Although PEPFAR hasn’t suf­fi­ciently addressed the issue of rape in Haiti through its pre­ven­tion pro­grams, the U.S. gov­ern­ment rec­og­nizes a major prob­lem. As a USAID Haiti Tran­si­tion Ini­tia­tive field report noted in March 2006, “Gangs in Port-au-Prince have been using rape as a con­scious tool to ter­ror­ize cit­i­zens and increase their influ­ence and power.”

The link between vio­lence against women and the trans­mis­sion of HIV seems to have not yet been incor­po­rated into the U.S. government-funded HIV pre­ven­tion pro­grams. But bipar­ti­san leg­is­la­tion that is mak­ing its way through Con­gress could change that.

The Pro­tec­tion Against Trans­mis­sion of HIV for Women and Youth Act, also known as the PATHWAY Act, intro­duced by Rep. Bar­bara Lee, D-Calif., with 85 co-sponsors, would require that PEPFAR cre­ate a pre­ven­tion strat­egy that addresses female vul­ner­a­bil­ity to HIV, includ­ing tak­ing action to pro­tect women and girls from violence.

“Women and girls are increas­ingly bear­ing the brunt of the HIV/AIDS pan­demic,” Lee said. “But our cur­rent HIV pre­ven­tion pol­icy is not effec­tively address­ing the key social, eco­nomic and cul­tural fac­tors that put them at risk of con­tract­ing HIV. My bill lays out a com­pre­hen­sive and inte­grated HIV pre­ven­tion strat­egy that rec­og­nizes the real­i­ties that women face and empow­ers them to take con­trol of their own lives, so that sound pub­lic health pol­icy and the needs of peo­ple on the ground can dic­tate how we spend our money.”

Mean­while, KOFAVIV’s sup­port group for women vic­tims of rape con­tin­ues to meet weekly. Eramithe, another vic­tim of vio­lence sit­ting in the cir­cle on the floor, tells the story of a woman who came in the day before. “A woman’s hus­band was out of the house for a cou­ple days, [she asked him to take an] HIV test and he beat her badly.” Eramithe tucks her legs under her pink dress as she con­tin­ues. “Coun­tries have to take real action in pro­vid­ing sup­port to women and chil­dren who have sur­vived polit­i­cal violence.”