Until last year, Domoud made a modest living in one of Haiti's few tourist destinations and managed to support his family, but when the HI virus began attacking his immune system, he became too sick to work. By the time he started feeling better after taking antiretroviral drugs (ARVs), he had no money left to buy materials for his artwork; he also lacked money for food.
"That is the main problem - that I don't have enough food," he told IRIN/PlusNews. "I always take my medication, because they explained that I have to take it every day, but I don't feel well when I take it without food."
ARVs are more effective and cause fewer side effects when taken with food; adequate nutrition is also essential for delaying the progression of the HI virus and the need for ARVs.
Over 60 percent of Haitians live below the poverty line of less than US$2 a day, and an estimated 2.7 million of the population of 9.2 million were facing food shortages before this year's ruinous hurricane season, according to the National Food Security Council (CNSA), an independent Haitian research and advisory body.
The four storms that hit the island in quick succession in August and September devastated an already ailing agricultural sector, increasing the number of food insecure people by another 800,000 and making some 500,000 people homeless, including Domoud, whose wife is also HIV-positive, and their four children.
"My family is spread out now; we're all staying with different people," he said, before hurrying to rejoin a long queue jostling for food parcels at Jacmel's St Michel Hospital.
The parcels are provided by Espoir Anaise, a local charity that relies on donations from the UN World Food Programme (WFP) and Catholic Relief Services to distribute food to 6,500 HIV-positive individuals and their families at the health facilities where they go for HIV/AIDS treatment.
"Treatment is available now," said Gladys Lauture, Espoir Anaise's energetic founder. "The strategy is to give them food to motivate them to get the treatment."
For the last two months, however, the WFP has diverted its contributions to provide emergency relief to hurricane survivors in hard hit areas such as the northern city of Gonaives. Lauture has scrambled to find alternative sources of food aid, but the supply of food parcels has been disrupted at some sites.
"It's difficult to assure [ARV drug] adherence without that food support," commented Dr Reynold Grand Pierre of GHESKIO, a non-governmental research and training organisation that supports 20 HIV/AIDS treatment sites around the country, as well as running two sites of its own in the capital, Port-au-Prince, with funding from the US President's Emergency Plan for AIDS Relief (PEPFAR).
Dr Michel Bertrand, coordinator of the GHESKIO-supported site in Jacmel, said while his clinic has 500 patients on ARVs, "Only 443 have been active since the hurricanes."
Many villages in the surrounding hills were cut off from the town for weeks after the storms, but even when patients were still able to make the journey to Jacmel they were often more concerned about finding food than picking up their drugs.
"If someone has social and economic problems, ARVs are not the priority," Bertrand said. "Sometimes they miss their consultations because they're going to the food distribution."
Hurricanes worsen food crisis
The combination of ineffective agricultural policies, resulting from decades of political instability, and the inability of local farmers to compete with subsidised food imported from the US, has made Haiti particularly vulnerable to the global food crisis. A sharp increase in the price of basic foods sparked deadly riots across the country in April and led to the ousting of Haiti's prime minister.
According to Dr Gary Mathieu of the CNSA, attempts to boost local agricultural production have been unable to keep up with Haiti's 3.3 percent annual population growth, let alone reduce the country's reliance on imports for more than half its food.
"You had a situation that was already precarious because of the food prices and low agricultural production; the hurricanes just made it worse," said Alan Isaac, director of programmes at Catholic Relief Services, one of several international NGOs distributing food aid donated by the US government.
Decades of chopping down trees to make charcoal have left Haiti with less than 3 percent of tree coverage. Farmers were about to harvest crops of rice, corn and plantain - a green skinned banana-like fruit, a staple part of the diet - when the hurricanes dumped rivers of rainwater that carried torrents of mud down Haiti's deforested hillsides.
"You can give a lot of money to agriculture, but if you don't give anything to the environment it doesn't help," Mathieu told IRIN/PlusNews. "We need to plant trees, protect the ravines and make sure rivers take their proper course, otherwise every year it's going to be the same thing."
HIV takes toll on poorest
Haiti was one of the first countries to experience an HIV epidemic in the early 1980s, but prevalence has dropped from 5.9 percent among pregnant women attending antenatal clinics in 1996 to 3.1 percent in 2004. An estimated 2.2 percent of the adult population are now infected, according to the latest UNAIDS figures, still the largest epidemic in the Caribbean.
One of the main reasons for the decline is thought to be the high mortality rate among people living with the virus. Organisations like GHESKIO have made good progress in expanding the availability of ARV treatment - nearly 50 percent of the 40,000 people estimated to be in need of the drugs are now receiving them - but according to Lauture of Espoir Anaise, "The poor people continue to die."
She estimates that the food her organisation distributes to people living with HIV covers less than one tenth of the need, while Isaac of Catholic Relief Services confirmed that, particularly in the more remote parts of the country, many HIV-positive people in need of food assistance were not receiving it even before the hurricanes.
"Everywhere you go, they do have ARVs, but they only have the same question: 'When are you coming with food?'" he said. "People who are nutritionally compromised are going to die, whether they're on ARVs or not."
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