The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been operating in Haiti since its launch in 2003, to address vital treatment, care, and prevention services. In January 2025, Trump’s ‘stop-work’ order for PEPFAR brought Haiti’s life-saving machinery to a standstill despite a limited waiver being issued a week later, allowing it to restart some limited services.
The NGO, Foundation for Reproductive Health and Family Education (FOSREF – Fondation pour la Santé Reproductrice et de l’Education Familiale) has been a key local partner of PEPFAR to reinforce and increase access to screening and treatment of Sexually Transmitted Infections (STI) and HIV screening for vulnerable and high-risk groups through a comprehensive package of integrated prevention services. FOSREF operates through a network of smaller Community-Based Organisations (CBO) that act to ensure that essential satellite services reach vulnerable communities throughout the country.
Citizen Action for Social Equality in Haiti (ACESH – Action Citoyenne pour l’Egalite Social en Haiti) is a small grassroots LGBT organisation based in Artibonite, one of the ten departments of Haiti located in central Haiti most affected by HIV. ACESH partners with FOSREF on a range of PEPFAR supported activities including fighting against discrimination based on sexual orientation, prevention, and support of people living with HIV in their daily lives. Gérald Marie Alfred is the President of ACESH and a board member of the Caribbean Vulnerable Communities (CVC). He was at the office of CVC in the Dominican Republic recently (mid-February 2025) when he had an opportunity to share some of the impact of the suspension of PEPFAR funding on ACESH’s critical contribution to the AIDS response in Artibonite.
ACESH has rapidly felt the impact of the cease work order imposed on the PEPFAR programme in Haiti. This has manifested itself in three main areas of their work – transportation stipends for PLHIV, delivery of psychosocial support, and increase in stigma and discrimination in health facilities where PLHIV receive their care and treatment.
ACESH provides auxiliary activities and psychosocial support to vulnerable communities in Artibonite to ensure they have equal access to HIV service delivery. These services may appear superfluous; however, ACESH actually provide essential services and amenities to enhance HIV outcomes amongst vulnerable groups. One such service is the identification and distribution of travel stipends to vulnerable groups who face substantial barriers due to long travel times and limited transportation options to reach health-care facilities. Ground transportation costs have increased substantially under the present political, economic, and security crisis in Haiti, to the point that these costs have become unbearable for many PLHIV. The travel support that ACESH was able to provide through PEPFAR funding is now no longer available and ACESH has observed many PLHIV have been forced to abandon their care and treatment visits.
ACESH was also funded under the PEPFAR programme to support vulnerable groups with psychosocial issues. The need for psychosocial support has also increased in Haiti in response to armed violence, yet ACESH is no longer able to offer these services since the PEPFAR project folded. The armed violence in the Port-au-Prince area has forced many families to leave their homes, leading to a massive displacement of the population to makeshift sites or to the rural areas outside of the capital. This has been particularly challenging for PLHIV as many have become separated from HIV treatment sites where they were originally assigned. Furthermore, PLHIV to begin with have a higher chance of developing mood, anxiety, and cognitive disorders. People may feel sadness or grief after acquiring HIV. They may also experience stress related to living with HIV or exposure to discrimination and social stigma.
ACESH has witnessed an increase in the stigma and discrimination experienced by key populations at the treatment sites. ACESH monitors seven treatment sites in Artibonite through support of a Gilead project that allows them to monitor human rights violations to vulnerable groups. “The sudden rise in reported cases of stigma and discrimination since the shutdown of PEPFAR funding is staggering” according to the Executive Director of ACESH. “This is because the PEPFAR programme sensitized and supported staff members of public health-care facilities that served the needs of key population members. The majority of this staff has now been laid off, rendering the public health sites much less hospitable to groups like sex workers and the LGBT community. ACESH may only be a small cog in the HIV response in Haiti, but the withdrawal of our services due to the PEPFAR cease work order have contributed in a big way to the dismantlement of HIV services to key populations in Artebonite in Haiti”.
