Partners In Health

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In 1999, Adeline Merçon weighed 79 pounds and was dying of AIDS in rural Haiti, even though effective treatment had become standard in wealthy countries years earlier. Partners In Health co-founders Dr. Paul Farmer and Ophelia Dahl hiked to her house and promised to bring back the antiretroviral drugs to save her life.

Partners In Health scrounged the cash to buy medicine for Merçon, and she quickly recovered. Her photo, taken at a party for herself and other patients, appeared in The Lancet in 2001. “What can I say? The medicines are eloquent enough,” Merçon said. “What they have done for me is amazing." 

Merçon was the first of about 60 patients whom Partners In Health and our Haitian sister organization, Zanmi Lasante, started on ART in the early 2000s. At the time, almost no poor rural people had access to the drugs, which were priced between $12,000 and $16,000 a year. So began the HIV Equity Initiative.

St. Coeur François, a Haitian farmer, weighed 88 pounds in 2000, when he started antiretroviral therapy. "Everyone with AIDS should be able to get treatment, since we’re all God’s children. Science is for everyone."

Nerlande Lahens was also dying of AIDS when she started ART. As more patients went on treatment and recovered, local attitudes about HIV began changing, and demand increased for prevention and HIV testing. "This is what they call the Lazarus effect," said Dr. Fernet Léandre, co-executive director of Zanmi Lasante. "For the first time, people see someone coming from their deathbed back to life." 

As HIV Equity Initiative patients regained their health, they became activists for increased access to the lifesaving drugs. Nerlande Lahens read the Cange Declaration before Madame Mildred Aristide, the first lady of Haiti at the time.“We are seeking your solidarity," the statement read. "The battle we are engaged in—to find adequate care for those with AIDS, tuberculosis, and other illnesses—is the same as the combat that has been waged by other victimized people over time so everyone can live as a human being.”

The HIV Equity Initiative helped show the world that treating HIV in poor, rural settings was possible with community health workers. Two years after the results of the project were published, the Global Fund to Fight AIDS, Tuberculosis and Malaria was born, making resources available to scale up access to ART worldwide. Madame Aristide and other government officials met in Cange, Haiti, to discuss how Haiti's Global Fund grants would be used.

The new Global Fund grant allowed PIH/ZL to expand access to lifesaving antiretroviral therapy and improve primary care services in dilapidated public clinics and hospitals around the Central Plateau. In Lascahobas, Joseph Jeune started antiretroviral therapy and treatment for tuberculosis through the expanded services.

Shortly after, Joseph Jeune was restored to health. As the Global Fund made ART available to poor people and the price of the drugs dropped, the images of Jeune before and after treatment became a worldwide symbol of the effectiveness of ART.

Community health workers formed the backbone of the HIV Equity Initiative, because they delivered medicines to patients in their homes and supported them in staying on treatment. Here, a community health worker looks on as Joseph Jeune takes antiviral drugs.

Dr. Paul Farmer and PIH worked with African health authorities to expand access to ART. While visiting health facilities in western Kenya, Farmer saw that Jeune had become the literal poster boy for the effectiveness of ART. 

Today, more than a decade after starting antiretroviral therapy, many of the first patients in the HIV Equity Initiative are still healthy and taking their medicines every day. Three of the first patients, Adeline Merçon (left), St. Couer François (middle), and Monèse Gracia (right), gathered for a photo last year on François's farm, in a remote area near Cange, Haiti. Merçon works as an HIV educator at the PIH hospital in Cange.

Providing access to antiretroviral therapy not only helped prevent the spread of the virus, but also allowed parents to survive to raise their children. François and his sons posed for a photo at their farm in 2013. 

Treatment for HIV can stop its spread from one generation to the next. Daphnee Joseph was infected with the virus from her mother, but her baby is now HIV-free because of access to treatment through the HIV Equity Initiative.

Joseph Jeune is still healthy today. In looking back on the HIV Equity Initiative, Dr. Fernet Léandre said, "When you succeed and you see the joy return in some family, in some village, you think that you've accomplished something good. There's nothing better than to bring people back to life."

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