In Haiti, HIV Treatment Is a Daily Gamble. Long-Acting Injections Could Change That.

By guest contributor Cassange BITERE

In 2024, Haiti accounted for 38% of all new HIV infections in the Caribbean, and although an estimated 71% of people living with HIV (PLHIV) in the country have achieved viral suppression, the fight remains a life-or-death struggle for many. PLHIV face persistent barriers to accessing consistent treatment, especially amid the current political turmoil, gang-controlled zones, and a deteriorating healthcare system caused by health facilities being shut down in recent months. Concurrently, other conditions such as the massive displacement of population fleeing gang-controlled areas increases the high risk of HIV exposure. In addition, certain environments, like prisons, face significant challenges that increase the likelihood of HIV acquisition among inmates due to overcrowding settings, exposure to physical and sexual violence, and limited access to condoms due to Haitian authorities’ reluctance to permit its distribution in carceral settings. Displaced and incarcerated populations in Haiti, already among the most marginalized, are particularly vulnerable and too often overlooked by HIV services.

These intersecting vulnerabilities make the consistent management of HIV even more difficult. While HIV is now a manageable condition in many parts of the world, thanks largely to daily oral antiretroviral therapy (ART), the reality in Haiti is much more precarious. Daily life is often disrupted by insecurity, fuel shortages, and infrastructure collapse . These conditions make even basic access to medication unreliable. Frequent stockouts, blocked roads, and fear of violence or kidnapping prevent people from reaching health centers or receiving timely care (Belt et al., 2024). Missing doses can quickly lead to resistance, treatment failure, and increased transmission.

While multi-month dispensing (MMD) – providing 3 to 6 months ART at a time – has been adopted in Haiti to reduce clinic visits,  it remains ineffective for displaced individuals or incarcerated populations who risk losing or being unable to store medication safely during instability. However, new treatment models such as  Long-Acting Injectables (LAI) reduce reliance on continuous travel and secure home storage, offering a promising alternative that eases daily adherence, reduces clinic visits, and minimizes stigma. This innovation would suit people who are newly diagnosed, unstable, or at high risk of treatment interruption.

In 2021, the U.S. Food and Drug Administration approved Long-Acting Injectable ART (LAI-ART), which replaces daily pills with monthly or bimonthly injections. These therapies have already transformed care in high-income countries – and offer specific advantages in fragile settings like Haiti, where adherence is compromised not just by individual behavior but by external disruptions, even for patients receiving multi-month supplies. Yet Haiti has not introduced LAI-ART.

The absence of LAI-ART in Haiti is not merely a matter of supply chains or cost. There is a gap in understanding what it would take to deliver this type of care effectively in a context like Haiti’s. Formative research might be needed to identify barriers and opportunities for implementing LAI-ART, both in urban and rural settings, and certain key populations affected by the current socio-economic turmoil such as displaced people, inmates, and adolescent girls and young women. What infrastructure is required? How will patients respond to injections instead of pills? What support do healthcare workers need?

At the time when science is advancing towards reducing the burden of HIV prevention and treatment, global HIV funding is shrinking. Major funding cuts have impacted programs across different parts of the world such as the Caribbean, sub-Saharan Africa, and Latin America, undermining prevention and treatment efforts in regions that are already under-resourced.

PEPFAR, which supported the massive HIV responses over the years, has faced serious disruptions. A 90-day freeze on U.S. foreign aid that began in January 2025 halted new PEPFAR disbursements, impacting services for more than 20 million people, including nearly half a million children. The human cost of these cuts is staggering. UNAIDS has warned that the loss of $4 billion in U.S. HIV funding could result in up to 4 million additional AIDS-related deaths and 6 million new infections by 2029. A study published in The Lancet projects 2.9 million additional HIV-related deaths by 2030 if current cuts remain in place. UNAIDS Executive Director Winnie Byanyima has described the situation as devastating and warned that decades of progress could collapse without immediate action (The Guardian, 2025).

This funding crisis comes at a time when promising innovations are finally within reach. Injectable PrEP, such as cabotegravir, and the newly FDA-approved drug called Yeztugo (approved in 2025), offer new tools for HIV prevention and treatment. But innovation without investment and evidence-based implementation will leave these tools unused in the very places they are needed most. In light of these innovations, Haiti must seize this pivotal moment to reimagine HIV care models. While the country is facing important socio-economic and political challenges, there is an urgent need to reimagine HIV care models through two key strategies: 1) adopting the new treatment methods and reinforcing national HIV surveillance, and 2) investing in capacity building of public health officers so that surveillance data can continue to function even amid an unstable socio-political environment.

1. Evidence from Uganda’s pilot of LAI-ART shows the approach is both feasible and highly acceptable, especially among those with adherence challenges due to displacement, stigma, or access barriers. Patients reported reduced stigma and improved convenience, while providers highlighted the need for cold-chain logistics, trained staff, and reliable appointment systems. These insights offer a practical roadmap for adapting LAI-ART delivery to Haiti’s fragile and disrupted health system.
2. Reinforcing and decentralizing HIV surveillance is equally urgent in the face of these innovations. Models from countries like Kenya, Uganda, and Sierra Leone offer valuable lessons. Kenya’s community-based monitoring networks, Uganda’s deployment of health information officers in rural districts, and Sierra Leone’s post-Ebola investment in local data hubs demonstrate that even when national systems are fragile, subnational and community-led efforts can sustain critical health data flows. For Haiti, this would mean training public health officers and university-based researchers in provinces outside major urban centers like Port-au-Prince, equipping them with tools for local monitoring, and embedding them into community-based organizations (CBOs) that already serve vulnerable populations. This investment would improve surveillance and help make informed decisions as the implementation of LAI-ART is ongoing.

However, these global experiences offer valuable blueprints for adaptation, rather than direct replication. Formative research is still needed to understand how these models can be adapted to Haiti’s unique social, geographic, and political context. We need to understand local individuals’ perception of injectable therapy. What are the logistical challenges of storing and administering injectables in remote or insecure areas? What incentives and protections would local health workers need to safely operate mobile services in remote areas?

It is time for development practitioners, researchers, and public health advocates to act decisively. The very factors that make Haiti a “hard place to work” are what make long-acting treatment models so urgent. Funding partners must prioritize implementation investment in fragile states – not after stability returns, but precisely because instability persists. The people of Haiti deserve a future where survival does not depend on proximity to a clinic or a pill bottle.

About the author:

Cassange Bitère is a Development Practitioner involved in development work, research and evaluation studies in low-resource settings in the Caribbean, Sub-Saharan Africa, and the United States of America. His work focuses on advancing implementation strategies that bridge the gap between scientific innovation and community realities.

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