Letter from Haiti.

Abstract

Never have the global inequities in the AIDS epidemic been more apparent than in the last few years. As AIDS death rates drop in the United States, they soar over the rest of the globe. As the number of infants born with HIV infection in this country plummets, thanks to widespread use of AZT in pregnancy, the corresponding numbers for developing nations grow more dismal by the day, because AZT prophylaxis is costly. To call attention to the wrenching situations physicians face in trying to stem the tide of the epidemic in these parts of the world, we are with this issue inaugurating a new feature for AIDS Clinical Care : periodic letters from overseas AIDS clinicians. This month, Dr. Paul Farmer writes to us from Haiti. Four months of the year Dr. Farmer, who is Associate Professor of Social Medicine at Harvard Medical School, is an infectious disease specialist at the Brigham and Women's Hospital in Boston. The rest of the year he spends mainly in rural Haiti at the Clinique Bon Sauveur, which he and his coworkers founded in 1985. Dr. Farmer, a recipient of the MacArthur fellowship, and his colleagues also founded Partners in Health, a nonprofit organization to support the Clinique Bon Sauveur and other medical projects in Haiti and South America (see address at end of article). -- Deborah Cotton, MD, MPH Founded in 1985, the Clinique Bon Sauveur serves the rural poor of Haiti's Central Plateau. Within a year of opening, we saw our first case of AIDS in a young man who presented with disseminated tuberculosis. In the intervening decade, we've cared for hundreds of patients, a majority of them women, and learned a great deal. We soon found, for example, that tuberculosis would be our leading opportunistic infection. We eventually discovered why …