About a mile down the bumpy country road that leads from the city of Les Cayes to the rural community of Fonfrede sits a small sundries shop called La Foi de Job. The Faith of Job. The name of this shop will probably seem unremarkable to anyone who has been to Haiti, whose cities and countryside are dotted with all manner of small storefronts called, variously, Dieu Avant Tout, La Puissance de Dieu, and so on. But in thinking about Haiti, whose health indicators and other development measures are not only the worst in the Western hemisphere but among the worst in the world, I can't help but wonder if this nation of avowed Catholics is suffering from a crisis of faith.
Faith is often defined as steadfast belief without benefit of proof, or simply belief without reason. Regardless, at the essence of faith is a constancy of trust. Trust in God, trust in one's leaders, trust in one's partner. I won't pretend to speak to the first, but this nation of faithfuls has undeniably been wronged time and time again by a succession of imperialist powers and, most tragically, by a succession of its very own political leaders, of both the democratically-elected and self-appointed variety. After speaking with several lifelong residents of this community of approximately 20,000, including women in an AIDS support group, I suspect that Haiti has long been suffering another crisis of faith -- a relatively silent and potentially deadly crisis centered in the home.
Among the 12 or so women in the support group whom I had the privilege to meet, not one could offer a guess as to how or when she had become infected. These women all had children and were or had been partnered for the long term. Most were widowed. Even without AIDS, the mortality rate for middle-aged men and older is higher than for women, perhaps due to the sheer arduousness of their daily lives. In addition to lifestyle and demographic details, these women also shared a now-common pattern of discovery: they had fallen ill and sought medical care, at which point tests revealed their HIV positive status. Some women's partners subsequently tested positive themselves, while several others' husbands had died of unspecified or unknown illness long before they themselves became sick. But the subtext seems clear.
In an unrelated conversation about dating and relationships (what else?) with one of my colleagues on the trip, a young woman who is of Haitian descent, she decried Haitian men's near-universal lack of fidelity. "The majority of Haitian men," she told me, "are unfaithful." Despite their devout Catholicism, many see extramarital relationships as their god-given right, so to speak. When asked what they would do differently if they could turn back the clock, every single woman in the support group responded, "I would never have had unprotected sex." Conventional public health wisdom knows that demanding your husband wear a condom can be particularly sticky business when you and your children are economically dependent on him. To my surprise, when I asked whether the women in the group would feel comfortable asking this of their husbands, there was no hesitation. Absolutely, yes.
These women expressed hope that the AIDS epidemic in Haiti had already peaked. They expressed regret that they had not had the benefit of the kind of in-school sex education that the students in their community now receive. Thanks to a bombardment of media efforts and aggressive education campaigns, today's children, even in the rural reaches of Haiti, are well versed in HIV prevention and the use of condoms.
In a society of women relatively unafraid to assert themselves but plagued by unfaithful husbands, how useful is all of this education? Even without the question of children, it is unrealistic to ask or expect a couple to use condoms for their entire lives together. Despite everything we know about common modes of transmission, for a variety of reasons, most prevention efforts still center on women. We can do better. As the international community continues to expand our HIV prevention efforts in this long-suffering nation, we need to take a closer look at this most personal crisis of faith. For Haiti, whose faith continues to be tested and tested again like an entire nation of Jobs, it's time we start with the men.