PORT-AU-PRINCE, Haiti - Hope is an elusive commodity here. But Dr. Jean W. Pape has found enough of it to confront one of the world's highest AIDS rates.
He has managed to slow the epidemic here, one of the worst outside Africa, by nimbly adapting his medical techniques to the country's political upheaval, withering poverty and crumbling infrastructure.
Pape has been so successful, in fact, that the world is now recognizing the work he and others have done by making Haiti the first country in the Western Hemisphere to receive a grant from the new, U.N.-initiated Global Fund to Fight AIDS, Tuberculosis and Malaria.
In awarding Haiti $25 million, international officials called the treatments and methods devised at the Gheskio Centers, which Pape directs, a model for how poor countries with limited resources can combat AIDS, as well as the tuberculosis and diarrhea that often attack people weakened by the disease.
"Haiti's work has shown conclusively that you cannot use a lack of infrastructure as an excuse not to treat patients," said Anil Soni, adviser to the fund's executive director. "We want to show you can adapt what is being done in poor settings to stabilize patients. That is a lesson for the world."
The award is going to a network of clinics like Gheskio in a consortium that includes the Haitian government itself.
Although direct foreign aid to the government has been frozen because of a political deadlock, the award is seen as a much-needed injection of money at a time when government-run clinics have decayed.
The funds will significantly increase treatment and prevention in a country where more than 250,000 people are infected by the virus, out of a population of about 7 million. Last year, AIDS claimed 30,000 lives.
"We are using this project to say you can't do such a program by ignoring public facilities," Pape said. "We still have the greatest presence of HIV outside of Africa. What is important is we have been able to control this epidemic in a place that people usually talk about as being in chaos."
Gheskio has had impressive results fighting severe diarrhea with antibiotics, has developed methods of diagnosing sexually transmitted diseases and has found some less expensive drug combinations to treat AIDS.
It and other private groups use funds provided by foundations and foreign governments to buy the medicines, which are priced far beyond the reach of most Haitians. The Global Fund grant will provide medication for about 1,200 more people.
The U.N. Development Program and the Sogebank Foundation, the philanthropic branch of Haiti's leading bank, will manage the funds, which are to arrive this month and to be used over a two-year period.