The severity of the situation prompted our initiative to
integrate community-based prevention and care efforts once
effective drugs became available. In 1995-1996, we introduced
zidovudine to our prenatal-clinic formulary. Prior to this, a
majority of young women who came to this clinic declined free
VCT services; however, once this effective method of preventing
mother-to-child transmission became available, more than 90% of
women offered these services accepted them. In 1998, we launched
the "HIV Equity Initiative" in order to complement prevention
efforts with ARV treatment for infected individuals who would
have died, in our opinion, without these drugs. Because
measurement of CD4 cell counts and viral loads is not available
in rural Haiti, a clinical algorithm—based on criteria that
include the nature and frequency of opportunistic infections,
weight, neurologic status, and severe hematologic abnormalities—
is used to identify those patients in greatest need. Currently,
some 200 of the more than 2100 HIV