DR: Concerns grow over Haitian patients abandoning HIV programs following USAID shutdown

Santo Domingo.- The recent suspension of funding from the United States Agency for International Development (USAID) in the Dominican Republic has sparked concerns that Haitian migrants living with HIV may abandon their treatment programs. For years, USAID has played a crucial role in supporting these patients by financing testing, transportation, and healthcare personnel fluent in Creole. With the agency’s exit, many fear a significant disruption in care for this vulnerable population.

Since 2015, the Dominican Republic has independently funded the purchase of antiretroviral medications for people living with HIV. According to Dulce Almonte, president of the Dominican Network of People Living with HIV, these direct purchases ensure a steady supply of medication. However, she warns that without USAID’s support services, many Haitian migrants may stop retrieving their prescriptions, leading to gaps in treatment and an increased risk of viral transmission.

“There will be no shortage of medications,” Almonte reassured in an interview with Diario Libre. “Patients can continue to collect their prescriptions as usual. However, the absence of USAID-funded staff and incentives for migrant populations, as well as a small percentage of LGBTQI individuals and sex workers, may impact service accessibility.”

Disruptions in essential services

One of the most immediate effects of USAID’s withdrawal is the elimination of free testing for migrants, along with the suspension of transportation services that helped patients reach healthcare centers. Additionally, the agency had been covering the salaries of specialized staff who assisted migrants, ensuring they received culturally and linguistically appropriate care. Without these resources, the burden falls entirely on the Dominican government, which now faces the challenge of maintaining outreach efforts to a highly mobile and often marginalized population.

Another pressing concern is the economic impact on healthcare workers. Many community health promoters and medical staff who relied on USAID funding now face unemployment, leading to uncertainty within the public health sector.

Public health risks and Government responsibility

Almonte emphasized that the Dominican government must step in to ensure continued support for migrant populations, particularly Haitian residents and those who frequently travel between the two nations. She warned that without intervention, the lack of essential services could lead to an increase in HIV prevalence among migrants due to interrupted treatment and decreased testing accessibility.

“The government must assess how to sustain services for the migrant population previously covered by USAID, whether they are permanent residents or part of the mobile population. Their HIV prevalence rates are higher than ours,” she noted.

A significant concern is the fear of deportation among undocumented migrants. Without USAID’s assistance, many may avoid seeking care altogether to reduce the risk of being intercepted by immigration authorities on their way to healthcare centers.

“Without USAID’s support—transportation, medication, and Creole-speaking promoters—many won’t go to clinics out of fear of being detained,” Almonte explained.

While Dominican nationals were not direct beneficiaries of USAID’s specialized migrant-focused programs, the country’s healthcare infrastructure and clinical personnel remain responsible for providing medication and essential services to all residents. With 79,000 people living with HIV nationwide, maintaining treatment adherence is a matter of public health urgency.

The Dominican government now faces a critical test: whether it can adapt to the sudden loss of external funding and implement mechanisms to keep Haitian patients engaged in life-saving HIV treatment. Without immediate action, the nation risks reversing years of progress in controlling the spread of the virus.