Yet each nation must face the challenge in the context of its own historical, cultural, economic, social, and political realities. The realities that shape the course of HIV in Haiti are devastating. The Haitian people have endured five decades of autocratic rule, disastrous economic policies, environmental decay, and social neglect. For much of this period, Haiti has been in the midst of the most destructive political upheavals of its history. Just as the forests that once blanketed her hillsides have been depleted, so too have the ranks of her citizens.
Death claims many as a result of the endemic poverty, hunger, disease, and political violence.
Woefully inadequate health care has left Haiti with one of the world's highest rates of infant and maternal mortality, and an average life expectancy of fifty-five years of age. Seventy-eight per cent of the population live in poverty. It is not surprising, given this situation, that Haitians in ever increasing numbers have fled the country. Beginning in 1957, with the advent of the Duvalier regime, Haiti began to experience a marked surge in emigration to other countries. It was the literate, educated, and skilled who began the exodus, but by the end of the Duvaliers' thirty-year reign, rural farmers, who had once migrated to the coastal cities, were leaving the country in ever growing numbers.