In the 1990s St. Martin and French Guyana were the French territories with the highest rate of HIV/AIDS cases outside of Paris; however no mention of AIDS cases was reported on either the French side or the Dutch side until a French pediatrician diagnosed the first case in 1991. During that decade, AIDS was a generalized epidemic in St. Martin, meaning that the main mode of transmission was heterosexual and the percentage of pregnant women infected by the HIV rate was higher than 1%. From 1989 until 1994 the number of pregnant women living with the HIV virus was 25 times higher than in mainland France. Until the late 1990s, the French Ministry of Health denied the very existence of the epidemic as most of the infected patients were foreign nationals. Due to the lack of specific blood tests, doctors used the World Health Organization clinical definition of AIDS to diagnose the disease and report cases, but the French Public Health Observatory (RNSP) rejected these reports. The combination treatments, including a protease inhibitor also known as “the AIDS cocktail” or “highly active antiretroviral therapies” that paved the road to significant improvements in people’s life became available in 1996 as soon as they were released on the market and a dermatology consultation focusing on HIV+ was created in 1997.
In the 1990s, despite healthcare being free for any person, foreign patients did not seek medical care, for fear of being deported to their home country if they were found to be undocumented. Because of the fear of stigmatization, those infected by the HIV/AIDS virus would not come to the hospital, whatever their national or visa status. Regardless of their own individual HIV status, Haitians in particular were heavily discriminated against because of their cultural background, and because of the high prevalence of HIV/AIDS in Haiti. For this reason, World AIDS Day, created to raise awareness of HIV, educate people on the disease, and provide understanding of HIV as a major global public health issue was attended by many French health care professionals in the 1990s; infected HIV/AIDS patients largely did not attend due to fear of being stigmatized. In 1998, following the implementation of a visa for foreigners suffering from a disease that could not be treated in their home country, as well as the arrival of a dermatologist who would take care of the HIV/AIDS patients, foreign nationals felt more confident coming to the French hospital.
On the Dutch side, there were no public health statistics registering the development of the epidemic. The St. Maarten Medical Center, being a semi-private health center, was not involved in any public health policy regarding AIDS. Only the tally of a private doctor who had the largest number of HIV+ patients and the data collected by The St. Maarten AIDS Foundation, a non-governmental organization created in 1990, signaled that the prevalence was extremely high.
In 2004, the last year a study was conducted, St. Martin still had the highest prevalence of any French territory with 1.7% of the population being either HIV+ or having reached the AIDS stage. In 2018, medical staff and foreign patients are still facing tremendous social and political challenges; people living with HIV/AIDS are still discriminated against and undocumented foreigners have difficulties getting the documentation needed to benefit from the French health care system, a service available to any individual living in France whatever their legal status.
Sint Maarten has the highest number of people living with HIV/AIDS within the Netherlands Antilles.
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