Economic Risk Factors for HIV Infection Among Women in Rural Haiti: Implications for HIV Prevention Policies and Programs in Resource-Poor Settings

Abstract

Aims: The goals of this study were to (1) estimate the prevalence of HIV infection among women accessing services at a women's health center in rural Haiti and (2) to identify economic risk factors for HIV infection in this population. Methods: Women who accessed healthcare services at this center between June 1999 and December 2002 were recruited to participate. The analysis was based on data from a case-control study of sexually transmitted diseases (STDs) in rural Haiti. HIV prevalence in the study population was 4%. Results: In multivariate analyses, partner occupation was associated with HIV infection in women, with mechanic (OR 9.0, 95% CI 1.8-45) and market vendor (OR 4.2, 95% CI 1.6-11) reflecting the strongest partner occupational risk factors. Partner's occupation as a farmer reduced the risk of infection in women by 60% (95% CI 0.14-1.1). Factors indicating low socioeconomic status (SES), such as food insecurity (OR 2.0, 95% CI 0.75-5.6) and using charcoal for cooking (OR 1.7, 95% CI 0.72-3.8) suggested an association with HIV infection. Conclusions: Given pervasive gender inequality in Haiti, women's economic security often relies on their partners' income earning activities. Our findings show that although factors reflecting poverty are associated with HIV-positive status, stronger associations are observed for women whose partners indicated a more secure occupation (e.g., mechanic or market vendor). Policies and programs that expand access to education and economic opportunities for women and girls may have long-term implications for HIV prevention in Haiti and other resource-poor settings.

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

“…Thus, stigma is a challenge when treating and caring for persons with HIV infection. The fear associated with being stigmatized may cause individuals to avoid care and services (Cox, 2002;Fawzi et al, 2010;DeSantis, Thomas, & Sinnett, 1999;Arrivillaga et al, 2011;Do et al, 2010). This fear is also associated with the lack of protective behaviors such as adherence to ART (Fawzi et al, 2010;DeSantis et al, 1999;Arrivillaga et al, 2011;Do et al, 2010).…”

“…Studies have found that stigma may be problematic especially among females (Fawzi et al, 2010;DeSantis, Thomas, & Sinnett, 1999;Arrivillaga et al, 2011;Do et al, 2010;Mills et al, 2006;Lillard & Panis, 1996;Smith & Waitzman, 1994;Bourne, 2009;Waldron, Hughes, & Brooks, 1996).…”

Association Between Childhood Sexual Abuse and HIV-Related Risk Factors for HIV-Positive Haitian Women

“…This proportion represents an increase from 46% in and 53% in 2007(UNAIDS, 2013aUNAIDS, 2008). Retrospective analyses have indicated that some of the most common risk factors associated with HIV infection among Haitian women living in Haiti include multiple lifetime sexual partners, lack of condom use within or outside of monogamous relationships, lack of education, and economic hardship (Logie, Daniel, Newman, & Loutfy, 2012;Rosenberg, Seavey, Jules, & Kershaw, 2011;Fawzi et al, 2010;Fawzi et al, 2003;Deschamps & Pape, 1996). While these risk factors appear to be the most common among Haitian women infected with HIV, other risk factors, such as childhood sexual abuse, may also contribute to the prevalence of HIV among this population.…”

“…Instead, many couples enter into an informal union called plasaj (Purcell, 2012;Fawzi, 2010;Boesten, 2009). In a plasaj, a woman enters into a long-term union with an unmarried man to support their children and family.…”

“…As it stands, the practice of males having multiple sex partners is a generally accepted practice within the Haitian culture whether it is within or outside of a plasaj (Severe et al, 2014;Dévieux et al, 2013b;Purcell, 2012;OECD, 2012;Magee et al, 2006;Fuller, 1999;Charles, 1995;Ulin, Cayemittes, & Metellus, 1995). Meanwhile, the woman is expected to remain monogamous (Padgett & Warnecke, 2011;Boesten, 2009;Fawzi, 2010;Fuller, 1999;Ulin, 1995). Because women do place such high value on being in some form of a union, they tend to overlook the infidelity of their partners (Padgett & Warnecke, 2011;Ulin, 1995).…”