Factors associated with forced sex among women accessing health services in rural Haiti: implications for the prevention of HIV infection and other sexually transmitted diseases

Abstract

The goals of the current study were to: (1) estimate the prevalence of forced sex among women accessing services at a women's health clinic in rural Haiti; and (2) examine factors associated with forced sex in this population. Based on data from a case-control study of risk factors for sexually transmitted diseases (STDs), a cross-sectional analysis to examine factors associated with forced sex was performed. A number of factors related to gender inequality/socioeconomic vulnerability placed women in rural Haiti at higher risk of forced sex. The strongest factors associated with forced sex in multivariate analyses were: age, length of time in a relationship, occupation of the woman's partner, STD-related symptoms, and factors demonstrating economic vulnerability. The findings suggest that prevention efforts must go beyond provision of information and education to the pursuit of broader initiatives at both local and national levels. At the community level, policy-makers should consider advancing economic opportunities for women who are vulnerable to forced sex. Improving access to community-based income-generating activities may begin to address this problem. However, the viability of these local projects depends largely upon Haiti's 'macro-economic' situation. In order to ensure the success of local initiatives, external humanitarian and development assistance to Haiti should be supported. By broadening the definition of "prevention" interventions, we may begin to address the systemic problems that contribute to the occurrence of forced sex and the increasing incidence of HIV infection throughout the world, such as gender inequality and economic vulnerability. Taking into account factors influencing risk at the local level as well as the macro-level will potentially improve our capacity to reduce the risk of forced sex and the spread of STDs, including HIV infection, for millions of women living in poverty worldwide.

Prevention of mother-to-child transmission of HIV in Haiti

“…GHESKIO and other researchers in Haiti and in several African countries have documented the prevalence of partner violence and higher levels of domestic violence upon notification of HIVpositive status, as well as the impact of partner violence on limiting participation in PMTCT programs (17,18). These factors speak to the need to integrate partner violence services into reproductive health care (19).…”

‘Life under the tent is not safe, especially for young women’: understanding intersectional violence among internally displaced youth in Leogane, Haiti

“…Moreover, a lack of parental support or disruption in living situations is linked to increased youth violence in Haitian communities [11]. Yet gender-based violence (GBV) has been a serious issue in Haiti for decades – even before the earthquake – shaped by contexts of poverty, ongoing civil and political conflict, and inequitable gender norms [12,13]. Nearly one-third of women prior to Haiti’s 2010 earthquake reported experiencing intimate partner violence (IPV) [14].…”

Sex, money, and premarital partnerships in southern Malawi

“…Malawi is no exception, where the 2004 Demographic and Health Survey found similar gender differences in HIV prevalence among the youth cohort (MDHS, 2004). To account for these disparities, explanations have typically highlighted age-discrepant relationships, inability to negotiate condom use in sexual relationships, or unequal access to key resources and the concomitant use of violence or coercion by men over women (Gregson et al, 2002;Jewkes, Levin & Penn-Kekana, 2003;Lary, Maman, Katebalila, McCauley & Mbwambo, 2004;Magnani et al, 2002;Nzyuko et al, 1997;Smith Fawzi et al, 2005). Despite notable exceptions (e.g.…”