Methods: In-depth qualitative interviews were conducted in Creole with 40 residents of three tent communities. Subjects were recruited using convenience sampling methods by investigators who spent time living in one of the communities in 2010. QSR N6 was used to analyze the data.
Results: The living conditions of the encampments were marked by cramped and unhygienic living conditions, violence, exposure to the elements and the scrutiny of fellow residents, lack of food and clean water, and complete dependence on aid providers that often resulted in coercive sexual encounters. These conditions posed significant challenges for PLWHA. Adherence was undermined by: 1) psychosocial factors such as feelings of depression and suicidality induced by the shame associated with living with HIV in public, 2) material challenges that included lack of access to food and water to take the pills with, lack of transportation to HAART centers, and the inability to store or ingest pills privately, and 3) institutional aid and healthcare agencies characterized by favoritism, homophobia and racism, that victimized participants and failed to address their medical needs.
Conclusion: The results indicate a need to reformulate interventions and policies targeting PLWHA in Haiti. First, interventions need to address the social determinants surrounding HAART adherence such as stable shelter, privacy, and access to food, water and healthcare. Second, the current protocol of providing aid and support exclusively to institutional providers such as the Red Cross and GHESKIO needs to be re-examined. We argue that efforts to establish local HIV care clinics, PLWHA-run support networks and advocacy groups within the encampments need to be supported and expanded. Third, the conditions of institutional care agencies need to be monitored, given the manner in which foreign aid has served to establish a system of patronage that has amplified the historic social cleavages in Haitian society.