Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

17205 Surviving the Aftershock: HAART Adherence Among HIV Positive Tent Residents In Post-Earthquake Haiti

Saturday, January 14, 2012: 3:30 PM
Farragut Square (Grand Hyatt Washington)
* noted as presenting author
Toorjo Ghose, PhD, Assistant Professor, University of Pennsylvania, Philadelphia, PA
Edner Boucicaut, BA, Haiti Coordinator, Housing Works, Brooklyn, NY
Andrea M. Doyle, MSW, PhD, Assistant Professor, University of Pennsylvania, Philadelphia, WA
Background: Haiti has one of the highest rates of HIV (2.2%) outside sub-Saharan Africa. The earthquake on January 12, 2010 dealt a severe blow to HIV intervention efforts by crippling the health service system in the country. Almost 1.3 million, (or 10%) of Haitians have been displaced by the earthquake, most of whom now live in temporary tent communities. The vulnerable housing situation in these encampment communities, combined with the disruption in health services present difficult hurdles for people living with HIV/AIDS (PLWHA). Given that high adherence to highly active antiretroviral treatment (HAART) is critical to successful HIV treatment and to the prevention of the emergence of resistant strains of the virus, the conditions after the earthquake may pose a significant public health challenge for the country. However, little is known about how PLWHA are coping with the challenges to remaining adherent to their medication in these encampments. We address this lacuna by examining the manner in which the living conditions of the tent communities influence adherence for PLWHA.

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.

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