Lesbian, Gay, Bisexual and Transgender Haitians Living with HIV Negotiating Safety in Post-Earthquake Encampment Settings
Haiti’s HIV prevalence (2.2%) is one of the highest outside sub-Saharan Africa. The January 12, 2010 earthquake displaced almost 1.3 million people, or 10% of the population, most of whom moved into tents in large encampments. The vulnerable housing situation in these encampment communities combined with the disruption in health services present difficult hurdles for people living with HIV (PLHIV). PLHIV who are lesbian, gay, bisexual or transgender (LGBT) are particularly vulnerable, given the high levels of stigma they are subjected to. However, little is known about how LGBT PLHIV are coping with the challenges of living in these encampments. We address this lacuna by examining the manner in which the conditions of the tent communities shape the lives of PLHIV, and the strategies they use to negotiate these conditions.
Methods:
In-depth qualitative interviews were conducted in Creole with 30 residents of three tent communities in two large Haitian cities. Participants were recruited using convenience sampling methods by investigators who spent time living in one of the communities in 2011. QSR N6 was used to analyze the data, with multiple forms of coding to identify latent patterns in participant narratives and member checking to support interpretation of the findings.
Results:
The results indicate that the living conditions of the encampments are marked by exposure to the scrutiny of fellow residents, rituals of shaming and stigma initiated by camp residents, subjection to constant surveillance and violence by roving gangs of young men, and segregation from aid and services provided by international nongovernmental organizations (NGOs). LGBT PLHIV countered these conditions by 1) forming a community action board (CAB) comprising community stakeholders, international partners and allies in the political spectrum that engaged in local governance of the community, 2) avoiding large medical institutions and accessing care in local care centers, 3) establishing networks of support within the LGBT PLHIV community, and 4) collaborating with members of the CAB to publicize their situation to the outside word in order to secure support and resources.
Conclusions and Implications:
The results emphasize the vulnerability of LGBT PLHIV. The stigma and violence they are subjected to as members of a doubly marginalized community exacerbates their vulnerability in Haiti’s encampments. At the same time, this community is engaged in innovative strategies that seek to reduce the risk environment they are operating in. Future interventions need to address the challenges highlighted in this research, while supporting and expanding on the community initiatives described here. Specifically, national policy on addressing the challenges of encampment residents needs to acknowledge and build on the local resources that have been developed in the encampments by the LGBT PLHIV community, such as local HIV care provision, established networks of peer support and functional local governance structures like the CAB.