An HIV/STI Prevention Intervention With Internally Displaced Women In Leogane, Haiti: Results From An Observational Cohort Pilot Study
Haiti has the highest HIV infection rate in the Western hemisphere. The January 2010 earthquake led to the collapse of Haiti’s social, economic and health infrastructure, exacerbating social and structural HIV risk factors. Internally displaced (ID) women are particularly at high risk for HIV infection due to breakdown of community networks, increased poverty and sexual violence. Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI) prevention interventions with internally displaced (ID) populations. The FASY (Famn an Aksyon Pou Sante´ Yo) (Women Taking Action For Their Health) study examined the effectiveness of a community health worker (CHW) delivered psycho-educational HIV/STI intervention with ID women in Leogane, Haiti.
Methods:
This observational cohort pilot study recruited 200 participants. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change.
Results:
The majority (90.3%) of participants (n=200) were unemployed; the mean monthly income was $3.87 USD (SD: 9.5). The mean age was 36.5 years (SD: 13.5) and two-thirds of participants had primary school education or less (63.7%). One-third (35.3%) perceived their partner, and one-quarter (25.0%) themselves, at medium-high risk for HIV infection. 176 (88%) of 200 participants assigned to the study were followed up at 8 weeks. Adjusted for baseline score and socio-demographic characteristics, HIV knowledge (β=4.81; 95% CI 0.54-0.68), STI knowledge (β=0.85; 95% CI 0.72-0.97), condom use (OR=4.32, 95% CI 1.99-9.37), social support (friends subscale) (β=0.51, 95% CI 0.00-1.03), and depression (β=-0.64, 95% CI -0.84- -0.44) scores showed statistically significant change post-intervention (p<0.05). Addressing all outcomes simultaneously, 58.9% of outcome variance was attributable to the intervention (Wilk’s Lambda=0.411, p<0.05).
Conclusions and implications:
A CHW-delivered intervention that involved a video-based individual session and a 6-week program of psycho-educational group sessions was effective in increasing HIV knowledge, STI knowledge, condom use, social support and in reducing depression among ID women in Leogane, Haiti. To our knowledge no evidence exists regarding women-focused, community-health worker delivered HIV/STI psycho-educational programs with internally displaced persons in post-earthquake Haiti. In fact we are not aware of a CHW and gender-specific approach to HIV prevention with internally displaced persons in other global contexts. There are over 27 million internally displaced persons globally, and internally displaced women are particularly vulnerable to HIV/STI infection due to social and structural contexts of poverty and gender inequity. Scant research has explored HIV/STI prevention interventions that address these contexts. Approaches that integrate cultural, gender and contextual factors in HIV/STI preventive interventions with internally displaced persons—and engage internally displaced persons in the development and implementation of these interventions—warrant further attention. The FASY approach, engaging ID women as CHW and participants in an individual and group-based strategy, shows promise as such an intervention.