Language of Sexual Violence in Haiti: Challenges for HIV Prevention in International Resource-Poor Settings
Methods: In March 2013, we, in collaboration with Haiti-based colleagues and community leaders conducted an exploratory study using targeted purposive sampling to accomplish our objectives. Syndemic Theory formed our framework and semi-structured focus group guides were developed to facilitate the collection of data in four focus groups (N=27). Focus group questions were translated into Haitian Kreyòl. Participants included VOSV, health providers, and community-level female combatants recruited with the support of Haitian community leaders. Focus groups were audio-recorded with informed consent of all participants and were transcribed directly from Kreyòl to English by the PI and a research assistant, both native Haitians. Grounded Theory served as the guiding framework for a content analysis of the transcribed focus group data. ATLAS.ti, a qualitative data software program, supported synchronous analysis of all focus group data as one corpus.
Results: Findings from the analysis of our focus group transcriptions highlight: 1) the use of metaphors by VOSV to indicate the severity of attacks and the extent of injuries sustained, e.g. “crushing the uterus”; 2) crucial regional differences exist between terminology used by victims and providers to describe sexual violence; 3) female VOSV in the Cité Soleil region constitute a key target population based on the syndemic interaction of poverty, gender-based violence, and lack of access to post-rape care and prophylaxis, but they were unaware of providers’ existence and resources; 4) there is an absence of EBI HIV in Haiti; also, 5) all (100%) of the participants across focus groups articulated an interest in HIV prevention, and all insisted that such intervention be rooted in the Haitian sociocultural context.
Conclusions and Implications: Our study provides crucial knowledge of contextual factors that can impact adaptation, acceptance, and implementation of existing EBI HIV for VOSV; it also identifies psychosocial/structural and contextual challenges to HIV prevention for VOSV in Haiti and similar settings. Adaptation of EBI HIV should involve engagement of and collaboration with key stakeholders (e.g., victims and providers) at every stage of development.