Language of Sexual Violence in Haiti: Challenges for HIV Prevention in International Resource-Poor Settings

Background and Purpose: Haiti has the largest HIV/AIDS epidemic in the Caribbean (approximately 1.8% of its adult population is living with HIV). Haitian women are at greater risk of HIV/AIDS, having less HIV knowledge and comprising a higher proportion of HIV+ persons in Haiti. The earthquake compounded the risk, as overcrowding, lack of adequate lighting and of privacy in unsanitary, dangerous displacement camps contributed to epidemic proportions of sexual violence (SV) against women. Sexual violence is an important risk factor for HIV infection, so victims of sexual violence (VOSV) presumably need evidence-based HIV intervention (EBI HIV); but currently, there is no indication that Haiti-based health providers who serve VOSV use EBI HIV or that they reach the most vulnerable victims. To understand how best to identify context-specific EBI HIV for Haitian VOSV, our objectives were to investigate how Haitians define SV, biopsychosocial needs of VOSV, and factors affecting accessibility of available services. 

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.