Understanding HIV Vulnerability Among Internally Displaced Women in Leogane, Haiti: Implications for Multi-Level Interventions

Objectives: Uptake of HIV prevention strategies, such as condom use, is underexplored among women in disaster contexts. Yet evidence suggests that the confluence of poverty, increased gender-based violence, and limited access to sexual health services, elevates HIV vulnerability among women displaced from disasters. It is particularly important to understand safer sex practices among internally displaced (ID) women in post-earthquake Haiti—even before the 2010 earthquake young women had lower HIV knowledge, and STI rates almost twice as high, as young men. Haiti has the highest number of new HIV infections in the Caribbean region. There are reports of increased and pervasive gender-based violence towards ID women and girls following Haiti’s 2010 earthquake. Little is known, however, about ID women’s HIV risks in post-earthquake Haiti. The study objective was to examine structural, interpersonal and intrapersonal factors correlated with consistent condom use among ID women in Leogane, Haiti. 

Methods: We conducted a community-based research project in collaboration with local community-based organizations. We trained ID women as peer research assistants (PRA); PRA implemented peer driven recruitment methods in addition to word-of-mouth and snowball sampling to recruit a purposive sample of ID women in Leogane, Haiti. We implemented a tablet-based cross-sectional survey with women 18 years old and over who were internally displaced (living in a tent, camp and/or different location than prior to the 2010 earthquake), capable of providing informed consent, and residing in Leogane or contiguous areas. Recruitment and survey implementation were conducted in Kreyol (local dialect). We conducted multivariate logistic regression analyses to examine structural, interpersonal and intrapersonal factors correlated with consistent condom use in the past month.

Results: Participants’ (n=175) mean age was 36.6 years old, the majority (>90%) were unemployed, and three-quarters reported eating one meal or less per day. We include 128 participants who reported sexual intercourse in the past month in our analyses. In logistic regression analyses adjusted for age and income, correlates of consistent condom use in the past month included: structural (meals per day [OR: 2.02, CI: 1.11-3.71, <0.05]; not experiencing physical violence [OR: 2.82, CI: 1.16-6.84, p<0.05]), interpersonal (sexual relationship power [OR: 1.12, CI: 1.03-1.22, p<0.01]; relationship duration over 1 year [OR: 0.18, CI: 0.05-0.58, p<0.01]); and intrapersonal (resilient coping [OR: 1.12, CI: 1.03-1.22, p<0.01]; poor self-rated health [OR: 3.25, CI: 1.05-10.02]; depression symptoms [OR: 0.62, CI: 0.47-0.81, p<0.001]) factors.

Conclusions: This research highlights the salience of a multi-level approach to explore ID women’s HIV vulnerability across intra/interpersonal and structural domains. Consistent condom use was associated with food security, sexual relationship power, freedom from physical violence, resilient coping, and poor self-rated health. Inconsistent condom use was associated with being in a relationship for longer and experiencing depression. Implications for international social work include and extend beyond HIV prevention. HIV prevention initiatives can focus on perceived risk associated with relationship duration and self-rated health. Multi-level interventions can involve structural changes to challenge poverty, food insecurity and gender-based violence; meso-level strategies to build women’s sexual relationship power; and micro-level changes to promote resilient coping and reduce depression.