Experiences of Dominican Women Living with HIV/AIDS When Accessing Health Services in Puerto Rico

Background: HIV/AIDS has disproportionately affected women in the Caribbean region, representing the 50% of all PLWHA in 2008. The Dominican Republic (DR) is one of the countries with the highest number of HIV/AIDS cases among women, representing more than 60% of all PLWHA. This is particularly pronounced for poor women, whose socio-economic conditions foster migration, often to Puerto Rico (PR) or the US. It is estimated that over 200,000 Dominicans live in PR, representing 60% of the total legal migrant population. The growing feminization of Caribbean migratory flows, especially from DR, has intensified the need to reduce disparities in the health services access by migrant women. However, there is scarce data in PR about this immigrant community and their use of the health care system. Method: The objectives of our study were to explore: 1) Dominican women’s experiences of coping with HIV/AIDS in Puerto Rico; and 2) factors related to access to HIV/AIDS prevention, diagnostic and treatment services from the perspective of Dominican women living with HIV/AIDS in the context of migration in San Juan, PR. A qualitative exploratory research design was implemented after being reviewed by the Committee of Human Subjects Protection in Research (protocol # UPR 1350114).  Twenty semi structured interviews were conducted with 21 to 40 years old Dominican women living with HIV, who were in treatment at the time, and had lived in PR for more than 6 months. Results: Qualitative results highlighted problematic scenarios for participants including: 1) lack of documentation, 2) economic conditions forcing them to keep working despite being sick, 3) lack of knowledge about prevention services, 4) negative perception of health services, and 5) lack of clarity regarding the rights of immigrant HIV patients. Implications: Results evidence the need to update existing data regarding the immigrant population in the Caribbean, foster a paradigmatic change in the conceptualization of migrant health, establish transnational collaboration for an effective HIV and Health policy that can help address health disparities for this population, and continue working with social determinants of health and a universal health policy.