CIRA Affiliated Project

Women are vulnerable to HIV due to biological, social, and economic factors. Economic dependence, combined with historical patterns of gender discrimination and neglect of women's sexuality, are viewed as main barriers in the development and implementation of woman-focused HIV prevention. Women from Haiti are in particular need of HIV risk reduction interventions. Women in Haiti have very high prevalence of HIV and sexually transmitted infection (STI). Pregnancy may be an ideal time to promote sexual behavior change in women, providing an important window of opportunity for long-term HIV risk reduction. The objective of this pilot study is to design a community-based intervention aimed to reduce HIV/STI transmission and risk for young pregnant women in Haiti by integrating an HIV/STI prevention program with prenatal care "health fairs" targeting pregnant women in community dispensaries associated with Hospital Albert Schweitzer (HAS) in rural Haiti. To address this objective we will conduct formative research to ascertain information about Haitian women's sexual risk behavior, prenatal care behavior, use of community health fairs, and sociocultural influences on health. This will be accomplished by conducting focus groups of pregnant women and community health promoters as well as semi-structured interviews of pregnant women. In addition, we will conduct a feasibility assessment of using prenatal care health fairs as the social context for an HIV/STI prevention intervention. This will enable us to identify potential challenges with implementing, running, and assessing an intervention in this setting. Results will be used to develop a community-based HIV/STI prevention intervention, and to apply for a larger grant to conduct a randomized clinical trial of the HIV/STI prevention intervention.

• Explores the potential barriers to successfully integrating an impactful HIV prevention intervention aimed at promoting sexual behavior change among pregnant Haitian women.
• Separate focus groups with pregnant women and community health promoters were conducted along with some semi-structured interviews with pregnant women.
• Pregnant Haitian women are at significant risk for HIV, as only 2% of the sample studied used condoms during pregnancy, and only 21% planned to use condoms after pregnancy. Women with more knowledge about HIV were more likely to use condoms, and the power dynamic within sexual relationship was also a significant determinant of condom use. Women who had more power to make decisions in their relationships reported more condom use. This suggests that while education will be an important feature of interventions, prevention efforts must be aimed at both women and men in order to promote a more balanced power dynamic.