Back to Basics: Correlates of HIV Risk in a Community Sample of Haiti

Abstract

Haiti has a 2.2 % HIV prevalence (highest in the Caribbean); this has diminished from over 12% in the past three decades (depending on sex and gender, province, and neighborhood). Preliminary studies indicate that in the Cite Soleil neighborhood of Haiti (HIV prevalence >3%) as in socioeconomically equivalent adjacent neighborhoods, over 50% of girls and women experience non-partner sexual violence (NPSV), typically perpetrated by groups of men. Rates of NPSV against men in those neighborhoods were not available. Coercive sex heightens HIV risk. Accurate HIV knowledge empowers individuals (including survivors of NPSV) to assess personal HIV risk and increases likelihood of getting tested and of determining personal HIV status; thus, accurate HIV knowledge is foundational to behavioral risk reduction for victims in future consensual relationships and to engagement in either the HIV prevention or care continuum.Between March and July 2017, we surveyed individuals 18 years or older (210 women, 257 men), assessing experience of NPSV, HIV knowledge, history of HIV testing, knowledge of HIV status, assessment of self-risk, and sexual risk behaviors. Nearly 30% of men and 24% of women endorsed having experienced NPSV. Knowledge of HIV transmission was low: 90% endorsed HIV myths, e.g. transmission occurs via public toilets, via sharing a glass with or by being exposed to a cough or sneeze from a person living with HIV. High endorsement of these myths contrasted with low endorsement of protective behavior: Only 14.3 % used a condom during consensual sex in the past year. Only 47.9% of the respondents had ever attended an HIV awareness program; 16% of knew their HIV status, although 79% assessed their HIV risk as moderate to high. Results regressing knowledge of HIV testing on participant characteristics indicated that women (OR=2.8), individuals with a partner (OR=2.2), individuals who attended an HIV awareness class (OR=2.1), individuals who knew someone with HIV (OR=3.9), and individuals who had an HIV test (OR=33.5) were more likely to know what an HIV test is. Participants who endorsed experiencing NPSV (OR=0.33) and those who had been diagnosed with an STI (OR=0.44) were less likely to know about HIV testing.Experience of NPSV combined with low HIV knowledge, awareness and testing heighten the HIV prevention needs of Cite Soleil residents and underscore the need to return to basics on the road to HIV eradication in that context.