AEGiS-15IAC: Forced sex and HIV prevention: Implications of findings among women accessing health services in rural Haiti.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Forced sex and HIV prevention: Implications of findings among women accessing health services in rural Haiti.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrD1123)

Smith Fawzi MC, Lambert W, Singler JM, Tanagho Y, Leandre F, Nevil P, Bertrand D, Claude MS, Bertrand J, Louissaint M, Joanis L, Mukherjee J, Goldie S, Salazar JJ, Farmer P
Harvard Medical School and Partners In Health, Boston, MA, United States

BACKGROUND: The goals of the study were to: 1) estimate the prevalence of forced sex among women accessing services at a women's health clinic in rural Haiti; 2) examine factors associated with forced sex in this population; and 3) explore the implications of these findings for HIV prevention among women in this extremely impoverished setting with a high burden of HIV. Haiti is the poorest country in the western hemisphere and has the highest rate of HIV (6%) outside of sub-Saharan Africa.

METHODS: Based on data from a case-control study of risk factors for sexually transmitted diseases (STDs), including HIV, a cross-sectional analysis to examine factors associated with forced sex was performed. Multiple logistic regression analyses were conducted in order to control for potentially confounding factors.

RESULTS: A number of factors related to gender inequality/socioeconomic vulnerability placed women in rural Haiti at higher risk of forced sex. The strongest factors associated with forced sex in multivariate analyses were: age, length of time in a relationship, occupation of the woman's partner, STD-related symptoms, and factors demonstrating economic vulnerability.

CONCLUSIONS: The findings suggest that HIV prevention efforts must go beyond provision of information and education to the pursuit of broader initiatives at micro-macro levels. At the community level, policy-makers should consider advancing economic opportunities for women who are vulnerable to forced sex. Improving access to community-based income-generating activities may begin to address this problem. However, the viability of these local projects depends largely upon Haiti's "macro-economic" situation. In order to ensure the success of local initiatives, external humanitarian and development assistance to Haiti should be supported. Taking into account factors influencing risk at the local level as well as the macro-level will potentially improve our capacity to reduce the risk of forced sex and the spread of STDs, including HIV, for millions of women living in poverty worldwide.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Sexually Transmitted Diseases, Coitus, Sex, Risk Factors, Rural Population, Health Services, HIV Seropositivity, Prevalence, Socioeconomic Factors, Safe Sex, Cross-Sectional Studies, Africa South of the Sahara, Haiti, Case-Control Studies, Humans, Female, prevention & control, diagnosis

040711
TuOrD1123