Knowledge and stigma in Haiti: The need for structural level interventions

Haiti's generalized HIV epidemic places it second in impact only to African nations. Pregnant women are at increased risk for contracting the disease due to gender disparities, lack of economic independence, stigma and discrimination . This study reports on the findings of an assessment of 4500 pregnant HIV+ and HIV- women assessed at GHESKIO, the main VCT and HIV treatment center in Haiti. A standardized questionnaire was used to evaluate prevention knowledge and behavior. The median age of pregnant HIV+ women was 27, and 24 for HIV- women. 84% of HIV+ women were either married or in common law relationships while 12% reported being single. Among HIV- women the numbers were 74% and 23%, respectively. Overall there was no significant difference in knowledge between the HIV positives and negatives, except for mother to child transmission: HIV+ women had significantly higher knowledge (p<.000). Pregnant women overall showed high knowledge of transmission by dirty needles, but low knowledge on issues related to magical transmission and mosquito bites. Focus groups provided supplemental qualitative information. With regard to disclosure, only 25% of the participants had disclosed to partners or family, as fear of repercussions and stigma remained an important reason for participants not to share information about their status. This data points to the need for improved education, not only for pregnant women, but also for the general population in order to reduce stigma and discrimination. Addressing disclosure issues and increasing access to barrier methods of protection are important directions for future programs.