Structural violence and HIV vulnerability among internally displaced youth in leogane, Haiti

Background

Haiti has the highest HIV infection rate in the Western Hemisphere. The 2010 earthquake led to the collapse of Haiti's social, economic and health infrastructure, resulting in the breakdown of community networks, increased poverty and violence. The study objective was to understand contexts of HIV vulnerability among internally displaced (ID) youth in Leogane, Haiti.

Methods

We conducted 6 focus groups in Kreyol with ID young women and young men (aged 18-24) and key informant interviews. Focus groups were digitally recorded and transcribed verbatim, then translated into English. We analyzed focus group transcripts using thematic analysis to identify, analyze and report themes.

Participants

Focus group participants included ID young men (n=30: age 18-19, n=10; age 20-21, n=10; age 22-24, n=10) and young women (n=30: age 18-19, n=10; age 20-21, n=10; age 22-24, n=10). We conducted 11 key informant interviews, including peer research assistants (n=6), community health workers (n=3), project coordinator (n=1) and youth worker (n=1).

Results

Findings revealed multi-level forms of direct and indirect violence that elevated vulnerability to HIV infection. Direct forms of violence include: macro-level (unsafe housing; transactional sex; sex trafficking); meso-level (gender norms; gang violence) and micro-level (intimate partner violence). Indirect forms of violence include: macro-level (hunger; NGO policies; education), meso-level (social protection) and micro-level (relationship power).

Conclusions

Findings reveal the complexity of social and structural contexts of violence that elevate HIV vulnerability. Violence emerged across multiple sites (housing, policy, community, family), levels (micro, meso, macro) and forms of violence included latent, direct, indirect, physical and psychological.