Online Program

Barriers to the access and use of HIV-care by HIV-infected Haitian migrants in La Romana, Dominican Republic

Monday, November 2, 2015

Alexis H. Fogel, MPH, Department of Sociomedical Sciences, Global Health Track, Mailman School of Public Health, Columbia University, Brooklyn, NY
Stephen W. Nicholas, MD, Departments of Pediatrics and Population and Family Health, Columbia University College of Physicians and Surgeons, New York, NY
Marlyn Delva, EdD, Mailman School of Public Health, Columbia University, New York, NY
Rafael E. Pérez Figueroa, MD, MPH, Mailman School of Public Health, Columbia University, New York, NY
Robert E. Fullilove, EdD, Mailman School of Public Health, Columbia University, New York, NY
Linda F. Cushman, PhD, Mailman School of Public Health, Columbia University, New York, NY
Background HIV-infected Haitian migrants in the Dominican Republic experience great difficulty obtaining and utilizing available HIV-care. Issues surrounding entry into and long-term use of HIV services may explain the disproportionately negative health outcomes of this group compared to HIV-infected Dominicans.

Purpose This exploratory qualitative study sought to identify the structural and behavioral barriers to care, perceptions of HIV infection, and health-seeking behaviors that reduce access to or use of healthcare by HIV-infected Haitian migrants in the Dominican Republic.

Methods 10 semi-structured interviews were conducted with a convenience sample of HIV-infected Haitian migrants in La Romana, Dominican Republic from October 2014 to January 2015. A constant comparative analysis was used to explore perceptions of HIV infection and learn about experiences gaining access to and using HIV-specialized healthcare.

Results Three main content areas emerged from the interviews: 1) diagnosis and entry into HIV-care; 2) knowledge, attitudes, and behaviors regarding HIV transmission and treatment adherence; and 3) social, cultural, and material influences on HIV-care. Lack of economic resources, refusal to accept a HIV-positive diagnosis, and limited social support from other Haitian migrants were articulated as major barriers to regular HIV-care.

Conclusions Culturally-appropriate HIV health education and Haitian migrant peer-support groups could increase engagement in long-term care, and reduce disparities in health outcomes between Haitian migrants and Dominicans receiving HIV-care in the Dominican Republic. Considering the unique contextual factors of HIV-infected Haitian migrants, their processes of acculturation, and their specific resource constraints in the Dominican Republic is critical for developing targeted prevention and treatment strategies for this high-risk population.

Learning Areas:

Diversity and culture
Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe the unique attitudes and perceptions toward HIV/AIDS by seropositive Haitian migrants living in the Dominican Republic. Identify the social, cultural, and material barriers to accessing and utilizing HIV-care by this population. Evaluate how the intersection of migration and HIV-positive status influences the access and use of HIV-care by this population. Discuss how to improve this population's ability to access reliable HIV healthcare in a non-native country setting.

Keyword(s): Health Care Access, Immigrant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a second-year graduate student at the Mailman School of Public Health at Columbia University, in the Sociomedical Sciences department and Global Health concentration. I've been an assistant investigator in multiple studies focused on global health disparities in low-income populations around the world. Drawing from my past work in Haiti I collaborated with experts from the Mailman School for this study, who collectively have over 30 years’ experience in the Dominican Republic and Haiti.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.