Intersectional Stigma and Barriers to Engagement in Care among Haitian Women with HIV

Authors

Edwine DanielFollow

Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Jessy Devieux

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Mariana Sanchez

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Patria Rojas

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Florence George

Fourth Advisor's Committee Title

Committee memeber

Keywords

Intersectional Stigma, Haitian Women Living with HIV, WLHV, HIV-related Stigma

Date of Defense

6-18-2021

Abstract

Women account for about half of HIV infections globally. After sub-Saharan Africa, the Caribbean is the most HIV-affected region in the world, with half of the region’s people living with HIV (PLHV) in Haiti and where the overwhelming majority of new HIV infections occur among adolescents and young women. Guided by Turan and colleagues’ conceptual framework for HIV-related stigma, engagement in care, and health outcomes, this cross-sectional study examined the patterns of intersectional stigma and relationships with the ability and willingness of women to stay engaged in care when living with HIV.

This study is a secondary analysis of baseline data collected from 276 PLHV in Haiti. The measures included: Perceived HIV Stigma; Centers for Epidemiological Studies Depression (CES-D); HIV visit and treatment adherence; Sexual Relationship Power (SRP); Childhood Sexual Abuse (CSA); and sexual risk behaviors.

A total of 173 women living with HIV (WLHV) participated in the study, with 67% experiencing high levels of HIV stigma. Participants had high levels of consistent adherence, with 69% reporting zero missed doses in the past 7 days. Mediation analyses revealed direct and indirect effects via depressive symptoms between history of CSA and higher perceived stigma (β = 0.17, 95% CI: .015 -.40).However, we found no direct and indirect effects of perceived stigma on treatment adherence or visit adherence. Our findings show that WLHV with high levels of perceived HIV stigma reported significantly lower levels of Sexual Relationship Power (β= -0.290; t= -2.998; p=.003; R 2=.176). Additionally, statistically significant differences were found between participants with low and high levels of SRP and engagement in HV risk behaviors where those with low SRP engaged in higher levels of risk behaviors such as alcohol use (p

The present study helps fill in the knowledge gap on the association between HIV-related stigma and multiple factors (interpersonal and sexual relationship power, risk behaviors, and psychological/mental health), suggesting the importance of contextual factors when examining the relationship between HIV-related stigma and health among Haitian WLHV.

Identifier

FIDC010208

ORCID

ORCID ID: 0000-0001-5028-7052

Recommended Citation

Daniel, Edwine, "Intersectional Stigma and Barriers to Engagement in Care among Haitian Women with HIV" (2021). FIU Electronic Theses and Dissertations. 4783.
https://digitalcommons.fiu.edu/etd/4783