The health topic I’ve decided to explore this class was the HIV epidemic in Haiti, specifically among women. Lots of effort has been put forth to try and curb this epidemic, however there are a few underlying problems that keep fueling the disease. Social, cultural, political, and economic determinants have aimed to help but ultimately HIV is still a large issue at hand for the people of Haiti. Through research and analyzing HIV with a critical medical anthropological lens I’m able to zero in on some of these underlying problems and explore how they play a huge role in fostering HIV in Haiti.
The critical medical anthropological theory asks one questions: Who benefits and who suffers? In Haiti, this applies well to HIV. Through constructs women in Haiti have a history of being reduced and told their voices doesn’t exist. Women who have higher education and more wealth aren’t as reduced but because Haiti is a poverty-stricken state there is still little opportunity for growth. Little access to clinics, safe sex classes, and even prevention methods put women in a rough spot in a male dominated society. These are examples of structural violence against women, I’ll get more into that later. In addition, HIV set a stigma towards Haitians that didn’t allow them to sell any goods during the onset of the epidemic, and destroyed their tourism sector.
Now that we know who suffers, who benefits because of HIV? This might seem like a small stretch but I hope taking an interdisciplinary approach will draw in enough factors that’ll paint a clear picture on the issue. I think Haiti is benefiting from this epidemic. It’s believed the disease made its way into Haiti sometime in the 1960s and became an epidemic by the 80s (New York Post). According to the NY Post, by 1982 almost 8% of women in the capital, Port-au-Prince, had contracted the disease. Through illegal sex work, prostitution, and “unsterile conditions at a private blood-collecting company, Hemo-Carribean, that opened in 1971 and exported 1,600 gallons of plasma to the United States monthly” (New York Times) HIV spread like wildfire. Hopefully now things are starting to become a bit clearer regarding how Haiti is benefiting. With the disease making its way into the United States, and since the dominate US health system is biomedicine, clearer skies look ahead for the HIV epidemic in Haiti. However, there were some pitfalls along the road, the number one being that officials were looking for a single cause rather than exploring multiple possibilities feeding into one, such as political, economic, social factors.
With the US now heavily involved, organizations such as USAID started investing in Haiti trying to rebuild public health infrastructure. Some of the brightest people in the United States, and around the world, started to look for possible solutions to the rising epidemic. According to Haiti Constitution and Citizenship Laws Handbook – Strategic Information and Developments, “Political insecurity and the failure of Haiti’s government to invest in developing the country’s natural and human resources contributed significantly to the country’s current state of development” (41). The handbook goes on saying, “The U.S has been Haiti’s largest donor since 1973, Between the fiscal years of 1995 and 1999 the U.S contributed roughly $884 million in assistance to Haiti”. Corruption, lack of strong government leaders, lack of care for natural resources, and lack of care for the health of their own people doomed Haiti. Poverty struck Haiti heavy, and coupled with the HIV epidemic Haiti was looking for a ‘bail out’.
Through integrating prevention methods and a further understanding of the disease Haiti starts to see decreased rates in the early 90s and as little as 4% prevalence in 2003. Culture also changed. PBS reported that in 2000, “11% of Haitians reported abstaining from sex (twice as many as in 1994)” (PBS). The article also went on to explain increased rates of men and women being faithful to a single partner.
According to the World Health Organization (WHO), today most of the driving factors of HIV in Haiti are sex work, severe poverty, high unemployment rates, stigmas, and gender inequalities (WHO). Something that’s not talked about often is the number of women in Haiti forced to have sex. One study found the prevalence of forced sex was 54% (M.C. Smith Fawzi et al., 2005). There is quite a bit of gender inequality and Paul Farmer writes, “This degree of gender inequality, compounded by deep poverty experienced by women in rural Haiti, has been shown to place women at significant risk of HIV infection and other STDs” (Farmer, 1992). Culturally speaking structural violence played a part in allowing the disease to grow to the rates it did. Structural violence is the idea that the system works in a way to harm or put certain individuals at a disadvantage. Structural violence is common in Haiti when it relates to HIV. Prevention efforts, education on HIV, testing, treatment, and care are scarce for women. This type of discrimination, structural violence if you will, puts women in Haiti at a serious disadvantage. There also is a shared idea amongst Haitians that because of the economic situation many young women are pushed towards sexual unions for financial security. With such little employment opportunities because of the little schooling they have, many women enter sexual relationships out of necessity, and “typically do not have the power to demand use of condoms” (Poverty Increases Risks of HIV in Haiti). High rates of poverty foster a home for HIV. In one study about one third of couples in Haiti recognized that they never discuss sex with their current partners (The Impact of Disaster on HIV in Haiti and Priority Areas Related to the Haitian Crisis). With inequalities that don’t allow women to have power to demand condom use the risk of HIV only increases.
With unemployment rates so high, there are social factors that go into the HIV epidemic in Haiti. According to the CDC, without access to testing many people who have the infection do not know until it’s too late. Since there is little work opportunity for women in Haiti many turn to sex work as a form of income. Without increased access to testing facilities these sex trade workers do not know they’re infected and continue to spread the disease through their work. Many women simply choose to not be tested because of fear of stigmas that will follow them if they’re diagnosed. Being affected by HIV/AIDS can completely isolate you from your social environment, decrease your access to food, and denial of human dignity (Surkan et al., 2011). Education has done some good. Now Haitians are more educated on prevention methods and since there is a fuller understanding of the disease some are abstaining from sex work. However, those stigmas still kill prevention efforts by scaring others off from testing and treatment centers (Malow, et al.,).
“Stigma is part of a complex social struggle used to create and perpetuate social inequalities, such that it is through understanding and acting on these social processes that the problem can be addressed” (Surkan et al., 2011). This type of discrimination has plagued Haitian women and helped foster the violence, whether structural or physical, against them. Since HIV is an autoimmune disease those infected are at increased risk of other disease. Being diagnosed with HIV and contracting other infections doesn’t bode well because of little access to treatment. Having weak health infrastructure coupled with extreme poverty is structural violence against women.
A companion to Medical Anthropology, a journal by Singer and Erickson, mentions “Biocultural approaches in medical anthropology can potentially provide fuller understanding of how large scale political-economic processes ‘get under the skin’” (Singer and Erickson) This is a strong point and with a multi-step approach we can start to formulate other solutions for the HIV epidemic that haven’t been explored as heavy. Economically Haiti was put in a tough position based on its natural resources. What was once a beautiful, highly sought after vacation stop, is now in some places a barren wasteland. Poverty and natural disasters have drastically hurt Haiti which in turn has hurt Haitian women. According to UNWomen “crises are not gender-neutral- they disproportionately affect women, especially in contexts where discriminatory gender norms exist” (unwomen.org). I’ve already mentioned a few inequalities so it’s easy to understand how any crisis, whether it’s a natural disaster like an earthquake or hurricane, or disease epidemic like HIV, would hurt women. When women survive this type of crisis they still have a much more challenging time rebuilding their lives (UNWomen). These types of disasters were not anticipated at all and therefore little to no prevention efforts were made prior to these crisis’. Structurally speaking, these types of crisis’ can lead to more serious issues and can link these events together. For example, the earthquake in 2010 displaced many women into camps. In these camps opportunity for work is there but these designed programs to give jobs only targeted men, a whopping 76% of the time. This has left women with little opportunity and they eventually turned to sex work to find an income. Again, this brings us back to a root problem that these women are corned in based on outside factors that they ultimately have little to no control over.
Haiti is at the bottom of the United Nations human development rankings (Human Development Report, 2018). Extreme poverty has been prolonged due to political corruption, public health crisis, and natural disaster (Honore, et al.,). Lack of stability in Haiti has challenged the health of the nation to a near breaking point. A positive note is that “Patients in Haiti with HIV can have similar survival rates to those initiating HIV treatment in the USA during the early phase of antiretroviral therapy” (Honore, et al.,). While there is a lot up against Haitians in the fight against HIV, there is still reason to hope this epidemic will eventually slow down. Amongst the younger generation of Haitians the trend of those infected is decreasing, suggesting that the infection is slowing down (WHO).
Through research and analyzing HIV with a critical medical anthropological lens there are many consistencies that add up to these underlying problems and explore how they play a huge role in foster HIV in Haiti. Cultural, economic, political, and social determinants go directly into nurturing the sustained success of the disease. Structural violence has built, through years, a culture that puts women at a disadvantage. Stigmas have followed that have socially banished women from communities, sidelined their professional careers, and forced them into sex trade that only exacerbates the issue. In terms of who suffers the most Haitian women will stand strong and beat this medical issue that is killing their demographic.
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Surkan, Pamela J, et al. “Perceived Discrimination and Stigma toward Children Affected by HIV/AIDS and Their HIV-Positive Caregivers in Central Haiti.” AIDS Care, U.S. National Library of Medicine, July 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3017757/#R15.