Haitian Women Research Articles

The “three delays” as a framework for examining maternal mortality in Haiti

Haiti has one of the highest rates of maternal mortality in the Caribbean. The “Three Delays” model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached. This framework was used to analyze a sample of 12 maternal deaths that occurred in a longitudinal cohort of pregnant Haitian women. Because of political upheavals in Haiti during the survey, these deaths are an underestimate of all deaths that occurred in the cohort. Family and friend interviews were used to obtain details about the medical and social circumstances surrounding each death. A delayed decision to see medical care was noted in eight of the 12 cases, whereas delays in transportation only appeared to be significant in two. Inadequate care at a medical facility was a factor in seven cases. Multiple delays were relevant in the deaths of three women. Family and friend interviews suggest that a lack of confidence in available medical options was a crucial factor in delayed or never made decisions to seek care. Expanding the coverage of existing referral networks, improving community recognition of obstetric emergencies, and improving the ability of existing medical institutions to deliver quality obstetric care, are all necessary. However, services will continue to be under-utilized if they are perceived negatively by pregnant women and their families. The current data thus suggest that improvements to Haiti’s maternity care system which focus on reducing the third delay—that is, improving the quality and scope of care available at existing medical facilities—will have the greatest impact in reducing needless maternal deaths.

Stressful events, pessimism, natural killer cell cytotoxicity, and cytotoxic/suppressor T cells in HIV+ black women at risk for cervical cancer.

This study examines whether stressful negative life events and pessimism were associated with lower natural killer cell cytotoxicity (NKCC) and T cytotoxic/suppressor cell (CD8+CD3+) percentage in black women co-infected with human immunodeficiency virus Type 1 (HIV-1) and human papillomavirus (HPV), a viral initiator of cervical cancer. Psychosocial interviews, immunological evaluations, and cervical swabs for HPV detection and subtyping were conducted on 36 HIV+ African-American, Haitian, and Caribbean women. Greater pessimism was related to lower NKCC and cytotoxic/suppressor cells after controlling for presence/absence of HPV Types 16 or 18, behavioral/lifestyle factors, and subjective impact of negative life events. A pessimistic attitude may be associated with immune decrements, and possibly poorer control over HPV infection and increased risk for future promotion of cervical dysplasia to invasive cervical cancer in HIV+ minority women co-infected with HPV.

HIV Testing Among Haitian Women: Lessons in the Recognition of Risk

Haitian women in Miami, Florida, responded to recruitment for testing of HIV antibody serostatus in ways that demonstrated the value of ethnographic methods for studying reactions to this kind of test, especially pre- and posttest counseling sessions. A total of 155 women between 14 and 61 years old, recruited in Miami in 1992 and 1993, participated. Response to testing identified three primary obstacles to the women's understanding of content presented in pre- and posttest counseling sessions: (1) their confusion about the meaning of positive versus negative, (2) the investigators' difficulty in communicating the concept of antibody, and (3) vagueness of the concept of window period between exposure and presentation of antibody. Retesting of a subset of Haitian participants helped to define sexual risk among these women in terms of having partners who had other partners and perception of supernatural risk.

Framing silence: revolutionary novels by Haitian women

Framing silence: revolutionary novels by Haitian women

Framing Silence: Revolutionary Novels by Haitian Women

Raped and colonized, coerced and silenced--this has been the position of Haitian women within their own society, as well as how they have been seen by foreign occupiers. Romanticized symbols of nationhood, they have served, however unwillingly, as a politicized site of contestation between opposing forces. In this first book-length study in English devoted exclusively to Haitian women's literature, Myriam Chancy finds that Haitian women have their own history, traditions, and stories to tell, tales that they are unwilling to suppress or subordinate to narratives of national autonomy. Issues of race, class, color, caste, nationality, and sexuality are all central to their fiction--as is an urgent sense of the historical place of women between the two U.S. occupations of the country. Their novels interrogate women's social and political stance in Haiti from an explicitly female point of view, forcefully responding to overt sexual and political violence within the nation's ambivalent political climate. Through daring and sensitive readings, simultaneously historical, fictional and autobiographical, Chancy explores this literature, seeking to uncover answers to the current crisis facing these women today, both within their country and in exile.The writers surveyed include Anne-christine d'Adesky, Ghislaine Rey Charlier, Marie Chauvet, Jan J. Dominique, Nadine Magloire, and Edwidge Danticat, whose work has recently achieved such high acclaim.

The Meaning of Multiculturalism in a Culturally Diverse Urban American Area

Abstract A crisis in North America revolves around how immigrants, established ethnic groups, and aboriginal people accommodate, and are accommodated by, the majority groups in society. Ethnic minorities appear motivated to retain their heritage culture and language, and this objective is often perceived as a threat to majority groups and to national unity. In the present study, the precise meaning that ethnic groups in Miami (Cuban, Nicaraguan, and Haitian women) attach to heritage culture and language maintenance and the views of the key majority groups (Black and White women) were examined. An unanticipated level of consensus emerged. All agreed that it is appropriate for heritage cultures and languages to be maintained in the home. Also, there was a consensus that groups should retain their distinctiveness in contexts outside the home when their group is in the majority. However, there was also unanimity in the belief that in the public domain, U.S. culture and the English language should predominate.

Arrested pregnancy syndrome in Haiti: findings from a national survey.

This report describes findings from a national survey of pregnant women in Haiti regarding the social epidemiology of pedisyon (perdition), or "arrested pregnancy syndrome," a condition believed to be associated with infertility. Data collected on mortality of respondents' sisters were used to indirectly measure the prevalence of this culture-bound syndrome in the adult female population and to compare its distribution in urban and rural areas. Perdition appears to be a fairly common event that affects a large proportion of Haitian women. Reported cases of pedisyon were significantly higher in urban areas, which also differed from rural areas on respondent education, economic status, use of prenatal care, and fertility. No differences were found on sociodemographic, health, or fertility variables when women reporting perdition deaths were compared with women who reported other sister deaths. The utility and limitations of the proxy respondent method are discussed. Possible explanations for the higher rate of pedisyon among urban Haitian women are discussed, and suggestions are made for future research on arrested pregnancy syndrome.

Effects of HIV on Cognitive and Motor Development

The cognitive and motor development of 126 infants born to nondrug-using.HIV-seropositive Haitian women, assessed at 3-month intervals from birth to 24 months, is reported from the University of Miami School of Medicine, FL.

The Effects of HIV on Cognitive and Motor Development in Children Born to HIV-Seropositive Women With No Reported Drug Use: Birth to 24 Months

This study documents delays in the mental and motor functioning of infants perinatally infected with human immunodeficiency virus (HIV) while controlling for confounding effects of prenatal drug exposure, ethnicity, socioeconomic status, and maternal separation and death. The cognitive and motor development of 126 infants born to nondrug-using, HIV-seropositive Haitian women was assessed at 3-month intervals through 24 months of age using the Bayley Scales of Infant Development. By 18 months of age, 28 of the infants were diagnosed as HIV-infected, and the 98 uninfected infants served as a control group. The infected and uninfected infants did not differ with respect to mean gestational age, birth weight, ethnicity, or rates of maternal separation and death. By 3 months of age, the mean mental and motor scores of the infected infants were significantly lower than those of the uninfected controls. Furthermore, the initial differences between the two groups increased over time, as many of the infected infants became increasingly delayed. Although the infected infants tended to perform more poorly than the uninfected infants, nearly one third of the infected infants exhibited relatively normal cognitive development and half demonstrated relatively normal motor development. Over the first 24 months of life, the mean rate of development of HIV-infected infants is significantly slower than that of noninfected infants born to seropositive mothers. This occurs even when the effects are not confounded with those of prenatal drug exposure.

Health-illness beliefs and practices of Haitians with HIV disease living in Boston

The authors of this qualitative study explored the health-illness beliefs and practices of Haitians with HIV disease. The authors obtained a purposive sample of five Haitian men and four Haitian women with symptomatic HIV disease or AIDS living in Boston. Five themes were identified through content analysis of interviews and medical record review: (a) incorporation of traditional health-illness beliefs into beliefs about HIV disease; (b) A perceived need to hide HIV disease to avoid rejection, humiliation, and isolation; (c) use of spirituality to help cope with HIV disease; (d) history of limited contact with doctors prior to diagnosis of HIV disease; and (e) use of traditional healing practices for HIV disease. The findings have implications for improving cross-cultural communication between Haitians with HIV disease and their healthcare providers.

Secular trend in the age at menarche in Haiti.

Trends in age at menarche of 10,563 pregnant Haitian women enrolled in a longitudinal study of maternal mortality are examined. Mean recalled age at menarche for adult women in the sample was 15.37 years. However, there was a clear decline in mean menarcheal ages from the oldest to the youngest women, with a mean rate of decline for adult women of 0.36 years per decade. Mean menarcheal age was higher in each age group of rural women than for women in the metropolitan Port-au-Prince area; the rate of decline for adult rural women (0.37 years per decade) was nonsignificantly higher than that for adult metropolitan women (0.30 years per decade). The data suggest a secular decline in age at menarche in Haiti, as well as a continuing disparity between metropolitan and rural women. A declining age at menarche has important implications for fertility and reproductive health in Haiti, and may reflect a gradual improvement in health and nutritional status. © 1995 Wiley-Liss, Inc.

Les chanteuses haïtiennes à Montréal: des témoins d’une culture

In Haiti, songs, widely sung by women, accompany almost every gesture of daily life, especially those related to domestic activities. This paper presents the results of research carried out on Haitian women living in Montreal. What types of songs do they sing in a culture not their own? Is there a modification of their traditional repertoire or does it remain the same? What social functions do these songs have in their original culture and in their culture of adoption? Are songs passed on to the next generation born in Montreal and, if so, how are they transmitted? This study will attempt to answer these questions.

HIV Infection and Smoking Behavior

<h3>To the Editor.</h3> —The interesting study by Halsey et al¹showed an association between smoking and an increased risk of human immunodeficiency virus type 1 (HIV-1) infection in Haitian women. We would like to add a few comments to the authors' discussion of their findings. The authors investigated the risk of HIV infection among "women who reported during the first interview that they had ever smoked." Presumably, every smoker in this case included current and former smokers. The authors did not report the percentage of ever smokers in their study who were former smokers. The observation that 29 (33%) of the 89 smokers at the first interview had stopped smoking by the second interview implies that a substantial proportion of the smokers at the first interview may have been former smokers. If the risk of HIV infection declines after smoking cessation—as do the risks of most smoking-related diseases²—the

HIV Infection and Smoking Behavior

<h3>To the Editor.</h3> —Halsey et al¹reported an association between cigarette smoking and the risk of HIV-1 infection in Haitian women that remained after adjustment for "all known risk factors." The authors suggest two alternative explanations for their results: First, that there is a "hidden" or "unrecognized" confounder that has not been accounted for and, second, that there is a biologic effect of cigarette smoking on the risk of HIV transmission. We would like to suggest a third possibility, namely, that the association is not due to an unknown confounder, but rather the inability to properly measure a well-known confounder—frequency of unprotected sexual intercourse with an HIV-infected man or men. The dichotomous variable "≥3 lifetime sexual partners" that was used in the study is only a poor proxy measure of this true confounder and thus considerably underestimates its association with risk of HIV infection.^2-4The underestimation of the

Sexual Behavior, Smoking, and HIV-1 Infection in Haitian Women

To determine whether a previously observed association between human immunodeficiency virus type 1 (HIV-1) infection and smoking in Haitian women could be explained by confounding high-risk behaviors. A nested case-control study at a primary care health clinic in Cité Soleil, Haiti. Women who reported having smoked (n = 89) and randomly selected nonsmokers (n = 329) who had participated in a survey 1 to 12 months earlier evaluating risk factors for HIV-1 infection. Lifetime sexual practices, smoking, health beliefs and practices, and other factors potentially confounding the relationship between smoking and HIV-1 infection. Compared with nonsmokers, smokers reported higher rates of high-risk behaviors, including more lifetime sex partners (P less than .001), being less likely to be married (P less than .01), and being more likely to have visited folk healers (P less than .01). No intravenous drug use was reported, and no significant differences were noted between smokers and nonsmokers in numbers of past surgical or dental procedures or injections. Adjustment for all factors associated with HIV-1 infection and smoking in regression analyses revealed an independent association between smoking and HIV-1 infection (odds ratio [OR], 3.4; 95% confidence interval [Cl], 1.6 to 7.5). Other factors associated with HIV-1 infection included having more than two life-time sex partners (OR, 3.4; 95% Cl, 1.7 to 6.8) and lower socioeconomic status as reflected by a dirt floor in the home (OR, 8.6; 95% Cl, 3.3 to 22.0). Smoking is a marker for high-risk sexual behavior and is associated with an increased risk of HIV-1 infection in this population. The persistent association between smoking and HIV-1 infection after adjustment for all known risk factors suggests the possibility of a biologic effect of smoking that warrants further evaluation in other populations.

Sexual behavior, smoking, and HIV-1 infection in Haitian Women

Sexual behavior, smoking, and HIV-1 infection in Haitian Women

The Process of Social Identification for Visible Immigrant Women in a Multicultural Context

Haitian and Indian women rated their identification with (self-perceptions), and the extent to which they believed majority Canadians perceived them as being (metaperceptions), Haitian or Indian, immigrant, and Canadian. Self-perceptions and metaperceptions were compared in order to understand the quality of integration for the two sample An attempt was made to predict self-perceptions on the basis of pragmatic (years in Canada, age at arrival, citizenship status) and social psychological (motivation for culture retention, perceived discrimination) predictors in a series of multiple regression analyses. Although both samples expressed a strong identification with their ethnic groups, different results emerged for immigrant and Canadian identifications. Identity perceptions for these labels were more closely related to pragmatic predictors for the Indian, whereas social psychological variables were more predictive for the Haitian. The results are discussed in relation to the different visibility of the two groups as well as other salient factors in a multicultural context.

Haitian Women's Fiction

The object of the present study has yet to be defined. Of course, it can readily be said that there is recognizable body of texts written by Haitian women. It is also obvious that common language, in this case French, serves to establish the identity of their work. What needs to be explored is whether one can speak of feminine writing in Haiti and whether women writers are bound by common concerns, perceptions, and practices. Are they aware of each other's existence? Is there territory of the feminine in which their project acquires its full meaning? Haitian male writers do form verifiable community with history and traditions. They have, over the years, engaged in continuous dialogue which has fostered strong affinities or violent animosities among them. The woman writer in Haiti in contrast appears solitary figure, isolated, deprived of literary history per se and community to sustain her project. Haitian literature has been and remains, to large extent, male dominion. The purpose of this examination, however, is not to analyze the circumstances which have forced Haitian women into relative literary silence nor to provide definitive answers to the questions raised above. Rather, I will survey the works of authors who have insisted on making their voices heard. Collectively, they have produced body of texts which point perhaps to new territories of the imagination and announce the emergence of new consciousness. The work of Marie Chauvet and Marie-Therese Colimon[-Hall] -two important figures in Haitian, and for that matter Caribbean, literature -will receive special attention. The first Haitian novel, Stella, by Emeric Bergeaud, was published in 1859. The first woman novelist, Mme. Virgile Valcin (nee Cleante Desgraves), published some seventy years later two novels: Cruelle destine'e (1929) and La blanche negresse (1934). Written in the sentimental language of romanticism, they tell stories of unhappy and impossible love. The first one recounts the passionate and fatal love of woman, Adeline, for her brother, Armand. The death of the heroine provides resolution to the sentimental and existential dilemma. One can note in passing that the incest motif (a major component of European romanticism) treated here is also found in more recent novel by Alice Hippolyte, Ninon, ma soeur (1976). Valcin's second novel shares in its spirit characteristics of nineteenth-century novels such as Ourika by Mme. de Duras. In both instances, history and race constitute impassable barriers separating lovers. The story is that of French woman who is loved by Haitian and an American. She loves the Haitian but marries the American. When, through fortuitous twist of events, she discovers that she has a drop of African blood, she is mercilessly rejected by her white husband. In relating these tales of baffled love, unhappiness, rejection, and death, Mme. Valcin goes beyond mere imitation of trite literary formulae. One

Evaluation of enzyme immunoassays for antibody to human T-lymphotropic viruses type I/II

To evaluate the sensitivity and specificity of HTLV-I/ II assays, serum from 1100 pregnant Haitian women was tested with seven commercially available HTLV I/II assays. Serum that was found to be reactive in any assay was analysed by western blot and all indeterminate samples were further characterised by radioimmunoprecipitation assays (RIPA). 59 (5·4%) samples were HTLV I/II antibody positive by western blot and/or RIPA. The sensitivity of these seven assays ranged from 93·2% to 100%, with the 'Recombinant HTLV-I' (Cambridge Bioscience) and 'Serodia HTLV-I' (Fujirebio) assays having the highest sensitivity (100%). The specificity of these assays ranged from 98·4% to 100%, with the Abbott assay having the highest specificity (99·5%, 100%) according to two different methods of evaluation. Whether the antigens used in any assay were whole disrupted virus or recombinant gene products made no difference. The low positive predictive values of some of these assays (71·8-91·7%), even in a high prevalence population, and the need for RIPA to test indeterminate sera, indicate that for routine screening of blood donors there is still room for improvement both in screening and confirmatory assays for HTLV-I/II.

Cervix and breast cancer incidence in immigrant Caribbean women.

Cervix and breast cancer incidence in 1978-82 was computed for immigrant and United States-born Black women in Brooklyn, New York. Compared to the national SEER (Surveillance, Epidemiology and End Results) rates, US-born and Haitian women had high rates of invasive cervical cancer, while English-speaking Caribbean immigrants had an average rate. However, while US-born women had an average rate of carcinoma in situ of the cervix, both immigrant groups had low rates. Both immigrant groups had low rates of breast cancer, whereas US-born Black women had an average rate.