Haitian Women Research Articles

The Greatest Gift Is Being a Woman, Above All, a Black Woman

The Greatest Gift Is Being a Woman, Above All, a Black Woman

Decision-making about motherhood among women living with HIV in Canada: a negotiation of multidimensional risks

Little research in Canada has examined the perspectives of women living with HIV on decision-making across the stages of motherhood. In 2004–2005, semi-structured interviews were conducted with 42 African, Caucasian and Haitian HIV-positive women recruited in Montreal. All were or wished to be biological mothers. Transcripts underwent thematic analysis organised by three culturally informed models of motherhood described by the participants, which influenced decision-making and perceived risks. For women who saw motherhood as ‘self-fulfilment and completeness’, vertical HIV transmission was a primary concern. It threatened their identity as a ‘good mother’, which also meant adhering to antiretrovirals. For women who viewed motherhood as a ‘social realisation’ (all African or Haitian), fears of compromised fertility dominated. Not becoming pregnant threatened their social status and presumed health within their community. Antiretrovirals were abandoned after delivery, fearing they would reveal their HIV status. For women endorsing a ‘personal growth’ model of motherhood (all Caucasian), threats to personal health were paramount. Pregnancy meant purifying body and soul. Antiretrovirals, seen as pollutants, were stopped after delivery. These findings can inform current research and sensitise health providers to the complex biological, psychological, social and spiritual risks that HIV-positive women negotiate in motherhood-related decision-making, towards more patient-centred care.

A randomized trial of mailed HPV self-sampling for cervical cancer screening among ethnic minority women in South Florida.

HPV self-sampling has previously been shown to increase cervical cancer screening among ethnic minority and immigrant women. We conducted a randomized pragmatic trial to examine the effectiveness of HPV self-sampling delivered via in-person versus by US mail for medically underserved Hispanic, Haitian, and non-Hispanic Black women living in South Florida. We randomized women aged 30-65 who had not completed Pap smear screening in the past 3years into two groups: (1) HPV self-sampling delivered in-person (IP) by a community health worker (CHW; IP + SS) or (2) HPV self-sampling delivered via US mail (SS + Mail). Our primary outcome was HPV self-sampling completion by 6-month post-study enrollment. We enrolled 600 women. Approximately 65% were Hispanic and 35% were Haitian or non-Hispanic Black. Nearly half (43%) had an income of less than $20,000/year and 67% were uninsured. In intent-to-treat analyses, 71.6% of participants in the SS + Mail group and 81.0% of participants in the IP + SS group completed HPV self-sampling. Mailed HPV self-sampling is an effective strategy to increase cervical cancer screening among underserved immigrant and ethnic minority women.

Cervical cancer screening: The first step in cancer care for women in Haiti

Cervical cancer screening: The first step in cancer care for women in Haiti

Prenatal follow-up of Haitian and Brazilian women in Mato Grosso

Abstract Objectives: to analyze the prenatal follow-up performed by pregnant women in Haiti and Brazil in the state of Mato Grosso. Methods: a cross-sectional study of secondary database, with analysis of SINASC birth records in Mato Grosso between 2013 and 2015, of Brazilian children, born from both Brazilian and Haitian mothers. Variables related to the identification of the newborn and the woman, maternal data on gestational history, including information on prenatal follow-up of the last gestation were evaluated, besides the birth characteristics. Results: 167,820 live births were registered in the state in the period, of which 139 (0.08%) were children of Haitian women. Haitian mothers were older, however with lower schooling when compared to Brazilian mothers. The proportion of mothers of Haitian nationality who had at least 6 prenatal consultations was lower, and the proportion of vaginal births was higher, when compared to Brazilian women. The prevalence of low birth weight among live births of Haitian mothers was also higher. Conclusions: the results of this study point to the need to understand these differences, since some indicators have distanced from those advocated by WHO. These findings may contribute to the public policies development aimed at this population.

Barriers to HPV Vaccination Among Unvaccinated, Haitian American College Women.

Background: Haitian women residing in the United States are disproportionately affected by cervical cancer. Human papillomavirus (HPV) vaccine has been licensed in the United States since 2006. Vaccination rates are less than optimal overall, and the rates are particularly low among young black women. We investigated barriers to HPV vaccination in a sample of Haitian American college women.Methods: Thirty self-identified Haitian American women, aged 17−26 years, were recruited from a large university campus in southeastern United States (n=30). They completed in-depth face-to-face interviews. The research team analyzed the transcripts using thematic analysis.Results: More than half of the participants (n=18) had not yet initiated the HPV vaccine series. Most of the unvaccinated participants stated that they had received a provider recommendation for the vaccine. Lack of provider recommendation, negative vaccine perception and attitudes, and side effect concerns constituted barriers to vaccination.Conclusions: Haitian American college women at high risk of cervical cancer have cited several barriers to HPV vaccination, with the most prominent being lack of physician recommendation. Healthcare providers should continue recommending the vaccine to college women as many of them may not have received a recommendation. When recommending the HPV vaccine, discussions should be framed with the intent to positively influence HPV vaccine perceptions and ultimately vaccine attitudes.

HPV Self-Sampling for Cervical Cancer Screening Among Ethnic Minority Women in South Florida: a Randomized Trial.

Ethnic minority women are at increased risk of cervical cancer. Self-sampling for high-risk human papillomavirus (HPV) is a promising approach to increase cervical screening among hard-to-reach populations. To compare a community health worker (CHW)-led HPV self-sampling intervention with standard cervical cancer screening approaches. A 26-week single-blind randomized pragmatic clinical trial. From October 6, 2011 to July 7, 2014, a total of 601 Black, Haitian, and Hispanic women aged 30-65years in need of cervical cancer screening were recruited, 479 of whom completed study follow-up. Participants were randomized into three groups: (1) outreach by CHWs and provision of culturally tailored cervical cancer screening information (outreach), (2) individualized CHW-led education and navigation to local health care facilities for Pap smear (navigation), or (3) individualized CHW-led education with a choice of HPV self-sampling or CHW-facilitated navigation to Pap smear (self-swab option). The proportion of women in each group whom self-reported completion of cervical cancer screening. Women lost to follow-up were considered as not having been screened. Of the 601 women enrolled, 355 (59%) were Hispanic, 210 (35%) were Haitian, and 36 (6%) were non-Haitian Black. In intent-to-treat analyses, 160 of 207 (77%) of women in the self-swab option group completed cervical cancer screening versus 57 of 182 (31%) in the outreach group (aOR 95% CI, p < 0.01) and 90 of 212 (43%) in the navigation group (aOR CI, p = 0.02). As compared to more traditional approaches, CHW-facilitated HPV self-sampling led to increased cervical cancer screening among ethnic minority women in South Florida. Clinical Trials.gov Identifier: NCT02121548.

An Illustrated Approach to HPV and Cervical Cancer Education among Haitian Women

An Illustrated Approach to HPV and Cervical Cancer Education among Haitian Women

Between Sovereignty and Belonging: Women’s Legal Testimonies in Nineteenth-Century Haiti

An analysis of the historical records of the Haitian Etat Civil, shows how rural Haitian women strategically presented themselves within Haitian law and bureaucracy in order to access legal personhood, citizenship and property ownership both for themselves and their families. Based on new archival research, the article further extends our knowledge of rural Haitian society in the nineteenth century, locating Haiti within the context of the historiography of the Caribbean in the post-slavery period.

Culturally anchoring an intervention for gender-based violence

Haitians continue to rebuild following the devastating earthquake in 2010, as many also strive to recover and heal from associated horrific events. Immediately following the earthquake, domestic and international agencies reported dramatic increases in violence against women and girls in this small Caribbean nation that shares the island of Hispaniola with the Dominican Republic. In this article, we highlight one segment of a situational analysis used as groundwork for developing an intervention to address gender-based violence (GBV). We sought to rapidly identify existing and needed resources and services for internally displaced women and girls in Haiti and to facilitate an immediate and sustainable response. During an eight-day period, we convened focus groups in Port au Prince. Displaced women and older girls, directors of nongovernmental organizations (NGOs), health care providers and administrators, and community youth leaders participated in the focus groups. Findings from these focus groups illuminate the multiple influences of GBV on displaced women and girls. Gaps, strengths, and limitations of existing resources, capacities, systems, and services for internally displaced Haitian women and girls were identified. In addition, factors that could potentially support or hinder effective implementation of preventive and response interventions were revealed. Our findings provided a foundation and structure for developing a culturally specific educational and safety plan which was used in Haiti following the earthquake and continues to have relevance for use, today.

Role of Healthcare Providers� Recommendation Style in HPV Vaccine Decision-Making among Haitian Parents and Female Patients

Background and Purpose: The strong influence of physician recommendation on vaccine uptake is well established in the literature. However, its influence on HPV vaccine decision-making among young Haitian women is understudied. This study investigated the role of healthcare providers� recommendation style in Haitian parents� and female patients� HPV vaccine decision-making. Methods: Thirty selfidentified Haitian women aged 17-26 years were recruited from a large university campus in the Southeastern United States (N=30). They completed in-depth face-to-face interviews regarding their HPV vaccine decision-making process. Transcripts were analyzed using thematic analysis. Results: Provider recommendation was cited as a major factor that influenced HPV vaccine uptake. Additionally, the framing of the HPV vaccine message greatly influenced vaccine decisions. Messages that framed the vaccine as a preventive measure for cervical cancer or as a preventive vaccine without an emphasis on the sexual transmission route of the virus were most effective. Messages that framed the vaccine as a preventive measure against a sexually transmitted infection did not positively influence young women to be vaccinated. Conclusions: These findings indicate that providers� recommendation style highly affects HPV vaccine decision. Thus, appropriate HPV vaccine framing is important for encouraging vaccine uptake in this ethnic group.

Exploring the use of labor and delivery services by women of Haitian nationality in a Dominican Republic border town

PurposeWomen of Haitian nationality comprise a sizeable proportion of all women seeking labor and delivery services in a public hospital in Dominican Republic (DR), along the central border of Haiti. The purpose of this paper is to better understand and address the needs of Haitian women receiving labor and delivery services in this border region.Design/methodology/approachThe authors conducted a mixed-methods study to identify personal motivations, demographic characteristics, and migration history of women seeking labor and delivery services at a public hospital.FindingsThe majority of women (83 percent) were born in Haiti but spoke Spanish (74 percent) and were long-term residents of the DR (mean 7.8 years). While many women reported they felt they had a positive experience delivering at the public hospital, some described feeling unwelcome or resented.Research limitations/implicationsThe study sample was small and from one hospital. Future studies could explore the differences in experiences among Haitian women who are long-term residents of the DR and those whose presence is more transient.Practical implicationsWomen residing on both sides of the border would likely benefit from coordinated efforts by the Haitian and DR Ministries of Health to strengthen referral services to and from either country.Social implicationsHospital staff and services in the DR should consider the unique needs of this population, which makes critical contributions to workforce and culture in the DR.Originality/valueThis study is the first to assess labor and delivery service seeking practices and experiences within this population.

Seroprevalence of Herpes Simplex Virus type-2 (HSV-2) among pregnant women who participated in a national HIV surveillance activity in Haiti

BackgroundHerpes simplex virus type 2 (HSV-2), one the most common causes of genital ulcers, appears to increase both the risk of HIV acquisition and HIV transmission. HSV-2/HIV co-infection among pregnant women may increase the risk of perinatal transmission of HIV. This study describes rates of HSV-2 among pregnant women in Haiti and HSV-2 test performance in this population.MethodsUnlinked residual serum specimens from the 2012 National HIV and Syphilis Sentinel Surveillance Survey among pregnant women in Haiti were tested using two commercial kits (Focus HerpeSelect, Kalon) for HSV-2 antibodies. We evaluated rates of HSV-2 seropositivity and HSV-2/HIV co-infection, associations between HSV-2 and demographic characteristics using multivariable Cox proportional hazards modeling, and HSV-2 test performance in this population.ResultsSerum samples from 1000 pregnant women (all 164 HIV positive and 836 random HIV negative) were selected. The overall weighted prevalence of HSV-2 was 31.4% (95% CI: 27.7–35.4) and the prevalence of HIV-positivity among HSV-2 positive pregnant women was five times higher than the prevalence among HSV-2 negative women (4.8% [95% CI: 3.9–6.0] vs. 0.9% [95% CI: 0.6–1.3], respectively). Factors significantly associated with HSV-2 positivity were HIV-positivity (PR: 2.27 [95% CI: 1.94–2.65]) and older age (PRs: 1.41 [95% CI: 1.05–1.91] for 20–24 years, 1.71 [95% CI:1.13–2.60] for 30–34 years, and 1.55 [95% CI: 1.10–2.19] for 35 years or greater]), while rural residence was negatively associated with HSV-2 positivity (PR 0.83 [95% CI: 0.69–1.00]), after controlling for other covariables. For this study a conservative Focus index cutoff of 3.5 was used, but among samples with a Focus index value ≥2.5, 98.4% had positive Kalon tests.ConclusionThe prevalence of HSV-2 is relatively high among pregnant women in Haiti. Public health interventions to increase access to HSV-2 screening in antenatal services are warranted.

The Use of Commercial and Plant Products in the Vaginal Hygiene Practices of Haitian Women: A Latent Class Analysis

The Use of Commercial and Plant Products in the Vaginal Hygiene Practices of Haitian Women: A Latent Class Analysis

Submicroscopic malaria infections in pregnant women from six departments in Haiti.

To describe the epidemiology of malaria in pregnancy in Haiti. Cross-sectional study among pregnant women in six departments of Haiti. After obtaining informed consent, whole blood samples and demographic surveys were collected to investigate malaria prevalence, anaemia and socio-behavioural risk factors for infection, respectively. A total of 311 pregnant women were screened for Plasmodium falciparum infection using a rapid diagnostic test (RDT), microscopy and a novel, quantitative reverse transcriptase polymerase chain reaction method (qRT-PCR). Overall, 1.2% (4/311) of pregnant women were tested positive for malaria infection by both microscopy and RDT. However, using the qRT-PCR, 16.4% (51/311) of pregnant women were positive. The prevalence of malaria infection varied with geographical locations ranging between 0% and 46.4%. Additionally, 53% of pregnant women had some form of anaemia; however, no significant association was found between anaemia and submicroscopic malaria infection. The socio-behavioural risk factors identified to be protective of malaria infection were marital status (P < 0.05) and travel within one month prior to screening (P < 0.05). This study is the first to document the high prevalence of submicroscopic malaria infections among pregnant women in Haiti and identify social and behavioural risk factors for disease transmission.

Risk factors associated with mortality among women with breast cancer in Haiti.

e13069 Background: According to recent estimations of GLOBOCAN 2012, breast cancer is the 2ndmost common cancer among Haitian women. This study aims to describe the epidemiology of breast cancer at a Haitian hospital and to determine the factors associated with mortality. Methods: A retrospective chart review was conducted on women treated for breast cancer at the Innovating Health International Cancer Center, in Port-au-Prince, Haiti. All charts with complete information from 2014 and 2015 were included. Charts were reviewed to collect key variables related to breast cancer. Odds ratios were calculated and Mantel-Haenszel Chi-square test was used to identify the factors associated with mortality. Results: Among the 289 charts reviewed, 275 were selected for this study. The mean age is 51.82 years-old [20 - 100]. 81.1% of the patients had stage III or IV breast cancer at their first consultation. 92% of the women were diagnosed with invasive ductal carcinoma. Of the 165 cases tested for hormone receptor status, 54.5% were ER-positive, 31.5% were triple negative and 12.1% were HER2-enriched. The mortality rate is 24.4%. The odds of dying from breast cancer was significantly higher among women who had their menarche before 15 years old [Odds Ratio (OR) = 4.2; P = 0.02], stage III or IV breast cancer (OR = 3.7; P = 0.01), triple-negative or HER2-positive breast cancer (OR = 2.5; P = 0.01). Mortality was significantly lower among women who benefited from hormone therapy (OR = 0.22; P &lt; 0.01). Conclusions: Breast cancer is often diagnosed at late stages in Haiti, which increases mortality. Women with ER-positive breast cancer survive significantly more than those with HER2-positive or triple-negative breast cancer, mainly due to the availability of hormone therapy and the absence of trastuzumab. A national awareness and screening program has to be implemented to educate Haitian women on breast cancer and increase early diagnosis. As an essential medicine in oncology according to the World Health Organization (WHO), biosimilar trastuzumab needs to be available to increase the survival of patients with HER2-positive breast cancer.

Health equity for women in Haiti

RESUMOObjetivos.Descrever a atenção básica em saúde prestada às mulheres no Haiti e avaliar a equidade da atenção.Métodos.Neste estudo transversal, 114 mulheres atendidas na atenção básica nos 10 departamentos de saúde do país foram entrevistadas. Para analisar a equidade, foram utilizados dois grupos de indicadores: acesso (tempo de caminhada para chegar aos serviços, tempo de espera na fila de consultas e necessidade de pagamento) e qualidade (conhecer o nome do prestador de serviços, tempo de consulta e discriminação). Pagamento e preconceito foram escolhidos como desfechos respectivamente para acesso e qualidade da atenção.Resultados.A maioria das mulheres tinha menos de 30 anos (59,0%), era negra (92,1%) e migrante (63,2%); apenas 21,3% souberam informar a renda familiar e 47,4% eram alfabetizadas. A maioria das consultas foi realizada em menos de 10 minutos (68,3%). O nome do profissional que prestou o serviço não era conhecido por 72,7% das mulheres. As consultas foram pagas por 63,4%, especialmente na região Sul (P = 0,016). Ainda, as mulheres no Sul levaram mais tempo para chegar aos serviços. Aquelas que não pagaram tiveram consultas com menor duração (P < 0,001). A discriminação nos serviços de saúde foi detectada em 28,9% das entrevistadas.Conclusões.Esta pesquisa mostrou dificuldades no acesso e discriminação na atenção primária em saúde prestada a mulheres no Haiti e indica o gênero como uma categoria de análise importante para avaliar a equidade nos serviços de saúde.

Women's and Healthcare Workers' Beliefs and Experiences Surrounding Abortion: The Case of Haiti.

Women in developing countries usually encounter serious inequities in terms of women's health. To date, there is limited understanding of abortion from the perspective of Haitian women. As a limited-resource country, Haiti faces complex social issues and healthcare challenges. With abortion being illegal, many adult and teenage women seek clandestine abortions. The aim of this study was to explore and gain a greater understanding of women's and healthcare workers' beliefs and experiences about abortion in Haiti. Descriptive qualitative design was used to elicit information for the study. Eight focus groups were conducted with Haitian women and healthcare workers in five communities in the south of Haiti: Les Cayes, Aquin, St. Louis du Sud, Cavaillon, Maniche, and Ile a Vache. Participants were purposively selected and consented to participate and to be tape recorded. Content analysis followed using the verbatim transcripts, with triangulation of four researchers; saturation was reached with this number of focus groups. The transcripts revealed six main themes regarding beliefs and experiences about abortion in Haiti: cultural aspects, consumers, perils of care, and legal concerns. Both women and healthcare workers discussed the repercussions of illegal abortion and the role of the government and hospitals. Participants identified similar perils and complications of unsafe abortions, such as postpartum hemorrhage and infection. Results showed an urgent need to create a public health response that addresses different dimensions of abortion by engaging women and healthcare providers in rapid and concrete actions that promote access and safe care of women. It is imperative to conduct more research related to abortion in order to examine other associated factors to better understand the links between abortion and sexual health disparities among Haitian women. These results highlight the need for a rapid response to the need of this vulnerable group, who are experiencing high rates of mortality. This can also serve as a directive to approach this issue in other developing countries in the Caribbean region, particularly from its clinical relevance. Unsafe abortions are prevalent in developing countries; yet limited research exists on the topic. It is paramount to gain an understanding of the women's and healthcare workers' beliefs and experiences surrounding abortion, in order to develop interventions that prevent abortion complications in Haitian women.

Mailed HPV self-sampling for cervical cancer screening among underserved minority women: study protocol for a randomized controlled trial

BackgroundUnderserved ethnic minority women experience significant disparities in cervical cancer incidence and mortality, mainly due to lack of cervical cancer screening. Barriers to Pap smear screening include lack of knowledge, lack of health insurance and access, and cultural beliefs regarding disease prevention. In our previous SUCCESS trial, we demonstrated that HPV self-sampling delivered by a community health worker (CHW) is efficacious in circumventing these barriers. This approach increased screening uptake relative to navigation to Pap smear screening. SUCCESS trial participants, as well as our community partners, provided feedback that women may prefer the HPV self-sampler to be delivered through the mail, such that they would not need to schedule an appointment with the CHW. Thus, our current trial aims to elucidate the efficacy of the HPV self-sampling method when delivered via mail.DesignWe are conducting a randomized controlled trial among 600 Haitian, Hispanic, and African-American women from the South Florida communities of Little Haiti, Hialeah, and South Dade. Women between the ages of 30 and 65 years who have not had a Pap smear within the past 3 years are eligible for the study. Women are recruited by CHWs and complete a structured interview to assess multilevel determinants of cervical cancer risk. Women are then randomized to receive HPV self-sampling delivered by either the CHW (group 1) or via mail (group 2). The primary outcome is completion of HPV self-sampling within 6 months post enrollment.DiscussionOur trial is among the first to examine the efficacy of the mailed HPV self-sampling approach. If found to be efficacious, this approach may represent a cost-effective strategy for cervical cancer screening within underserved and underscreened minority groups.Trial registrationClinicalTrials.gov, NCT02202109. Registered on 9 July 2014.

Vaginal Infections in Haitian Immigrant Women Living in Miami, Florida.

To characterize vulvovaginal candidiasis (VC), trichomonas vaginalis (TV), and bacterial vaginosis (BV) among Haitian women living in Miami to identify contributing factors to cervical cancer disparity in this population. Using a CBPR framework, 246 Haitian women (ages 21-65) were recruited. Self-collected cervical cytology specimens were analyzed for VC, TV, and BV. The proportion of participants with VC, TV, and BV, were 7.3%, 9.3%, and 19.9%, respectively. Haitian women may have a higher prevalence of TV than the general U.S. population, which may increase susceptibility to HPV, the primary cause of cervical cancer.