title: Factors associated with forced sex among women accessing health services in rural Haiti: implications for the prevention of HIV infection and other sexually transmitted diseases.
abstract: The goals of the current study were to: (1) estimate the prevalence of forced sex among women accessing services at a women's health clinic in rural Haiti; and (2) examine factors associated with forced sex in this population. Based on data from a case-control study of risk factors for sexually transmitted diseases (STDs), a cross-sectional analysis to examine factors associated with forced sex was performed. A number of factors related to gender inequality/socioeconomic vulnerability placed women in rural Haiti at higher risk of forced sex. The strongest factors associated with forced sex in multivariate analyses were: age, length of time in a relationship, occupation of the woman's partner, STD-related symptoms, and factors demonstrating economic vulnerability. The findings suggest that prevention efforts must go beyond provision of information and education to the pursuit of broader initiatives at both local and national levels. At the community level, policy-makers should consider advancing economic opportunities for women who are vulnerable to forced sex. Improving access to community-based income-generating activities may begin to address this problem. However, the viability of these local projects depends largely upon Haiti's 'macro-economic' situation. In order to ensure the success of local initiatives, external humanitarian and development assistance to Haiti should be supported. By broadening the definition of "prevention" interventions, we may begin to address the systemic problems that contribute to the occurrence of forced sex and the increasing incidence of HIV infection throughout the world, such as gender inequality and economic vulnerability. Taking into account factors influencing risk at the local level as well as the macro-level will potentially improve our capacity to reduce the risk of forced sex and the spread of STDs, including HIV infection, for millions of women living in poverty worldwide.
authors.affiliation: Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA 02115, USA. mksfawzi@msn.com
authors.forename: M C
authors.initials: MC
authors.lastname: Smith Fawzi
authors.forename: W
authors.initials: W
authors.lastname: Lambert
authors.forename: J M
authors.initials: JM
authors.lastname: Singler
authors.forename: Y
authors.initials: Y
authors.lastname: Tanagho
authors.forename: F
authors.initials: F
authors.lastname: Léandre
authors.forename: P
authors.initials: P
authors.lastname: Nevil
authors.forename: D
authors.initials: D
authors.lastname: Bertrand
authors.forename: M S
authors.initials: MS
authors.lastname: Claude
authors.forename: J
authors.initials: J
authors.lastname: Bertrand
authors.forename: M
authors.initials: M
authors.lastname: Louissaint
authors.forename: L
authors.initials: L
authors.lastname: Jeannis
authors.forename: J S
authors.initials: JS
authors.lastname: Mukherjee
authors.forename: S
authors.initials: S
authors.lastname: Goldie
authors.forename: J J
authors.initials: JJ
authors.lastname: Salazar
authors.forename: P E
authors.initials: PE
authors.lastname: Farmer
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009790:Occupations; D011902:Rape / Q000706:statistics & numerical data*; D019035:Rural Health Services; D012424:Rural Population; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D012959:Socioeconomic Factors