Economic risk factors for HIV infection among women in rural Haiti: implications for HIV prevention policies and programs in resource-poor settings.
OBJECTIVE
The goals of this study were to (1) estimate the prevalence of HIV infection among women accessing services at a women's health center in rural Haiti and (2) to identify economic risk factors for HIV infection in this population.


METHODS
Women who accessed healthcare services at this center between June 1999 and December 2002 were recruited to participate. The analysis was based on data from a case-control study of sexually transmitted diseases (STDs) in rural Haiti. HIV prevalence in the study population was 4%.


RESULTS
In multivariate analyses, partner occupation was associated with HIV infection in women, with mechanic (OR 9.0, 95% CI 1.8-45) and market vendor (OR 4.2, 95% CI 1.6-11) reflecting the strongest partner occupational risk factors. Partner's occupation as a farmer reduced the risk of infection in women by 60% (95% CI 0.14-1.1). Factors indicating low socioeconomic status (SES), such as food insecurity (OR 2.0, 95% CI 0.75-5.6) and using charcoal for cooking (OR 1.7, 95% CI 0.72-3.8) suggested an association with HIV infection.


CONCLUSIONS
Given pervasive gender inequality in Haiti, women's economic security often relies on their partners' income earning activities. Our findings show that although factors reflecting poverty are associated with HIV-positive status, stronger associations are observed for women whose partners indicated a more secure occupation (e.g., mechanic or market vendor). Policies and programs that expand access to education and economic opportunities for women and girls may have long-term implications for HIV prevention in Haiti and other resource-poor settings.
Fawzi
M C Smith
MC
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA. mary_smith-fawzi@hms.harvard.edu
Lambert
W
W
Boehm
F
F
Finkelstein
J L
JL
Singler
J M
JM
Léandre
F
F
Nevil
P
P
Bertrand
D
D
Claude
M S
MS
Bertrand
J
J
Louissaint
M
M
Jeannis
L
L
Farmer
P E
PE
Yang
A T
AT
Mukherjee
J S
JS
D000328:Adult; D002391:Catchment Area, Health / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006205:Haiti / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D009790:Occupations; D011203:Poverty; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012959:Socioeconomic Factors