Presentation given by Carmen Logie at the Under the Baobab African Diaspora Networking Zone at the International AIDS Conference, AIDS 2014.

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Social and Structural Contexts of
HIV Vulnerability Among
Internally Displaced Youth in
Leogane, Haiti
Carmen Logie, PhD1;
CarolAnn Daniel, PhD2
1: Factor-Inwentash Faculty of Social Work, University of
Toronto, Toronto, Canada;
2: Faculty of Social Work, Adelphi University, New York, USA

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Background

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• Haiti has the highest HIV infection rate in the
Western Hemisphere with 1 in 50 people
infected (UNAIDS, 2011)
– highest rates of poverty in the region
• HIV vulnerability in Haiti:
– structural (e.g. poverty) and social factors (e.g. stigma) (Farmer, 2004)
– high rates of TB co-infection, malaria and poor nutrition (Malow et al.
2010)

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• Poverty and gender inequity shape women’s
vulnerability to HIV infection in Haiti (Walton et al., 2004)
– young women had lower rates of HIV knowledge than young
men (UNAIDS, 2010)
– young women twice as likely as young men to have an STI
(Dorjgochoo et al., 2009)

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• January 12, 2010 earthquake devastated social,
health and social infrastructure: 2 million
homeless
• Over four years later approximately 280,000
persons remain displaced in Haiti and lack
protection and basic services (Human Rights Watch, 2014;
IOM, 2013)
– In Leogane 5,000 people remain displaced and live in 15 IDP
camps

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Objectives
• Understand contexts of HIV vulnerability among
internally displaced (ID) young men and women
in Leogane, Haiti

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Methods

8. Focus groups:
young women
(n=30)
18-19 (n=10)
20-21 (n=10)
22-24 (n=10)
Focus groups:
young men (n=30)
18-19 (n=10)
20-21 (n=10)
22-24 (n=10)
Individual
interviews: key
informants
(n=11)
peer leaders (n=6;
3 young ID women,
3 young ID men)
youth ID
community health
workers (n=3)
project coordinator
(n=1); youth worker
(n=1)

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• Focus groups were conducted in Kreyol, digitally
recorded and transcribed verbatim, then
translated into English
• Thematic analysis, a method used to identify,
analyze and report themes in the data (Braun & Clarke, 2006)

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Theoretical Approach

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Structural Violence
Social structures (economic, political, legal,
religious, cultural) that prevent individuals,
groups and societies from reaching their
full potential
Unequal access to resources, power,
education, health care and legal standing
Emerges as unequal life chances (Farmer 1999; 2004; Galtung,
1969)

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Types of Violence
- Physical and psychological violence: “violence that
works on the body and violence that works on the soul”
- Intended vs. unintended
- Direct/personal: an actor commits the violence
- indirect/structural: there is no individual actor
- Manifest vs. latent: manifest violence is observable;
latent violence is not yet there, yet may easily appear
(Galtung, 1969)

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Findings

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Macro-level: Direct Violence
Tents/housing
Sexual violence
Poverty driven transactional sex

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Housing
Life under the tent is not safe, especially for young women.
There was a young woman living under a tent alone, when
three young men came in and violated her. After this
happened, she wanted to take it to the police, however she
was scared that they may come back and kill her. She was
also discouraged because no one felt that the police would
take charge. (FG girls 18-19)

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Sexual Violence
Lack of money is the cause of the violence. A group of men
can break into a house to steal, but when they get there
they find women, they automatically add rape to their list of
crimes, just because. Now the problem is with housing,
women are forced to sleep somewhere that is unsafe. (FG
girls 20-21)

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Poverty driven transactional sex
Because you are not in a good economic situation, if the
person does something for you, you are forced to sleep
with him even if you did not want to. This is another type
of violence because you did it, but did not do it
voluntarily. (FG girls 24)

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Poverty driven transactional sex
In Leogane the young men do not respect women. There is
economic hardship. There is no work and young girls do
not go to school. She decides to sell her body so that she
can eat or to make money to go to school. The men who
have money want young girls. Because she is in need,
whether she was interested in him or not, she sleeps with
him. (FG girls 20-21)

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Macro-level: Indirect Violence
Tent distribution policies
Hunger

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Tent Distribution Policies
It’s the way the NGO’s are distributing the help, which is
causing this increase [violence]. They should be seeking
out the head of the households; they shouldn’t be offering it
to children. The mother has a tent, the brother has a tent,
and everyone gets a tent. And once everyone has their own
tent, they offer them each some food. But in fact it the
distribution should go to the head of the home to avoid all
of this chaos. (FG boys 18-19)

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Tent Distribution Policies
There is more violence. The family is living in camps and
are somewhat separated. The kids make their own little
house and then the parents have no control, this now
opens the door for rape and violence. (FG girls 20-21)

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Hunger
Well it’s something that I can tell you that all Haitians
already know. The major problem is hunger. Hunger. Once
there is hunger in a country, the country will not function
properly. The more a child doesn’t eat properly….
Sometimes, someone doesn’t need to know the person to
offer him or her food. And just that can cause them to do
things they don’t want to do, like have sex without
condoms. And they could then catch HIV. (FG boys 20-21)

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Protective Factors

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Protective Factors
Micro
• Intrapersonal
(hope, goals)
• interpersonal
Meso
• community
support
• social capital
Macro
• education
• employment

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Discussion

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Complexity of Violence
Sites
• Housing
• Community
• NGO
• Police
Levels
• Micro
• Meso
• Macro
Forms
• Latent
• Direct and
indirect
• Physical,
sexual

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Implications for HIV Prevention
Structural: macro
Poverty reduction
Gender-based violence
Education
Housing
Effective law
enforcement
Community: meso
Gender equity
Community mobilization
for social protection
Social capital and
social support
Intra/interpersonal: micro
Intra: resilience, self-
worth, hope
Inter: safer sex
negotiation skills

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Research Implications
Efficacious strategies to promote equitable
gender norms
Structural interventions to address poverty,
violence and HIV prevention
Disconnect: surviving vs. realizing potential

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Acknowledgments
• NEGES Foundation, Leogane, Haiti
• Participants, peer research assistants
• Funders:
– Grand Challenges Canada Rising Star in Global
Health Award
– Canadian Institutes of Health Research (CIHR)
Contact me: carmen.logie@utoronto.ca