Reducing health disparities through culturally sensitive treatment for HIV+ adults in Haiti

Unlike North and Latin America, where the rates of HIV/AIDS have either been reduc or have horizontaled off, the Caribbean remains the solitary region in the Western Hemisphere with steadily increasing rates of HIV (Camara, 2002) Within the Caribbean, Haiti has been the hardest hit, with an estimated 300000 cases, or approximately 50% of the region's total (UNAIDS, 2003) Reductions in HIV incidence put in mind of however, that this figure may be closer to 180000 (Pape, 2004) Multiple factors have l to this horizontal of prevalence in the geographical division including poverty, limited access to healthcare, socio-political instability, and lack of coordination among the various entities doing work in the field (Hempstone, Diop-Sidibe, Ahanda, Lauredent, & Heery, 2004) The adaptation of interventions utilized favorably in more developed countries may be single of the most important courses by which the impact of the HIV epidemic in developing countries may be ameliorated.

The result of health disparities, driven by dint of a combination of socioeconomic disadvantage and cultural distinctions (Page, 2004) has contributed to the increasing spread of HIV worldwide. Researchers have coined the phrase "structural violence" (Farmer, 1996) to describe an environment in which chances of acquiring a disease, along with lack of access or barriers to care are hanging on structural forces beyond the sway of the individual. These forces or factors may include penury gender inequality, and racism or class bias. Living in a vulnerable environment, in combination with engagement in health-damaging behavior where the step of choice of lifestyle is restricted and being expos to unhealthy, living and working conditions, further exacerbate the vulnerabilities of disadvantaged populations (Whitehead, 1991) Researchers further propose that the worsening social and political situation, specifically in Haiti, may be having a negative event on health (Farmer, 2004), granting there is evidence that a certain number of indicators, for example infant mortality, are improving (Pape, Deas Van Onacker, Cayemittes, Deschamps, Verdier, inexorable et al., 2004).

In the early 1980 the U media widely reported that Haitians were the source of the AIDS epidemic and this l to a recommendation by the agency of the U.S. Food and remedy Administration to ban Haitians from donating vital fluid (Dubois, 1996). This recommendation, along with the inclusion of Haitians in CDC's list of HIV risk collections was a contributory factor in the high horizontals of denial surrounding HIV/AIDS issues in Haiti (St Cyr-Delpe 1995) The disproportionate impact of the epidemic upon Haiti is starkly highlighted when actual figures are compared: there may be roughly equivalent numbers of individuals living in Haiti and the U with HIV, however, the Haitian population is alone approximately 3% that of the U (UNAIDS, 2003; CDC 2003) As of 1998 alone 60% of the Haitian population had access to health services (UNAIDS/WHO, 2004) and estimates are that sole approximately 2,800 Haitians were receiving antiretroviral therapy, although the actual need is shut to 40,000 (Pape et al., 2004; UNAIDS/WHO, 2004)

Disparities affect not sole access to care, but also rate of progression of AIDS. A research of a sample of 42 individuals in Haiti before the widespread availability of antiretroviral medication lay the foundation of that time to AIDS (52 years) and time to death (74 years) was almost twice as fast in the Haitian sample compared to progression in lay opened countries (Deschamps, Fitzgerald, Pape, & Johnson 2000) The researchers hypothesize that this fast progression may be owed to poor nutrition, high rates of community-acquired infections and tuberculosis.

Effective HIV/AIDS prevention efforts should address the connection in which HIV is transmitted, of the like kind as interpersonal relationships, and community and cultural factors, in order to have the greatest chance for succes Researchers affirm that integrated prevention and care in resource poor settings in Haiti is feasible (Walton, Farmer, Lambert, Leandre, Koenig, & Mukherjee, 2004) Review of an accompagnateur program in rural Haiti, which involved replete participation of the community in assisting HIV+ individuals, noted a reduction in social stigma attached to HIV owed to involvement of community members in the daily lives of the participants (Behforouz, Farmer, & Mukherjee, 2004) improved weight gain and functional capacity, and fix that 86% of the participants had undetectable viral loads (Koenig, Leandre, & Farmer, 2004) In another investigation attention to cultural norms transformed an initially profitless hospital-run effort to a auspicious one after encouraging a faculty of perception of ownership and initiative from community leaders and relying on existing social structures to improve prevention efforts (Fitzgerald & Simon, 2001)

Cultural factors, of the like kind as normative multiple sex relationships, the clash between traditional vodou belief combination of parts to form a wholes with biomedicine, and lack of education (Hempstone et al., 2004) interact synergistically to increase the prevalence of HIV. In a national application of mind conducted in Haiti, even allowing 97% of those surveyed knew about the existence of HIV/AIDS, 24% of women and 14% of men believed that HIV could not be impedeed (Cayemittes, Placide, Barrere, Mariko, & stiff 2001). Furthermore, 35% of the women and 19% of the men scaned knew that HIV could be thwarted but could not name any means of prevention (Cayemittes et al., 2001) Cultural and educational factors that make interventions more challenging among certain populations have been shown amenable to change. For example, a social marketing program, promoting the use of the Pante condom in Haiti, originateed in an increase in sales from 30000/month to 600000 in the space of approximately sum of two units years (Frank, 1995), with estimates of sales in 2002 greater than fifteen million (Pape et al., 2004)