Political impunity and HIV vulnerability among Haitian female sex workers in the Dominican Republic

Author(s): E. Felker Kantor, Y. Donatstorg, B. Gomez, K. Andrinopoulos

Year: 2018

Abstract:

This poster was presented at the 2018 International AIDS Conference. 

Background: In the Dominican Republic (DR), Haitian female sex workers (FSWs) are at increased risk for HIV (5.4% HIV prevalence vs. 0.7% national HIV prevalence). Haitian FSWs in the DR exist in a context of political impunity resulting from lack of citizenship and the liminal criminality of sex work. Exploratory research was conducted to understand the vulnerability of Haitian FSWs to HIV in the DR.

Methods: In-depth interviews were conducted with 40 FSWs of Haitian descent (two interviews each) in Puerto Plata (n=20) and Santo Domingo (n=20). Semi-structured guides asked about sex work, family and social networks, HIV risk behavior, gender and ethnic identity following an intersectional framework. Interviews were recorded and transcribed for thematic analysis.

Results: Participants reported high risk for HIV including low HIV knowledge, alcohol use prior to sex, and challenges in negotiating condom use with clients. Relative to Dominicans, participants reported that they were more likely to be street-based (versus venue), charged less per client, and were more often threatened by the client for deportation. While described as not ideal, sex work was noted as one of the few economic opportunities available to Haitian women. Participants described both spiritual and biomedical illness narratives related to HIV. Discrimination in the healthcare setting was reported, but access to HIV testing and care was seen as feasible. Participants reported experience with and fear of violence from male clients.

Conclusions: Haitian FSWs, similar to other stateless populations globally, are doubly at risk for HIV and in need of increased access to HIV education, substance use services, and condom negotiation skills. Street-based sex work combined with the threat of deportation increases their risk of violence and lowers their ability for condom negotiation. Health services targeted to this population should accommodate their belief in both spiritual and biomedical causes of HIV.