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Objective This article examines how Haitian families with youth interfacing with the juvenile justice system cope with structural racism and socioethnic discrimination (RSD). Background Haitian families' experiences of discrimination based on their histories, immigrant status, and positionality illustrates the need for more scientific scrutiny of the experiences of RSD among Black immigrant groups. This National Institute on Drug Abuse (NIDA)–funded study details the narratives of and responses to RSD experienced by Haitian families interfacing with the juvenile justice system. Method Data are drawn from psychosocial assessment tools, therapeutic sessions, and ethnographic interviews conducted with Haitian families participating in a family‐based therapeutic intervention. Using critical race theory, we foreground the voices of those negatively impacted and use Bourdieu's theory of practice to examine the intersectionality of race and ethnicity in this population's experiences of RSD. Results The different experiences of and responses to RSD among youth and caregivers of Haitian descent are both a variation of the complex continuum of structural racism in the United States and unique to their immigrant experience of marginalization and cultural invalidation by public institutions, community members, and peers. Conclusion Professionals working with this population must be sensitive to the ways these experiences impact young people's identity development processes, their health, and well‐being. Haitian caregivers should be encouraged to protect their children by engaging in racial and socioethnic socialization that validates their RSD experiences. Implications Understanding the intergenerational experiences of RSD among Black, immigrant groups and encouraging family dialogue and adolescent support will strengthen family cohesion during this period of racial reckoning.

This study examined the relationship between antiretroviral therapy use, participants’ knowledge of partner’s HIV serostatus, number of sex partners, perceived infectivity and HIV disclosure to a main sexual partner among 258 HIV-positive Haitian alcohol users. Only 38.6 % had disclosed their HIV serostatus to sexual partners. Logistic regression analyses revealed that participants who self-reported having an HIV-negative partner (OR = 0.36, 95 % CI 0.13–0.97) or a partner of unknown HIV status (OR = 0.09, 95 % CI 0.04–0.22) were less likely to disclose their HIV serostatus than participants who self-reported having an HIV-positive partner. Participants who had more than one sexual partner in the past 3 months (OR = 0.41, 95 % CI 0.19–0.90) were also less likely to disclose than participants who had one partner. These findings suggest the need for couples-based programs to assist people living with HIV (PLWH) with the disclosure process, especially among PLWH who have more than one sexual partner and/or are in serodiscordant relationships.

Haiti has the highest number of people living with HIV infection in the Caribbean/Latin America region. Medical male circumcision (MMC) has been recommended to help prevent the spread of HIV. We sought to assess knowledge, attitudes, practices and beliefs about MMC among a sample of health care providers in Haiti. A convenience sample of 153 health care providers at the GHESKIO Centers in Haiti responded to an exploratory survey that collected information on several topics relevant to health providers about MMC. Descriptive statistics were calculated for the responses and multivariable logistic regression was conducted to determine opinions of health care providers about the best age to perform MMC on males. Bayesian network analysis and sensitivity analysis were done to identify the minimum level of change required to increase the acceptability of performing MMC at age less than 1 year. The sample consisted of medical doctors (31.0%), nurses (49.0%), and other health care professionals (20.0%). Approximately 76% showed willingness to offer MMC services if they received training. Seventy-six percent believed that their male patients would accept circumcision, and 59% believed infancy was the best age for MMC. More than 90% of participants said that MMC would reduce STIs. Physicians and nurses who were willing to offer MMC if provided with adequate training were 2.5 (1.15-5.71) times as likely to choose the best age to perform MMC as less than one year. Finally, if the joint probability of choosing \"the best age to perform MMC\" as one year or older and having the mistaken belief that \"MMC prevents HIV entirely\" is reduced by 63% then the probability of finding that performing MMC at less than one year acceptable to health care providers is increased by 35%. Participants demonstrated high levels of knowledge and positive attitudes towards MMC. Although this study suggests that circumcision is acceptable among certain health providers in Haiti, studies with larger and more representative samples are needed to confirm this finding.

In Miami-Dade County, women with HIV (WWH) enrolled in Ryan White Program (RWP) services belong to groups that have historically faced structural barriers to care. To examine provider perceptions of WWH's barriers to care and elicit possible solutions, we conducted semi-structured interviews (n = 20) with medical case managers and human immunodeficiency virus (HIV) healthcare providers from medical case management sites serving WWH enrolled in the Miami-Dade RWP. Verbatim transcripts were analyzed thematically by two coders through an iterative process; disagreements were resolved through consensus. Barriers included lack of disclosure and stigma, additional psychosocial barriers to care, structural and logistical barriers, and negative interactions with health care providers. Participant suggestions to address these barriers included strategies that support women and foster individualized services that are responsive to their lived experiences and needs. Other solutions, such as those related to transportation, housing, and general funding for the RWP, will require advocacy and policy change.

Background People with HIV (PWH) from racial and ethnic minority groups in the United States (US) face a high risk for severe COVID-19 outcomes and have low uptake of the COVID-19 vaccine primary series and booster doses. This study aims to provide insights into barriers and facilitators to vaccination and identify strategies to increase vaccine trust and uptake in these populations. Methods Between November and December 2022, we conducted qualitative interviews with 24 vaccinated and unvaccinated adult PWH who self-identified as Hispanic/Latinx, Black/African American, or Haitian, and were clients of the Miami-Dade County Ryan White HIV/AIDS Program in Florida, US. Data were analyzed using deductive thematic analysis. Results Main barriers to vaccine uptake reported by participants included low or no perception of COVID-19 risk, concerns about safety and efficacy related to HIV status, mistrust of COVID-19 vaccines, general vaccine hesitancy, negative experiences and advice against vaccination within social networks, lack of provider recommendation, and exposure to negative messaging and misinformation about vaccines. Facilitators included perceived risk, awareness of the vaccines’ protective benefits for HIV-immunocompromised individuals and reducing transmission, encouragement and role modeling within social networks, provider recommendation, and exposure to accurate information from reputable sources. Some recommended strategies to increase uptake and trust in vaccines included incorporating vaccination into routine HIV care, leveraging peers with HIV, tailoring vaccine information and messaging, and partnering with trusted individuals for outreach. Conclusion Vaccination efforts for PWH should prioritize addressing specific barriers and concerns related to their HIV status and tailoring strategies to meet their needs.

This study examined the impact of individual, peer, family, school, and neighborhood level variables on sexual activity among 276 Haitian-American adolescents. Differences between those who were sexually active and those who were not were analyzed using Chi square and t tests. Significant factors at p ≤ 0.1 were entered into logistic regression for the full group and for girls-only. Half of males and 36.6 % of females were sexually active. The multivariable model revealed that adolescents were more likely to be sexually active if they reported delinquent behaviors; had sexually active friends; and were living with only one parent, friends or relatives. For girls, living with both parents was protective against sexual activity, while substance use and emotional distress were risk factors. No language or acculturation measures were associated with sexual activity. Haitian-American adolescents may benefit from interventions that focus on gender-specific, contextual and cultural factors to prevent early sexual activity.

Patient-provider trust is associated with optimal HIV care engagement and ART adherence. However, cross-cultural examination of trust in providers in this diverse population is limited. The current study examines data from 1272 Miami-Dade County Ryan White Program clients. Study objectives were to explore the psychometric properties of the HCR Trust Scale-Revised translated in Haitian Creole and Spanish and to evaluate similarities and differences in responses to the HCR Trust Scale-Revised across Non-Hispanic Black, Haitian, and Hispanic participants and the English, Haitian Creole, and Spanish translations of the scale. Results indicated that the HCR Trust Scale-Revised has a single structure with good reliability for all groups except Haitian participants, for which response patterns were characterized by low variance and high endorsement of alternative response options. We draw on previous literature examining patient-provider experiences to discuss the importance of considering culture in the measurement of patient-provider trust.

Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented.

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American ( n  = 28), Hispanic/Latina ( n  = 22), or Haitian ( n  = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery.

In this paper, we assessed the preliminary efficacy and acceptability of a quasi-experimental, clinic-based sexual risk reduction pilot intervention for pre-exposure prophylaxis (PrEP)-initiated, alcohol- and other drug-using women of color and explored their self-reported barriers to, and facilitators of, PrEP use. Using a mixed methods design, analyses incorporated pre- and post-intervention study assessment data from 38 women and semi-structured process evaluations using a subsample of 25. The intervention administered over an 8-week period consisted of 4 one-on-one in person educational sessions, a process evaluation, and study assessments conducted at baseline and 3 and 6 months. Post intervention, statistically significant changes in sexual risk scores were not observed; however, we found significant decreases in alcohol use ( Z  =  − 3.02, p  = .003, η 2  = .41). Process evaluation data revealed interpersonal relationships as a key motivator for PrEP initiation as well as a prominent barrier to PrEP use; these relationships rarely facilitated adherence. Overall, women found the intervention to be acceptable and reported a wide range of benefits of participation—most notably its therapeutic benefits. Findings from this study provide preliminary evidence of the potential for the Talking PrEP with Women of Color intervention to improve risky behaviors, knowledge, and attitudes related to sexual risk taking. Furthermore, findings suggest that interventions to increase PrEP uptake and adherence in at-risk women may benefit from supporting them in accurately estimating their risk for HIV and increasing their sense of social support.