Relationship between low self-esteem and risky sexual behavior among young Haitian women: Two qualitative studies in Port-Au-Prince, Haiti.

摘要

INTRODUCTION: In spite of the numerous research studies and policy changes regarding HIV and AIDS, HIV remains highly prevalent in Haiti with a rate of 2.2%. The objective was to identify the factors that drive the HIV epidemic and the reasons for not using condoms among young Haitian women.;Background. An important change in the epidemiology of AIDS is that it is becoming increasingly more prevalent among young women.;Methods. This qualitative study, nested in another study, had all twenty-one participants who gave their consent answering at baseline a series of five open-ended questions during one and one interviews.;Results. When asked about life satisfaction and perception, the overarching themes that emerged during these interviews are dependence, obligation to meet societal and gender based norms. There is a deep sense of obligation to fulfill gender and societal norms that leads to economic dependence on men and therefore creates opportunities taking risk. Despite hardships, they were resolved to be better and improve economic situation for themselves and their family. This resourcefulness and general sense of well-being because they were "free from HIV infections" were associated with optimism and a certain faith in the future. These women had therefore a "by any means necessary" attitude that enabled them to persevere.;MANUSCRIPT I -- Understanding the Factors that Drive the HIV Epidemic among Young Haitian Women: Lessons learned in the Process of Developing a Theoretically Based Intervention.;Conclusion. Young Haitian women with low socio-economic background may engage in risky sexual behavior because of poor quality of life, little social support and lack of economic leverage. Gender role in the context of societal norms may modulate self-perception. Risk taking may correlate with perception of higher purpose and optimism may derive from the "by any means necessary" attitude, strong family ties or even faith. Perception of risk may depend on the perception of severity of the disease and self-efficacy in the absence of economic independence may have less relevance.;MANUSCRIPT II -- Challenges in Condom Use among Young Haitian Women: Lessons Learned through a qualitative Study.;Background. Promotion of condom use remains to date the most efficient weapon in the fight against HIV/AIDS.;Methodology. This qualitative study nested in a larger study, with a subsample of nineteen participants who gave their consent, answering during one and one interviews two subscales on perceived susceptibility to disease and on perceived barriers to condom use. Detailed field notes were taken in the process of exchanging and brainstorming on the reason for not using condom and self-perception was the focus of the second session.;Results. When asked about condom use the prevalent themes that emerged were condom itself, negative "attitude" toward condom use, coping with the risk, and the structural determinants. There is an implication that external forces like economic dependency and the man's needs may supersede every other aspects; this notion equated to not using condom and therefore leads to sexual risk. However, these women are determined to improve their quality of life. Therefore, education and economic empowerment are the common aspirations.;Conclusion. In conclusion, young women with low socioeconomic background may fail to use condom due to misconceptions rooted in certain beliefs. By giving the proper skills to these women, condom use can be more effective. The social and environmental context may be as important as the participant's self-efficacy to ensure sustainability, of condom use, over time. Participants' views on education and economic empowerment suggest that a tailored intervention offering those components, will further the fight against HIV and will be well received.