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Health Education Training Embedded in a Microfinance Platform Associated with Safer Sexual Behavior in Haitian Women

  • Molly RosenbergEmail author
  • Reginal Jules
  • Maya Luetke
  • Sina Kianersi
  • Erik Nelson
  • Florence Jean-Louis
Original Paper

Abstract

Sexual health education interventions have generally yielded modest impact, but may be more successful when integrated into programs designed to alleviate poverty and empower women. Between December 2017 and February 2018, we interviewed 304 Haitian female microfinance clients, 75 of whom had received health education training delivered within their regular meetings. Participants reported six key sexual health outcomes. We used log-binomial models to estimate the association between health education training and each outcome, and tested for interaction by age and literacy status. Women with health education training reported more condom use with unfaithful partners [PR (95% CI) 1.78 (1.04, 3.02)], more HIV testing [PR (95% CI) 1.56 (1.28, 1.90)], and fewer STI symptoms [PR (95% CI) 0.37 (0.19, 0.73)], compared to women with no training. Some of the associations were stronger among older women [e.g. HIV testing: PR (95% CI) 2.09 (1.49, 2.82)] and illiterate women [e.g. condom use: PR (95% CI) 3.46 (1.05, 11.38)]. These findings add to the growing body of evidence demonstrating the potential to use microfinance programs as platforms for health education delivery, and provide the first evidence for the association in Haiti.

Keywords

Microfinance HIV STI Sexual behavior Haiti 

Notes

Acknowledgements

The authors are very grateful to all involved in the field research and data collection activities including fieldworkers (Phidler Etienne, Donald Louis, Roltila Antoine, Keketie Ibo Nella Leopold), the Fonkoze Okay branch manager (Jn Moise Jean Pierre), and, most importantly, the study participants themselves. This project was supported by a Project Development Team within the Indiana CTSI NIH/NCRR (Grant Numbers UL1TR001108, PDT 744) and by the Indiana University Vice Provost for Research through the Faculty Research Support Program. Reginal Jules and Florence Jean-Louis are employed by Fonkoze. Molly Rosenberg, the corresponding author, had full access to the complete dataset, was responsible for data analysis, and had the final responsibility to decide to submit for publication.

References

  1. 1.
    Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet (London, England). 2008;372(9639):669–84.CrossRefGoogle Scholar
  2. 2.
    Joint United Nations Programme on HIV/AIDS. The Gap Report. Geneva: UNAIDS; 2014.Google Scholar
  3. 3.
    UNAIDS. Country Fact Sheet: Haiti. 2017. http://www.unaids.org/en/regionscountries/countries/haiti.
  4. 4.
    Republique D’Haïti Ministere de la Sante Publique et de la Population. Declaration d’engagement sur le VIH/sida: Rapport de situation nationale, Haïti, 2016.Google Scholar
  5. 5.
    Fawzi MS, Lambert W, Singler J, Koenig S, Leandre F, Nevil P, et al. Prevalence and risk factors of STDs in rural Haiti: implications for policy and programming in resource-poor settings. Int J STD AIDS. 2003;14(12):848–53.CrossRefGoogle Scholar
  6. 6.
    Jobe KA, Downey RF, Hammar D, Van Slyke L, Schmidt TA. Epidemiology of sexually transmitted infections in rural southwestern Haiti: the Grand’Anse Women’s Health Study. Am J Trop Med Hyg. 2014;91(5):881–6.CrossRefGoogle Scholar
  7. 7.
    Bristow CC, Desgrottes T, Cutler L, Cutler D, Devarajan K, Ocheretina O, et al. The aetiology of vaginal symptoms in rural Haiti. Int J STD AIDS. 2014;25(9):669–75.CrossRefGoogle Scholar
  8. 8.
    Fitzgerald DW, Behets F, Caliendo A, Roberfroid D, Lucet C, Fitzgerald JW, et al. Economic hardship and sexually transmitted diseases in Haiti’s rural Artibonite Valley. Am J Trop Med Hyg. 2000;62(4):496–501.CrossRefGoogle Scholar
  9. 9.
    Lo NC, Lowe A, Bendavid E. Abstinence funding was not associated with reductions in HIV risk behavior in sub-Saharan Africa. Health Aff. 2016;35(5):856–63.CrossRefGoogle Scholar
  10. 10.
    Institut Haïtien de l’Enfance (IHE) [Haïti] et ICF. 2016-2017 Enquête Mortalité, Morbidité et Utilisation des Services (EMMUS-VI): Indicateurs Clés. Rockville, Maryland, et Pétion- Ville, Haïti: IHE et ICF, 2017.Google Scholar
  11. 11.
    Cayemittes M, Busangu M, Bizimana J, Barrère B, Sévère B, Cayemittes V. Enquête Mortalité, Morbidité et Utilisation des Services, Haïti. 2012. Calverton, Maryland, USA: MSPP, IHE and ICF International; 2013. 2012.Google Scholar
  12. 12.
    Channon AA, Falkingham J, Matthews Z. Sexual and reproductive health and poverty. Social determinants of sexual and reproductive health; 2010. P. 73.Google Scholar
  13. 13.
    Krishnan S, Dunbar MS, Minnis AM, Medlin CA, Gerdts CE, Padian NS. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. Anne N Y Acad Sci. 2008;1136(1):101–10.CrossRefGoogle Scholar
  14. 14.
    Central Intelligence Agency. The world factbook 2016. Langley: Central Intelligence Agency; 2016.Google Scholar
  15. 15.
    Dorjgochoo T, Noel F, Deschamps MM, Theodore H, Charles S, Dupont W, et al. Risk factors for HIV infection among Haitian adolescents and young adults seeking counseling and testing in Port-au-Prince. J Acquir Immune Defic Synd. 2009;52(4):498.CrossRefGoogle Scholar
  16. 16.
    Agha S, Kusanthan T. Equity in access to condoms in urban Zambia. Health Policy Plan. 2003;18(3):299–305.CrossRefGoogle Scholar
  17. 17.
    Connell RW. Gender and power: society, the person and sexual politics. Cambridge: Polity Press; 1987.Google Scholar
  18. 18.
    Wamoyi J, Stobeanau K, Bobrova N, Abramsky T, Watts C. Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc. 2016;19(1):20992.CrossRefGoogle Scholar
  19. 19.
    Luke N, Goldberg RE, Mberu BU, Zulu EM. Social exchange and sexual behavior in young women’s premarital relationships in Kenya. J Marriage Fam. 2011;73(5):1048–64.CrossRefGoogle Scholar
  20. 20.
    Pettifor A, Macphail C, Nguyen N, Rosenberg M. Can money prevent the spread of HIV? A review of cash payments for HIV prevention. AIDS Behav. 2012;16:1729.CrossRefGoogle Scholar
  21. 21.
    Rosenberg MS, Seavey BK, Jules R, Kershaw TS. The role of a microfinance program on HIV risk behavior among Haitian women. AIDS Behav. 2011;15(5):911–8.CrossRefGoogle Scholar
  22. 22.
    Isangula KG. Improving women and family’s health through integrated microfinance, health education and promotion in rural areas. J Sustain Dev. 2012;5(5):76.CrossRefGoogle Scholar
  23. 23.
    Hargreaves JR, Delany-Moretlwe S, Hallett TB, Johnson S, Kapiga S, Bhattacharjee P, et al. The HIV prevention cascade: integrating theories of epidemiological, behavioural, and social science into programme design and monitoring. Lancet HIV. 2016;3(7):e318–22.CrossRefGoogle Scholar
  24. 24.
    Pomeranz D. The promise of microfinance and women’s empowerment: what does the evidence say? Netherlands: Ernst & Young Study; 2014.Google Scholar
  25. 25.
    Leatherman S, Metcalfe M, Geissler K, Dunford C. Integrating microfinance and health strategies: examining the evidence to inform policy and practice. Health Policy Plan. 2012;27(2):85–101.CrossRefGoogle Scholar
  26. 26.
    Maes J, Reed L. State of the microcredit summit campaign report 2012. Washington, DC: MCS; 2012.Google Scholar
  27. 27.
    Witte SS, Aira T, Tsai LC, Riedel M, Offringa R, Chang M, et al. Efficacy of a savings-led microfinance intervention to reduce sexual risk for HIV among women engaged in sex work: a randomized clinical trial. Am J Public Health. 2015;105(3):e95–102.CrossRefGoogle Scholar
  28. 28.
    Spielberg F, Crookston BT, Chanani S, Kim J, Kline S, Gray BL. Leveraging microfinance to impact HIV and financial behaviors among adolescents and their mothers in West Bengal: a cluster randomized trial. Int J Adolesc Med Health. 2013;25(2):157–66.CrossRefGoogle Scholar
  29. 29.
    Pronyk PM, Kim JC, Abramsky T, Phetla G, Hargreaves JR, Morison LA, et al. A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS (London, England). 2008;22(13):1659–65.CrossRefGoogle Scholar
  30. 30.
    Arrivillaga M, Salcedo JP, Pérez M. The IMEA project: an intervention based on microfinance, entrepreneurship, and adherence to treatment for women with HIV/AIDS living in poverty. AIDS Educ Prev. 2014;26(5):398–410.CrossRefGoogle Scholar
  31. 31.
    Stratford D, Mizuno Y, Williams K, Courtenay-Quirk C, O’leary A. Addressing poverty as risk for disease: recommendations from CDC’s consultation on microenterprise as HIV prevention. Public Health Rep. 2008;123(1):9–20.CrossRefGoogle Scholar
  32. 32.
    Lorenzetti LM, Leatherman S, Flax VL. Evaluating the effect of integrated microfinance and health interventions: an updated review of the evidence. Health Policy Plan. 2017;32(5):732–56.Google Scholar
  33. 33.
    Tucker M, Tellis W. Microfinance institutions in transition: Fonkoze in haiti moves toward regulated banking status. ESR Rev. 2005;7(2):101.Google Scholar
  34. 34.
    UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, et al. Facts for life. 4th ed. New York: UNICEF; 2010.Google Scholar
  35. 35.
    Abels MD, Blignaut RJ. Sexual-risk behaviour among sexually active first-year students at the University of the Western Cape,South Africa. Ajar-Afr J Aids Res. 2011;10(3):255–61.CrossRefGoogle Scholar
  36. 36.
    Chatterji M, Murray N, London D, Anglewicz P. The factors influencing transactional sex among young men and women in 12 sub-saharan African countries. Soc Biol. 2005;52(1–2):56–72.Google Scholar
  37. 37.
    Cluver L, Orkin M, Boyes M, Gardner F, Meinck F. Transactional sex amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty. JAIDS J Acqir Immune Defic. 2011;58(3):336–43.CrossRefGoogle Scholar
  38. 38.
    Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L. Transactional relationships and sex with a woman in prostitution: prevalence and patterns in a representative sample of South African men. BMC Public Health. 2012;12:325.CrossRefGoogle Scholar
  39. 39.
    Ranganathan M, Heise L, Pettifor A, Silverwood RJ, Selin A, MacPhail C, et al. Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection. J Int AIDS Soc. 2016;19:20749.CrossRefGoogle Scholar
  40. 40.
    Wamoyi J, Stoebenau K, Kyegombe N, Heise L, Ranganathan M. STRIVE technical brief: transactional sex and HIV risk. Washington, DC: International Center for Research on Women; 2018.Google Scholar
  41. 41.
    SAS. 9.4 ed. Cary, NC: SAS Institute Inc.; 2014.Google Scholar
  42. 42.
    Kulldorff M. A spatial scan statistic. Commun Stat Theory Methods. 1997;26:1481–96.CrossRefGoogle Scholar
  43. 43.
    Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, et al. Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa. Bull World Health Organ. 2009;87:824–32.CrossRefGoogle Scholar
  44. 44.
    Dunford C. Building better lives: sustainable integration of microfinance and education in child survival, reproductive health, and HIV/AIDS prevention for the poorest entrepreneurs. J Microfinance/ESR Rev. 2001;3(2):2.Google Scholar
  45. 45.
    Hamad R, Fernald LC, Karlan DS. Health education for microcredit clients in Peru: a randomized controlled trial. BMC Public Health. 2011;11(1):51.CrossRefGoogle Scholar
  46. 46.
    Mwale M, Muula A. Systematic review: a review of adolescent behavior change interventions [BCI] and their effectiveness in HIV and AIDS prevention in sub-Saharan Africa. BMC Public Health. 2017;17(1):718.CrossRefGoogle Scholar
  47. 47.
    Scott-Sheldon AJL, Walstrom P, Harrison A, Kalichman SC, Carey MP. Sexual risk reduction interventions for HIV prevention among South AfricanYouth: a meta-analytic review. Curr HIV Res. 2013;11(7):549–58.CrossRefGoogle Scholar
  48. 48.
    Peregrin T. Picture this: visual cues enhance health education messages for people with low literacy skills. J Am Diet Assoc. 2010;110(5):S28–32.CrossRefGoogle Scholar
  49. 49.
    Garcia-Retamero R, Cokely ET. Communicating health risks with visual aids. Curr Dir Psychol Sci. 2013;22(5):392–9.CrossRefGoogle Scholar
  50. 50.
    Rosenberg MS, Gómez-Olivé FX, Rohr JK, Houle BC, Kabudula CW, Wagner RG, et al. Sexual behaviors and HIV status: a population-based study among older adults in rural South Africa. J Acquir Immune Defic Syndr (1999). 2017;74(1):e9.CrossRefGoogle Scholar
  51. 51.
    Arán-Matero D, Amico P, Arán-Fernandez C, Gobet B, Izazola-Licea JA, Avila-Figueroa C. Levels of spending and resource allocation to HIV programs and services in Latin America and the Caribbean. PLoS ONE. 2011;6(7):e22373.CrossRefGoogle Scholar
  52. 52.
    Stover J, Bollinger L, Izazola JA, Loures L, DeLay P, Ghys PD, et al. What is required to end the AIDS epidemic as a public health threat by 2030? The cost and impact of the fast-track approach. PLoS ONE. 2016;11(5):e0154893.CrossRefGoogle Scholar
  53. 53.
    Poku NK. UN political declaration on HIV and AIDS: where to begin? Lancet. 2016;388(10046):743–4.CrossRefGoogle Scholar
  54. 54.
    Isbell MT, Kilonzo N, Mugurungi O, Bekker L-G. We neglect primary HIV prevention at our peril. Lancet HIV. 2016;3(7):e284–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and BiostatisticsIndiana University School of Public HealthBloomingtonUSA
  2. 2.Fonkoze FoundationPort-au-PrinceHaiti

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