Health Education Training Embedded in a Microfinance Platform Associated with Safer Sexual Behavior in Haitian Women
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.
KeywordsMicrofinance HIV STI Sexual behavior Haiti
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.
- 2.Joint United Nations Programme on HIV/AIDS. The Gap Report. Geneva: UNAIDS; 2014.Google Scholar
- 3.UNAIDS. Country Fact Sheet: Haiti. 2017. http://www.unaids.org/en/regionscountries/countries/haiti.
- 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
- 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.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.Channon AA, Falkingham J, Matthews Z. Sexual and reproductive health and poverty. Social determinants of sexual and reproductive health; 2010. P. 73.Google Scholar
- 14.Central Intelligence Agency. The world factbook 2016. Langley: Central Intelligence Agency; 2016.Google Scholar
- 17.Connell RW. Gender and power: society, the person and sexual politics. Cambridge: Polity Press; 1987.Google Scholar
- 24.Pomeranz D. The promise of microfinance and women’s empowerment: what does the evidence say? Netherlands: Ernst & Young Study; 2014.Google Scholar
- 26.Maes J, Reed L. State of the microcredit summit campaign report 2012. Washington, DC: MCS; 2012.Google Scholar
- 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.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.UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, et al. Facts for life. 4th ed. New York: UNICEF; 2010.Google Scholar
- 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
- 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.SAS. 9.4 ed. Cary, NC: SAS Institute Inc.; 2014.Google Scholar
- 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