Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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.

    Article  Google Scholar 

  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.

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  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.

  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.

  12. Channon AA, Falkingham J, Matthews Z. Sexual and reproductive health and poverty. Social determinants of sexual and reproductive health; 2010. P. 73.

  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.

    Article  Google Scholar 

  14. Central Intelligence Agency. The world factbook 2016. Langley: Central Intelligence Agency; 2016.

    Google Scholar 

  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.

    Article  Google Scholar 

  16. Agha S, Kusanthan T. Equity in access to condoms in urban Zambia. Health Policy Plan. 2003;18(3):299–305.

    Article  Google Scholar 

  17. Connell RW. Gender and power: society, the person and sexual politics. Cambridge: Polity Press; 1987.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  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 

  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.

    Article  Google Scholar 

  26. Maes J, Reed L. State of the microcredit summit campaign report 2012. Washington, DC: MCS; 2012.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  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.

    PubMed  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 

  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.

    Article  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  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.

  42. Kulldorff M. A spatial scan statistic. Commun Stat Theory Methods. 1997;26:1481–96.

    Article  Google Scholar 

  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.

    Article  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 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  49. Garcia-Retamero R, Cokely ET. Communicating health risks with visual aids. Curr Dir Psychol Sci. 2013;22(5):392–9.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  53. Poku NK. UN political declaration on HIV and AIDS: where to begin? Lancet. 2016;388(10046):743–4.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA

    Molly Rosenberg, Maya Luetke, Sina Kianersi & Erik Nelson

  2. Fonkoze Foundation, Port-au-Prince, Haiti

    Reginal Jules & Florence Jean-Louis

Authors
  1. Molly Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reginal Jules
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maya Luetke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sina Kianersi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erik Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Florence Jean-Louis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Molly Rosenberg.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosenberg, M., Jules, R., Luetke, M. et al. Health Education Training Embedded in a Microfinance Platform Associated with Safer Sexual Behavior in Haitian Women. AIDS Behav 23, 2375–2385 (2019). https://doi.org/10.1007/s10461-019-02511-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02511-x

Keywords

Search

Navigation