Joel Piton, MD, M.Ed Reach Us Project Director Center for ...

HIV/AIDS, STIs, TB, and Haitians
Health Beliefs and Practices
Presenter: Joel Piton MD, M.Ed
May 4, 2012

Outline
• Geographic location of Haiti
• Language
• Religion
• HIV/AIDS & TB rates
• Mental Health
• Health beliefs and practices
• Challenges
• Tips while working with Haitians

Learning Objectives
• Provide a better understanding of some of
the health beliefs and practices among
Haitians
• Explore barriers or challenges you may
encounter while working with this
population
• Discuss some strategies that may assist in
your work with Haitians

Haiti

Haiti
• The least developed country (LDC) in the
region
• Literacy rate 52.9% compared to 99.9 %
in Cuba and 62.1% in the Dominican
Republic
• Life expectancy of 53 compared to 75 in
Cuba and 70 in DR
• Per capita $1,200.00 per year

Geographic Area
• First Black Republic (1/01/1804)
• Haiti shares the Island of Hispaniola with
the Dominican Republic
• Land area: 10,641 sq mi (27,560 sq km)
• Population: 9,598,000
• 10% of the population have some sort of
disability

Religion & Languages
Religion
• Catholicism
• Protestantism
• Voodooism
• Others
Languages
• French
• Haitian Creole

Haitian Culture Health Beliefs
• The Haitian health belief system is one
that consists of several networks of
traditional, mystical, and holistic
approaches to health care
• Effective treatment requires providers who
can navigate between the religions
practices in Haiti and modern medicine

Haitian Culture Health Beliefs
Continuation
In the Haitian belief structure,
diseases may be attributed to both:
• Natural Causes
• Supernatural Causes

Natural Illnesses
• Are known as maladi Bon Dye (diseases of
the Lord)
• Are believed to be of short duration
• Is one with familiar symptoms and a
determinate duration

Supernatural Illnesses
• Appear suddenly, without any previous
signs of discomfort
• Is thought by the Haitian to be caused
either by the loa (familial spirit) or by the
dead, curse, spells
• Spirits are thus the prime source of
supernatural illnesses

Degrees of Illness Among Haitians
• I do not feel well “ transitory disturbance”
• I feel sick from time to time
• I am convalescing “recuperating”
• I am sick “ not life threatening”
• I am very sick “ in critical condition”
• I will never be well again “ expect to die”

Haitian Health Care Alternatives
Traditional
Modern
Supernatural
Natural
Public
Physicians
Private
Physicians
Houngan
Mambo
Voodoo Priestess
Mayetizè
Bokò
Fanm Saj
Christian
Catholic Priest
Pastors
Doktè Zo
Pikirist
Docktè Fèy
Chalatan
Mayetizè
J. Piton, M.D.

HIV/AIDS and TB in Haiti
• Haiti has one of the highest rates in the
Caribbean. The rate has declined from 5.
9% in 1996 to 2.2% in recent years
• Estimated population living with HIV/AIDS
was 120,000 in 2007
• Percentage of HIV infected people
receiving Antiretroviral Therapy was 61%
2009

Tuberculosis
• In 2007, the estimated incidence for all
forms of TB disease in Haiti was 306
cases/100,000
• The WHO estimates that 23% of new TB
patients in Haiti are co-infected with HIV.

Impact of the Earthquake
• More than 200,000 deaths
• More than 7000 deaths due to cholera and
the infection continues to spread across
the country
• No long term plan to address the problem
of cholera

Background
• Boston’s HAITIAN community continues
to be one of the city’s fastest growing
ethnic communities.
• The Massachusetts Department of Public
Health (MDPH) estimates that there are
45,000 Haitians living in the city of
Boston, with some statewide estimates as
high as 80,000 (MDPH, 1998).

Historical Context of HIV
• Identified in the early 1980s by CDC as
“4Hs”
• Homosexuals
• Heroin drugs users
• Hemophiliacs
• Haitians

Boston’s Haitian Community
• Haitians comprise

A glimpse on HIV Cases diagnosed from
2003-2005 in Massachusetts
Haiti 17% N=129
Brazil 10% N=72
Dominican Republic 7% N=55
Uganda 6% N=44
Kenya 5% N=40
Source: MDPH

Tuberculosis Rate in Boston
• Mattapan has the highest rate followed by
South Dorchester, then North Dorchester
• Foreign born patients represent almost
70% of all TB cases in MA
• People from the Caribbean have the third
highest rate
• Mattapan and Dorchester are the primary
locations where Haitians live.

Mental Illnesses
• Mental illnesses usually are perceived to be of
supernatural causes
• Access and exposure to traditional mental health
services in Haiti is virtually non-existent
• There are only 23 psychiatrist working in Haiti
• 7 in the public sector and the remaining in the
private one
• Cap Haitian-the second largest city of Haiti does
not have a psychiatrist doctor
• Only 1% of the government’s budget goes to
medical care

Continuation
• There is strong stigma attached to mental
illnesses
• Mental illness can be the result of a spell or
curse
• Psychiatric disorders unless they give raise to
gross social disturbances are of minor practical
importance
• Unless the individual exhibit behaviors patterns
that put the public at risk. It will not be
addressed

Continuation
• There is tremendous shame attached to
mental illness
• The impact of the earthquake has further
exacerbated the mental needs of the
Haitian community back home & in the US
• The earthquake has changed the way
people see mental health and mental
illness in terms of awareness

Common Health Beliefs & Practices
• TB is the disease of the poor
• Malnourished people are the ones who get TB
• TB and AIDS can be caused by spell and are
both highly stigmatized
• BCG vaccine causes PPD test to positive
• Obesity is seen as a sign of wealth
• Being thin is seen as unhealthy and economic
hardship

Continuation
• Hot and cold theory as an explanation for
contracting some diseases such as:
– Pneumonia
– Gonorrhea
– Tuberculosis
– Arthritis
• Sickness is when you have signs and symptoms
• TB infection vs. TB disease is hard to grasp

Continuation
• Fatalistic view: God is on charge
• Prefer syrup over pills
• Try home remedies first or in combination
with prescribed medication
• No history of disease prevention and
screening
• Share prescription drugs
• Time required to build trust

Psychosocial and Economic Factors
• Stress: the every day pills taking is reminder of
their health status
• Side effects
• Mistrust of providers
• Disengagement and non-cooperation due to
racism and stereotypes
• Language barriers
• Other social determinants of health such as:
poverty, immigration status, housing, lack of
health insurance

Continuation
• Stigma & intra-community stigma
• Ignorance
• Denial
• Mistrust among providers and community
members
• Financial and human resources

Expectations in a Medical
Encounter
• Quick diagnosis
• Want to be treated politely
• Physicians are interested in helping them
• Expensive prescriptions are better than
inexpensive ones.
• The use of a stethoscope

Lesson Learned
• The Messenger has to be credible
• Stay out of political drama back home
• Radio and TV are keys for health promotion
• Group Education conducted in their own language works
for this community, it provides them with a forum to
discuss other pertinent issues affecting their lives
• We did not start at the same level compared to other
ethnic groups, meaning more effort and time required to
educate this community
• CBOs could play a tremendous role when it comes to
educate marginalized population like the one we are
serving

Lessons Learned Continuation
• Addressing HIVAIDS, STI, and TB required multiple
approaches
• Need to be addressed while addressing other needs that
are vital for the individual
• The community have to buy in to it to be effective and
involve different stakeholders
• HIV work required patience and determination
• Human and financial resources
• Dedication and Commitment

Recommendation for Health
Promotion
• Know the history and the culture of the
community you are targeting
• Know about pertinent cultural beliefs regarding
cause and treatment of disease
• Role of religion in the patient health
• Effectively utilize community resources
• Meet your target at the level they are at
• Build trust and be consistently consistent
• Aware of ethnic differences

Continuation
• The philosophical basis for culturally
mental health service for Haitians is
accepting and valuing health and related
disease customs and beliefs held by the
population
• In practice, cultural competence means
providing health services in the manner
best understood and accepted by the
people who receive it.

Conclusion
• This framework gives you a better
understanding about the Haitian community
• This framework also does not account for subtle
variations and practices due to subcultures
based on class, education, skin color, and
geographic location
• This framework suggests that the best way to
work with any group is by cultivating trust and
engaging them in the design and
implementation of the interventions

References
• Center for Community Health, Education &
Research, Inc.
• Haitian Health Institute and Technical
Development Corporation
• Common Vision (The added Burden)
• MDPH
• Michel Laguerre
• BPHC