HIV Care Provider Perceptions of the Needs of Haitian Migrants Living with HIV in the Dominican Republic

Introduction Human Immunodeficiency Virus (HIV) is one of the greatest global health challenges, but HIV is preventable and can be managed with treatment. Important aspects of HIV prevention include raising awareness, ensuring individuals know their status, and assisting HIV positive individuals with starting and remaining in HIV treatment and care. These primary and secondary prevention strategies are imperative to decreasing the overall burden of HIV in a community and globally. Using the HIV treatment cascade, a framework that outlines stages of HIV care, to drive prevention efforts is integral to achieving the 90-90-90 global HIV targets: 90% of all persons living with HIV (PLWH) are aware of their HIV status, 90% of all PLHIV who know their status are receiving antiretroviral therapy (ART), and 90% of those on ART are virally suppressed. This represents one of the key monitoring strategies and public health significance for supporting expansion and linkage of HIV care, treatment, and prevention services. Additionally, using the cascade can highlight gaps and progress along the continuum of care that can help scientists and practitioners determine the best opportunities for intervention. In 2017, the Centers for Disease Control and Prevention in the Dominican Republic named migrants of Haiti and Dominicans of Haitian descent as their priority population, as this demographic group is diagnosed with HIV at higher rates in comparison to the general population and there are no official HIV prevention programs targeting Haitian migrants. Methods This qualitative needs assessment explored barriers that exist in HIV testing and gaps in the treatment cascade for Haitian migrants in the Dominican Republic from the perspectives of medical doctors and community health workers. Participants of the key informant interviews were recruited through convenience and snowball sampling. The key informant interviews were thematically analyzed using Braun and Clark’s 6-phase framework. Results Participants of the key informant interviews identified barriers to HIV testing and treatment such as, discrimination, HIV-related stigma, income, and politics. Collectively, participants stated recommendations that a targeted program for Haitian migrants living with HIV would need to address these barriers: 1) human rights to decrease discrimination and increase access to services, 2) cultural humility and stigma reduction training for Dominican medical providers, 3) international care coordination (between Haiti and the Dominican Republic) for persons living with HIV/AIDS, and 4) sexual health education. Discussion The results demonstrate that Haitian migrants in the Dominican Republic have many unmet needs and that effectively addressing HIV among this demographic group will require an intersectional approach between human rights policy, systems level trainings, social support, and increased educational and employment opportunities