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i Distribution Agreement In presenting this thesis or dissertation as a partial fulfillment of the requirements for an advanced degree from Emory University, I hereby grant to Emory University and its agents the non-exclusive license to archive, make accessible, and display my thesis or dissertation in whole or in part in all forms of media, now or hereafter known, including display on the world wide web. I understand that I may select some access restrictions as part of the online submission of this thesis or dissertation. I retain all ownership rights to the copyright of the thesis or dissertation. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. Signature: ________________________ ________________ Dorie Josma Date ii Development and implementation of a sexually transmitted infections (STIs) and HIV education curriculum for at-risk young people and adults in rural communities in Haiti: A Special Studies Project By: Dorie Josma, B.S. Master of Public Health Hubert Department of Global Health _______________________________ Roger Rochat, MD Committee Chair iii Development and implementation of a sexually transmitted infections (STIs) and HIV education curriculum for at-risk young people and adults in rural communities in Haiti: A Special Studies Project By: Dorie Josma, B.S. Bachelor of Science in Nutritional Sciences University of Florida 2017 Thesis Chair: Roger Rochat, MD An abstract of A thesis submitted to the Faculty of the Rollins School of Public Health of Emory University in partial fulfillment of the requirements for the degree of Master of Public Health in Global Health 2019 iv Abstract Development and implementation of a sexually transmitted infections (STIs) and HIV education curriculum for at-risk young people and adults in rural communities in Haiti: A Special Studies Project By: Dorie Josma Background: In Haiti, sexually transmitted infections (STIs) and HIV education and services are less accessible in rural areas than in urban areas. Often, local clinics and grassroots organizations that play a significant role in supplying healthcare services to rural communities lack the resources to provide STIs and HIV-centered education and services. A plethora of research data has revealed an increase in prevalence and incidence rates of STIs and HIV infections among people living in rural communities. Additional research has also recommended increasing STIs and HIV education to improve people’s knowledge of sexual health and prevention methods against STIs and HIV. Purpose: The purpose of this thesis was to develop a culturally appropriate STIs and HIV education curriculum that can be implemented in health and local community organizations in rural areas in Haiti. The five-module STIs and HIV education curriculum was designed to provide health educators with a tool that they can use to increase STIs and HIV knowledge among people living in rural communities. Methods: The STIs and HIV education curriculum was developed with inputs from clinic staff from NOVA Hope for Haiti, Inc (NOVA) and community members in Cavaillon, Haiti. The project team utilized qualitative research, the Health Belief Model (HBM), and Community Based Participatory Action Research (CBPAR) to enhance curriculum development and implementation. The STIs and HIV education curriculum, consisting of five modules, was implemented at a community health organization (NOVA) and was evaluated using pre-and- post-tests and a course evaluation survey. Results: An average of 25 community members between the ages of 18-35 years old participated in the sexual and reproductive health (SRH) education project. The SRH project lasted two hours for five days, followed by an optional four-hour Training-of-Trainers session on a separate day. Pre-and-post-test evaluations showed a statistically significant improvement in knowledge among participants. The curriculum was revised, and a final curriculum was created based on inputs from the participants, clinic staff, and classroom observations. Discussion: The STIs and HIV education curriculum provides a tool that can be used to educate community members in rural parts of Haiti about STIs and HIV. It can also serve as a foundation to develop a more comprehensive sexual health education curriculum. Additionally, educational interventions are not enough to change health behaviors. Implementation of behavioral-change interventions may be necessary to improve adoption of healthy sexual health practices. v Development and implementation of a sexually transmitted infections (STIs) and HIV education curriculum for at-risk young people and adults in rural communities in Haiti: A Special Studies Project By Dorie Josma, B.S. Bachelor of Science in Nutritional Sciences University of Florida 2017 Thesis Chair: Roger Rochat, MD A thesis submitted to the Faculty of the Rollins School of Public Health of Emory University in partial fulfillment of the requirements for the degree of Master of Public Health in Global Health 2019 vi Acknowledgments I must publicly acknowledge my life companion, God, who, since I started my Master of Public Health journey at the Rollins School of Public Health (RSPH), Emory University, responded to my request to create this exact thesis. Forever will You be praised. I would like to thank myself for my dedication to the vision and for pushing forward through this testing phase of my academic career. I’d like to thank Dr. Joanne McGriff, my practicum advisor, for your support, assistance, and affirmation; you believed in the project in its entirety when most people doubted it. To my thesis committee chair, Dr. Roger Rochat, thank you for advising me and allowing me to create what I had envisioned for this thesis. I would like to thank my co-researcher and friend, Cassandra Savino. Your passion, dedication, and motivation to our project inspired me and kept me motivated all the way through. A special thank you to the NOVA Hope for Haiti, Inc. (NOVA) board, Dr. Nixon Altenord, and the clinic staff for your support. My most profound appreciation goes to the community of Cavaillon for having welcomed me, encouraged me, and participated in all aspects of the health education project. Lastly, I would like to thank my friends and family for supporting me throughout this journey. “5 Trust in the Lord with all your heart and lean not on your own understanding; 6 in all your ways submit to him, and he will make your paths straight.” (New International Version, Proverbs 3:5-6) vii Table of Contents CHAPTER 1: INTRODUCTION AND BACKGROUND ............................................................................... 1 PROBLEM STATEMENT ............................................................................................................................................. 1 PURPOSE STATEMENT .............................................................................................................................................. 2 INTRODUCTION ......................................................................................................................................................... 2 The Burden of STIs and HIV in Haiti ................................................................................................................ 2 STIs and HIV Education Curriculum Development.......................................................................................... 4 STIs and HIV Education Curriculum Implementation ..................................................................................... 5 DEFINITION OF TERMS AND ABBREVIATIONS ......................................................................................................... 6 CHAPTER 2: LITERATURE REVIEW ......................................................................................................... 9 PEARL OF THE ANTILLES ......................................................................................................................................... 9 Geography ............................................................................................................................................................ 9 Structure............................................................................................................................................................... 9 Culture ............................................................................................................................................................... 10 Demographics of Haiti ...................................................................................................................................... 10 Government ........................................................................................................................................................ 11 History of Haiti .................................................................................................................................................. 11 Poverty in Haiti .................................................................................................................................................. 13 OVERVIEW OF SEXUALLY TRANSMITTED INFECTIONS (STIS) ............................................................................ 15 SEXUALLY TRANSMITTED INFECTIONS (STIS) IN HAITI ...................................................................................... 17 STIS AND HIV EDUCATION EFFORTS IN RURAL COMMUNITIES ........................................................................
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