Lehigh University Lehigh Preserve Volume 20 - 2012 Lehigh Review 2012 Poverty, Inequality and Power Dynamics: Women and their Role in the Haitian AIDS Epidemic Emily Purcell Follow this and additional works at: http://preserve.lehigh.edu/cas-lehighreview-vol-20 Recommended Citation Purcell, Emily, "Poverty, Inequality and Power Dynamics: Women and their Role in the Haitian AIDS Epidemic" (2012). Volume 20 - 2012. Paper 38. http://preserve.lehigh.edu/cas-lehighreview-vol-20/38 This Article is brought to you for free and open access by the Lehigh Review at Lehigh Preserve. It has been accepted for inclusion in Volume 20 - 2012 by an authorized administrator of Lehigh Preserve. For more information, please contact [email protected]. Most countries in the Western Hemisphere have reduced their incidence rates of HIV/ AIDS, but Haiti continues to experience alarming increases in diagnosed cases. This paper examines how political turmoil, poverty, violence and gender inequality contribute to the threat of HIV/AIDS throughout this region, and in particular, how POVERTY, gendered societal constraints make women especially INEQUALITY vulnerable by compelling them to prioritize economically- AND POWER beneficial sexual unions over personal health. Only when DYNAMICS: societal and economic factors Women and their Role in the Haitian are identified can a global AIDS Epidemic eradication of the disease become possible. by Emily Purcell Winged Orange (detail) Heather K. Salwach 75 The Haitian AIDS Epidemic: The disease has shifted from prevalence in to the early years when cases of AIDS were An Introduction one gender to another. “By the end of 2007, observed almost exclusively in men, HIV he AIDS pandemic has 53 per cent of all reported cases of HIV in infection in today’s society has now shifted caused great alarm across the country were among women aged 15 to women and children.”7 When the first the globe in the past thirty to 49 years old.”5 The expansion of AIDS cases of the epidemic reached the village years. Initially, research ef- throughout Haiti is fuelled by poverty, of Do Kay, the people infected were inter- forts were launched in an at- various types of sexual union, violence viewed. Out of all the natives of Do Kay, Ttempt to control the spread of the disease: and power dynamics between genders—all “None of the first four villagers diagnosed However, the infection spread rapidly. No of which are factors involved in gender with AIDS had a history of transfusion longer just the disease of Caucasian ho- inequality. Societal expectations and limi- with blood or blood products; none used mosexual men, AIDS has expanded to en- tations for women draw the focus away illicit drugs, and none had a history of ho- compass people of all races, sexual orienta- from personal health and protection and mosexual contact or other ‘risk factors’ as tions, and genders. The shift from distinct towards economic support and stability. designated by the CDC.”8 All four natives risk groups to an entire global population Although dynamics within society did share one characteristic, though—they humbled all prevention efforts. Recent and between genders drive the majority all lived in severe poverty. Many women prevention efforts have resulted in reduced of the AIDS epidemic, women’s biologi- who contracted HIV, like those in Do Kay, or leveled rates of HIV/AIDS incidents in cal vulnerability plays a small role in their were blamed to be sexually promiscu- countries such as such as North and Latin increased infection. HIV is transmitted ous. However, in a cross-sectional study America. Unfortunately, not all regions more easily from men to women than from conducted on pregnant women attending are experiencing such favorable results. women to men. This is because the virus prenatal care in a hospital in Descha- According to the Central Asian Regional “is more highly concentrated in semen pelles, Haiti, “participants were primarily Economic Corporation (CAREC), “The than in vaginal secretions; male ejaculate monogamous, with 61% reporting only Caribbean remains the only region in the is orders of magnitude larger than that of one partner in their entire life…How- Western Hemisphere with steadily increas- females; anatomic considerations clearly ever, despite the monogamous behavior ing rates of HIV.”1 Areas within the Carib- favor viral penetration of the vagina (or by the women, 61% of women reported bean, including the Republic of Haiti, have rectum), in which infected ejaculate may that they perceived their primary partner been struggling to control the disease due easily pool.”6 Although this biological dis- had another partner.”9 Therefore, women to a long history of poverty and political advantage is not the underlying cause of were more at risk not because of their own turbulence. Just before the arrival of HIV/ the epidemic in Haiti, it does highlight the sexual promiscuity, but because of their AIDS, there was a sizeable interval of overall theme of female vulnerability. partners’ activity. Women with only a few political and social turmoil.2 This chaos partners still risked contraction of HIV. undermined preventative efforts, and was The Transition: The Risk Group Subsequent research conducted in the a catalyst for the rapid integration of AIDS Shift impoverished regions of Port-au-Prince into all aspects of Haitian society. Today, When AIDS first emerged in Haiti, the concluded that the “high seropositivity about six percent of Haiti’s adult popula- high risk groups, such as gay men, drug rate (8%) found in pregnant women 14 to tion is infected with HIV (the highest rate users and prostitutes, were blamed for the 19 years of age suggests that women [in of infection in the western hemisphere) spread of the disease. However, as the epi- Cite Soleil] appear to acquire HIV infec- and approximately 30,000 Haitians die demic progressed, it shifted to encompass tion soon after becoming sexually active. from the disease each year.3 Risk of HIV heterosexual couples and genders. It was Moreover, this age group is the only one infection spread from distinct groups, clear in the early phases of the AIDS epi- in which a higher seropositive rate is not such as sex workers and homosexual men, demic that the focus of the prevention pro- associated with a greater number of sexual to encompass the entire Republic of Haiti. grams was prostitutes and their customers. partners. Women with only one sexual Not only was the entire region affected, This was because the destitute conditions partner in the year prior to pregnancy but the demographics of the illness shifted. of Haiti drove women to sell their bodies actually have a slightly higher prevalence Eighty-eight percent of initial cases of to earn enough to survive. However, “the rate…This suggests that they were infected AIDS in Haiti were among men, but by epidemic moved out from these primary by their first and only partner.”10 This 1983, women accounted for about a quar- risk groups to Haitians not at first re- research discounts the former belief that ter to a third of all cases of the disease.4 garded as populations at risk. In contrast sex workers were the ones at highest risk 76 THE LEHIGH REVIEW for contracting HIV. Because of this sig- in rural areas. Searching for conjugal al- around and saw how poor [they] all were nificant seropositivity rate, marriage and liances with men with salaries, such as …It was a way out, that’s how I saw it.’”15 sexual unions are now included in the risk soldiers or truck drivers, suggests women’s Acephie follows the trend of young, rural factors for women along with prostitution economic dependence on men for finan- Haitian women entering sexual unions and drug use. cial security.13 These unions with salaried in exchange for monetary support. Ac- men are an indicator of poverty, one of the cording to Farmer et al., Acephie is by no The Exodus Towards the Cities strongest causes for the increase in infec- means a unique story: “In fact, in each Haiti has experienced a significant amount tion rates in Haiti. case of AIDS diagnosed in Do Kay, young of political unrest, among other tumultu- adults were driven to Port-au-Prince by ous conditions. The spread of the AIDS Poverty, Inequality, and Sexual the lure of an escape from the harshest epidemic is fueled not only by poverty and Unions poverty…women were straightforward economic instability, but also by political Poverty has been an issue in Haiti ever about the non-voluntary aspect of their crisis. This is due to the fact that “anarchy since colonists started producing sugar sexual unions: in their opinions, they had and violence are likely to lead to higher cane as a cash crop. Foreigners exploited been driven into unfavorable unions by rates of rape, and women in isolated areas the countryside and its inhabitants, and poverty.”16 Unfortunately, because many who have no access to food for their fami- Haiti was left impoverished and desolate. of these sexual unions are nonbinding, the lies might be driven to form partnerships Numerous political upheavals and a his- men are free to leave the women without with soldiers or truckers.”11 Because of the tory of political unrest have encumbered consequence at any point in the relation- political unrest, the economy of Haiti is Haiti with massive losses in unemploy- ship. According to marriage laws in Haiti, dwindling. People who live in the rural ment, education, and health care. These a husband is obligated to support his wife Haitian countryside travel to cities such issues affect all inhabitants of Haiti, but and children. However, “less than 25 as the capital Port-au-Prince in search “women pay the greatest price in terms of percent of Haitian men and women aged of better economic opportunity.