Abstinence, Fidelity, Condom Use and the Stabilization of the AIDS Epidemic in Haiti Antoine Augustin MD, MPH Centre dAnalyse des Politiques de Santé

HIV Prevalence among Pregnant Women, Haiti, Source: IHE/GHESKIO 1993, 1996, 2000

Source: IHE /GHESKIO 1993, 1996, 2000; MARCH 2003

HAITI AND AIDS

Country context 8 million people 10,000 square miles 40% urban Per capita income: US$ Centre dAnalyse des Politiques de Santé MIREBALAIS

Trends in per capita GNP Centre dAnalyse des Politiques de Santé Source: BRH 2002; CAPS 2003

Trends in infant mortality Centre dAnalyse des Politiques de Santé Source: EHF 1978; DHS 1994; DHS 2000

Per capita income and IMR Centre dAnalyse des Politiques de Santé Source: BRH 2000; CAPS 2003

METHODS Secondary data analysis from DHS surveys (1994 and 2000) Secondary data analysis from DHS surveys (1994 and 2000) Secondary data analysis from sentinel site seroprevalence surveys of 1993, 1996 and 2000 Population-based data analysis from central Haiti Review of various qualitative surveys Review of the international literature on condom data analysis

Factors reviewed for this presentation Knowledge of AIDS Personal risk perception Age at sexual debut Recent sexual activity AbstinenceFidelity Condom use Behavior to reduce risk Centre dAnalyse des Politiques de Santé

Knowledge of AIDS Source: DHS 1994; DHS 2000

Knowledge of Mode of Transmission of HIV Centre dAnalyse des Politiques de Santé Source: DHS 1994; DHS 2000

Age at Sexual Debut, Women and Men Centre dAnalyse des Politiques de Santé Source: DHS 1994; DHS 2000

Age at first sex, women Source: DHS 2000

Recent Sexual Activity (Preceding Four Weeks) Centre dAnalyse des Politiques de Santé Source: DHS 1994; DHS 2000

Proportion of young men and women who never had sex Centre dAnalyse des Politiques de Santé Source: DHS 1994; DHS 2000

Risk perception for HIV, women Centre dAnalyse des Politiques de Santé Source: DHS 1994; DHS 2000

HIV risk perception, men Source: DHS 1994; DHS 2000

Factors linked to levels of risk perception, women Source: DHS 1994; DHS 2000

Factors linked to HIV risk perception, men Source: DHS 1994; DHS 2000

Behavior to reduce HIV risk, women Source: DHs 1994; DHS 2000

Behavior change to reduce HIV risk, men Source: DHS 1994; DHS 2000

Condom use, women and men Source: DHS 1994; DHS 2000

Male condom sales, PSI/Haiti Centre dAnalyse des Politiques de Santé Source: PSI

DISCUSSION Haitians know about HIV/AIDS They do not feel at high risk of contracting HIV and they feel less at risk than 10 years ago Age at first sex is probably lower than what was measured via DHS There is no evidence that patterns of abstinence have changed Not enough data on casual recreational sex

Discussion (continued) The perception that the partner is more faithful has increased Despite large numbers of condoms reported as being sold, there is no evidence that condom use has increased The proportion of women and men who cite condom use as the reason they feel less at risk has remained essentially unchanged between 1994 and 2000, at 1.8% and 3.4% respectively for women, and 13% and 16% for men.

CONCLUSION The data on condom use and condom sales should be interpreted with caution. Several studies have found that it is difficult to extrapolate level of use from levels of sales In all likelihood, many factors have acted in a synergistic manner to stabilize the AIDS epidemic in Haiti