Comparison of Trauma Symptoms Among Nonpartner Sexual Violence Victims and Nonvictims in Urban Haiti’s Cité Soleil Neighborhood

Abstract

Women in resource-constrained, postdisaster, urban enclaves, such as Haiti’s Cité Soleil, are at risk for nonpartner sexual violence (NPSV) by multiple perpetrators, and subsequently, psychological trauma and sexually transmitted infections (STIs), including HIV/AIDS. These biopsychosocial risks suggest that NPSV victims may benefit from an adapted evidence-based intervention for sexually transmitted infection (EBI-STI) that includes a trauma component. Yet there is a dearth of knowledge on trauma symptoms experienced by victims in Haiti. We administered a Haitian Kreyòl version of Trauma Symptom Checklist (TSC-40), including its subscales (depression, dissociation, anxiety, sexual problems, sleep disturbance, sexual abuse trauma) to women in Cité Soleil, comparing victims’ scores ( n = 54) with those of nonvictims ( n = 179). After controlling for child sexual abuse, arrest, transactional sex, and sociodemographics, being a victim was associated with higher scores on the full TSC-40, and subscales of anxiety and sexual abuse trauma index. These increased scores of victims underscore the need to incorporate trauma in adaptation of EBI-STI for Haitian NPSV victims like our sample.

‘‘Now, I know my life is not over!’: Introduction and Adaptation of the RESPECT HIV Intervention, OraQuick, and Trauma-Informed Care for Female Victims of Non-Partner Sexual Violence in Haiti

“…[7-8] Victims in previous studies also reported shame and discomfort experienced in health care settings among reasons that they did not seek post-NPSV care, so that even if those settings could provide PeP, they were not accessing it. [7-8; 11]…”

“…[11] Kadejak involves multiple aggressors, deliberate reproductive injuries, psychological trauma, and heightened risks of sexually transmitted infections (STIs). [7][8][9][10][11] Addressing the HIV susceptibility of women who survive NPSV in that context must take into account the characteristics of the NPSV, that their HIV risk profile involves sexual risk behaviors that are forced and beyond their control, and that they have little awareness of the risks associated with kadejak experiences. [3; 11-13] Evidence-based interventions for HIV (EBI HIV) can increase these women's HIV awareness, lead to HIV testing, and reduce HIV risk.…”

“…We introduced TIC because victims in previous studies endorsed symptoms of PTSD as a result of their NPSV experiences, and women from the same neighborhood who had experienced NPSV in addition to neighborhood violence had higher rates of trauma than nonvictims. [7-8] Victims in previous studies also reported shame and discomfort experienced in health care settings among reasons that they did not seek post-NPSV care, so that even if those settings could provide PeP, they were not accessing it. [7-8; 11]…”

“…Second, consistent with the WHO’s findings that context-specific HIV prevention and testing methods that are spearheaded by familiar community partners increase HIV testing and engagement in treatment, [1-2; 4] these women have been our partners in the adaptation of the RESPECT EBI for several years and have indicated that any intervention that presumes to help them must include their voices. [7-8; 11-12] Thus, it would be a grave injustice to deny them the EBI that can reduce their HIV risk if they deem the EBI desirable, acceptable, and feasible to implement in their context. Fourth, coercive sex increases the risks of coital injury, sexually transmitted infections (STIs), and psychological trauma among women of color and was found to cause symptoms of PTSD in NPSV victims previously interviewed.…”

“…[9; 12; 45] Presumably, the risks of injuries, HIV, and trauma are greater as the number of assailants increases, and trauma increases HIV risk in survivors by impeding their capacity to negotiate for safer sex and to make beneficial health decisions. [8; 45] Sixth, there is evidence that inadequate scale-up in EBI and other HIV services in countries such as Haiti is among the obstacles to advance mitigating their HIV burden. [2] Seventh, Haiti continues to have the second highest estimated HIV prevalence in the world.…”