Trauma, Mental Health, & Haiti Final Project - Katie Guidera April 2014 | Page 4

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PART
 I.
 Research
 Brief

Communities
 affected
 by
 natural
 disasters

are
 frequently
 faced
 with
 compromised
 HIV

service
 systems
 as
 well
 as
 high
 rates
 of
 mental

illness
 and
 substance
 abuse
 after
 the
 event
 (Reilly

et
 al.
 2009,
 Clark
 et
 al.
 2006).
 Each
 of
 these

factors
 have
 been
 shown
 in
 global
 studies
 to

reduce
 adherence
 to
 highly
 active
 antiretroviral

treatment
 (HAART),
 which
 is
 critical
 to
 successful

treatment
 and
 prevention
 of
 the
 spread
 of
 the

HIV
 (Bangsberg
 et
 al.
 2000,
 Altice
 et
 al.
 2010,

Bruce
 and
 Altice
 2007,
 Starace
 et
 al.
 2002).
 Other

aspects
 of
 HIV
 care,
 such
 as
 social
 support
 and

behavior
 change
 efforts,
 may
 also
 be

compromised
 by
 natural
 disaster.
 Given
 Haiti’s

historically
 high
 prevalence
 of
 HIV
 and
 its
 long

history
 of
 political,
 social,
 and
 cultural
 turmoil,
 it

is
 important
 to
 understand
 the
 state
 of
 both
 HIV

care
 and
 mental
 health
 in
 the
 country
 since
 the

2010
 earthquake.
 An
 understanding
 of
 existing

knowledge
 in
 this
 area
 could
 inform
 the

development
 of
 future
 interventions
 to
 address

the
 unique
 challenges
 faced
 by
 people
 living
 with

HIV/AIDS
 (PLWHA)
 in
 post-­‐earthquake
 Haiti.
 The

following
 research
 brief
 seeks
 to
 draw
 upon

existing
 literature
 on
 HIV/AIDS
 and
 mental
 health

care
 in
 post-­‐earthquake
 Haiti.

HIV
 &
 Mental
 Health
 Care
 Pre-­‐Earthquake

Mental
 health
 counseling
 has
 been

inextricably
 linked
 to
 HIV/AIDS
 care
 in
 Haiti
 since

the
 late
 1980s,
 shortly
 after
 HIV
 first
 emerged
 in

the
 country.
 Although
 Haiti
 adopted
 a
 model
 of

centralized
 mental
 health
 care
 through
 the

introduction
 of
 psychiatric
 hospitals
 in
 the
 1950s,

it
 was
 not
 until
 a
 rising
 number
 of
 patients
 began

presenting
 to
 clinics
 with
 HIV/AIDS
 that
 many
 of

the
 first
 formal
 mental
 health
 counseling
 services

in
 Haiti
 began
 to
 appear
 (Nicolas,
 Jean-­‐Jacques,

and
 Wheatley
 2012,
 Pape
 2000).
 At
 that
 point
 in

time,
 little
 was
 known
 about
 HIV
 transmission
 or

treatment,
 so
 education
 and
 counseling
 were

seen
 to
 be
 the
 only
 available
 means
 of
 preventing

HIV/AIDS.
 As
 a
 result,
 health
 services
 tended
 to

focus
 on
 educating
 young
 adults
 about
 responsible

sexual
 behaviors
 and
 the
 promotion
 of
 positive

attitudes
 such
 as
 a
 positive
 sense
 of
 self,
 the

future,
 and
 the
 world
 (Nicolas,
 Jean-­‐Jacques,
 and

Wheatley
 2012).
 Over
 the
 course
 of
 a
 few
 years,

these
 counseling
 campaigns
 gained
 traction
 among

large
 public
 and
 private
 institutions
 such
 as
 the

Global
 Fund
 and
 the
 United
 Stats’
 President’s

Emergency
 Plan
 for
 AIDS
 Relief,
 which
 led
 to

increased
 funding
 to
 support
 psychosocial

counseling
 among
 Haitians
 living
 with
 or
 at
 risk
 of

HIV
 (Nicolas,
 Jean-­‐Jacques,
 and
 Wheatley
 2012).

Although
 HIV
 prevalence
 rose
 through
 the

late
 1980s,
 it
 peaked
 at
 around
 5%
 in
 1994
 and
 has

since
 declined
 gradually
 to
 its
 prevalence
 of
 about

2.2%
 today
 due
 to
 a
 number
 of
 systemic

improvements
 in
 care
 including
 decreased
 vertical

transmission
 from
 mother
 to
 child
 (Gaillard
 et
 al.

2006,
 Malow
 et
 al.
 2010).
 The
 majority
 of
 studies

conducted
 on
 HIV
 before
 the
 earthquake
 focused

on
 the
 threats
 that
 economic
 and
 structural

challenges
 posed
 to
 making
 HIV
 prevention
 and

treatment
 accessible
 (Ghose
 et
 al.
 2013).
 However,

a
 few
 studies
 did
 focus
 on
 the $4