Rapid Ethnographic Assessment of HIV/AIDS among Garífuna Communities in Honduras: Informing HIV Surveillance among Garífuna Women

ABSTRACT

Garífuna, an Afro-Caribbean ethnic group in Honduras, have among the highest HIV prevalence rates in Central America; 15- to 49-year-old Garífuna have HIV rates comparable to heterosexual transmission rates in regions of sub-Saharan Africa. The heightened rates in this age range pose a significant risk of vertical transmission from woman to child at birth. In 2006, a Behavioral Surveillance Survey plus Biomarkers (BSS+) reexamined seroprevalence of HIV, sexually transmitted infections, and HIV-related risk behaviors among Garífuna to inform HIV prevention activities and monitor trends in HIV transmission over time. To inform the BSS+ survey protocol, we conducted a rapid ethnographic assessment (REA) in Garífuna communities to specifically examine acceptability among Garífuna to be surveyed, suggest ways to minimize HIV-testing related stigma, and determine female gender-specific concerns among BSS+ respondents. Data were collected in 2 weeks in November, 2004, using a semi-structured interview guide for key informant interviews and focus groups. Seventeen key informant interviews and three focus groups were conducted; participant observation and 11 site visits were also conducted. Major findings included high Garífuna acceptability to participate in the BSS+ with key member involvement and incentives. Maintaining confidentiality at HIV testing sites is required to minimize Garífuna women's risk of intimate partner violence. Recommendations to BSS+ partners from this REA informed the BSS+ study protocol and was expected to increase participation and validity and decrease potential risks associated with women's survey participation.

KEYWORDS:

• Garífuna
• rapid ethnographic assessment
• Honduras
• HIV/AIDS
• women and HIV/AIDS

Notes

We thank the following people and organizations: Garífuna health promoters, PLWHA Support Group, and Garífuna communities; CDC: GAP/Central America/ Panama Regional Office; Atlanta: Theresa Diaz MD, MPH; Honduras Ministry of Health, Tegucigalpa, Honduras; Rosalinda Hernandez, MD, MPH; USAID: Herbert Caudill; U.S. Peace Corps: Helmuth Castro; Hedda Mclendon, MPH; AED: Licida Bautista PhD; Enlace de Mujeres Negras: Ester Vargas. Disclaimer: The findings and conclusions in this paper are those of the authors and do not necessarily reflect the views of the Centers for Disease Control and Prevention.