Dèyè mòn, gen mòn: Qualitative examination of drivers and facilitators of stigma as a barrier to sexual and maternal healthcare in Haiti

Haitian women face heightened risk of contracting HIV and encounter challenges in accessing quality care due to sociocultural and economic barriers. Stigma compounds these challenges, especially for pregnant women living with HIV. Globally, HIV-related stigma is a recognized barrier to testing, treatment, and prevention, contributing to low testing rates and substandard treatment and care. This study examines sources and origins of stigma that impact pregnant women's access to and experience with sexual and maternal healthcare. Qualitative data was collected from 85 participants via focus groups with HIV-positive pregnant women (n = 26) and HIV-negative pregnant women (n = 35). We also conducted 24 interviews with maternal health care providers, HIV prevention specialists, and traditional healers. We used thematic analysis to identify key themes related to drivers and facilitators of stigma and its impact on access to healthcare among pregnant women in rural Haiti. Drivers of stigma were: 1) Lack of Knowledge, 2) Stereotypes, Prejudice, & Blaming People Living with HIV (PLHIV), 3) Lack of Hospital Resources and Protocols. Facilitators of stigma were: 1) Underdeveloped Healthcare Infrastructure, 2) Classism, 3) Healthcare as a Commodity, 4) Hospital Policies and Practices, and 5) Patriarchal Society. Each of these facilitators uniquely influence HIV stigma experiences and practices. Our study identified complex multilevel drivers and facilitators of HIV and class related stigma and its impact on sexual and maternal healthcare access in Haiti, emphasizing the need for more comprehensive interventions that address psycho-socio-cultural determinants of health.