Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs

A Moderated Mediation Analysis of HIV and Intersectional Stigmas and Antiretroviral Adherence in People Living with HIV in the Dominican Republic

Experiencing HIV and intersectional stigmas in healthcare settings may affect antiretroviral treatment (ART) adherence among people with HIV (PWH), given their need for frequent interactions with clinical settings and healthcare providers. Considering the importance of reducing stigmas to promote well-being and the need to elucidate how stigma influences health across various settings, we examined how experienced HIV stigma in Dominican Republic healthcare settings impacts ART adherence through internalized HIV stigma and whether race or sexual orientation stigma moderates this relationship. Participants were 471 PWH (aged 17-71) who were recruited from two HIV clinics in the Dominican Republic in 2021-2022. Results revealed a significant mediation effect (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) after adjusting for effect of age and time since HIV diagnosis, suggesting that experienced HIV stigma in healthcare settings was associated with more internalized HIV stigma (B = 0.39, SE = 0.11, p = .001), subsequently linked to lower ART adherence (B=-0.26, SE = 0.11, p = .016). The indirect effect was significant at low levels of race stigma (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) but not at high levels of race stigma (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). This indirect effect was also significant at low levels of sexual orientation stigma (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) but not at high levels of sexual orientation stigma (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). These findings suggest that addressing experienced HIV stigma in Dominican Republic healthcare settings, along with various dimensions of HIV-related stigma (e.g., internalized stigma) and intersecting stigmas (e.g., race, sexual orientation), is vital for improving health outcomes, such as optimal ART adherence.

Disparities in Cancer Control in Central America and the Caribbean

Central America and the Caribbean is a highly heterogeneous region comprising more than 30 countries and territories with more than 200 million inhabitants. Although recent advances in the region have improved access to cancer care, there are still many disparities and barriers for obtaining high-quality cancer treatments, particularly for those from disadvantaged populations, immigrants, and rural areas. In this article, we provide an overview of cancer care in Central America and the Caribbean, with selected examples of issues related to disparities in access to care and suggest solutions and strategies to move forward.

Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes

PURPOSE

The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM).

METHODS

A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data.

RESULTS

Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care.

CONCLUSIONS

NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.

Perception of discrimination against immigrants compared to Chilean-born and its relationship with access to services and health outcomes

OBJECTIVES

Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital.

METHODS

Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models.

RESULTS

Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8).

CONCLUSIONS

In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.

Hoping for a Better Future during COVID-19: How Migration Plans Are Protective of Depressive Symptoms for Haitian Migrants Living in Chile

This paper explores the migration experiences, perceived COVID-19 impacts, and depression symptoms among Haitian migrants living in Santiago, Chile. Ninety-five participants from eight neighborhoods with a high density of Haitian migrants were recruited. Descriptive statistics, univariate analysis, and logistic regression analysis were conducted. Chi-squared tests were used to confirm univariate results. We found that 22% of participants had major depressive symptoms based on the CESD-R-20 scale, 87% reported major life changes due to COVID-19, and 78% said their migration plans had changed due to the pandemic. Factors associated with more depressive symptoms were being in debt (OR = 3.43) and experiencing discrimination (ORs: 0.60 to 6.19). Factors associated with less odds of depressive symptoms were social support (ORs: 0.06 to 0.25), change in migration plans due to COVID-19 (OR = 0.30), and planning to leave Chile (OR = 0.20). After accounting for relevant factors, planning to leave Chile is significantly predictive of fewer symptoms of depression. Haitian migrants living in Chile had a high prevalence of depression. Planning to leave Chile was a significant protector against depressive symptoms. Future studies should explore how nuanced experiences of uncertainty play out in migrants' lives, mental well-being, and planning for their future.

COVID-19 Public Stigma Scale (COVID-PSS): development, validation, psychometric analysis and interpretation

OBJECTIVE

Amid the COVID-19 pandemic, social stigma towards COVID-19 infection has become a major component of public discourse and social phenomena. As such, we aimed to develop and validate the COVID-19 Public Stigma Scale (COVID-PSS).

DESIGN AND SETTING

National-based survey cross-sectional study during the lockdown in Thailand.

PARTICIPANTS

We invited the 4004 adult public to complete a set of measurement tools, including the COVID-PSS, global fear of COVID-19, perceived risk of COVID-19 infection, Bogardus Social Distance Scale, Pain Intensity Scale and Insomnia Severity Index.

METHODS

Factor structure dimensionality was constructed and reaffirmed with model fit by exploratory and confirmatory factor analyses and non-parametric item response theory (IRT) analysis. Psychometric properties for validity and reliability were tested. An anchor-based approach was performed for classifying the proper cut-off scores.

RESULTS

After factor analysis, IRT analysis and test for model fit, we created the final 10-item COVID-PSS with a three-factor structure: stereotype, prejudice and fear. Face and content validity were established through the public and experts' perspectives. The COVID-PSS was significantly correlated (Spearman rank, 95% CI) with the global fear of COVID-19 (0.68, 95% CI 0.66 to 0.70), perceived risk of COVID-19 infection (0.79, 95% CI 0.77 to 0.80) and the Bogardus Social Distance Scale (0.50, 95% CI 0.48 to 0.53), indicating good convergent validity. The correlation statistics between the COVID-PSS and the Pain Intensity Scale and Insomnia Severity Index were <0.2, supporting the discriminant validity. The reliability of the COVID-PSS was satisfactory, with good internal consistency (Cronbach's α of 0.85, 95% CI 0.84 to 0.86) and test-retest reproducibility (intraclass correlation of 0.94, 95% CI 0.86 to 0.96). The proposed cut-off scores were as follows: no/minimal (≤18), moderate (19-25) and high (≥26) public stigma towards COVID-19 infection.

CONCLUSIONS

The COVID-PSS is practical and suitable for measuring stigma towards COVID-19 in a public health survey. However, cross-cultural adaptation may be needed.

[Maternal and child health inequalities among migrants: the case of Haiti and the Dominican RepublicDesigualdades na saúde materno-infantil entre migrantes: o caso do Haiti e da República Dominicana]

Objective

To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans.

Methods

Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition.

Results

Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups.

Conclusion

Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.

Lymphatic filariasis elimination in the Dominican Republic: History, progress, and remaining steps

Lymphatic filariasis (LF) is a mosquito-transmitted parasitic disease that is a leading cause of disability globally. The island of Hispaniola, which the Dominican Republic shares with Haiti, accounts for approximately 90% of LF cases in the Americas region. In 1998, the Dominican Ministry of Public Health created the Program to Eliminate Lymphatic Filariasis (PELF) with the goal of eliminating LF transmission by 2020. Baseline mapping revealed 19 (12% of total) endemic municipalities clustered into three geographic foci (Southwest, La Ciénaga and East), with a total at-risk population of 262,395 people. Beginning in 2002, PELF sequentially implemented mass drug administration (MDA) in these foci using albendazole and diethylcarbamazine (DEC). In total, 1,174,050 treatments were given over three to five annual rounds of house-to-house MDA per focus with a median coverage of 81.7% (range 67.4%–92.2%). By 2018, LF antigen prevalence was less than 2% in all foci, thus meeting criteria to stop MDA and begin post-treatment surveillance (PTS). This success has been achieved against a shifting landscape of limited domestic funding, competing domestic public health priorities, and sporadic external donor support. Remaining steps include the need to scale-up morbidity management and disability prevention services for LF and to continue PTS until LF transmission is interrupted across Hispaniola.

Lymphatic filariasis (LF) is a neglected tropical disease caused by thin worms transmitted to humans by the bites of mosquitoes. LF is a leading cause of disability globally, resulting from the long-term physical (swelling of legs and genitals) and psycho-social impacts on affected individuals. The Dominican Republic is one of four LF-endemic countries in the Americas. This report describes the efforts to eliminate the disease in the country, including a review of disease mapping and implementation of mass drug administration (MDA)—the provision of safe and effective medicine to at-risk communities—to interrupt parasite transmission. Particular emphasis is given to program planning and community mobilization for MDA due to the divergent environments of endemic foci, which ranged from rural agricultural regions to densely populated urban neighborhoods. Impact evaluation data for each focus demonstrates interruption of LF transmission and that criteria to stop MDA have been met. Finally, plans for post-treatment surveillance and the scale-up of clinical care services for those who remain affected by chronic LF are presented—required elements for eliminating LF as a public health problem.

Hair cortisol concentrations among urban and rural-dwelling mother-child dyads, La Romana, Dominican Republic

Hair cortisol concentrations (HCC) were studied in mother-child dyads of La Romana, Dominican Republic (DR), a low-income city, and of the surrounding bateyes, sugarcane plantation villages with inhabitants frequently of Haitian descent. Populations of low socioeconomic status (SES) experience hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Urban communities may be increasingly exposed to stressors such as crime and concentrated poverty whereas rural communities may be devoid of important community resources. As a result, the experience of stress in poverty may differ by place of residence. The goal of this study was to examine differences in HCC among urban and rural-dwelling mother-child dyads in socioeconomically disadvantaged communities surrounding La Romana, DR. Forty-five mother/child dyads were enrolled in La Romana and 45 at several bateyes surrounding La Romana. Mothers were ≥18 years and children were between 7 and 14 years. Mothers self-reported perceived stress and demographic factors. Hair samples were collected from mothers and children, and HCC was assessed using enzyme-linked immunosorbent assays. General linear models examined associations between socioeconomic factors and HCC, and between maternal and child HCC. HCC were measured in 88 maternal and 87 child samples (N = 175). Mothers living in a batey had higher HCC than those living in La Romana (p = 0.001). HCC was positively associated among maternal-child dyads (p = 0.001). Further, Haitian-born mothers as a population who frequently live in a rural batey experienced higher HCC (p = 0.025) that may partially be explained by discriminatory practices in the DR. This research helps to elucidate the impact of urban and rural environmental settings on HCC.Lay summaryThis study focuses on chronic stress, measured by hair cortisol levels, among a low-income population of Dominican and Haitian mother-child pairs who live in urban and rural settings. We found that Haitian-born mothers, who frequently live in a rural batey, had higher hair cortisol levels than Dominican born mothers. Hair cortisol levels between mothers and their children were positively associated. This study addresses the impact of urban and rural environments on the stress response among socioeconomically disadvantaged persons living in an upper middle income country who bear an excessive burden of psychosocial stress.

Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic

This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country's three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7-6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2-11.8%) and 20.4% (95% CI, 17.9-23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2-96 years), and 10.0% (95% CI, 7.2-13.8%) and 20.0% (95% CI, 17.4-23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.

Maternal and child health inequalities among migrants: the case of Haiti and the Dominican Republic

Objective.

To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans.

Methods.

Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition.

Results.

Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups.

Conclusion.

Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.