Utilization of Preventive Care by Haitian Immigrants in Miami, Florida

A Single-Center Case-Control Study of Glaucoma Severity on Initial Presentation in Haitian Americans

Purpose

To assess relative glaucoma severity between Haitians and non-Haitians upon presentation to a tertiary referral practice using a retrospective case-control design.

Patients and Methods

All Haitian descent patients were age- and zip code-matched with non-Haitian Hispanic American controls from a tertiary glaucoma service in a 1:1 ratio. Clinical and social vulnerability characteristics were analyzed for differences in functional and structural glaucoma deficits. Those who did not return after 1 year were considered lost to follow-up. Outcome measures included a comparison of blindness, glaucoma severity [visual field and retinal nerve fiber layer (RNFL) loss], and follow-up rates between groups.

Results

At presentation, 95 Haitians had worse average mean deviation (MD) than controls in the better (-9.4 ± 9.8 vs -5.1 ± 6.4 dB, p < 0.02) and worse eyes (-12.7 ± 10.0 vs -7.3 ± 7.0 dB, p < 0.01). Haitians also had a greater percentage of functional blindness (22.4% vs 4.1%, p < 0.02) in the worse eye. RNFL thickness and loss to follow-up were similar between groups. Haitians were also less likely to have had a glaucoma surgery or laser prior to presentation than controls (p ≤ 0.009). In multivariable models, Haitian descent was associated with worse MD in the worse eye. Worse neighborhood area deprivation indices were associated with higher likelihood of loss to follow-up, but Haitian descent was not.

Conclusion

Haitians had greater vision loss than controls despite similar exam findings. Higher burden of blindness and fewer prior procedures upon presentation may indicate a care disparity. Haitian patients may benefit from greater surveillance or earlier treatment for glaucoma.

Exploring the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic: how this community coped with the public health emergency

Objective

To explore and describe the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic, including their attitudes and practices towards vaccination.

Design

We interviewed 15 community members and 15 stakeholders in the Haitian/Haitian American community in Miami-Dade County, Florida using a semi-structured interview guide. The qualitative interviews were conducted between February 4, 2021, and October 1, 2021. They were conducted in both English and Haitian Creole, audio recorded transcribed/translated, and coded using thematic content analysis.

Results

The analyses revealed 9 major themes: (1) thoughts about the pandemic, (2) concerns about the COVID-19 vaccines, (3) healthcare access, February-October 2021, (4) intrapersonal relationship dynamics, (5) thoughts about individuals diagnosed with COVID-19, (6) thoughts about prevention measures (e.g., wearing masks, hand hygiene, social distancing, vaccination), (7) mental health struggles and coping, (8) food insecurity, and (9) overall experiences of the pandemic. The findings reveal that the COVID-19 public health emergency negatively affected Haitians/Haitian Americans across several domains, including employment, healthcare access, personal relationships, and food security.

Conclusion

This research echoes the compounding negative experiences reported by multiple disadvantaged groups during the COVID-19 pandemic. From loss of employment to healthcare barriers, the pandemic forced many Haitians/Haitian Americans into greater economic and social instability. Interventions addressing these issues should recognize how these factors may interact and compound the experiences of this group. Health and public health agencies should work alongside community partners to build trust so that preventive efforts will be more readily accepted during public health emergencies.

Systematic Review and Meta-Analysis of Metabolic Syndrome and Its Components in Latino Immigrants to the USA

The Metabolic Syndrome (MetS) is an increasingly prevalent condition globally. Latino populations in the USA have shown an alarming increase in factors associated with MetS in recent years. The objective of the present systematic review was to determine the prevalence of MetS and its risk factors in immigrant Latinos in the USA and perform a meta-analysis of those prevalence. The review included cross-sectional, cohort, or case−control studies involving adult immigrant Latinos in the USA, published during the period 1980−2020 in any language. Studies involving individuals who were pregnant, aged <18 years, immigrant non-Latinos, published outside the 1980−2020 period, or with other design types were excluded. The Pubmed, Web of Science, Embase, Lilacs, Scielo, and Google Scholar databases were searched. The risk of bias was assessed using the checklists of the Joanna Briggs Institute. The review included 60 studies, and the meta-analysis encompassed 52 studies. The pooled prevalence found for hypertension, diabetes, general obesity, and abdominal obesity were 28% (95% Confidence Interval (CI): 23−33%), 17% (95% CI: 14−20%), 37% (95% CI: 33−40%), and 54% (95% CI: 48−59%), respectively. The quality of the evidence of the primary studies was classified as low or very low. Few studies including immigrants from South America were identified. Further studies of those immigrants are needed due to the cultural, dietary, and language disparities among Latin American countries. The research protocol was registered with the Open Science Framework (OSF).

Exploring engagement in cervical cancer prevention services among Haitian women in Haiti and in the United States: a scoping review

PROBLEM IDENTIFICATION

Haitian women in Haiti and in the United States experience a disproportionate burden of cervical cancer, however their uptake of cervical cancer prevention services remains concerningly low.

LITERATURE SEARCH

A comprehensive search on bibliographic databases coupled with a grey literature search was conducted. A total of 401 studies were identified, with 28 studies retained after following Arksey and O'Malley's Scoping Review Guidelines.

DATA EVALUATION/SYNTHESIS

Knowledge levels of HPV and cervical cancer, along with preventative measures was alarmingly low. Traditional health practices, cultural worldviews, and social networks had an influence on the uptake of cervical cancer prevention. Health systems barriers were found to be a prevalent barrier among Haitian women in the U.S.

CONCLUSIONS

Future health promotion interventions developed for Haitian women must address personal, cultural, social, and structural factors with an emphasis on modifying knowledge and beliefs to improve engagement in cervical cancer prevention behaviors.

Improving hypertension knowledge, medication adherence, and blood pressure control: A feasibility study

AIMS AND OBJECTIVES

To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension.

BACKGROUND

Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension.

DESIGN

Pre-test and post-test feasibility study.

METHODS

A convenience sample of forty-four participants who identified as Haitian immigrants was enrolled in this evidence-based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill-Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes.

RESULTS

Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six-week follow-up period.

CONCLUSION

The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in-depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities.

RELEVANCE TO CLINICAL PRACTICE

Advanced practice nurses are uniquely qualified to implement evidence-based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence-based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.

Sociodemographic Determinants of Acute Myocardial Infarction Hospitalization Risks in Florida

Background Identifying social determinants of myocardial infarction (MI) hospitalizations is crucial for reducing/eliminating health disparities. Therefore, our objectives were to identify sociodemographic determinants of MI hospitalization risks and to assess if the impacts of these determinants vary by geographic location in Florida. Methods and Results This is a retrospective ecologic study at the county level. We obtained data for principal and secondary MI hospitalizations for Florida residents for the 2005-2014 period and calculated age- and sex-adjusted MI hospitalization risks. We used a multivariable negative binomial model to identify sociodemographic determinants of MI hospitalization risks and a geographically weighted negative binomial model to assess if the strength of associations vary by location. There were 645 935 MI hospitalizations (median age, 72 years; 58.1%, men; 73.9%, white). Age- and sex-adjusted risks ranged from 18.49 to 69.48 cases/10 000 persons, and they were significantly higher in counties with low education levels (risk ratio [RR]=1.033, P<0.0001) and high divorce rate (RR, 0.995; P=0.018). However, they were significantly lower in counties with high proportions of rural (RR, 0.996; P<0.0001), black (RR, 1.026; P=0.032), and uninsured populations (RR, 0.983; P=0.040). Associations of MI hospitalization risks with education level and uninsured rate varied geographically (P for non-stationarity test=0.001 and 0.043, respectively), with strongest associations in southern Florida (RR for <high school education, 1.036-1.041; RR for uninsured rate, 0.971-0.976). Conclusions Black race, divorce, rural residence, low education level, and lack of health insurance were significant determinants of MI hospitalization risks, but associations with the latter 2 were stronger in southern Florida. Thus, interventions for addressing MI hospitalization risks need to prioritize these populations and allocate resources based on empirical evidence from global and local models for maximum efficiency and effectiveness.

Preventive Health Screening Disparities Among Immigrants: Exploring Barriers to Care

Immigrant health research has highlighted the relevance of socioeconomic, health services, and immigration-related factors in explaining disparities in health screening rates between native- and foreign-born individuals. This study advances knowledge in this area by investigating the explanatory strength of such factors for cardiovascular risk screening across eight immigrant groups. Using nationally representative data from the National Health Interview Survey, we test the hypothesis that known correlates of preventive healthcare seeking differ in their ability to predict screening behavior depending on region of origin. Results show that health service factors (lack of insurance and no place for care) are fairly consistent predictors of preventive screening while socioeconomic and immigration-related factors are less so. These findings surface the complex processes underlying observed differentials in health-seeking behaviors and illuminate potential targets for public health and clinical intervention.

Duvalier Regime in Haiti and Immigrant Health in the United States

BACKGROUND

Haitians immigrate to the United States for many reasons, including the opportunity to escape political violence. The extant literature on Haitian immigrant health focuses on post-migration, rather than pre-migration, environments and experiences. Objective: In this study, we analyze health outcomes data from a nationally representative sample of Haitian immigrants in the United States from 1996 to 2015. We estimate age-adjusted associations between pre-migration residence in Haiti during the repressive regimes and generalized terror of Francois and Jean-Claude Duvalier, who ran Haiti from 1957 to 1986.

METHODS

We used ordered probit regression models to quantify age-adjusted associations between the duration of pre-migration residence in Haiti during the Duvalier regime, and the distribution of post-migration health status among Haitian immigrants in the United States. Findings: Our study sample included 2,438 males and 2,800 females ages 15 and above. The mean age of males was 43.5 (standard deviation, 15.5) and the mean age of females was 44.7 (standard deviation, 16.6). Each additional decade of pre-migration residence in Haiti during the Duvalier regime is associated with a 2.9 percentage point decrease (95% confidence interval 0.6 to 5.3) in excellent post-migration health for males, and a 2.8 percentage point decrease (95% confidence interval, 0.8 to 4.8) for females. Within the subsample of Haitian immigrants with any pre-migration residence in Haiti during the Duvalier regime, each additional decade since the regime is associated with a 3.3 percentage point increase (95% confidence interval, 1.2 to 5.5) in excellent post-migration health for males, and a 2.3 percentage point increase (95% confidence interval, 0.5 to 4.1) for females.

CONCLUSIONS

Overall, we found statistically significant and negative associations between the Duvalier regime and the post-migration distribution of health status 10 to 57 years later. We found statistically significant and positive associations between the length of time since the Duvalier regime and post-migration health.

Duvalier Regime in Haiti and Immigrant Health in the United States

Background:

Haitians immigrate to the United States for many reasons, including the opportunity to escape political violence. The extant literature on Haitian immigrant health focuses on post-migration, rather than pre-migration, environments and experiences.

Objective:

In this study, we analyze health outcomes data from a nationally representative sample of Haitian immigrants in the United States from 1996 to 2015. We estimate age-adjusted associations between pre-migration residence in Haiti during the repressive regimes and generalized terror of Francois and Jean-Claude Duvalier, who ran Haiti from 1957 to 1986.

Methods:

We used ordered probit regression models to quantify age-adjusted associations between the duration of pre-migration residence in Haiti during the Duvalier regime, and the distribution of post-migration health status among Haitian immigrants in the United States.

Findings:

Our study sample included 2,438 males and 2,800 females ages 15 and above. The mean age of males was 43.5 (standard deviation, 15.5) and the mean age of females was 44.7 (standard deviation, 16.6). Each additional decade of pre-migration residence in Haiti during the Duvalier regime is associated with a 2.9 percentage point decrease (95% confidence interval 0.6 to 5.3) in excellent post-migration health for males, and a 2.8 percentage point decrease (95% confidence interval, 0.8 to 4.8) for females. Within the subsample of Haitian immigrants with any pre-migration residence in Haiti during the Duvalier regime, each additional decade since the regime is associated with a 3.3 percentage point increase (95% confidence interval, 1.2 to 5.5) in excellent post-migration health for males, and a 2.3 percentage point increase (95% confidence interval, 0.5 to 4.1) for females.

Conclusions:

Overall, we found statistically significant and negative associations between the Duvalier regime and the post-migration distribution of health status 10 to 57 years later. We found statistically significant and positive associations between the length of time since the Duvalier regime and post-migration health.

Mailed HPV self-sampling for cervical cancer screening among underserved minority women: study protocol for a randomized controlled trial

Background

Underserved ethnic minority women experience significant disparities in cervical cancer incidence and mortality, mainly due to lack of cervical cancer screening. Barriers to Pap smear screening include lack of knowledge, lack of health insurance and access, and cultural beliefs regarding disease prevention. In our previous SUCCESS trial, we demonstrated that HPV self-sampling delivered by a community health worker (CHW) is efficacious in circumventing these barriers. This approach increased screening uptake relative to navigation to Pap smear screening. SUCCESS trial participants, as well as our community partners, provided feedback that women may prefer the HPV self-sampler to be delivered through the mail, such that they would not need to schedule an appointment with the CHW. Thus, our current trial aims to elucidate the efficacy of the HPV self-sampling method when delivered via mail.

Design

We are conducting a randomized controlled trial among 600 Haitian, Hispanic, and African-American women from the South Florida communities of Little Haiti, Hialeah, and South Dade. Women between the ages of 30 and 65 years who have not had a Pap smear within the past 3 years are eligible for the study. Women are recruited by CHWs and complete a structured interview to assess multilevel determinants of cervical cancer risk. Women are then randomized to receive HPV self-sampling delivered by either the CHW (group 1) or via mail (group 2). The primary outcome is completion of HPV self-sampling within 6 months post enrollment.

Discussion

Our trial is among the first to examine the efficacy of the mailed HPV self-sampling approach. If found to be efficacious, this approach may represent a cost-effective strategy for cervical cancer screening within underserved and underscreened minority groups.

Trial registration

ClinicalTrials.gov, NCT02202109. Registered on 9 July 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1721-6) contains supplementary material, which is available to authorized users.

Barriers to HIV Testing in Black Immigrants to the U.S

BACKGROUND

Late HIV testing is common among immigrants from sub Saharan Africa and the Caribbean. Since 2010, HIV testing is no longer a required component of immigrant screening examinations or mandatory for immigrants seeking long term residence in the US. Thus, barriers to HIV testing must be addressed.

METHODS

Five hundred and fifty-five (555) immigrants completed a barriers-to-HIV testing scale. Univariate and multivariate linear regression were performed to examine predictors of barriers.

RESULTS

In multivariate analysis, primary language other than English (β=2.9, p=.04), lower education (β=5.8, p=.03), low income [= below $20K/year] (β=4.6, p=.01), no regular provider (β=5.2, p=.002) and recent immigration (β=5.7, p=.0008) were independently associated with greater barriers. Barriers due to health care access, privacy, fatalism, and anticipated stigma were greater for recent versus longer term immigrants.

DISCUSSION

Immigrants from sub-Saharan Africa and the Caribbean face significant barriers to HIV testing. Interventions to improve access and timely entry into care are needed.

Undiagnosed and uncontrolled hypertension and hyperlipidemia among immigrants in the US

Cardiovascular disease is a major cause of mortality and disability. We analyzed the National Health and Nutrition Examination Survey (1998-2008). We used logistic regression analysis to compare the odds of having undiagnosed and uncontrolled hypertension and hyperlipidemia among FB and US born adults sequentially adjusting for (1) age and gender, (2) income and education, and (3) insurance status. Among FB individuals, we identified factors independently associated with having each outcome using logistic regression analyses. Of 27,596 US adults, 22.6 % were foreign-born. In age- and -gender adjusted analyses, FB were more likely to have undiagnosed hypertension (OR 1.35, 95 % CI 1.13-1.63, p < 0.001), uncontrolled hypertension (OR 1.37, 95 % CI 1.15-1.64, p < 0.001), and uncontrolled hyperlipidemia (OR 1.35, 95 % CI 1.11-1.63, p = 0.002), while undiagnosed hyperlipidemia approached significance (OR 1.24, 95 % CI 0.99-1.56, p = 0.057). Having insurance was associated with a 5-15 % decrease in FB-US born disparities. Immigrants are at increased risk of undiagnosed and uncontrolled hypertension and hyperlipidemia.

Integration of Screening for Syphilis, Hepatitis C, and Other Sexually Transmitted Infections with HIV Testing in a Community-Based HIV Prevention Program in Miami, Florida

The South Beach AIDS Project (SoBAP) in Miami, Florida, is a nonprofit community-based organization that recently began offering syphilis, chlamydia and gonorrhea, and hepatitis C screening along with confidential HIV screening to its clients. We retrospectively reviewed data from SoBAP collected from January 2011 to June 2012 to describe the prevalence of sexually transmitted infections (STIs) among persons seeking testing services. Our findings are in line with national data demonstrating that men who have sex with men (MSM) of color are disproportionately affected by STIs, especially Latino MSM. Integrating HIV, STI, and hepatitis C screening in community-based testing programs is feasible and an important means to identify infected persons.

Cultural Values Influencing Immigrant Haitian Mothers' Attitudes Toward Human Papillomavirus Vaccination for Daughters

Although research has shown that mothers significantly influence daughters' willingness to be vaccinated against the human papillomavirus (HPV), cultural factors influencing immigrant Haitian mothers' willingness to have adolescent daughters to be vaccinated are unknown. This is of concern as this population experiences disproportionately higher rates of HPV infection and related cervical cancers. This study identifies cultural beliefs influencing 31 immigrant Haitian mothers' willingness to vaccinate their daughters against HPV using semistructured interviews. Mothers had low levels of HPV and HPV vaccine knowledge, and desired more information. Concerns centered on cultural values regarding adolescent sexuality and HIV/AIDS stigmas specific to Haitian communities. If vaccination were recommended by a physician, mothers are more likely to have their daughters vaccinated. HPV vaccination uptake efforts targeting Haitian months should emphasize physician involvement and incorporate culturally relevant health concerns.

A culturally competent approach to exploring barriers in organ donation consent among Haitian immigrants: formative focus group findings and implications

African Americans consent to donation less often than whites, have fears and misconceptions about donation specific to their cultures, and wait longer to receive transplants when the need is identified. However, there is less detailed empirical data on the transplant needs and barriers for Haitian immigrants. This paper describes focus group results designed to identify culturally grounded beliefs, attitudes, and barriers to organ donation. Results were used to design and implement the "Bay Lavi" (Give Life) campaign designed to raise awareness and increase organ donation consent among Haitian Immigrants.

Healthy Eating Index and Alternate Healthy Eating Index among Haitian Americans and African Americans with and without Type 2 Diabetes

Ethnicities within Black populations have not been distinguished in most nutrition studies. We sought to examine dietary differences between African Americans (AA) and Haitian Americans (HA) with and without type 2 diabetes using the Healthy Eating Index, 2005 (HEI-05), and the Alternate Healthy Eating Index (AHEI). The design was cross-sectional N = 471 (225 AA, 246 HA) and recruitment was by community outreach. The eating indices were calculated from data collected with the Harvard food-frequency questionnaire. African Americans had lower HEI-05 scores β = -10.9 (-8.67, 13.1); SE = 1.12, P < .001 than HA. Haitian American females and AA males had higher AHEI than AA females and HA males, respectively, (P = .006) adjusting for age and education. Participants with diabetes had higher adherence to the HEI-05 β = 3.90 (1.78, 6.01), SE = 1.08, P < .001 and lower adherence to the AHEI β = -9.73 (16.3, -3.19), SE = 3.33, P = .004, than participants without diabetes. The findings underscore the importance of disaggregating ethnicities and disease state when assessing diet.

Use of HIV primary care by HIV-positive Haitian immigrants in Miami, Florida

Little is known about the use of HIV primary care among Haitian immigrants in the USA. The present study utilizes data from a survey of HIV-positive Haitians recruited from an HIV primary care clinic in Miami, Florida, to examine barriers and facilitators of regular use of HIV care by this population. Selection of measures was guided by the Andersen Model of Health Services Utilization for Vulnerable Populations. The dependent variable, regular use of HIV primary care, was operationalized as completion of four or more HIV primary care visits during the previous 12 months. Of the 96 participants surveyed, approximately three-fourths did not graduate from high school and reported an annual income of up to $5000. Seventy-nine percent of participants completed four or more visits in the past year. On univariate as well as multivariate analyses, participants without formal education or those with high psychological distress were significantly less likely to have used HIV primary care regularly than those who attended school or who were less distressed, respectively. The findings emphasize the need for health care practitioners to pay close attention to the education level and the mental health status of their Haitian HIV patients. The data also suggest that once these individuals are linked to care and offered assistance with their daily challenges, they are very likely to stay connected to care and to take their antiretroviral medicines.

Barriers to cervical cancer screening among Haitian immigrant women in Little Haiti, Miami

Previous research has not examined barriers to Pap test screening among Haitian immigrant women through their own discourse. Community Health Workers conducted in-depth interviews with Haitian women in Little Haiti, Miami. We used a grounded theory approach to analyze data from the in-depth interviews. Emergent themes coalesced into three core categories of screening barriers: structural, psychosocial, and sociocultural. We developed a model of screening barriers to depict the themes within each core category. Screening barriers must be examined and understood from the social contexts in which they are produced in order to create meaningful interventions.

Barriers to breast cancer screening among Haitian immigrant women in Little Haiti, Miami

Previous research has not examined barriers to mammography screening among Haitian immigrant women through their own discourse. Community Health Workers conducted in-depth interviews with Haitian women in Little Haiti, Miami. We used a grounded theory approach to analyze data from the in-depth interviews. Emergent themes coalesced into three core categories of screening barriers: Structural, Psychosocial, and Socio-Cultural. We developed a model of screening barriers to depict the themes within each core category. Screening barriers must be examined and understood from the social contexts in which they are produced in order to create meaningful interventions.

Comparison of the perforation rate for acute appendicitis between nationals and migrants in Taiwan, 1996-2001

OBJECTIVE

Immigrant populations have grown rapidly in recent years in many countries. Immigrant-related healthcare issues have thus become more and more important. The aim of this study was to assess any possible disparity in access to care between migrants and nationals under the national health insurance (NHI) system in Taiwan.

STUDY DESIGN

Retrospective population-based observational study.

METHODS

National population-based data on patients aged ≥20 years in Taiwan under the NHI programme were studied. The frequency of use and expenditure on ambulatory care, inpatient care and emergency care were analysed separately. Ruptured appendicitis was also analysed as an outcome indicator for access to care. Logistic regression and two-part models were applied.

RESULTS

Overall, migrants had a lower rate of healthcare utilization than nationals, and this gap remained consistent from 1996 to 2001. However, using ruptured appendicitis as the outcome indicator, no significant overall difference in access to care was found between nationals and migrants under the NHI programme in Taiwan (odds ratio 1.01, 95% confidence interval 0.93∼1.11).

CONCLUSION

This study found that although migrants had a lower rate of healthcare utilization than nationals, their rate of adverse outcome was similar to nationals when they faced an acute, non-selective emergency condition such as appendicitis. The findings suggest that the use of more dimensional indicators may help to avoid possible misleading inferences on the variation in access to health care in Taiwan.

Patnè en Aksyon: addressing cancer disparities in Little Haiti through research and social action

Haitian women living in Miami, Florida, experience an increased risk of developing and dying from cervical cancer compared with women in other racial/ethnic minority and immigrant groups in the area. In response to this disparity, academic investigators from a local university-based cancer center and community leaders from Little Haiti, the predominately Haitian neighborhood in Miami, created Patnè en Aksyon (Partners in Action), a campus-community partnership. We describe the partnership's effort to document the prevalence of lifetime and routine Papanicolau test use using community-based participatory research methods. Community health workers indigenous to the area recruited participants from various community venues throughout Little Haiti and administered informal, brief interviews to assess their screening practices. The results indicate that Haitian women are underscreened and underscore the importance of community involvement in study implementation.

Differences in HIV-related hospitalization trends between Haitian-born blacks and US-born blacks

OBJECTIVES

To examine the HIV care needs and hospital admission patterns of HIV-positive Haitian-born blacks (Haitians) and compare them with those of US-born blacks (Blacks).

METHODS

We abstracted the medical records of 635 Blacks and Haitians consecutively admitted to the adult HIV Service at Jackson Memorial Hospital during 2004 for information on demographics, use of antiretroviral therapy, CD4 cell counts, primary and secondary diagnoses at admission, and substance use. The probability of being prescribed highly active antiretroviral therapy (HAART) was examined by country of origin.

RESULTS

There was no statistically significant difference between the groups in likelihood to be prescribed HAART. In controlled analyses, however, Haitians were 76% more likely than Blacks to have a CD4 count <51 cells/mm3 and tended to be more recently diagnosed with HIV Moreover, tuberculosis was the most prevalent opportunistic infection for Haitians compared with candidiasis for Blacks.

CONCLUSIONS

Findings suggest that barriers to medical care may exist for Haitians at an early stage of the access continuum and that prevention efforts among the Haitian HIV-positive population should be directed at promoting the need for timely use of health services.