Applying a human security model using HIV/AIDS resources to reduce vulnerability in Southwestern Bateyes of the Dominican Republic: the “Robin Hood” theory in action
E. Perez-Then1,2, G. Shor-Posner2,3, J. Beier3, S. Porcelain4, A. de Moya5, K. McCollister3, C. McCoy3, L. Metsch3, A. Ammann6
1Centro Nacional de Investigaciones en Salud Materno Infantil (CENISMI), Santo Domingo, Dominican Republic, 2Fogarty International Research and Training Program, Miami, United States, 3University of Miami, Epidemiology, Miami, United States, 4University of Miami, International Studies and Epidemiology, Miami, United States, 5COPRESIDA, Santo Domingo, Dominican Republic, 6Global Strategies for HIV Prevention, San Rafael, United States
Issues: Following the “Robin Hood” principle of using resources allocated for HIV prevention and treatment as a base from which to build infrastructure for other health and human security needs, this project sought to reduce vulnerability (health inequalities) in populations living in Bateyes (sugar mill camps), located at the border region of Haiti and the Dominican Republic (DR).
Description: The impact of a human security model, integrating social, political, ethical and health-related factors (Batey A) vs non-intervention (standard of care-Batey B) was examined longitudinally in relationship to specific outcomes (prevention of morbid events such as HIV, tuberculosis, diarrhea, dengue, malaria, and model impact on breastfeeding and vaccines rates). A quasi-experimental, pre-test, post-test control group design was implemented in three phases: baseline assessments, implementation of a human security model over a six month period, and evaluation of the model at six and twelve months. Qualitative evaluation methods were used to complement quantitative assessments. An economic analysis was also conducted to evaluate costs-savings.
Lessons learned: The intervention population (Batey A) had better outcomes (no new HIV infections and fewer cases of malaria, tuberculosis, diarrhea and dengue, as well as higher vaccine and breastfeeding rates) at six and twelve months. Qualitative interviews highlighted the necessity for structural interventions (water pump, construction of latrines) to overcome community security-related issues. Implementation of the human security model resulted in a major total cost-savings to the Ministry of Health and society overall, equal to US $252,399, demonstrating that the money allocated for HIV prevention could be utilized to both reduce HIV disease burden and to invest in health systems.
Next steps: HIV prevention and treatment resources strategies need to be implemented in other Bateyes of the DR, as well as in vulnerable settings living under structural violence circumstances, to reduce the global burden of disease and to improve human security conditions.
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