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

Garifuna, an Afro-Caribbean ethnic group in Honduras, have among the highest HIV prevalence rates in Central America; 15- to 49-year-old Garifuna 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 (BSSC) reexamined seroprevalence of HIV, sexually transmitted infections, and HIV-related risk behaviors among Garifuna to inform HIV prevention activities and monitor trends in HIV transmission over time. To inform the BSSC survey protocol, we conducted a rapid ethnographic assessment (REA) in Garifuna communities to specifically examine acceptability among Garifuna to be surveyed, suggest ways to minimize HIV-testing related stigma, and determine female gender-specific concerns among BSSC 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 Garifuna acceptability to participate in the BSSC with key member involvement and incentives. Maintaining confidentiality at HIV testing sites is required to minimize Garifuna women's risk of intimate partner violence. Recommendations to BSSC partners from this REA informed the BSSC study protocol and was expected to increase participation and validity and decrease potential risks associated with women's survey participation.