Health and Haitian Migrants to the Dominican Republic

Geographic, economic, and cultural barriers to health prevent migrants from achieving the same outcomes as their non-migrant peers. Coupled with anti-migrant discrimination, these barriers can have devastating impacts on physical and mental health (Sargent and Larchanché, 2011). Poverty and poor health outcomes are well-known in Haiti but less attention is given to Haitian migrants. The estimated number of migrants from Haiti to the Dominican Republic ranges from 500,000 to one million due to a large number of undocumented Haitians (Leventhal, 2013). Stephanie Leventhal describes how Haitian migrants to the Dominican Republic often grapple with barriers in accessing healthcare, due to isolation from the health system and anti-Haitian discrimination, known as Anti-Haitianismo (2013). The marginalized place of Haitian migrants in the Dominican Republic entails multiple barriers to health, related to structural violence, or a network of structures which “prevent an individual from reaching their full potential” (Farmer et al., 2006). Due to structural violence, namely poor working conditions, discrimination, and inadequate infrastructure, Haitian migrant populations struggle with high rates of chronic and infectious conditions, including HIV/AIDS, undernutrition, waterborne disease, anxiety, and depression.

Haitians living in the Dominican Republic are relegated to the margins of society, both geographically and socially. Haitian migrants or Dominicans of Haitian origin often live in the Bateys, communities of migrants associated with sugar cane cultivation. The island of Hispaniola, where Haiti and the Dominican Republic are located, has the highest prevalence of HIV/AIDS in the Western hemisphere, with 1.2% of the population infected (Rajas et al., 2011). On Hispaniola, the majority of HIV/AIDS cases are in Haiti or in Haitian populations (Rajas et al., 2011). In the late 1990’s, the majority of Batey residents were young Haitian men looking for work. Women made up only around 10% of the Haitian migrant population (Brewer et al., 1998). However, a significant portion of these women resorted to sexual exchanges as a means to survive. This was particularly true for women who came to the Dominican Republic without a partner; 19.8% reported being a prostitute or engaging in sexual exchanges versus 10.3% of those who did come with a partner (Brewer et al., 1998). Among these women, rates of HIV for all age groups were 11.4% without a partner and 4.2% with a partner (Brewer et al., 1998). A more recent study from 2007 indicated a similar phenomenon; many women infected with HIV were mothers who did not know they were infected and acquired and transmitted the virus through serially monogamous relationships which they used as a means to secure financial support (López-Severino & Moya). Haitian women in the Bateys continue to lack the agency to secure an income, increasing HIV transmission. Due to this lack of economic agency, sex work and dependency on men are a means to survive, leading to higher HIV rates.

In the larger Bateys population, rates of HIV among these populations varied by age, but range from 5% to 12% (Rojas et al., 2011). Among the sexually active general population in the Dominican Republic, the prevalence of HIV is 0.8% (Rojas et al., 2011). Women in the Bateys have trouble accessing health care, with 87% reporting obstacles to access, exposing significant structural barriers in HIV care for these populations. There are also barriers to knowledge about HIV transmission; 25% and 30% of women and men, respectively, demonstrate knowledge of how HIV is transmitted (Rojas et al., 2011). In the Bateys, 25% of women and 22% of men believed that HIV can be acquired through supernatural powers, advancing the claim that the Bateys’ population lacks formal knowledge of HIV (Rojas et al., 2011). Intense stigma further complicates the matter; only 4% of the Bateys’ population would engage in casual interactions with an HIV-positive person, such as buying vegetables, or provide care to a HIV-positive family member (Rojas et al., 2011). By reducing structural barriers and increasing education around HIV through long-term community-based programs, prevalence of HIV could be reduced in the Bateys.

In Haitian neighborhoods in the Dominican Republic, infectious and chronic disease are seen in higher rates than in other neighborhoods due to structural inequalities. Risk of waterborne disease is elevated due to higher counts of E. coli Bacteria in the water supply in Haitian neighborhoods than in Dominican neighborhoods (Rogers-Brown et al., 2016). Not only are the levels of contamination high, but Haitians living in the Dominican Republic struggle to access any clean water (Rogers-Brown et al., 2016). Diarrheal deaths, many of which are associated with unclean water, account for 9.4% of death nationally in the Dominican Republic, in communities without clean water this rate is further elevated (Simmons, 2010). Of six Bantey communities surveyed, only two had access to a public community well, demonstrating a striking structural barrier to health for Haitian migrants (Simmons, 2010). Another concern in the Bateys is undernutrition due to food insecurity. In one study of chronic undernutrition, 63% of children experienced mild undernutrition, 28% experienced moderate undernutrition, and 9% experienced severe undernutrition (Parikh et al., 2010). Undernutrition is caused and exacerbated by a lack of access to consistent food sources and geographic isolation from healthcare (Parikh et al., 2010). Due to structural and geographic obstacles, Batey populations suffer from infectious and chronic conditions, impacting their overall health outcomes and increasing their vulnerability to further disease.

Many Haitian migrants to the Dominican Republic are stateless, since Haitians, even those who have lived in the Dominican Republic for generations, are denied citizenship and are not registered as Dominican citizens at birth (Kosinski, 2009). Statelessness impairs the ability of Haitians to operate in Dominican society, but also increases discrimination and impacts mental health. Moreover, Haitians are marginalized through Anti-Haitinismo, or anti-Haitian hate (Simmons, 2010). Discrimination by Dominicans was associated with depression and a 6.6-point increase in the Beck Depression Inventory scale (Keys et al., 2015). Moreover, many Dominicans were found to believe that discrimination did not exist against Haitians and attributed the outcomes of Haitian migrants to sociocultural, behavioral, and biological differences, demonstrating a deeply ingrained system of marginalization (Keys et al., 2015). For Haitian migrants, lack of social support was associated with poor mental health outcomes, particularly anxiety, depression, and mental distress (Kaiser et al., 2015). In particular, anxiety was associated with knowing someone who was deported Haiti, especially since Dominican authorities were known to make arbitrary arrests (Kaiser et al., 2015). Due to statelessness, migration, threat of deportation, and discrimination in Dominican society, Haitian migrants are susceptible to mental illness.

Coupled with the geographic, social, economic, and structural barriers leading to higher risk of infectious and noncommunicable disease, mental illness associated with Anti-Haitianismo can have devastating impacts on Haitian migrants to the Dominican Republic.

Related Articles

• Health and Migration
• Cholera in Haiti

Additional Resources

Miller, A. S., Lin, H. C., Kang, C. B., & Loh, L. C. (2016). Health and Social Needs in Three Migrant Worker Communities around La Romana, Dominican Republic, and the Role of Volunteers: A Thematic Analysis and Evaluation. Journal of tropical medicine, 2016.

Farmer, P. (2004). An Anthropology of Structural Violence. Current Anthropology, 45(3), 305-325.

Alami, A. (2018, August 13). Between Hate, Hope, and Help: Haitians in the Dominican Republic. The New York Review of Books. https://www.nybooks.com/daily/2018/08/13/between-hope-hate-help-haitians-in-the-dominican-republic/. Last Accessed: May 9, 2019.

References

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Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS medicine, 3(10), e449.

Kaiser, B. N., Keys, H. M., Foster, J., & Kohrt, B. A. (2015). Social stressors, social support, and mental health among Haitian migrants in the Dominican Republic. Revista Panamericana de Salud Pública, 38, 157-162.

Keys, H. M., Kaiser, B. N., Foster, J. W., Burgos Minaya, R. Y., & Kohrt, B. A. (2015). Perceived discrimination, humiliation, and mental health: a mixed-methods study among Haitian migrants in the Dominican Republic. Ethnicity & Health, 20(3), 219-240.

Kosinski, S. (2009). State of uncertainty: Citizenship, statelessness, and discrimination in the Dominican Republic. BC Int'l & Comp. L. Rev., 32, 377.

López-Severino, I., & Moya, A. D. (2007). Migratory routes from Haiti to the Dominican Republic: implications for the epidemic and the human rights of people living with HIV/AIDS. Interamerican Journal of Psychology, 41(1), 7-16.

Parikh, K., Marein-Efron, G., Huang, S., O'Hare, G., Finalle, R., & Shah, S. S. (2010). Nutritional status of children after a food-supplementation program integrated with routine health care through mobile clinics in migrant communities in the Dominican Republic. The American journal of tropical medicine and hygiene, 83(3), 559-564.

Rogers-Brown, J., Johnson, R., Smith, D., & Ramsey-White, K. (2016). A pilot study to examine the disparities in water quality between predominantly Haitian neighborhoods and Dominican neighborhoods in two cities in the Dominican Republic. International journal of environmental research and public health, 13(1), 39.

Rojas, P., Malow, R., Ruffin, B., Rothe, E. M., & Rosenberg, R. (2011). The HIV/AIDS epidemic in the Dominican Republic: key contributing factors. Journal of the International Association of Physicians in AIDS Care, 10(5), 306-315

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