In Dominican Republic, Pact builds trust, stability to reach Haitians with critical HIV services

As a community case worker with the Building Resilience project in the Dominican Republic, Amancia de León has a vital role. The 20 HIV-affected families in her portfolio are all Haitian, either migrants or descendants, and they face extreme challenges: Besides HIV, they are grappling with poverty and the vast uncertainty that comes with being Haitian here. They are under constant threat of deportation and often move around to avoid problems and find work. 

De León relies on many resources to serve the families under her care. She received comprehensive training to do her job, and Building Resilience, a Pact-led, USAID and PEPFAR-funded program, includes a network of clinical and social service providers that can help families to cover basic needs, gain skills to earn income, keep their children in school, access HIV testing and treatment, and much more. 

But perhaps de León’s greatest resource is her own background. She is Haitian herself, fluent in Creole, and understands firsthand families’ struggles. This allows her to build trust in a way that would be difficult for an outsider. 

“Haitian people here have so many barriers,” de León says. 

Pact has been working to prevent and respond to HIV among Haitians in DR since 2019, first under the ACHIEVE project and then with Building Resilience. Working with local partners, we use a case management approach that is employed around the world in HIV programming to serve vulnerable populations, such as orphans and vulnerable children (OVC). Under the approach, case workers regularly visit enrolled families and provide a range of services from encouragement to education to referrals, in order to reduce families’ vulnerability to help them either maintain their HIV-negative status or adhere to treatment to reach viral load suppression. 

But to effectively reach Haitian migrants specifically, Pact has tailored its efforts in DR in unique ways. 

“They are an extremely vulnerable group,” says Pact’s Desirée Luis, head of the Building Resilience project. “The discrimination and threats they face make them harder to reach.”

Building Resilience serves about 13,000 Haitians across five provinces of DR. As a group, Haitians have the highest HIV prevalence in DR. Luis explains that their HIV status by itself puts them at risk – HIV stigma is rampant here – and being Haitian only adds complexity. 

As a result, Building Resilience focuses on creating stability and trust. “We go beyond health services,” Luis says, “to help kids find educational stability, to improve nutrition, to address family violence and provide psychosocial support and economic strengthening interventions.”

Once a family is identified to take part in Building Resilience, their case worker completes a comprehensive assessment of their needs and creates a plan to support each family member. Eventually, when families reach stability, they are “graduated” from the program. 

“We have a lot of families that really need the help,” says Melvin Perez, the Building Resilience project coordinator for IDEV, a Dominican organization and Pact partner. “It’s not just about getting treatment for HIV. It’s about dealing with the issues they are facing in their day-to-day life.”

De León notes that many of the families she serves require legal support and assistance related to their migration status. She recognizes that this is not a common component of HIV programming, but here it is needed. When a family’s breadwinner is deported, everyone becomes more vulnerable.

“So many challenges begin with not having documentation – access to education, to health care, to social protections, to economic opportunities,” says Pact’s Bac Alexandre. 

As a senior priority population specialist, his role is to ensure that Building Resilience understands the community it serves and meets needs as best as possible. Haitian himself, he supports on especially difficult cases or when hard-to-solve challenges arise. 

“It’s a privilege to be a voice for this community,” Alexandre says. 

The most important way that Building Resilience has tailored its approach is by employing community case workers, or CCWs, who are almost all Haitian; 95% of the program’s 170 CCWs are Haitian migrants or of Haitian descent. Pact works with community groups that serve migrants in order to recruit CCWs. 

“This is essential for building trust and relationships,” Luis says. “Our most important strategy has been focusing on relationships and making sure they are strong so that even if a family moves or has a significant disruption in their life, they will maintain contact with their CCW.” 

Sometimes, CCWs are the ones who are deported. It is a challenge that Building Resilience has unfortunately had to adapt to. “We try to have backup relationships with families so that if a case worker cannot maintain contact, we don’t lose the families they were supporting,” Luis explains. 

For Bethania Ruiz, 19, the program has helped her to turn her life around. Her family enrolled after her mother, who is HIV-positive and a migrant, visited an IDEV clinic. 

“My mother was always a merchant,” Ruiz says. “She could not have a well established job to provide a good quality of life for our family.”

Her mother’s health was at a point of no return when their case worker, Cindy, began supporting the family. Thinking she would not survive, Bethania’s mother was looking to put her children up for adoption. Cindy brought food and hygiene kits, supported Bethania’s mother to stay on medication, and connected the household with assistance to keep its youngest members in school. Bethania received psychological support and vocational training, and is now her family’s breadwinner.

“There is a future,” she says. 

Building Resilience staff have gone to great lengths to help HIV-positive participants stay on antiretroviral therapy, including making visits to detention centers to try to deliver supplies of medication before a deportation. At PEPFAR-supported clinical sites, there are staff who speak Creole. Patients are reassured that they will not face discrimination, and CCWs help families find safe routes to get to clinics. Pact is building the capacity of four local organizations to carry on the program’s work after it ends. 

The program has made other adaptations, too, including adding a self-care component for CCWs because the challenges of their job can be so intense.

“It is difficult when you can’t solve every problem,” de León says. “But I know I am making a difference.”