Week 4 Discussion
The St. Fleur family is well respected in the Haitian community because they are religious with great moral values. They moved to the United States because of political issues in Haiti. Ronald, the youngest son of this family, is 27 years old and lives at home with his mother and father. Recently, he began having fevers and subsequently developed pneumonia. He was admitted to the hospital, where laboratory tests were HIV positive. Ronald was in shock when the doctor informed him that he was HIV positive. He confessed to the doctor that he was gay, but he could not tell his family. He said that he did not want to bring shame to the family. Because he couldn’t be in a formal relationship disowning to his family and the Haitian community’s view of homosexuality, he has been very promiscuous over the years.
In the Haitian culture, homosexuality is considered taboo (Purnell, 2013).  Because it is considered taboo, most gay and lesbians do not reveal their sexuality.  If they do disclose this information to family, their sexuality is kept quiet and family pretends that the conversation never happened.  Homosexual relationships are not discussed, and homosexual conduct is not displayed publicly.  The primary religions in Haiti are Catholicism and Protestantism, aside from Voodooism.  Due to the strong religious beliefs, these also have a large impact against homosexuality.    
If Ronald’s parents were to learn of his HIV status and were strongly religious and traditional, they may react very negatively.  Haiti is the poorest country in the Western hemisphere and has the highest number of people with HIV.  People that are infected with HIV in Haiti are vulnerable to stigmatization, and are perceived as having socially despised behaviors (The Conversation, 2019).  While the incidence of HIV is higher in heterosexual relationships, it is the homosexual community that bears the brunt of the stigma.  
As a healthcare provider, three major culturally congruent strategies that can implemented to address HIV prevention practices in the Haitian community include relationships, medical care, and transmission methods. Each of these items would need to be approached with great sensitivity and would need to stay within the cultural boundaries.  In the Haitian culture, it is accepted that men have a wife and a mistress, should one of them be infected with HIV, it is a high likelihood that all will become HIV positive.  
Encouraging the Haitian community to seek routine medical care and screening could reduce the spread of HIV simply by testing/screening them for HIV.  For those that test positive, getting them started on antiretroviral medications promptly will likely extend their lives beyond what those that are not on medications would have.  Providing education on the transmission methods would greatly reduce the spread of HIV.  In the Haitian culture, sex is not openly discussed with females, and males are encouraged to have sexual relations early in age.  By educating females regarding sex and the transmission of HIV, this will help to reduce the spread.  Adolescent females are more likely to be infected with HIV compared to males of the same age due to having sex with older men.  By teaching the male and female population on safe sex methods, we can aid in reducing the spread of HIV.  Another method of transmission includes sharing needles, educating regarding this method can also help reduce the spread.
References
Devieux, J.G., Malow, R.M., Jean0Gilles, M.M., Samuels, D.M., Descheamps, M.M., Ascencio, M., Jean-Baptiste, L., & Pape, J.W. (2008).  Reducing Health Disparities Through Culturally Sensitive Treatment for HIV+ Adults in Haiti.  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605017/ (Links to an external site.)

Purnell, L.D. (2013).  Transcultural Health Care:  A Culturally Competent Approach.  (4th ed).  Philadelphia:  F. A. Davis
The Conversation. (2019).  In Haiti, gay men infected with HIV are targets of discrimination.  

https://theconversation.com/in-haiti-gay-men-infected-with-hiv-are-targets-of-discrimination-119318