Money, Medicine, and Motherhood: Developing a Cash Transfer for Pregnant Women with HIV in Rural Haiti.

Improving perinatal engagement in HIV care is critical to prevent disease progression and transmission. In Haiti and other low-resource settings, poverty contributes substantially to poor perinatal HIV outcomes. Cash transfers are a promising intervention that may alleviate poverty and improve perinatal HIV outcomes through economic and psychological pathways. To inform the design of an unconditional cash transfer intervention, we conducted semi-structured interviews with 20 pregnant and postpartum women with HIV receiving care at St. Boniface Hospital in rural Haiti 12/2023-5/2024. Using an interview guide with open-ended questions, we explored barriers and facilitators to HIV care around the time of birth and perspectives on and preferred features of a potential unconditional cash transfer. Interviews were conducted in Haitian Creole, transcribed and translated into English, and analyzed thematically using a codebook developed through deductive and inductive coding. Participants (median age 24 years; 50% pregnant) described barriers including antiretroviral therapy side effects, particularly when taken without food, interpersonal stigma, poverty, and food insecurity. Facilitators included motivation to protect the child's health, understanding treatment benefits, transportation reimbursement, and social support. Participants viewed cash transfers as a promising way to address poverty-related barriers, reporting they would use funds for household needs, child expenses, and small business activities. Preferred transfer sizes varied, as did preferences about delivery, timing, and frequency. Findings underscore poverty's central role in shaping perinatal HIV care engagement and support the potential of unconditional cash transfers to improve outcomes.