Background: Because economic conditions are both a risk factor for disease and may themselves be objectives for health delivery interventions, monitoring changes in economic outcomes has become a routine priority for health and development efforts. However, the lack of formal commerce in poor agrarian communities creates challenges for measuring economic status. Data on household finances, such as income, are ideal but are time-consuming, costly, and less reliable, whereas proxy measures of wealth such as indices of durable assets are easier to measure but relatively coarse and are less sensitive to rapid changes in underlying drivers. Methods: We used data from a cohort of 528 people living with HIV/AIDS (PLHA) enrolled in a food intervention study on household demographics, agricultural production, cash income, in-kind income, household durable assets and health status, including CD4 count. We created a household economic index using principal components analysis (PCA) and compared it with three other economic indicators generated from the data (income, expenditures, poverty score). Through multivariate logistic regression analysis we evaluated the effect of the economic metric on probability of survival within the first year of study. Results: Socioeconomic status determined by PCA of durable assets, weighted by the square root of the household size, was the only consistently significant economic predictor of probability of death. It remained significant even after controlling for direct health indicators such as CD4 count. There was no significant correlation between CD4 count and the economic indicators, which may be attributable to uniform access to ART among study participants. Conclusion: Among people who have HIV and are all enrolled in ART and food programs, household socioeconomic status is an important predictor of mortality rates, even after controlling for direct health measurements such as CD4 count and other health-related covariates. The SES indicator from PCA is also a simple metric to estimate. The study underscores that poverty is a social determinant of mortality even in the context of equal access to health services, and is suggestive of the importance of poverty alleviation activities as an important supplement to clinical interventions.

Ausgehend von narrativen Interviews, Beobachtungen und gemeinsamen Erfahrungen während eines interkulturellen Lehrerfortbildungsprojekts im ländlichen Haiti wird in dieser Arbeit ein detailliertes Bild der Lebenswelt ausgewählter haitianischer Grundschullehrer/-innen gezeichnet. Insbesondere wird den Fragen nachgegangen, welchen Hindernissen diese Lehrer/-innen in ihrer eigenen Ausbildung begegneten, welche professionellen und sozialen Herausforderungen ihre alltägliche Berufsausübung mit sich bringt und wie ein genaues Verstehen ihres Hintergrunds und ihres Alltags dazu beitragen kann, sowohl die Qualität ihres Unterrichts als auch ihre sozio-ökonomischen Aussichten zu verbessern. Verspätete und unzureichende Ausbildung, ein geringer Verdienst und herausfordernde Arbeitsbedingungen, sowie weitgehende Vernachlässigung durch den Staat kennzeichnen die Realität dieser Lehrer/-innen. Dennoch zeigen sie Elan und vertrauen auf eine bessere Zukunft. In dieser Studie kommen die haitianischen Lehrer/-innen selber zu Wort. Darüber hinaus wird der Prozess der interkulturellen Kommunikation und Reflexion, der mit einem solchen Projekt und einer derartigen Recherche einhergeht dokumentiert. / This study offers a detailed description of selected Haitian primary school teachers’ living and working conditions based on narrative interviews, observations, and common experiences during a cross-cultural in-service teacher training program in rural Haiti. The research is focused on the following questions: What type of obstacles did primary school teachers in rural Haiti encounter in their own education, what professional and social challenges are faced in the daily routines of these teachers, and how can a thorough knowledge of both their backgrounds and the conditions of their current lives help to improve the quality of their teaching as well as their prospects for socio-economic advancement? The reality of these teachers is characterized by a delayed and limited education, low remuneration and challenging working conditions, as well as a more or less complete lack of state support. Nevertheless, they demonstrate vitality and trust in a better future. Central to this study are the Haitian teachers’ viewpoints, but the process of cross-cultural communication and reflection going on during such a program and research is documented as well.