Self-identification as a Crucial Aspect of Inclusion of Sexual and Gender Minorities in a Study of Adverse Childhood Experiences in Haiti

Research studies are inevitably affected by contextual norms, local ideologies, social mores, and self-identification in addition to extant policies and laws. Self-identification is often emotionally laden and can be constrained by fear of reprisal if ones self-identification departs from acceptable and affirmed norms. Such complexities can hinder measurement efforts and results from established measures can fail to yield accurate and thus useful data. Studies of Adverse Childhood Experiences (ACEs) are important but understudied in Haiti. We investigated ACEs in urban Haiti using the ACE International Questionnaire (ACE-IQ). Descriptive statistics revealed: (1) A relationship between participants self-identification and sex recorded as observed by interviewers, and (2) Prevalence of ACEs by self-reported identity. Roughly half participants self-identified as Woman (56%; n = 380), 39% as Man (n = 265), 2% as Homosexual (n = 13), and 2% as Lesbian (n =14). Contradictions emerged between participant self-identification and interviewers record of sex: 98% self-identified women were observed/recorded as Female, one was observed/recorded as Male, and there was no record for five. Similarly, 95% self-identified men were observed/recorded as Male, six as Female, two as Other, and there was no record for five. Although Sexual and Gender Minorities (SGM) constituted a small subsample (n = 27), their responses underscored misclassification and disproportionate burdens of physical, emotional, and sexual abuse, family dysfunction, and other forms of interpersonal violence. Conducting ACE-IQ studies in Haiti that provide inclusive categories of self-identification may more equitably capture unique ACEs of all Haitians.