Flatley Earns Fellowships to Study HIV/AIDS in Guatemala

April 29, 2008

Each November nearly a million Guatemalans of Mayan descent trek to the country's southern coast, where they stay in camps and work for the coffee industry until April. Away from their homes and families, the workers may engage in risky behavior that could further exacerbate one of the highest rates of HIV/AIDS infection in Central America. Third-year law student Kate Flatley hopes to help ensure that doesn't happen.

Kate Flatley

Flatley is the recipient of the Law School's Monroe Leigh Fellowship in International Law, an award worth $10,000, and a $17,900 fellowship offered by the University of Virginia's Center for Global Health, the Glenn and Susan Brace Center for Global Health Scholar Award and Pfizer Initiative in International Health/CGH Research Award in Infectious Disease.

Flatley will use the fellowships to study HIV/AIDS among the migrant coffee worker population over an 18- to 24-month period.

"I'm going to do a survey that studies the knowledge, attitudes, and practices of this population with regard to HIV," Flatley said. From those findings she will develop recommendations that can be implemented by the Guatemalan government, the Ministry of Health or by plantation owners to protect their workers.

Some fear that a widespread Guatemalan AIDS epidemic is being triggered by cultural factors such as early sexual activity in young people, social norms that encourage men to engage in risky sexual behavior and high levels of internal migration. Vulnerable populations such as sex workers and homosexual men exhibit very high infection rates: 3 to 4 percent and 10 percent respectively. The most affected region is also a key trade route through Central America.

"It's a concentrated group of vulnerable populations in this area. There's concern that this is a big issue," Flatley said.

Flatley is experienced at human rights work at home and in international settings. Prior to law school, she worked for the Soros Foundation on international health issues in New York. She has spent most of her free time as a law student on human rights projects, and last year studied communal violence in India as a Cowan Fellow with the Human Rights Study Project. Last summer, she worked for Human Rights Watch in their Americas division in Washington, D.C.

As a summer intern at the Soros Foundation's Access to Justice Program in Guatemala in 2006, Flatley honed her Spanish and field research skills while investigating labor disputes on coffee plantations. When Flatley looked into what she wanted to do after law school, she again zoned in on Guatemala's migrant coffee workers, a population she said lacks access to legal resources, health care, education and other services.

"I started thinking about trying to work with migrant workers in the future and was reading a lot about the HIV epidemic in Central America," she said. "I had wanted to try to find a way to combine my interest in public health with my human rights experience from law school."

She couldn't find information on the frequency of HIV in migrant coffee workers, which constitute 12 percent of Guatemala's working population, but a study of a similar group - sugar cane workers - revealed high infection rates.

"People expect to find the same within the coffee workers, but they aren't sure yet," she said.

Although Guatemala has implemented a program to target the spread of AIDS, current government policies don't address high-risk populations that may not already be infected, or work to better protect them from the epidemic, Flatley said.

"There are a lot of different health policies that could be implemented to better protect the population."

The Center for Disease Control's Global AIDS Program for Central America and Panama and Anacafe, the national coffee producers' association, are serving as Flatley's mentor organizations during her study.

Professor Deena Hurwitz, who served on the selection committee for the Monroe Leigh Fellowship, said she was pleased that the Center for Global Health recognized Flatley's potential and the value of her project, and that the committee was impressed with her proposal.

"She has given it a lot of thought. She has been researching the issues and working on the methodology through an independent study this semester," Hurwitz said. "Though public health and human rights is a burgeoning field, Kate identified a problem that has not yet received much attention."

Flatley will also research Guatemala's legal protections for HIV and vulnerable populations, the right to health and how those laws may protect migrant workers. Laws there are now focused on protecting people from discrimination, not protection from the epidemic through access to health and treatment.

"I'm really interested in the interaction between public health and human rights. There are a lot of connections between those two issues," she said. "It's a newer area of human rights law - social, economic and cultural rights. Jurisprudence around the area is still developing. It's an area that I think is really interesting to work in right now."

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