A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya

Abstract

Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya. In the current study, we drew upon longitudinal, in-depth interviews with 45 intervention participants and 9 control participants (N = 54) in order to examine the impacts of the intervention on gendered power and sexual risk reduction among both women and men. Female and male participants in the intervention described positive changes in sexual practices and gendered power dynamics as a result of intervention participation. Changes included reduced sexual risk behaviors, improved gender-related power dynamics, and enhanced quality of intimate relationships. These findings illuminate how a multisectoral agricultural intervention may affect inequitable gender relations and secondary transmission risk. Further research is needed to explore how to best leverage agricultural interventions to address the important intersections between poverty and inequitable gender relations that shape HIV risks.

Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings

“…We integrated a longitudinal qualitative study into the pilot trial, aiming to unpack the mechanisms behind intervention impacts (Zakaras et al, 2016). The purpose of the current manuscript is to explore the mental health impacts of the intervention.…”

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

“…In an ongoing longitudinal qualitative study, this intervention also improved ART adherence and clinic attendance, and reduced HIV-related stigma and discrimination [157]; its impacts on stigma were hypothesized to occur through restoration of health, increased social integration, and an increased ability to make reciprocal economic contributions to community safety nets [158]. The same study also found changed gendered power dynamics, reduced high-risk behaviors, and improved prioritization of health [157,159].…”

Economic strengthening for HIV prevention and risk reduction: a review of the evidence

“…Both microcredit studies with FSW found that combined interventions comprised of HIV risk reduction support and multiple HES components including microcredit, were associated with self-reported risk reduction, and one found a reduction in STI incidence though the study quality was low (Odek et al, 2009;Souverein et al, 2013). Finally, adult PLHIV in Kenya participating in a qualitative study cited in the previous section of this paper, reported reduced behaviors associated with onward transmission of HIV resulting from a combined intervention, including microcredit (Zakaras et al, 2016).…”

“…A qualitative study with an adult female population in Kenya reported that participation in an IGA was not protective against HIV risks, including IPV (Gnauck et al, 2013). A final qualitative study with an HIV-positive adult population in Kenya found an IGA plus an in-kind loan for farming inputs reduced behaviors associated with onward transmission of HIV (Zakaras et al, 2016).…”