Abstract
HIV and poverty are inextricably intertwined in sub-Saharan Africa. Economic and livelihood intervention strategies have been suggested to help mitigate the adverse economic effects of HIV, but few intervention studies have focused specifically on HIV-positive persons. We conducted three pilot studies to assess a livelihood intervention consisting of an initial orientation and loan package of chickens and associated implements to create poultry microenterprises. We enrolled 15 HIV-positive and 22 HIV-negative participants and followed them for up to 18 months. Over the course of follow-up, participants achieved high chicken survival and loan repayment rates. Median monthly income increased, and severe food insecurity declined, although these changes were not statistically significant (P-values ranged from 0.11 to 0.68). In-depth interviews with a purposive sample of three HIV-positive participants identified a constellation of economic and psychosocial benefits, including improved social integration and reduced stigma.
Highlights
HIV and poverty are inextricably intertwined in sub-Saharan Africa
With increased risks for secondary HIV transmission resulting from suboptimal adherence and engagement in care, this complex web of mutually reinforcing effects yields a vicious cycle of HIV acquisition, worsening poverty and food insecurity, and increasing HIV-related morbidity (Weiser, Young, Cohen, Kushel, Tsai, Tien et al 2011)
With the increasing availability and scale-up of HIV treatment in sub-Saharan Africa, it has been expected that the economic and psychosocial benefits of HIV treatment would have a normalizing effect on the meaning of living with HIV
Summary
HIV and poverty are inextricably intertwined in sub-Saharan Africa. Poverty and food insecurity are well-known risk factors for HIV acquisition among women (Miller, Bangsberg, Tuller, Senkungu, Kawuma, Frongillo et al 2011; Schoepf 1988; Weiser, Leiter, Bangsberg, Butler, Percy-de Korte, Hlanze et al 2007). With increased risks for secondary HIV transmission resulting from suboptimal adherence and engagement in care, this complex web of mutually reinforcing effects yields a vicious cycle of HIV acquisition, worsening poverty and food insecurity, and increasing HIV-related morbidity (Weiser, Young, Cohen, Kushel, Tsai, Tien et al 2011). With the increasing availability and scale-up of HIV treatment in sub-Saharan Africa, it has been expected that the economic and psychosocial benefits of HIV treatment would have a normalizing effect on the meaning of living with HIV. In a number of qualitative and epidemiological studies, HIV-positive persons initiating treatment have described a constellation of economic and psychosocial benefits, including greater economic productivity and selfefficacy, reduced stigma, and improved mood (Campbell, Skovdal, Madanhire, Mugurungi, Gregson & Nyamukapa 2011; Martinez, Tsai, Muzoora, Kembabazi, Weiser, Huang et al 2014; Tsai, Bangsberg, Bwana, Haberer, Frongillo, Muzoora et al 2013; Ware, Idoko, Kaaya, Biraro, Wyatt, Agbaji et al 2009). The extent to which HIV treatment alone can completely reverse pre-treatment losses and bring about economic and psychosocial normalcy has been questioned
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