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Women account for more than 60% of all HIV infections in sub-Saharan Africa and 75% in people ages 15-24. HIV/AIDS among women has serious implications for healthy development of youth, as well; 15 million children have been orphaned due to AIDS in Sub-Saharan Africa. Evaluation of interventions addressing the HIV’s structural drivers remain urgently needed, yet studies on social development and other structural interventions are rare. Evaluations that do exist typically omit participants’ own voices—a limitation of particular social work significance when these marginalized voices are from women facing the unique “triple threat” of HIV, gender inequities, and poverty. This mixed method study evaluated the impact of a social development program for HIV-positive Kenyan women living in extreme poverty. A participatory evaluation approach was used, involving program participants and staff as collaborators throughout the study. This paper reports findings from the initial qualitative study phase.
Methods
Phase one aimed to: (1) explore perceived impact of social development program participation for women and their children; (2) collaboratively with program participants and staff, establish the set of core program outcomes to be measured in phase two. Semi-structured qualitative interviews were conducted with program participants; questions focused on women’s lived experience with HIV/AIDS and how their lives have changed since entering the program. Capacity-building sessions were conducted with program staff to build research skills and identify the agency’s priority program outcomes for evaluation. Data were analyzed thematically using an inductive analytic approach by a U.S./Kenya-based team. Prolonged engagement, reflexivity, member checking, and peer debriefing were used to enhance trustworthiness of findings (Lincoln & Guba, 1985).
Results
The program participant sample (n=27) included women ages 20-48 from five rural villages and two urban informal settlements. Four major themes and nine sub-themes emerged regarding perceived program impact: (1) Economic Security (Skills; Resources), (2) Well-being (Physical health; Emotional wellness; Spiritual wellness), (3) Empowerment (Empowerment as women; Empowerment as mothers), and (4) Social Capital (Social support; Social influence). From the staff capacity building sessions, five priority outcomes emerged: (1) Physical health; (2) Psychosocial health; (3) Economic, food, and housing security; (4) Assets; and (5) Child/dependent wellbeing. Finally, researchers, staff, and other stakeholders met to discuss areas of overlap and reconcile divergent results, creating a participant-informed set of Core Outcomes to be measured in the subsequent project phase.
Conclusions and Implications
Despite some overlap, results revealed distinctly different perspectives regarding most important intervention outcomes to evaluate. Staff prioritized outcomes related to physical/emotional wellbeing and family stability. Participants identified the most meaningful program benefits as those contributing to their dramatic personal transformations: from failing health, inability to provide for children, and social rejection to empowered entrepreneurs and community role models no longer burdened by the stigma of HIV. These divergent findings suggest that social development programs can have a multilevel impact on HIV-positive women and their children; results also highlight the need for evaluators to intentionally create space for participant voices in order to effectively assess program impact. Further implications for social work research will be discussed.