Building Community-Based Evidence to Improve Wellbeing for HIV-Positive Kenyan Women in Extreme Poverty

Background

Women account for more than 60% of all HIV infections in Sub-Saharan Africa and 75% of those among ages 15-24.  Although it is generally acknowledged that social development interventions addressing the structural drivers behind these disparities remain urgently needed, few studies explicitly focus on the “triple threat” of HIV/AIDS, gender inequity, and poverty that women in Sub-Saharan Africa face.  Further, while the adaptation, testing, and acceptability of Western evidence-based interventions in African contexts permeate the literature, the evaluation of existing interventions developed by and for African communities themselves have received comparably little attention.  This pilot study aimed to advance this critical research area by assessing the preliminary impact of a community-driven social development intervention on the physical, emotional, and economic wellbeing of HIV-positive single mothers living in extreme poverty in Kenya.

Methods

Part of a larger mixed-method community-based participatory project that began with an extensive qualitative phase, this quantitative pilot utilized a quasi-experimental design to determine the extent of change in key wellbeing indicators following participation in an 18-month intervention: the Women Equality Empowerment Project (WEEP). The intervention comprised three phases, each tailored by the local community: (1) stabilization (addressing immediate food, housing, and medical needs); (2) skill development (income-generating skills trainings, health promotion activities); and (3) sustainability (business training, collaborative microfinance activities). Both participants and NGO staff were research partners throughout the larger project, guiding development of the evaluation instrument, data collection procedures, and selecting the first two cohortsof program graduates as the pilot sample.  Following descriptive analysis, one-way ANOVAs assessed mean differences in key wellbeing indicators over three time points (Enrollment, Midpoint, Graduation). 

Results

Pilot participants (n=20) were women ages 29-55 (Mean=39.7) with 2-7 children in their care (Mean=4.1) from two geographically diverse areas of Kenya: anurban informal settlementand rural village. Women demonstrated significant improvement over time in poverty-related outcomes including income-generating skills (F [2, 57]=29.86, p<.001), meals eaten per day (F [2, 56]=3.75, p=.03), housing security (F[2, 49]=17.59, p<.001), independence (F [2, 56]=55.40, p<.001), and ability to provide for her family (F [2, 54]=3.00, p=.05).  Significant positive changes were also observed for health/mental health outcomes including acceptance of HIV status (F [2, 53]=4.17, p=.02), HIV stigma (F [2, 56]=44.46, p<.001), malaria prevention behaviors (F [2, 55]=13.59, p<.001), life stress (F [2, 56]=8.32, p=.001), and hope for the future (F [2, 54]=22.30, p<.001).

Conclusions and Implications

Pilot study findings, while preliminary, suggest WEEP is a promising intervention approach to improve wellbeing for single mothers facing the complex, interconnected challenges of HIV/AIDS, poverty, and gender inequality in Kenya.  The intervention’s community-tailored approach highlights the importance of community and cultural contexts in addressing these critical issues and the program’s potential transferability beyond these localities. More rigorous studies are needed to examine the ways in which using a bottom-up social development approach--consistent with social work values and honoring local community priorities--can advance the field by identifying model community-driven programs with demonstrated local impact and potential for scale-up elsewhere in Sub-Saharan Africa.