Impact of Family-Based Economic Empowerment Intervention on Multidimensional Poverty for Adolescents Living with HIV (ALWHIV) in Uganda

Background:  The evidence from Sub-Saharan Africa (SSA) indicates that economically vulnerable children are disproportionately affected by HIV (Haberer, et al, 2010; Li et al., 2010; Nachega et al., 2009; Sutcliffe et al, 2008). The association between poverty and HIV has been theorized to be bidirectional (Piot, Greener & Russell, 2007). Those living in poverty are more likely to engage in transactional or age-disparate sexual relationships as well as have limited access to health infrastructure, which increases their susceptibility to HIV infection (Steinert et al, 2017) and difficulties to  Antiretroviral therapy (ART) treatment adherence once infected (Marais et al., 2008). In addition, HIV/AIDS can exacerbate household poverty via higher household expenditure related to medical expenses and/or loss of income (Steinert et al, 2017).

Methods:This paper used the data from Suubi+Adherence, a five-year longitudinal randomized control trial with 702 ALWHIV aged 10 to 16 years old at enrollment. The trial examined the effects of a family-based economic empowerment intervention on Adolescents living with HIV(ALWHIV) in Uganda. The 24-month intervention consisted of a savings account with savings match, mentorship and trainings to increase financial capabilities.

Following the Global Multidimensional Poverty Index (MPI) structure, our MPI index considered Ugandan context and consists of individual and household indicators such as Health (malnutrition, perception of physical health, mental health), Asset (savings, clothing & shoes, means of communication), Housing (type of housing, water source,  electricity) and Family Dynamics (family cohesion, child work, school drop-out). After applying the 2/4 poverty cutoff we computed the proportion of children who are multidimensionally poor (H),  poverty intensity (A) and adjusted headcount ratio (M0). These three indicators were used to depict multidimensional poverty patterns across treatment and non-treatment groups at different time points (baseline, 12, 24, 36 and 48-month after baseline). The analysis was conducted with -mpi- command in STATA 15 (Pacifico & Poege, 2017). This paper will present the results on changes that happened at wave 5 (48-month after baseline) in comparison to baseline.

Results: Analysis showed that at baseline 35.5% of treatment group participants and 38.1% of adolescents from non-treatment group were multidimensionally poor.  The intervention reduced multi-dimensional poverty incidence by 10.8 percentage points (30.4%)  treatment group versus 6.6 percent point (17.3%) for non-treatment group at wave 5 (24 months after the intervention ended). The results also indicated that the percent of multidimensionally poor children from treatment group decreased by almost twice as much with 6.6 percent points (32.4%) for treatment group adolescents versus 3.3 percent points (15.1%) for non-treatment group at wave 5. In addition, the analysis showed that while poverty intensity increased for non-treatment group by 1.7 percent points, it decreased by 1.5 percent points for treatment group.

Implications:Our study showed that economic strengthening family-based interventions have the potential to decrease multi-dimensional aspects of adolescence poverty. However, future research is needed to explore which specific aspects of the intervention (a savings account with savings match, mentorship,  financial capability trainings) produced a stronger effect.