Money as a health intervention
Living with AIDS # 290

KHOPOTSO: It’€™s unconventional research: asking whether affording rural women relatively easy access to micro-finance could change circumstances that could make them easy prey for HIV infection. Speaking at a business conference in Johannesburg, Dr Julia Kim, Principal Investigator in the trial said the research recognised that whether women can follow the Abstain, Be faithful and Condomise principle is largely determined by the conditions in which they live.    

 

Dr JULIA KIM: We were really interested in looking at micro-finance as an entry point for HIV prevention, but going beyond the simple risk behaviour model ‘€“ really trying to see if we could affect the risk environment in these communities, particularly focusing on three factors: poverty, gender inequalities and domestic violence’€¦ and in doing that look at tackling HIV risk.    

 

KHOPOTSO: The study, called IMAGE or Intervention with Micro-finance for AIDS and Gender Equity, targeted eight villages in rural Limpopo province over a four-year period (2001 ‘€“ 2005). It was a randomised study, so the villages were divided into two. About 36 000 women in half the villages got the micro-finance, the others didn’€™t. The average age of the participants was 41 and just over 40% were married. A further 40% had never been to school and the majority used to beg for food and money. One in 4 had experienced domestic violence. Primarily a micro-loan provider for income-generation projects, the second aspect of the IMAGE programme was to provide education.            

 

Dr JULIA KIM: The clients get together every two weeks to repay their loans and to discuss their business plans before they get their next loan. Because this was a captive audience we thought ‘€˜why don’€™t we introduce HIV and gender training into these repayment meetings as a way of getting their attention’€™? So, the 10 one-hour sessions took place during these repayment meetings. They focussed on things like women looking at traditional wedding songs and unpacking what are the gender-related messages for women. They did role-plays around domestic violence. They talked about how they communicate with their partners and children’€¦ And we looked at building skills such as conflict resolution, communication (and) leadership.    

 

KHOPOTSO: Kim says the training programme was initially seen as rocking the boat.  

 

Dr JULIA KIM: The women were coming for business loans. And these women said: ‘€˜It’€™s not our culture. We don’€™t talk about these sensitive issues. We don’€™t talk to our kids about that’€™. But over time, probably around four or five months into the project we noticed a distinct change as women began to realise that they themselves were at risk even though they were married and that their children were at high risk and they began to realise why the trainings might important for them.

 

KHOPOTSO: With the money from the project ‘€“ small loans from R500 to R1000 ‘€“ the women started their own businesses selling fresh produce; others used clothing and child care centres. As their livelihoods improved, so did the circumstances in their homes.

 

Dr JULIA KIM: Women who were in the training expressed attitudes that no longer condoned domestic violence as being acceptable. And probably the most startling result we found was that women who had participated in this intervention – their risk of domestic violence had been reduced by more than half – compared to women who hadn’€™t participated in this intervention.

 

KHOPOTSO: The impact was empowering for the women.        

 

Dr JULIA KIM: They were negotiating condom use with their partners more. Women were able to leave abusive relationships without feeling a great deal of shame about it. They actually got support from women in their loan centres who understood why they were wanting to leave. They were more open about talking about their own HIV status or those of their children.                    

 

KHOPOTSO: Men were not included in the study. But Kim says they were interviewed for their response to the changes.

 

Dr JULIA KIM: We found that because jobs are so scarce in rural areas and because men are used to seeing women on the roadside selling food and so on, we weren’€™t transgressing sensitive gender norms, here’€¦ They were actually quite grateful that somebody was bringing money in and didn’€™t feel threatened by the changes that were happening. They were glad to see the education that was being shared with their children.

KHOPOTSO: The IMAGE study wrapped up in 2005. Its success has attracted more funding and the programme will be scaled up and introduced in 150 villages in Limpopo province covering 2000 square kilometres of land.

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