Microfinance and health interventions: Factors influencing loan repayment success with young men in Dar es Salaam,Tanzania

Poverty is associated with numerous poor health outcomes. Youth unemployment in Tanzania is approximately 13.7%, and concentrates in urban areas. These youth lack relevant job skills and access to financial capital. Microfinance continues to be implemented globally to address poverty, and increasingly has been linked to health interventions. Men less frequently are recipients of microfinance loans. We offered microcredit to young men in an area of Dar es Salaam with high poverty as part of a randomised controlled-trial to assess the efficacy of a microfinance and health leadership intervention in preventing STI acquisition. We used mixed methods to understand predictors of successful loan repayment. Our qualitative sub-study showed that leader influence, prior business experience, personal motivation, and planning facilitated repayment. Using a modified Poisson approach, our quantitative analysis showed that successful repayment was associated with business experience, education, increasing number of children, community of residence, percentage of network members trained in business, and repayment success of peer leaders. Our results suggest that enforcing group accountability and repayment rules, offering ongoing training, and using successful entrepreneurs as role models could increase repayment success in similar populations. These strategies could provide financial opportunity for men while minimising risk for microfinance institutions.     

Peer-led, school-based nutrition education for young adolescents: feasibility and process evaluation of the TEENS study

Peer education has become a popular strategy for health promotion interventions with adolescents, but it has not been used widely in school-based nutrition education. This paper describes and reports on the feasibility of the peer leader component of a school-based nutrition intervention for young adolescents designed to increase fruit and vegetable intakes and lower fat foods. About 1,000 seventh-grade students in eight schools received the nutrition intervention. Of these, 272 were trained as peer leaders to assist the teacher in implementing the activities. Results from a multicomponent process evaluation based on peer leader and classroom student feedback, direct classroom observation, and teacher ratings and interviews are presented. Results show that peer-led nutrition education approaches in schools are feasible and have high acceptability among peer leaders, classroom students, and teachers.     

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa

Objective

To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone.

Methods

Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa: (i) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity (IMAGE), a combined microfinance–health training intervention; (ii) four villages with 2-year exposure to microfinance services alone; and (iii) four control villages not targeted by any intervention. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects.

Findings

A total of 1409 participants were enrolled, all female, with a median age of 45. After 2 years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women’s empowerment, intimate partner violence and HIV risk behaviour.

Conclusion

The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.     

Microfinance and HIV mitigation among people living with HIV in the era of anti-retroviral therapy: emerging lessons from Cote d'Ivoire

The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Cote d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth.     

Adolescents, Celebrity Worship, and Cosmetic Surgery

PurposeTo evaluate the acceptability, feasibility, and effectiveness of a population-based intervention to promote health of youth (age: 16–24 years) in Goa.MethodsTwo pairs of urban and rural communities were selected; one of each was randomly assigned to receive a multi-component intervention and the other wait-listed. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer education, and health information materials. Effectiveness was assessed through before–after population surveys at baseline and at 18 months. Outcomes were measured using a structured interview schedule with all eligible youth. Logistic regression compared each pair, adjusted for baseline differences, on prevalence of outcomes in the domains of reproductive and sexual health (RSH), violence, mental health, substance use, and help seeking for health concerns.ResultsIn both intervention communities, prevalence of violence perpetrated and probable depression was significantly lower and knowledge and attitudes about RSH significantly higher (p < .05). The rural sample also reported fewer menstrual complaints and higher levels of help-seeking for RSH complaints by women, and knowledge and attitudes about emotional health and substance use; and, the urban sample reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and RSH complaints. Although information materials were acceptable and feasible in both communities, community peer education was feasible only in the rural community. The institution-based interventions were generally acceptable and feasible.ConclusionsMulticomponent interventions comprising information materials, educational-institution interventions and, in rural contexts, community peer interventions are acceptable and feasible and likely to be effective for youth health promotion.     

Integrated Gender-Based Violence and HIV Risk Reduction Intervention for South African Men: Results of a Quasi-Experimental Field Trial

South Africa is in the midst of one of the world’s most devastating HIV/AIDS epidemics and there is a well-documented association between violence against women and HIV transmission. Interventions that target men and integrate HIV prevention with gender-based violence prevention may demonstrate synergistic effects. A quasi-experimental field intervention trial was conducted with two communities randomly assigned to receive either: (a) a five session integrated intervention designed to simultaneously reduce gender-based violence (GBV) and HIV risk behaviors (N = 242) or (b) a single 3-hour alcohol and HIV risk reduction session (N = 233). Men were followed for 1-, 3-, and 6-months post intervention with 90% retention. Results indicated that the GBV/HIV intervention reduced negative attitudes toward women in the short term and reduced violence against women in the longer term. Men in the GBV/HIV intervention also increased their talking with sex partners about condoms and were more likely to have been tested for HIV at the follow-ups. There were few differences between conditions on any HIV transmission risk reduction behavioral outcomes. Further research is needed to examine the potential synergistic effects of alcohol use, gender violence, and HIV prevention interventions. National Institute of Mental Health Grant R01-MH MH071160 supported this research.     

Impact of peer group education on HIV prevention among women in Botswana

A peer group HIV prevention intervention based on social-cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change HIV prevention knowledge, attitudes, and behaviors for ordinary urban employed women in sub-Saharan Africa.     

Evaluating the Impact of a Substance Use Intervention Program on the Peer Status and Influence of Adolescent Peer Leaders

The current study involved an examination of the impact of a peer-led substance use intervention program on the peer leaders beyond the substance use-related goals of the intervention. Specifically, unintended consequences of an adult-sanctioned intervention on the targeted peer leader change agents were investigated, including whether their participation affected their peer status, social influence, or self perceptions. Twenty-two 7th grade peer-identified intervention leaders were compared to 22 control leaders (who did not experience the intervention) and 146 cohort peers. Three groups of measures were employed: sociometric and behavioral nominations, social cognitive mapping, and leadership self-perceptions. Results indicated that unintended consequences appear to be a legitimate concern for females. Female intervention leaders declined in perceived popularity and liked most nominations over time, whereas males increased in total leader nominations. Explanations for these results are discussed and further directions suggested.     

Born of war: Protecting children of sexual violence survivors in conflict zones

Abstract

The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Côte d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth.     

Factors influencing participation in weekly support groups among women completing an HIV/STD intervention program

Over the past three decades, the influence and importance of social support has been well documented and the findings have suggested a beneficial effect on stress-related situations, mental and physical health, and social functioning. More recently, small group/skills training behavioral interventions have demonstrated success in changing behaviors which affect the transmission of sexually transmitted diseases, including HIV among populations at risk for these diseases. Studies of support groups to date have been conducted exclusively in research settings where women are offered financial incentives for participation. Little is known about the willingness of women to participate in ongoing support groups after successfully completing a skills training intervention. The present study examines the factors that may influence participation among women in a weekly support group after completing a structured, six session HIV/STD intervention. Both quantitative and qualitative data are collected from 265 women in the intervention arm of a multi-site randomized controlled behavioral intervention trial. Results reveal that less than a quarter (22%) of women participated in at least one support group. Participation varied significantly by site, ranging from 34% to 15% (p = .008). Participation was also strongly linked to recent use of domestic violence services. Qualitative data indicated that although monetary incentives play some role in the woman's decision to participate, other factors are also important. These include program outreach, support group size, salience of the group content, consistency of group leadership from the intervention to the support group, and use of peer leaders along with professional facilitators. Implications for design of post-intervention support groups programs are discussed.     

IMPACT OF PEER GROUP EDUCATION ON HIV PREVENTION AMONG WOMEN IN BOTSWANA

A peer group HIV prevention intervention based on social–cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change HIV prevention knowledge, attitudes, and behaviors for ordinary urban employed women in sub-Saharan Africa.     

On inspiration and leadership: a conversation with Barbara Sabol, MA, RN, and Henrie M. Treadwell, PhD. Interview by Kathleen M. Nelson

This article began with Barbara Sabol and Henrie Treadwell's conversations about public health leadership and their assertion that today's leaders must take bolder steps to ensure health care for the underserved. They discuss a number of characteristics that they consider essential if leaders are to reach beyond the status quo and create change in their hospitals, health systems, and communities.     

Rapid Human Immunodeficiency Virus Testing and Risk Prevention in Residents of Battered Women's Shelters

BackgroundHuman immunodeficiency virus (HIV) infection and intimate partner violence (IPV) are interconnected public health problems. However, few HIV prevention interventions address the unique needs of IPV survivors in shelter and none of the Centers for Disease Control and Prevention’s best-evidence risk reduction interventions adequately explore the complex relationship between IPV and HIV risk. Although battered women's shelters provide a safe and supportive environment for women in crisis, most do not offer HIV risk reduction services or sexual safety planning.MethodsThis study evaluated the feasibility, acceptability, and initial efficacy of rapid HIV testing and brief risk prevention intervention developed for residents of battered women's shelters. The Safe Alternatives For Empowered sex for intimate partner violence intervention (SAFE-IPV) was evaluated in an open trial (N = 98). Participants were assessed with a series of standardized interviews and self-reports at screening and 3 months after leaving the shelter.ResultsFew eligible participants declined SAFE-IPV and participants who received SAFE-IPV reported high levels of satisfaction. No participants in the open trial tested positive for HIV. However, participants reported significantly fewer unprotected vaginal and anal sexual occasions and increased intentions to engage in risk preventative behaviors 3 months after leaving shelter compared with the 3 months before shelter. Additionally, participants reported significant improvements on HIV risk factors addressed in SAFE-IPV at the 3-month follow-up (i.e., reduced emotional, physical, and sexual harm by abuser, posttraumatic stress symptoms, hazardous alcohol use, and drug use).DiscussionThese results extend prior research on HIV prevention with women with IPV, demonstrating the acceptability, feasibility, and initial efficacy of SAFE-IPV within battered women's shelter settings.     

广州市吸毒人群预防艾滋病及减少伤害的同伴教育效果研究

目的探讨和评价同伴教育对吸毒人群进行预防艾滋病及减少伤害的干预效果，为今后针对该人群提高预防艾滋病的知识和技能以及进一步开展艾滋病健康教育干预提供科学依据。方法采用横断面研究方法，使用统一的调查问卷收集干预前后调查对象的资料。将研究对象分为同伴教育组和普通宣教组，对同伴教育组开展为期3个月的同伴教育干预措施，普通宣教组实行常规宣传教育。结果干预前，2组吸毒人员对绝大部分知识知晓率差别无统计学意义（P〉0．05）；干预后，2组差别有统计学意义（P〈0．05）。干预后同伴教育组艾滋病知识的净增长率从大到小依次是：正确使用安全套知识（61．7％）、高危行为减少伤害（26．5％）和艾滋病基础知识（16．8％），干预手段和职业是影响吸毒人员艾滋病相关知识得分的2个因素。结论在吸毒人群中开展同伴教育取得了良好的效果，有效提高了吸毒人员在艾滋病防治基本知识、高危行为减少伤害、正确使用安全套方面的知识。但同伴教育能否改变吸毒人员对艾滋病高危行为的态度和行为还需进一步研究。     

Taking early action in emergencies to reduce the spread of STDs and HIV

The disintegration of family life, disruption of social norms, poverty, and commercial sexual activity associated with the lives of Rwandan refugees in camps in northwest Tanzania increase their susceptibility to sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). To prevent such an outcome, the African Medical and Research Foundation proposed that STD/HIV interventions be launched under the auspices of the governing body in the refugee camps. A rapid assessment methodology survey was conducted to acquire baseline data for resource allocation (drugs and personnel), case finding strategies, and staff training. Each refugee community was visited by a team of specially trained health behavior promoters who presented a four-part IEC package: sensitization of camp leaders, general STD/HIV awareness, STD treatment-seeking behaviors, and sexual behavior modification through peer education. Condoms and health education materials were distributed by peer educators. STD services have been introduced to outpatient, family planning, and prenatal clinics in the camps. Although HIV testing was not undertaken for political reasons, pregnant women at three camps received screening for syphilis. Such STD control interventions should become a standard component of refugee assistance.     

The legacy of gender-based violence and HIV/AIDS in the postgenocide era: Stories from women in Rwanda

Drawing on qualitative interviews with 22 Rwandan women, we describe the lived experiences of women survivors of gender-based violence (GBV) more than a decade and a half after the 1994 Genocide. We argue that the intersection between GBV and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) has long-term implications: the majority of women interviewed continue to endure trauma, stigma, social isolation, and economic hardship in the postgenocide era and are in need of expanded economic and mental health support. Our findings have implications for the importance of providing integrated psychosocial support to survivors of GBV postconflict contexts.