Implementing an integrated land tenure/property rights and HIV prevention program: A qualitative study examining the barriers and facilitators of a community-led intervention in Western Kenya

Background: Despite the recognized need for structural HIV prevention interventions, few scientific programs have integrated women's property and inheritance rights with HIV prevention. To lay the groundwork for future structural interventions at this intersection, the University of California at San Francisco partnered with the Kenyan Medical Research Institute and GROOTS Kenya (a Kenyan CBO). The study sought to examine GROOTS Kenya's “Community Land and Property Watch Dog Model,” designed to prevent women's disinheritance and asset stripping from HIV affected households. The current project focuses on implementation barriers and facilitators in two rural areas in Western Kenya where HIV prevalence rates are 24-33%, and property rights violations are common. Methods: Locally hired and trained interviewers conducted in-depth interviews with 20 women and men who developed and implemented the Watch Dog Model. Interviews were content coded and data analysis followed a grounded theory approach. Dedoose analytical software was used to assist with thematic analysis. Results: Four themes were identified as facilitators: a) community health workers as program entry point, b) regional government administrators as strategic partners, c) traditional leaders as key stakeholders, and d) a legislative context supporting a community-led mechanism to reduce disinheritance. Two barriers were identified: e) limitations of a voluntary program and f) lack of integration between formal and informal justice systems. Conclusions: Science-based researchers interested in the integration of property rights and HIV prevention interventions should consider the facilitators and barriers encountered by existing health and economic empowerment models when designing future structural interventions at this intersection.