Online Program

Shamba maisha: Pilot agricultural intervention on food security, women's empowerment and HIV health outcomes in Kenya: Design, methods, and baseline results

Monday, November 4, 2013

Sheri Weiser, MD, MPH, Division of HIV/AIDS, Department of Medicine, University of California at San Francisco, San Francisco, CA
Elizabeth Bukusi, MD, MPH, PGD, PHD, Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
Rachel Steinfeld, MPH, OB/GYN and Reproductive Sciences, University of California, San Francisco
Elly Weke, MA, Kenya Medical Research Institute
Shari Dworkin, PhD, MS, Social and Behavioral Sciences, School of Nursing and Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA
Kyle Pusateri, University of California, San Francisco
Phelgona Otieno, MD/MPH, Kenya Medical Research Institute, Kenya Medical Research Institute, Nairobi, Kenya
Lisa Butler, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco
Craig Cohen, MD, MPH, OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
ISSUES: Food insecurity, gender inequality and HIV/AIDS are inextricably linked in sub-Saharan Africa. We report on preliminary outcomes of a pilot multisectoral agricultural intervention aimed to improve food insecurity, women's empowerment, and HIV health outcomes among HIV-infected Kenyan farmers.

DESCRIPTION: The intervention includes: i) a human-powered water pump ii) a microfinance loan (~$125) to purchase the pump and farm commodities, and iii) education in sustainable farming practices and financial management. Two health facilities in Nyanza Province were randomly assigned as intervention or control. HIV-infected adults ages 18-49 with access to surface water and land were enrolled beginning in April 2012, and followed quarterly. Data are collected on food security, nutritional status, women's empowerment, HIV risk behaviors, sexual violence, household economic indicators, and health indicators (HIV viral load, antiretroviral adherence, physical and mental health status).

LESSONS LEARNED: We enrolled 72 and 68 participants at the intervention and control sites, respectively. At baseline, participants at the 2 sites were similar in age, gender, education and marital status. Our process evaluation data at 6 months indicate that: 1) the intervention is well received in the community; 2) food security and income are improving among individuals in the intervention arm; 3) the intervention is contributing to improvements in sexual relationship power, economic empowerment and decision-making autonomy among women.

RECOMMENDATIONS: Livelihood interventions may be a promising approach to tackle the intersecting problems of food insecurity, women's disempowerment and HIV/AIDS morbidity. We plan to scale up this work through a large clustered randomized trial in Kenya.

Learning Areas:

Public health or related education
Social and behavioral sciences

Learning Objectives:
Explain how livelihood interventions can contribute to improved HIV/AIDS health outcomes and women's empowerment Explain the linkages between food insecurity, gender inequality and HIV/AIDS List some of the challenges of implementing multisectoral livelihood interventions

Keyword(s): Food Security, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am HIV/AIDS doctor and Assistant Professor of Medicine at UCSF (Associate as of 07/2013). My research has focused on the bidirectional links between food insecurity and HIV/AIDS. I have published over 20 manuscripts in peer-reviewed journals linking food insecurity to ART adherence, HIV health outcomes and HIV risk behaviors. I am the principal investigator of the pilot intervention study upon which the abstract is based.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.