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

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.