Economic Vulnerabilities and the Syndemic of Risky Sexual Behaviors, Alcohol Abuse and Violence In Rural Kenya
METHODS: We recruited 72 participants (42 women, 30 men) from existing support groups to participate in qualitative focus groups interviews for 1.5-4 hours. We used MAXQDA qualitative software, applying Grounded Theory principles to develop themes.
RESULTS: Study participants reported episodes of economic stress, alcohol misuse, violence and sexual risk behaviors—driven primarily by economic vulnerability. Economic vulnerability influences HIV risk/vulnerabilities in multiple ways: 1) economic stress—inability to provide financially for the family due to underemployment or unemployment—drove some men to drink “cheap” unregulated alcohol as a coping mechanism which reduced productivity, compromise household financial security to feed alcoholic addictions, and engage in alcohol-induced sexual risky behaviors; 2) beyond survival, some women can engage in risky but economically-profitable relationships to elevate/maintain their standard-of-living following economic loss; 3) economic windfalls—a sudden influx of cash—increased men’s temporal purchasing power to maintain multiple sexual relationships—including with married women—by providing “luxurious” incentives, thus increasing HIV transmission/acquisition risk in these sexual network; 4) inability to pay “school fees” and “put food on the table” creates conflict leading to alcohol misuse and violence; and 5) marital distrust, exacerbated by poverty and scrambling for scarce “economic pie”, can escalate to conflict and violence.
CONCLUSION: Our findings suggest that economic empowerment programs alone are insufficient to address the underlying HIV transmission/acquisition risk in rural Kenya. More research needed to inform targeted and culturally-appropriate multi-level support-group based interventions to break the vicious cycle of economic vulnerability, alcohol misuse, violence and sexual risky behaviors to reduce susceptibility and vulnerability to HIV transmission/acquisition in rural Kenya.
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health
Discuss the syndemics of HIV that impact rural populations in sub-Saharan Africa. Explain how economic vulnerability impacts HIV risks and vulnerability, including sexual risky behaviors, violence and alcohol abuse.
Keyword(s): HIV Risk Behavior, Poverty
Qualified on the content I am responsible for because: I am the Principal Investigator of the study on which this findings are based. I am an Assistant Professor and have extensive years of experience in HIV-related research.
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.