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Arch Sex Behav. 2017 May;46(4):1121-1133. doi: 10.1007/s10508-016-0828-x. Epub 2016 Aug 9.

A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya.

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Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA.
UCSF School of Nursing, 3333 California Street, LHTS #455, San Francisco, CA, 94118, USA.


Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya. In the current study, we drew upon longitudinal, in-depth interviews with 45 intervention participants and nine control participants (N = 54) in order to examine the impacts of the intervention on gendered power and sexual risk reduction among both women and men. Female and male participants in the intervention described positive changes in sexual practices and gendered power dynamics as a result of intervention participation. Changes included reduced sexual risk behaviors, improved gender-related power dynamics, and enhanced quality of intimate relationships. These findings illuminate how a multisectoral agricultural intervention may affect inequitable gender relations and secondary transmission risk. Further research is needed to explore how to best leverage agricultural interventions to address the important intersections between poverty and inequitable gender relations that shape HIV risks.


Food security; Gender relations; HIV/AIDS prevention; Microfinance; Poverty; Structural interventions

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