Jennifer Kibicho is Assistant Professor in the College of Nursing at the University of Wisconsin-Milwaukee. She is a Health Economist with expertise in the economics of prescription drug cost drivers and Medicaid policies, and a Certified Public Accountant of Kenya (CPA(K)). She has received funding as the Principal Investigator of a National Institute of Mental Health (NIMH) R21 Project, and served as an economic consultant on several research and program evaluation projects. She has several publications in top health policy journals including AIDS and Behavior, and Health Affairs. Her global health research is focused on the intersection of economic vulnerability and structural-level factors including alcohol misuse and gender-based violence as key drivers of HIV transmission and acquisition risk in sub-Saharan Africa.
Abstract:
Economic Self-Help Support Groups and the Syndemics of Sexual Risky Behaviors, Alcohol Misuse, Violence, and Economic Vulnerability
The syndemic of HIV infection, economic vulnerability, substance abuse, and domestic violence has been well studied. Support groups’ important role in destigmatizing HIV/AIDS and addressing social-psychological needs of HIV-positive people is well documented. Our study compares HIV- and non-HIV- support group member perspectives of the syndemics of sexual risk behaviors, alcohol misuse, violence, and economic vulnerability in their communities, and the impact of support groups in providing social-psychological and economic empowerment for HIV-positive or at-risk groups in rural Kenya.
Our study design was mixed quantitative/qualitative methods with 37 HIV-positive and 43 HIV-negative participants (N=80) from existing rural-based Kenyan self-help groups, most of which were engaged in micro-savings and micro-lending. Participants were asked open-ended questions on their experiences with, the benefits and challenges derived from support group membership. Qualitative data analysis was done in MAXQDA. We used thematic analysis informed by Grounded Theory to develop themes.
More participants reported benefiting socially and psychologically (81%) compared to financially (49%) from involvement in support groups. Non-HIV groups—mostly micro-financing initiatives—offered financial assistance (e.g., school fees), start-up capital for business projects, and served as ‘social insurance’ to mitigate life events (e.g., wedding, funeral and hospital expenses), which improved the standard of living and generated positive psychological/mental health benefits for members. Young men in support groups overwhelming reported that group accountability and peer-influence mitigated alcohol misuse and domestic violence. However, some participants reported challenges including marital conflict and violence about finances, high rate of loan-default among members; and high direct (e.g., membership financial contribution, transport costs) and indirect (e.g., time commitments) costs of group participation. In particular, intimate partner violence and economic vulnerability was associated with loan repayment challenges especially in cases where a woman used household assets to secure loans without her husband’s knowledge or approval. However, a few couples reported working collaborating through their individual support group membership to strategically raise finances for mutually agreed large household projects and for coping with uncertain life events.
Support groups have been very successful in uplifting the quality and standard of living, as well as promoting the economic and socio-psychological welling of HIV-positive and at-risk for HIV rural Kenyans. Support groups could benefit from leadership and financial training before engaging in micro-finance activities to ensure their long-term sustainability and to increase group benefit and effectiveness in the community. Our findings suggest that targeted and culturally-appropriate multi-level interventions within a support group setting that empower both men and women economically and provides financial management skills, can be very effective in breaking the syndemics of economic vulnerability, violence and sexual risk for HIV-positive and at-risk populations living in rural Kenya.