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Resource documents > Social Interventions for HIV/AIDS - Evaluation Monograph

Social Interventions for HIV/AIDS Intervention with Micro-finance for AIDS and Gender Equity IMAGE Study Monograph No 1: Evaluation

May 2002 James Hargreaves, Tesmer Atsbeha, John Gear, Julia Kim, Benjamin Mzamani Makhubele, Kalipe Mashaba, Linda Morison, Mmatshilo Motsei, Chris Peters, John Porter, Paul Pronyk, Charlotte Watts For more information on this monograph contact: James Hargreaves email: jimharg@soft.co.za [Download complete document - 2.4Mb ~ 14 min]

Executive Summary There are over 4 million people living with HIV in South Africa - more than in any other country in the world. Many communities are just beginning to feel the impact of the epidemic, but it is clear that a humanitarian disaster is approaching. By 2010, over 5 million people are likely to have died of AIDS in South Africa. HIV prevention efforts in South Africa have been ambitious and rights oriented but have fallen short on implementation, being lost among a wide range of profound and immediate concerns inherited from the apartheid regime. South Africa's strategic plan for HIV/AIDS/STDs 2000-2005 represents the current policy blueprint. It highlights important health sector led interventions in targeting HIV prevention. It is necessary for the prevention goals outlined in that document to be urgently met, yet it remains unclear if this will be sufficient to combat HIV in South Africa. Despite widespread agreement that the rapid spread of HIV has been facilitated by migrant labour, widespread poverty and entrenched gender inequalities, there have been no attempts to pre vent HIV by targeting these environmental level factors. The IMAGE study seeks to fill this gap. Intervention with Micro-finance for AIDS and Gender Equity (IMAGE) emphasises the importance of the environment in which sexual behaviours, gender-based violence and HIV infections are occurring. IMAGE is targeted at disadvantaged women and their households. It combines the introduction of a poverty -targeted micro-finance programme to rural communities with a participatory learning and action curriculum (Sisters for Life) for clients. The combined intervention aims to be mutually reinforcing, seeking to strengthen individual client agency and to improve household well-being , communication and power relations. IMAGE plans to enrol 10-20% of households within targeted communities and thus aims to have an impact on social norms, social networks and relationships, and community level responses to issues such as poverty, gender-based violence and HIV. Through an impact on these environmental level factors it is hypothesised that IMAGE has the potential to influence levels of gender-based violence and vulnerability to HIV/AIDS. The IMAGE study is an integrated, prospective, randomised, controlled, community-matched intervention trial being conducted in the Sekhukhuneland region of South Africa's rural Limpopo province . The evaluation programme integrates data from participatory, qualitative and quantitative methodologies to investigate the impact of the IMAGE program. The study is built around the prospective follow up of three cohort pairs; IMAGE clients, young people living in the household of IMAGE clients and young people living in communities where the IMAGE programme is operating. Appropriate comparison groups are recruited from villages where the program is not operating. Prospective data will be used to analyse differences in key indicators (including gender-based violence, sexual behaviour and HIV) between groups from Intervention and Comparison communities. Qualitative data will examine processes of change, interrogate and triangulate results of quantitative work and provide a detailed understanding of the IMAGE study context. The IMAGE study represents an opportunity to explore the potential for developmental programs to have a role in pre venting HIV infections and gender-based violence. The study re p resents a rigorously designed programme of evaluation in which multiple analyses, both qualitative and quantitative, will be used to paint a picture of process and impact.

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