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

Social Interventions for HIV/AIDS Intervention with Microfinance for AIDS and Gender Equity IMAGE Study Monograph No 2: Intervention

November 2002 Julia Kim, John Gear, James Hargreaves, Benjamin Mzamani Makhubele, Kalipe Mashaba, Linda Morison, Matshilo Motsei, Chris Peters, John Porter, Paul Pronyk, Charlotte Watts For more information on this monograph contact: Dr Julia Kim email: jkim@soft.co.za [Download complete document - 2.7Mb ~ 15 min]

Introduction In 1999, in response to the escalating AIDS epidemic in South Africa, the National Department of Health established a new initiative to design, implement and evaluate strategies for addressing HIV/AIDS within three pilot sites across the country. All three sites were responsible for implementing a core package of HIV-related services and support, including the provision of voluntary counselling and testing services and the training of health care workers in the implementation of National HIV/AIDS clinical care guidelines. However, in addition to this basic package, the pilot sites were encouraged to test more innovative and multi-sectoral approaches to HIV control, and it is in this context that IMAGE (Intervention with Microfinance for AIDS and Gender Equity) has been developed. The IMAGE study is based in Sekhukhuneland - a densely settled rural area of South Africa's Limpopo Province. Collaborative partners include a microfinance NGO (Small Enterprise Foundation), academic institutions from the South (University of the Witwatersrand) and North (London School of Hygiene and Tropical Medicine) and government (South African National Department of Health). The aim of this initiative is to develop and evaluate an innovative approach to the prevention of HIV/AIDS - one which explicitly addresses key structural factors driving the epidemic, such as poverty, gender-based violence and broader gender inequalities. By integrating and mainstreaming a program of gender awareness and HIV education into an existing microfinance initiative, IMAGE attempts to operationalize a model for addressing the HIV epidemic which is relevant to settings where poverty and gender inequalities continue to pose a critical challenge to prevention efforts. This document describes the IMAGE intervention. The objectives of this initiative are: To expand access to an existing microfinance initiative to women from the poorest households within a group of villages in rural South Africa, as a means of facilitating improvements in household welfare and individual empowerment. To develop a participatory approach to gender awareness and HIV education for loan recipients, and to mainstream this into existing microfinance program activities. To investigate whether, in combination with social and economic benefits, the attitudes and skills gained through participation in this program can support patterns of decision making that reduce vulnerability to both gender-based violence and HIV. To use a range of quantitative, qualitative and participatory methods to describe and document related processes and outcomes at multiple levels. To implement and evaluate this intervention within the framework and policy environment of a South African National Department of Health HIV/AIDS Pilot Initiative. Designed as a prospective, randomised community intervention trial, this study will evaluate and document the impact of IMAGE at individual, household, and community levels. A description of the study design is beyond the scope of this monograph, and is fully documented in the IMAGE Evaluation Monograph [1] (available www.wits.ac.za/radar) This document describes the evolution of the IMAGE intervention. It begins by setting the context of the AIDS epidemic in South Africa - in many ways a case study in the importance of structural factors in shaping an epidemic. It then turns to a description of microfinance, its potential strengths and limitations, and the rationale underlying its central role in IMAGE. Arguments for incorporating a program of Gender and HIV training into a microfinance initiative are then described. Finally, the monograph closes with a detailed description of how the IMAGE intervention attempts to operationalize this by developing and integrating a program of participatory learning and community mobilisation into an existing microfinance initiative.

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