HIV This Week

Pronyk PM, Kim JC, Abramsky T, Phetla G, Hargreaves JR, Morison LA, Watts C, Busza J, Porter JD. A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS. 2008 Aug 20;22(13):1659-65.

Pronyk and colleagues aimed to assess effects of a combined microfinance and training intervention on HIV risk behaviour among young female participants in rural South Africa. The study was secondary analyses were conducted using quantitative and qualitative data from a cluster randomized trial, the Intervention with Microfinance for AIDS and Gender Equity study. Eight villages were pair-matched and randomly allocated to receive the intervention. At baseline and after 2 years, HIV risk behaviour was assessed among female participants aged 14-35 years. Their responses were compared with women of the same age and poverty group from control villages. Intervention effects were calculated using adjusted risk ratios employing village level summaries. Qualitative data collected during the study explored participants’ responses to the intervention including HIV risk behaviour. The authors found that after 2 years of follow-up, when compared with controls, young participants had higher levels of HIV-related communication (adjusted risk ratio 1.46, 95% confidence interval 1.01-2.12), were more likely to have accessed voluntary counselling and testing (adjusted risk ratio 1.64, 95% confidence interval 1.06-2.56), and less likely to have had unprotected sex at last intercourse with a nonspousal partner (adjusted risk ratio 0.76, 95% confidence interval 0.60-0.96). Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality. Although women noted challenges associated with acceptance of condoms by men, increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships. In addition to affecting impacts on economic well being, women’s empowerment and intimate partner violence, interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behaviour .

Editors´note: The original trial which collected these data, known as the IMAGE trial, suggested that microfinance combined with gender and HIV training lead to improvements in household economic well being, women’s empowerment, and reductions in levels of intimate partner violence. This secondary analysis reveals improvements in risk behaviours, increased communication about sex, and greater uptake of HIV testing, with potential synergies between these. The IMAGE trial has made its mark by highlighting the potential for structural interventions that address the economic and social vulnerability of women to contribute to measurable health gains. These findings underscore the need for further innovation and operational research.