The restored physical health that often accompanies HIV care and ART is insufficient to enable many PLHA to achieve economic health in developing countries where poverty and unemployment are dominant. Microcredit programs have the potential to be a valuable resource in developing income generating microenterprises;however, microfinance institutions (MFIs) have shown reluctance to reach out to HIV-infected individuals, and HIV clients typically do not see MFIs as a viable option for them-- resulting in NGOs and ASOs feeling the pressure to incorporate microcredit services into their programs, as such services may need to be tailored to meet the needs of PLHA. Unfortunately, there is very little published literature on the effects of microcredit in this population to guide these efforts. Microcredit and income-generation programs can play a critical role in enabling clients to provide for themselves and their families, but can also increase debt and economic vulnerability for those who are unable to repay loans. Drawing from both Social Cognitive Theory and Asset Theory, the proposed project will explore the impact of microcredit services on the economic status of HIV clients and their households in Uganda, and how changes in economic status are associated with physical and mental health, social well-being (school attendance, household continuity) and sexual risk behavior (commercial sex, condom use). The study will consist of two phases and will be conducted at three organizations that service HIV clients and offer microcredit services. Phase 1 will consist of semi-structured interviews with HIV clients and program administrators to explore how these microcredit programs function and clients'experience in terms of economic and social impact. Phase 2 is a prospective cohort study that will use an encouragement design to follow 180 HIV clients who do or do not receive microcredit assistance over 6 months. The proposed study will (1) provide data on microcredit's socioeconomic effects, either positive or negative, on client's and their household, (2) identify characteristics of the client, household and programmatic structure that are associated with success versus failure to benefit from microcredit, and (3) identify lessons learned for informing the future development and testing of an intervention to improve the effectiveness of microcredit services targeting PLHA.
This study is important to public health as it will provide empirical information about the effects of microcredit on people living with HIV, and the factors associated with microcredit benefits, and thus inform the development of interventions aimed at maximizing the economic and social benefits of microcredit for people living with HIV in resource constrained settings.
|Wagner, Glenn; Rana, Yashodhara; Linnemayr, Sebastian et al. (2012) A Qualitative Exploration of the Economic and Social Effects of Microcredit among People Living with HIV/AIDS in Uganda. AIDS Res Treat 2012:318957|