Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention

Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention.     

Born of war: Protecting children of sexual violence survivors in conflict zones

Abstract

The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Côte d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth.     

Understanding and mitigating HIV-related resource-based stigma in the era of antiretroviral therapy

The perception in low-resource settings that investment of resources in people living with HIV (PLHIV) is wasted because AIDS is both an incurable and deadly disease is known as resource-based stigma. In this paper, we draw on in-depth interviews (IDI), focus group discussions (FGD), and key informant interviews (KII) with 77 HIV-positive microfinance participants and nongovernmental organization leaders to examine resource-based stigma in the context of increased access to antiretroviral therapy (ART) at an individual, household, and community level in Côte d'Ivoire. The purpose of this exploratory paper is to examine: (1) resource-based stigmatization in the era of ART and (2) the relationship among microfinance, a poverty-reduction intervention, and HIV stigmatization. The frequency with which resource-based stigma was discussed by respondents suggests that it is an important component of HIV-related stigma in this setting. It affected PLHIV's access to material as well as social resources, leading to economic discrimination and social devaluation. Participation in village savings and loans groups, however, mitigated resource-based HIV stigma, suggesting that in the era of increased access to antiretroviral therapy, economic programs should be considered as one possible HIV stigma-reduction intervention.     

Do microfinance programs help families insure consumption against illness?

Families in developing countries face enormous financial risks from major illness both in terms of the cost of medical care and the loss in income associated with reduced labor supply and productivity. We test whether access to microfinancial savings and lending institutions helps Indonesian families smooth consumption after declines in adult health. In general, results support the importance of these institutions in helping families to self-insure consumption against health shocks.     

A Congolese–US participatory action research partnership to rebuild the lives of rape survivors and their families in eastern Democratic Republic of Congo

Abstract

The Democratic Republic of Congo (DRC) remains an all-too-potent reminder of how war, human rights violations and their related health and economic impacts can devastate a society. The last decade has seen the use of rape as a weapon of war in the DRC, where rebels and soldiers subject women and girls to brutalising attacks, rape, torture and mutilation. Survivors of sexual and gender-based violence (SGBV) are often further traumatised by infections, disease, poverty, stigma and social isolation. Substantial evidence exists showing an association between social determinants (e.g., poverty, stress and trauma, stigma, lack of access to health care) and health; however, limited research has been conducted to elucidate these relationships or to develop and test interventions to change social determinants of health, especially in conflict and post-conflict settings such as the DRC. The purpose of this article is to present a Congolese–US community-academic research partnership to obtain evidence to develop and implement a sustainable intervention to begin to address the social determinants of health, including poverty and traumatic stress for survivors of SGBV and their families in the South Kivu province of eastern DRC.     

Microfinance and health interventions: Factors influencing loan repayment success with young men in Dar es Salaam,Tanzania

Poverty is associated with numerous poor health outcomes. Youth unemployment in Tanzania is approximately 13.7%, and concentrates in urban areas. These youth lack relevant job skills and access to financial capital. Microfinance continues to be implemented globally to address poverty, and increasingly has been linked to health interventions. Men less frequently are recipients of microfinance loans. We offered microcredit to young men in an area of Dar es Salaam with high poverty as part of a randomised controlled-trial to assess the efficacy of a microfinance and health leadership intervention in preventing STI acquisition. We used mixed methods to understand predictors of successful loan repayment. Our qualitative sub-study showed that leader influence, prior business experience, personal motivation, and planning facilitated repayment. Using a modified Poisson approach, our quantitative analysis showed that successful repayment was associated with business experience, education, increasing number of children, community of residence, percentage of network members trained in business, and repayment success of peer leaders. Our results suggest that enforcing group accountability and repayment rules, offering ongoing training, and using successful entrepreneurs as role models could increase repayment success in similar populations. These strategies could provide financial opportunity for men while minimising risk for microfinance institutions.     

小额贷款公司的使命偏移及其有效治理--基于江浙两省相关统计数据

我国设立小额贷款公司的政策初衷是服务“三农”和低收入群体。文章首先设计出小额贷款公司使命偏移的衡量标准,然后以江苏、浙江两省小额贷款公司为主要数据来源,用设定的衡量标准来考察其使命偏移情况,认为其提供的贷款额度和服务对象已经偏离了政府设立小额贷款公司的政策初衷,离农现象十分明显,出现使命偏移问题。最后提出相关政策建议,以期有效治理小额贷款公司的使命偏移。     

Discrimination against people with disabilities in accessing microfinance

The purpose of this paper is to explore the state of existing research on microfinance lending discrimination against people with disabilities. It argues that existing literature suggests people with disabilities face notable discrimination in accessing microfinance (Labie et al., 2015). The attitudes of employees within microfinance institutions (MFIs) are one of the principal sources of such discrimination, which has important implications for the lives of people with disabilities (Cramm & Finkenflugel, 2008; Mersland et al., 2009; Labie et al., 2015). Moreover, studies conducted by Beisland & Mersland (2012) and Nuwagaba et al. (2012) found that people with disabilities tend not to apply for microfinance due to the anticipation of such rejection. People with disabilities face both ‘taste-based discrimination’ (prejudice) and ‘statistical discrimination’ (when a decision-maker uses individuals’ observable characteristics as a substitute for unobservable ones). It is reasonable to assume that reducing discrimination in the microfinance market would greatly benefit existing and prospective entrepreneurs with disabilities. However, this requires targeted interventions aimed at inducing systematic institutional reforms, changing the mindsets of employees and people with disabilities, and integrating appropriate accommodations within microfinance operations. In order to implement these changes, I conclude that microfinance regulators must work to identify areas of discrimination that are not correctly covered by existing lending practices.