Preventing HIV/AIDS through Microeconomic Development
Originally published in Juxtaposition Global Health Magazine, Volume 2, Issue 2.
Summary: In Sub-Saharan Africa, it is estimated that 25 million people are living with HIV/AIDS, and 2 million have already died. There are hundreds of organizations working to eradicate the pandemic through prevention, care and treatment. Dominant prevention approaches focused on education have been met with mixed results, leading to questions about the underlying causes of HIV/AIDS. Gender inequality and poverty continue to play a significant role in HIV vulnerability, and until these factors can be addressed, education alone will not be enough to stop the pandemic. Economic empowerment projects, such as microfinance and microenterprise initiatives, provide an opportunity to tackle the social and economic causes of HIV/AIDS among the most vulnerable. This article looks at one individual’s experience working on an economic empowerment project for adolescent orphans in Ethiopia and its potential for decreasing vulnerability to HIV/AIDS.
Slipping between two corrugated iron walls, down a narrow pathway, I enter the two-room house of Makeda Girma. I am meeting with Makeda as part of my internship with a non-profit organization in Ethiopia working to combat HIV/AIDS. At 18, Makeda has been responsible for her 4-year-old daughter and her younger brother and sister since her mother died of AIDS three years ago. As the translator introduces us, I ask myself where Makeda fits into the HIV/AIDS pandemic that is ravaging the African continent.
Makeda holds a unique place within the tragedy of HIV/AIDS. Though not infected, she is affected by the pandemic through the loss of her mother, and her new responsibilities as the head of her household will make it difficult for her to remain HIV negative. Pressures to care for her family put Makeda in danger of entering the sex trade or ‘trading’ sex to meet basic needs. Her low-income status puts her at risk of sexual violence and makes it less likely that she can access important information about the virus.
Last year, Makeda participated in a project that gave her training in hairdressing, and is now preparing to establish a salon business. Economic empowerment projects like the one I worked on are increasingly being used to tackle the underlying issues of poverty that lead to higher rates of HIV infection among certain groups. The financial, social and environmental impacts of economic empowerment projects make them a powerful new tool in the HIV/AIDS prevention toolbox.
When Knowledge is Not Enough
Pioneered by the Grameen Bank’s microcredit projects in Bangladesh , the microeconomic development approach is gaining steam as a response to a wide variety of development problems including HIV/AIDS. Traditionally, HIV/AIDS prevention has been approached through education campaigns, relying on individuals to change their behaviour based on the HIV messages in mass media. An example is the controversial “Abstain, Be Faithful, Use Condoms” (ABC) campaign. The huge posters and billboards depicting ABC slogans that I saw everywhere in Ethiopia are evidence of the popularity of the approach, despite questions about its effectiveness.
However, because HIV/AIDS communication strategies are comparatively easy to scale up, they continue to receive the biggest slice of funding for HIV prevention. The ABC approach assumes that everyone is equally at risk for HIV infection, and that knowledge about the virus is the crucial component in prompting individuals to protect themselves. It has become clear, however, that AIDS is by no means a “democratic disease”. In Africa, HIV/AIDS infection rates are highest among 15 to 24 year-olds, with women in this age group three times more likely to contract the virus than men. Risk clearly goes beyond biological susceptibility; social and economic factors are crucial in understanding who is most likely to get infected by HIV. The problem with the education-based approach is that while it provides information about the disease, it does not necessarily provide at-risk individuals with the tools needed to protect themselves.
In Africa, and many other resource-poor settings, HIV/AIDS is mainly transmitted through heterosexual intercourse. Pervasive gender inequality and poverty in this context create obstacles to safe sex that make it difficult for individuals to protect themselves even if they know how. An oft-cited example is when women are unable to negotiate condom use with unfaithful husbands for fear of losing the economic security they provide. Another obstacle, sometimes referred to as “prioritizing risk”, arises when protection against HIV/AIDS becomes secondary to the immediate needs of food and shelter, leading young women to become involved in unequal relationships with older men. As well, women who work as domestic servants – one of the few jobs available to women of low-socioeconomic status in Ethiopia – are at risk of sexual abuse, and are often isolated from community networks and information about HIV/AIDS. Makeda’s experience of sexual violence is another good example: community stigma and her inability to afford secure housing put her at risk of rape, and possibly infection. In these situations, individuals may know that they are at risk, but are powerless to do anything about it.
Poverty and HIV/AIDS – Breaking the Cycle
New approaches to prevention help high-risk individuals to protect themselves against HIV infection by tackling sexual violence, gender inequality, economic dependence and lack of safe housing or jobs. Recently, development practitioners have seen potential in linking the hugely successful micro-credit model with HIV prevention efforts. The economic empowerment approach to HIV/AIDS works explicitly to dismantle factors that push women and other vulnerable groups into dangerous situations which leave them open to infection.
While in Ethiopia last year, I saw an economic empowerment project in action, and witnessed its impact first-hand as I collected data for my thesis. The organization I represented, Canada-Africa Partnerships for AIDS (CAPAIDS), partnered with two Ethiopian organizations working to combat HIV/AIDS in their communities. The goal was to deliver vocational training and microfinance to a group of adolescent orphans, like Makeda, who became responsible for their younger brothers and sisters after the death of their parents. Over the course of my research, sixty youths were trained in carpentry, leatherwork and hairdressing and began to form cooperative businesses with others in the program. At the bustling and chaotic graduation ceremony of the 20 women who participated in hairdressing training, the pride and confidence they exuded was palpable.
The power of these programs to reduce HIV/AIDS vulnerability lies in their impact on participants’ economic situation and environment, as well as in improving selfesteem, reducing stigma and building social networks. I visited each participant to see how the program impacted their lives, navigating my way to their workshops
and homes via public transit in the middle of Addis Ababa’s rainy season.
Many of the male participants I spoke to had given up work in the informal sector to join the program, and consequently experienced a dip in income. They felt that the immediate benefits were control over their own productivity and the hope and self-respect that came from building their own business. The women involved had
often relied on husbands and family members for income prior to the project, so the change they experienced related directly to an increase in income and greater independence. As well, some participants were able to leave the sex trade to embark on a new profession. With a proud smile on her face, one of the members
of a carpentry cooperative described to me that she now slept in a bed that she made with her own hands.
More than just Increased Incomes
Changes in the economic situation of participants were accompanied by several social changes that play an important role in reducing HIV vulnerability. All participants experienced an increase in confidence, often in dramatic opposition to their desperation prior to the project. When I went to visit a group on their first
day of business in a new leather craft workshop, one of the members told me that he had been perceived as a hooligan within his community before getting involved with the project.
As I tried desperately to balance my notebook and tape recorder on my lap in the absence of a table, he explained that as neighbours watched him attending vocational training regularly, they began to see him as an asset to the community, even going so far as to suggest others follow in his footsteps.
Participants used the project as an entry point to connect with other youth in similar situations and build a support network. Through several attempts at translation, I learned that one participant referred to other youths in her community as “shiny,” whereas she felt dull. When surrounded by other project participants, she felt like she was on equal footing. This interaction with peers also provides opportunities for informal discussion about HIV/AIDS, caring for younger siblings, sex and relationships
Economic empowerment projects against HIV/AIDS continue to operate on a smaller scale than other prevention initiatives, like the ABC programs. Both the comparatively high implementation cost-per-person and the need to adapt and improve approaches for each group make this type of project difficult to scale up to a macro level. As a result, vulnerable groups who could benefit from economic empowerment are missing out. In addition, prevailing norms of the sex trade and sexual violence still exist within the communities where economic empowerment projects are implemented, so inhabitants will continue to face risk, even if it is minimized.
Former UN Secretary-General Kofi Annan has called for a “deep social revolution that transforms relations between women and men, so that women will be able to take greater control of their lives – financially, as well as physically” as an important element of HIV/AIDS prevention. Though they operate on a micro level, economic empowerment projects have profound impact on the vulnerable communities they target. As well, programs like the CAPAIDS do not operate in a vacuum: their impact goes beyond HIV/AIDS to affect several other development issues.
When I left Ethiopia, several participants had taken jobs in the private sector as they waited to secure workplaces and formalize their cooperatives. All the participants I spoke to felt hopeful and empowered. By providing vocational training and microfinance to men and women facing high HIV risk, it is possible to influence empowerment and the way income is earned, as well as challenging traditional gender roles and attitudes towards women.
During my last visit, Makeda was passing on hairdressing techniques to her younger sister, with the hope that they would open a salon together. She also understood that having some sort of skill would, in turn, help her sister become less vulnerable. The broad range of impacts of this type of program on the underlying causes of HIV/AIDS make it an exciting new opportunity for tackling the pandemic and preventing new infections.
