Microfinance interventions are designed to ensure that the most impoverished groups in society can improve their living conditions. Typically, microfinance interventions provide financial intermediation through provision of small loans, savings and other financial products and services. The HIV/AIDS epidemic has been particularly pronounced in countries where poverty is a major problem, and microfinance institutions have found that many of their clients are people infected with or affected by the virus. Consequently, microfinance organisations are increasingly recognising the linkages between HIV infection and poverty, and some have started integrating health and education programmes with microfinance services or targeting services to those affected by HIV.
To provide an overview of the scope and effectiveness of microfinance interventions for people living or at risk of infection with HIV/AIDS.
The authors included a range of study designs assessing microfinance services (either alone or in combination with health programmes) on people with HIV or affected by HIV/AIDS. No inclusion criteria were set for outcomes or contexts. The authors included peer-reviewed research articles written in English and available in full text, covering the period between 1986 and 2012. The authors excluded books, dissertations, grey literature and theoretical reviews. Their search strategy covered five electronic databases, including ESBCO and JSTOR. The authors narratively reviewed the included studies.
Headline Findings: a summary statement
Most microfinance interventions had beneficial effects for HIV/AIDS prevention, although results depended on the type of programme, setting, monitoring conditions and sustainability.
The authors included 14 studies: nine conducted in Africa, three in Latin America and the Caribbean, one in India and one in the United States. The studies included evaluations of a range of different microfinance interventions designed to target different populations or deliver different outcomes. Four of the studies evaluated the project IMAGE (Intervention with Microfinance for AIDS and Gender Equity), conducted in South Africa. Three studies evaluated programmes targeting female sex workers, while one targeted children and their families. Five studies evaluated programmes designed to develop life skills and reduce risk behaviours, and one focused on treatment adherence.
Implications for policy and practice
The authors reviewed four studies of the same development initiative: project IMAGE (Intervention with Microfinance for AIDS and Gender Equity), conducted in South Africa.
- One study found increases in economic welfare and equity and empowerment, along with reduced intimate-partner violence.
- Two studies conducting secondary analysis of the data found increased empowerment, a reduction in intimate-partner violence, increased HIV-related communication, and increased willingness to attend counselling and testing for HIV. The secondary analysis does not find changes in sexual behaviour in the treatment group but notes an increase in unprotected sex in the control group.
- Another study analysed the feasibility, acceptability and accessibility of the IMAGE intervention. The study reported that barriers to community mobilisation for the intervention included illness, limitations imposed by husbands, child-care and pressure for businesses to work adequately.
The authors included three studies of interventions for female sex workers.
- A study of the JEWEL programme (Jewelry Education for Women Empowering their Lives) in the USA found an increase in income and a reduction in the number of sex partners, drug use, and exchange of money or drugs for sex.
- A study in Chennai, India, compared an intervention group receiving HIV-prevention education and microfinance with a control group that received only the education component. They report a higher average monthly income, a lower monthly income from sex work and a significantly lower number of sexual partners, compared to the control group.
- A study in Kenya reports a reduction in sex work and the number of weekly partners and increased condom use.
The authors included five studies of life skills and risk behaviour interventions:
- A study in Zimbabwe found that the microenterprises set up under the intervention were viable and profitable.
- A study in Dominican Republic found that HIV-related negotiation of condom use was associated with control of own money but not with receiving a loan or women's group participation.
- A study in Haiti found that greater exposure to a microfinance programme was associated with lower risk taking in sexual behaviour.
- A qualitative study in C'te d'Ivoire found that participants described positive effects on access to money and self-sufficiency, health, social status within the community, and perceived social support and self-esteem.
- A qualitative study in Uganda found that participants reported improved self-esteem, provide school for their children and sustain their families. Over half of participants also reported difficulties with repayment of the loans.
The authors included one study of an adherence intervention.
- The study in Peru found that participants were more likely to comply with the intervention, achieve virologic suppression and have improved psychosocial indicators.
The authors included one study of an intervention aimed at children and families.
- The study in Uganda found that children had a statistically significant reduction in depression.
Implications for further research
The authors call for more research in this field, particularly relating to programmes in different settings and with different target populations. They also call for research to evaluate the effects of interest rates on the ability of microfinance customers to sustain debts.