Impact of a livelihood intervention on gender roles and relationship power among people with HIV

OBJECTIVE

To evaluate the impact of an agricultural livelihood intervention on gender role conflict and sexual relationship power among people with HIV (PWH) in western Kenya.

DESIGN

Study participants were enrolled in Shamba Maisha , a cluster randomized controlled trial of an agricultural intervention conducted among PWH across 16 health facilities during 2016-2020. Intervention participants received a water pump, seeds, and agricultural and financial training; control participants received standard of HIV care.

METHODS

We assessed men's views on masculinity and gender roles via the validated gender role conflict score (GRCS; range 18-78, higher = greater gender role conflict). We measured gender power imbalances among women via the validated Sexual Relationship Power Scale (SRPS), which combines subscales of relationship control and decision-making dominance (range 1-4, higher = female holds more power). We compared changes over the study period by arm using longitudinal multilevel difference-in-difference linear regression models accounting for clustering of facilities using the intention-to-treat cohort.

RESULTS

We enrolled 720 participants (366 intervention, 354 control); 2-year retention was 94%. Median age was 40 and approximately 55% of participants were female. Among men, after 24-months the decrease in GRCS scores was 4.3 points greater in the intervention than the control arm ( P  < 0.001). Among women, the intervention resulted in 0.25 points greater increase in the SRPS compared to the control arm ( P  < 0.001).

CONCLUSIONS

Shamba Maisha resulted in less gender role conflict in men and greater sexual relationship power for women. Agricultural livelihood interventions may be a powerful tool to improve gender power imbalances, which may subsequently mitigate poverty and food insecurity.

The bean method as a tool to measure sensitive behavior

Conservationists need to measure human behavior to guide decisions and evaluate their impact. However, activities can be misreported and reporting accuracy may change following conservation interventions, making it hard to verify any apparent changes. Techniques for asking sensitive questions are increasingly integrated into survey designs to improve data quality, but some can be costly or hard for nonexperts to implement. We demonstrate a straightforward, low-cost approach, the bean method in which respondents give anonymous answers by adding a colored bean to a jar to denote a yes or no response. We applied the bean method to measure wild-meat hunting and trading over 2 years at a conservation-project (hunting reduction) site in Gola Forest, Liberia. We extended the technique to accommodate questions about hunting and meat-selling frequency. We compared responses given using the bean method and direct questioning for groups that did and did not participate in conservation interventions. Results from the bean method corresponded to those from direct questioning, and there was no indication of change in question sensitivity following conservation interventions. Estimates from both methods indicated that wild-meat trading decreased in project and nonproject households (from 36% to 20%) and that hunting decreased in 1 project group (38-28%). Where inconsistent answers were given (2-6% of respondents), differences were in both directions and were most likely attributable to measurement error. The bean method was quick and straightforward to administer in a low-literacy setting. We showed how it can be modified for answers of more than 2 categories and consider it a valuable tool that could be adapted for a wide range of conservation settings.