“The group” in integrated HIV and livelihoods programming: Opportunity or challenge?

Abstract

HIV care and treatment providers across sub-Saharan Africa are integrating livelihood interventions to improve food security of their clientele. Many integrated HIV and livelihood programmes (IHLPs) require the formation and use of groups of HIV-infected/affected individuals as the operational target for programme interventions, indeed, virtually without exception the group is the focal point for material and intellectual inputs of IHLPs. We sought to critically examine the group approach to programming among IHLPs in Uganda, and to explore and problematise the assumptions underpinning this model. A case study approach to studying 16 IHLPs was adopted. Each IHLP was treated as a case comprising multiple in-depth interviews conducted with staff along the livelihood programme chain. Additionally, in-depth interviews were conducted with staff from The AIDS Support Organization (TASO), and with members of 71 HIV-infected TASO-registered client households. Our analysis reveals three important considerations in IHLP programming regarding the group-centred approach: (1) Group membership is widely held to confer benefits in the form of psycho-social and motivational support, particularly in empowering individuals to access HIV services and handle stigma. This is contrasted with the problem of stigma inherent in joining groups defined by HIV-status; (2) Membership in groups can bring economic benefits through the pooling of labour and resources. These benefits however need to be set against the costs of membership, when members are required to make contributions in the form of money, goods or labour; (3) Sharing of goods and labour in the context of group membership allow members to access benefits which would otherwise be inaccessible. In exchange, individual choice and control are diminished and problems of resources held in common can arise. While the group model can bring benefits to IHLP efficiency and by extension to food security, and other outcomes, its application needs to be carefully scrutinised at the individual programme level, in terms of whether it is an appropriate approach, and in terms of mitigating potentially adverse effects.

Keywords:

• HIV/AIDS
• livelihoods
• food security
• groups
• Uganda

Acknowledgements

The authors are grateful to the following able team of research assistants: Fiona Mulowooza, Eric Ssegujja, Rossette Kyohangirwe, Elizabeth Achola, Susan Werikhe, Christopher Omoding, Murisho Shafi, Robert Bob Okello and Ismail Sentamu. The study also benefited from the involvement of TASO staff from Jinja, Mbale, Gulu, Soroti and Kampala. This research study would not have been possible without the cooperation of the 16 organisations we examined here and the TASO clients we interviewed.

This study was funded by the Regional Network on AIDS, Livelihoods and Food Security (RENEWAL) facilitated by IFPRI, and through an IFPRI–Concern Worldwide research partnership funded by the Kerry Group. RENEWAL is grateful for support, at present, from Irish Aid, the Swedish International Development Cooperation Agency, the International Development Research Centre (Canada) and the United States Agency for International Development.

Notes

 1. The differences between a group and a network are subtle but important. A group is usually defined as an aggregate of people who share certain commonalities in identity, interact with one another and accept rights and obligations as members of the group. The emphasis here is upon shared identity and common action; in a network, much greater emphasis is placed upon the web of connectedness between individual members, and upon how these connections between entities are articulated. In this paper, we follow the lead of our informants in preferring the term “group”; while we recognise that there is space for semantic debate, we do not find compelling reasons to engage in it here.

 2. While content analysis was generally preferred over a grounded theory approach, coders were encouraged to discuss emerging themes which were not adequately covered by existing codes.

 3. It is difficult to determine exactly how many of the IHLP groups had formal systems for saving and lending. Interviews with programme staff indicate that 5 of 16 IHLPs implemented such systems; client data, however, indicated a wider prevalence. It should also be noted that communities and other institutions also implement these initiatives, and some conflation in the data is likely.

 4. While there is some degree of natural overlap with the material presented in the preceding section, here we place greater emphasis on the social dimension.