Intervention with Microfinance for AIDS and Gender Equity Study 2001-2003
Other Household Health Survey [hh/hea]
In 1999, in response to the escalating AIDS epidemic in South Africa, the National Department of Health established a new initiative to design, implement and evaluate strategies for addressing HIV/AIDS within three pilot sites across the country. All three sites we re responsible for implementing a core re package of HIV- related services and support, including the provision of voluntary counselling and testing services and the training of health care workers in the implementation of National HIV/AIDS clinical care guidelines. However, in addition to this basic package, the pilot sites we re encouraged to test more innova t i ve and multi-sectoral approaches to HIV control, and it is in this context that the IMAGE (Intervention with micro-finance for AIDS and Gender Equity) Study was developed.
The IMAGE study 2001-2003 is a programme of intervention research based in Sekhukhuneland - a densely settled rural area of South Africa’s Limpopo Province. Collaborative partners include a microfinance NGO, the Small Enterprise Foundation (SEF), academic institutions from the South and North - the University of the Witwatersrand's Rural AIDS & Development Action Research Programme (RADAR) and the London School of Hygiene and Tropical Medicine - and national government (South African
National Department of Health).
The study combines a poverty alleviation programme and participatory learning and action intervention. The intervention comprises participation in TCP and access to "Sisters for Life" training sessions. The Small Enterprise Foundation Credit Program, (TCP) is a poverty-targeted micro-finance programme operating in the Limpopo Province. The "Sisters for Life" programme, a two phase participatory learning and action curriculum developed in South Africa, and implemented with TCP clients during fortnightly centre meetings. The IMAGE study seeks to evaluate the impact of this work among clients, their households and their communities. The research provides an opportunity to explore the potential for d e velopmental programs to have a role in pre venting HIV infections and g e n d e r-based violence.The study is built around the prospective follow-up of three cohort pairs; IMAGE clients, young people living in the household of IMAGE clients and young people living in communities where the IMAGE programme was operating.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Units of analysis in the study include households and individuals
v1: Edited, anonymised dataset for use in DataFirst's Research Data Centre
IMAGE study is an integrated attempt to evaluate the potential role of an intervention that combines poverty alleviation and participatory learning and action intervention in promoting women's a g e n c y, improving household we l f a re, changing attitudes and behaviour, and preventing new HIV infections and gender-based violence.
Fi n a n c i a l Wo m e n's Association of New Yo rk
All households in these villages were eligible for inclusion in the IMAGE Study Baseline survey. Households in settlement areas outside village boundaries we re not included in the sampling frame. 200 households were randomly selected in each of the eight study villages (total sample size 1600). A household in this study was defined as a group of people who are permanently resident on the same property (or dwelling) and who eat from the same pot of food when staying at home. Within selected households, all individuals aged 14-35 years at the date of interview were eligible for inclusion in the study. Individuals listed as permanent household members we re eligible for inclusion, including those household members staying staying away from the home. The total expected sample size, including adjustment for people who refuse and those who could not be traced, was 3000.
A sampling frame including all households within recognised boundaries of the eight study villages was generated from Participatory Wealth Ranking (PWR) data.
The Participatory Wealth Ranking (PWR) process assisted the project to identify households eligible for inclusion in IMAGE in both intervention and comparison villages. Community members were invited to attend an open meeting in the village. Those who attended were sub-divided by neighbourhood and these groups each drew a map of their village section (usually of 50-200 households), providing a list of all the households. Following this, groups of 4-6 village section residents who know the community well (known as reference groups) held a discussion on aspects of poverty in their section. Participants were asked to characterise households that are poor, those that are doing a bit better and those that are doing well. Households are then ranked in categories by these residents, from the poorest to the most well off households, according to the poverty definitions provided. Each house was ranked on three occasions by different groups of individuals, providing an aggregate "score". Consistent agreement between the three reference groups is usually achieved through this process. The groups must produce results that are consistent in identifying poor households for the results to be accepted. After this process, participants were asked to describe the characteristics of the households in each category. The number of categories was not set in advance, but at least four categories had to be delineated for the results to be deemed valid. Ranking information was recorded on pre-designed forms at all stages of the process. The discussions were then assessed by a trained SEF staff member, who assigns a cut-off score. Households below a given "cut-off" are characterised as poor enough to be eligible for loans.
C o h o rt Study I: The impact of IMAGE on loan re c i p i e n t s
Eligible women in villages where IMAGE was operating joined the pro g r a m m e t h rough a self-selection process in response to house-to-house visits from SEF staff. All such loan recipients recruited in the first year of program operation were asked to join the study. Comparison women ("non-loan recipients") were recruited from randomly selected households that were eligible to be involved in IMAGE (on the basis of PWR), but from a village where IMAGE was not operating. Comparison women were current residents, matched to a loan recipient both on village type and age (in groups of 18-25, 26-35, 36-45, 46-55, over 55 yrs).
Approximately 500 new loan recipients were recruited in Intervention villages. This represents programme penetration such that approximately 10% of households in intervention villages will be likely to have an IMAGE client. The recruitment period was approximately 12 months. Each loan recipient was matched to a single comparison woman. The total sample size was thus double the number of loan recipients recruited during the recruitment period, i.e. about 1000.
C o h o rt Study II: The impact of IMAGE on young-people living in the households of loan recipients
All individuals of both sexes aged 14 - 35 years who are currently re s i d e n t members of households of loan recipients and non-loan recipients enrolled to Cohort Study I were eligible for inclusion to Cohort Study II. IMAGE clients
falling in this age group were also recruited to IMAGE Cohort Study II.
Demographic data suggested that there will be, on average, three individuals in this age group in every two households recruited to Cohort Study I. The total sample size was thus approximately 750 in each arm of the study (Total 1500).
C o h o rt Study III: The impact of IMAGE on communities
Individuals of both sexes aged 14 - 35 years living in randomly selected households from the study villages were eligible for this study. Both young people currently staying in the home (the de facto population), and young people who are recorded as
"permanent household members", but who are not currently staying in the home were eligible for Cohort Outcome Study III.
Sampling and sample size
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The IMAGE study recruited individuals in a "baseline" state, before they have access to the interventions, and data was collected from these individuals before, during and after the intervention programme. The use of a prospective design minimises the likelihood of distortion of results through recall bias. " Intervention" in this study was assigned at the village level and consisted of SEF and RADAR making IMAGE available to a village. In advance of services being made available SEF conducted a participatory wealth ranking procedure to identify the poorest households in the village. The IMAGE programme was made available to four intervention villages from late 2001. In four comparison villages, IMAGE will be made available three years later. The primary study compares information from individuals recruited in villages that have access to IMAGE over the the 3 years period, with individuals from those villages that don't.
The decision about which villages would receive IMAGE, and which would not, was made randomly. This randomised, controlled design lends academic rigor to the work, increasing its potential impact. The use of comparison groups has not been widely adopted in micro-finance evaluations on ethical grounds. IMAGE was not previously available to any of the study villages. IMAGE will be extended so that it is available to the population of all eight villages in three years, after the completion of comparative studies. This time period is equivalent to that in which SEF would normally expand to an area of this size, so these factors answer ethical concerns.
Cohort Study I: The impact of IMAGE on loan recipients
Study procedures : Baseline:Each loan recipient and non-loan recipient was interviewed at this stage with a standardised questionnaire (Senior Female Questionnaire). Additionally, information on the household was gathered at this point in an interview either with the woman, or with the head of the household (using the Household Questionnaire).
Study procedures : Follow up:Loan recipients and non-loan recipients were re-interviewed using an adapted version of the above questionnaires two years after enrolment of the loan recipient to IMAGE. Follow-up interviews were conducted with all women enrolled at baseline, including those who later dropped out of IMAGE. An effort was made to interview women who had moved out of their home during this two years of follow-up, but who were still traceable at that point.
Cohort Study II: The impact of IMAGE on young-people living in the households of loan recipients
Study procedures : Baseline: The baseline state for Cohort Study II was as for Cohort Study I. Young people were interviewed within two months of loan recipient/non loan recipient interviews being conducted, where possible.
Interviews were conducted using a standardised questionnaire (Young Person Questionnaire). Study recruits were also asked to provide a sample collected from inside the mouth (Oral Mucosal Transudate, or OMT), using a specially designed collection device to test for the presence of antibodies to HIV.
Study procedures: Follow-up: Follow up interviews with young people were conducted two years after their enrolment in the study, utilising a modified version of the Young Person Questionniare. Repeat OMT samples were also collected at this time.
Cohort Study III: The impact of IMAGE on communities
Study procedures : Baseline: A survey covering all villages was conducted during the three months prior to IMAGE being made available in the Intervention villages. Household Questionnaires and Young Person Questionnaires were completed in all selected households. Study recruits were asked to provide a sample of Oral Mucosal Transudate (OMT), using a specially designed collection device which tests for the presence of antibodies to HIV.
Study procedures: Follow up: Households and individuals interviewed in the baseline survey were re-interviewed during a final survey conducted three years after the introduction of IMAGE to Intervention villages. Repeat OMT samples were also collected at this time.
Datasets for the IMAGE Study 2001-2003 are only accessible in the DataFirst research data centre.
Rural AIDS & Development Action Research Programme. Intervention with microfinance for AIDS and gender equity study 2001-2003. [dataset]. Version 1. Johannesburg: RADAR, Small Enterprise Foundation [producers], 2005.Cape Town: DataFirst [distributor], 2011.
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.