ABSTRACT
Background:
Greater
social capital is associated with positive
health outcomes and better
HIV management. The ways by which
social capital may influence
household water insecurity (HHWI), a critical determinant of
health among
persons living with
HIV, remain underexplored. Further, despite the importance of reliable
water access and use for
health and agricultural
productivity, few studies have described the
strategies smallholder
farmers living with
HIV use to manage
water insecurity.
Objective:
We qualitatively explored how an agricultural intervention (
provision of a treadle pump for irrigation) influenced HHWI
coping strategies through its impacts on
social capital among smallholder
farmers living with
HIV in western
Kenya.
Method:
In 2018, we purposively recruited participants from the Shamba Maisha study, a randomized agricultural intervention (NCT02815579) that provided irrigation
pumps to improve
treatment outcomes and
food security among smallholder
farmers living with
HIV in western
Kenya (nâ¯=â¯42). Participants
shared their experiences with
water insecurity through go-along and photo-elicitation interviews. Data were thematically analyzed using inductively developed
codes.
Results:
Participants described diverse
strategies for coping with agricultural
water insecurity. Dimensions of
social capital such as
feelings of
belonging, connectedness, and
trust influenced the use of the treadle
water pump and other
water access
behaviors. For instance, participants reported borrowing or sharing
water pumps with
friends and neighbors if they felt they had a good rapport. In addition, participants indicated a willingness to engage in collective activities, such as supporting the operation of the irrigation pump during
planting, when they felt sufficiently connected to a larger group. Overall, individuals in the intervention
arm described greater
social cohesion, reciprocity, and
community connectedness than those in the control
arm.
Conclusion:
The impact of an agricultural intervention on
water access and use was described as being modified by
social capital among
female smallholder
farmers living with
HIV. Findings suggest that
social capital may create an enabling
environment for implementing
strategies that improve the management and reduce the burden of
HIV. Measuring these
strategies and their
associations with
HIV outcomes may strengthen our
understanding of
resilience among
female smallholder
farmers living with
HIV. The development of a
coping strategies index and its use in a
longitudinal study could help to identify pathways through which
social capital influences
health and the
effectiveness of livelihood interventions.