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The Role of Social Capital in HIV Prevention

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The Role of Social Capital in HIV Prevention UMEÅ UNIVERSITY MEDICAL DISSERTATION UMEÅ UNIVERSITY MEDICAL DISSERTATION NEW SERIES NO 1453 ISSN 0346-6612 ISBN 978-91-7459-307-5 NEW SERIES NO 1453 ISSN 0346-6612 ISBN 978-91-7459-307-5 Department of Public Health and Clinical Medicine Department of Public Health and Clinical Medicine Epidemiology and Global Health Epidemiology and Global Health Umeå University, SE-901 87 Umeå Umeå University, SE-901 87 Umeå The role of social capital in HIV prevention The role of social capital in HIV prevention Experiences from the Kagera region of Tanzania Experiences from the Kagera region of Tanzania Gasto Frumence Gasto Frumence 2011 2011 Department of Public Health Muhimbili University Department of Public Health Muhimbili University and Clinical Medicine of Health and Allied Sciences and Clinical Medicine of Health and Allied Sciences Epidemiology and Global Health School of Public Health and Epidemiology and Global Health School of Public Health and Umeå University, Umeå, Sweden Social Sciences Umeå University, Umeå, Sweden Social Sciences Department of Public Health and Clinical Medicine Department of Public Health and Clinical Medicine Epidemiology and Global Health Epidemiology and Global Health Umeå University Umeå University SE-901 87 Umeå, Sweden SE-901 87 Umeå, Sweden © Gasto Frumence 2011 © Gasto Frumence 2011 Printed by Print & Media, Umeå University, Umeå 2011: 00200 Printed by Print & Media, Umeå University, Umeå 2011: 00200 02 02 To my family – my wife Diana To my family – my wife Diana and our children Lorraine, Laura and Larry and our children Lorraine, Laura and Larry 03 03 04 04 Abstract Abstract Background Background The role of social capital for promoting health has been extensively studied in The role of social capital for promoting health has been extensively studied in recent years but there are few attempts to investigate the possible influence of recent years but there are few attempts to investigate the possible influence of social capital on HIV prevention, particularly in developing countries. The over- social capital on HIV prevention, particularly in developing countries. The over- all aims of this thesis are to investigate the links between social capital and HIV all aims of this thesis are to investigate the links between social capital and HIV infection and to contribute to the theoretical framework of the role of social infection and to contribute to the theoretical framework of the role of social capital for HIV prevention. capital for HIV prevention. Methods Methods Key informant interviews with leaders of organizations, networks, social groups Key informant interviews with leaders of organizations, networks, social groups and communities and focus group discussions with members and non-members of and communities and focus group discussions with members and non-members of the social groups and networks were conducted to map out and characterize various the social groups and networks were conducted to map out and characterize various forms of social capital that may influence HIV prevention. A quantitative commu- forms of social capital that may influence HIV prevention. A quantitative commu- nity survey was carried out in three case communities to estimate the influence of nity survey was carried out in three case communities to estimate the influence of social capital on HIV risk behaviors. A cross-sectional survey was conducted to social capital on HIV risk behaviors. A cross-sectional survey was conducted to estimate the HIV prevalence in the urban district representing a high HIV prevalence estimate the HIV prevalence in the urban district representing a high HIV prevalence zone to determine the association between social capital and HIV infection. zone to determine the association between social capital and HIV infection. Main findings Main findings In early 1990’s many of the social groups in Kagera region were formed because In early 1990’s many of the social groups in Kagera region were formed because of poverty and many AIDS related deaths. This formation of groups enhanced of poverty and many AIDS related deaths. This formation of groups enhanced people’s social and economic support to group members during bereavement people’s social and economic support to group members during bereavement and celebrations as well as provided loans that empowered members economi- and celebrations as well as provided loans that empowered members economi- cally. The social groups also put in place strict rules of conduct, which helped to cally. The social groups also put in place strict rules of conduct, which helped to create new norms, values and trust, which influenced sexual health and thereby create new norms, values and trust, which influenced sexual health and thereby enhanced HIV prevention. Formal organizations worked together with social enhanced HIV prevention. Formal organizations worked together with social groups and facilitated networking and provided avenues for exchange of informa- groups and facilitated networking and provided avenues for exchange of informa- tion including health education on HIV/AIDS. Individuals who had access to tion including health education on HIV/AIDS. Individuals who had access to high levels of structural and cognitive social capital were more likely to use con- high levels of structural and cognitive social capital were more likely to use con- doms with their casual sex partners compared to individuals with access to low doms with their casual sex partners compared to individuals with access to low levels. Women with access to high levels of structural social capital were more levels. Women with access to high levels of structural social capital were more likely to use condoms with casual sex partners compared to those with low levels. likely to use condoms with casual sex partners compared to those with low levels. Individuals with access to low levels of structural social capital were less likely Individuals with access to low levels of structural social capital were less likely to be tested for HIV compared to those with access to high levels. However, there to be tested for HIV compared to those with access to high levels. However, there was no association between access to cognitive social capital and being tested for was no association between access to cognitive social capital and being tested for HIV. Individuals who had access to low levels of both structural and cognitive HIV. Individuals who had access to low levels of both structural and cognitive social capital were more likely to be HIV positive compared to individuals who social capital were more likely to be HIV positive compared to individuals who had access to high levels with a similar pattern among men and women. had access to high levels with a similar pattern among men and women. i i Conclusion Conclusion This thesis indicates that social capital in its structural and cognitive forms is This thesis indicates that social capital in its structural and cognitive forms is protective to HIV infection and has played an important role in the observed protective to HIV infection and has played an important role in the observed decline in HIV trends in the Kagera region. Structural and cognitive social capi- decline in HIV trends in the Kagera region. Structural and cognitive social capi- tal has enabled community members to decrease number of sexual partners, tal has enabled community members to decrease number of sexual partners, delay sexual debut for the young generation, reduce opportunities for casual sex delay sexual debut for the young generation, reduce opportunities for casual sex and empower community members to demand or use condoms. It is recom- and empower community members to demand or use condoms. It is recom- mended that policy makers and programme managers consider involving grass- mended that policy makers and programme managers consider involving grass- roots’ social groups and networks in the design and delivery of interventions roots’ social groups and networks in the design and delivery of interventions strategies to reduce HIV transmission. strategies to reduce HIV transmission. ii ii Original papers Original papers This thesis is based on the following papers: This thesis is based on the following papers: I Frumence G, Killewo J, Kwesigabo G, Nyström L, Eriksson M, Emmelin M. I Frumence G, Killewo J, Kwesigabo G, Nyström L, Eriksson M, Emmelin M. Social capital and the decline in HIV transmission – A case study in three Social capital and the decline in HIV transmission – A case study in three villages in Kagera region, Tanzania. Journal of Social Aspects of HIV/AIDS villages in Kagera region, Tanzania. Journal of Social Aspects of HIV/AIDS (SAHARA) 2010;7:9–19. (SAHARA) 2010;7:9–19. II Frumence G, Eriksson M, Killewo J, Nyström L, Emmelin M. Exploring the II Frumence G, Eriksson M, Killewo J, Nyström L, Emmelin M. Exploring the role of cognitive and structural social capital in the declining trends of HIV/ role of cognitive and structural social capital in the declining trends of HIV/ AIDS in the Kagera region of Tanzania – A grounded theory study. African AIDS in the Kagera region of Tanzania – A grounded theory study. African Journal of Aids Research 2011;10:1–13. Journal of Aids Research 2011;10:1–13. III Frumence G, Emmelin M, Kwesigabo G, Killewo J, Eriksson M, Nyström L. III Frumence G, Emmelin M, Kwesigabo G, Killewo J, Eriksson M, Nyström L. Social capital and HIV risk related behaviors in Kagera region, Tanzania Social capital and HIV risk related behaviors in Kagera region, Tanzania (Submitted). (Submitted). IV Frumence G, Emmelin M, Kwesigabo G, Killewo J, Eriksson M, Nyström L. IV Frumence G, Emmelin M, Kwesigabo G, Killewo J, Eriksson M, Nyström L. Social capital and HIV infection in Bukoba urban district, Kagera region, Social capital and HIV infection in Bukoba urban district, Kagera region, Tanzania. (Submitted). Tanzania. (Submitted). Paper I and II are printed with the permission of the publishers.
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