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The role of social capital in HIV prevention: experiences from the Kagera region of Tanzania
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Background

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 social capital on HIV prevention,particularly in developing countries. The overall 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 capital for HIV prevention.

Methods

Key informant interviews with leaders of organizations, networks, social groups 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 forms of social capital that may influenceHIV prevention. A quantitative community survey was carried out in three case communities toestimate the influence of 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 zone to determine the association between social capital and HIV infection.

Main findings

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 people’s social and economic support to group members during bereavement and celebrations as well as provided loans that empowered members economically. The social groups also put in place strict rules of conduct, which helped to create new norms, values and trust, which influenced sexual health andthereby enhanced HIV prevention. Formal organizations worked together with social groups and facilitated networking and provided avenues for exchange of information including healtheducation on HIV/AIDS. Individuals who had access to high levels of structural and cognitive social capital were more likely to use condoms 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 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 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 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 had access to high levels with a similar pattern among men and women.

Conclusion

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 decline in HIV trends in the Kagera region. Structural and cognitive social capital has enabled community members to decrease number of sexual partners, delay sexual debut for the young generation, reduce opportunities for casual sex and empower community members to demand or use condoms. It is recommended that policy makers and programme managers consider involving grassroots’ social groups and networks in the design and delivery of interventions strategies to reduce HIV transmission.

Place, publisher, year, edition, pages
Umeå: Department of Public Health and Clinical Medicine, Umeå university , 2011. , 61 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1453
Keyword [en]
Structural social capital, cognitive social capital, HIV risk behaviors, HIV infection, HIV prevention
National Category
Medical and Health Sciences
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-49319ISBN: 978-91-7459-307-5 (print)OAI: oai:DiVA.org:umu-49319DiVA: diva2:454854
Public defence
2011-11-25, Sal 135, Allmänmedicin, Norrlands universitetssjukhus, Ingång X5, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2011-11-11 Created: 2011-11-08 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Social capital and the decline in HIV transmission: a case study in three villages in the Kagera region of Tanzania
Open this publication in new window or tab >>Social capital and the decline in HIV transmission: a case study in three villages in the Kagera region of Tanzania
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2010 (English)In: SAHARA-J: Journal of Social Aspects of HIV/AIDS, ISSN 1729-0376, E-ISSN 1813-4424, Vol. 7, no 3, 9-20 p.Article in journal (Refereed) Published
Abstract [en]

We present data from an exploratory case study characterising the social capital in three case villages situated in areas of varying HIV prevalence in the Kagera region of Tanzania. Focus group discussions and key informant interviews revealed a range of experiences by community members, leaders of organisations and social groups. We found that the formation of social groups during the early 1990s was partly a result of poverty and the many deaths caused by AIDS. They built on a tradition to support those in need and provided social and economic support to members by providing loans. Their strict rules of conduct helped to create new norms, values and trust, important for HIV prevention. Members of different networks ultimately became role models for healthy protective behaviour. Formal organisations also worked together with social groups to facilitate networking and to provide avenues for exchange of information. We conclude that social capital contributed in changing HIV related risk behaviour that supported a decline of HIV infection in the high prevalence zone and maintained a low prevalence in the other zones.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-41247 (URN)10.1080/17290376.2010.9724964 (DOI)000283711900002 ()21409300 (PubMedID)
Available from: 2011-03-22 Created: 2011-03-22 Last updated: 2017-12-11Bibliographically approved
2. Exploring the role of cognitive and structural social capital in the declining trends of HIV/AIDS in the Kagera region of Tanzania: A grounded theory study
Open this publication in new window or tab >>Exploring the role of cognitive and structural social capital in the declining trends of HIV/AIDS in the Kagera region of Tanzania: A grounded theory study
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2011 (English)In: African Journal of AIDS Research, ISSN 1608-5906, E-ISSN 1727-9445, Vol. 10, no 1, 1-13 p.Article in journal (Refereed) Published
Abstract [en]

The article presents a synthesis of data from three village case studies focusing on how structural and cognitivesocial capital may have influenced the progression of the HIV epidemic in the Kagera region of Tanzania. Groundedtheory was used to develop a theoretical model describing the possible links between structural and cognitivesocial capital and the impact on sexual health behaviours. Focus group discussions and key informant interviewswere carried out to represent the range of experiences of existing social capital. Both structural and cognitive socialcapital were active avenues for community members to come together, empower each other, and develop norms,values, trust and reciprocal relations. This empowerment created an enabling environment in which members couldadopt protective behaviours against HIV infection. On the one hand, we observed that involvement in formal andinformal organisations resulted in a reduction of numbers of sexual partners, led people to demand abstinencefrom sexual relations until marriage, caused fewer opportunities for casual sex, and gave individuals the agency todemand the use of condoms. On the other hand, strict membership rules and regulations excluded some members,particularly excessive alcohol drinkers and debtors, from becoming members of the social groups, which increasedtheir vulnerability in terms of exposure to HIV. Social gatherings (especially those organised during the night) werealso found to increase youths’ risk of HIV infection through instances of unsafe sex. We conclude that even thoughsocial capital may at times have negative effects on individuals’ HIV-prevention efforts, this study provides initialevidence that social capital is largely protective through empowering vulnerable groups such as women and thepoor to protect against HIV infection and by promoting protective sexual behaviours.

Place, publisher, year, edition, pages
Grahamstown, South Africa: NISC, 2011
Keyword
Africa, behaviour change, community empowerment, health behaviour, HIV/AIDS, sexual behaviour
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-48721 (URN)10.2989/16085906.2011.575543 (DOI)
Available from: 2011-10-27 Created: 2011-10-27 Last updated: 2017-12-08Bibliographically approved
3. Social capital and HIV risk related behaviors in Kagera region, Tanzania
Open this publication in new window or tab >>Social capital and HIV risk related behaviors in Kagera region, Tanzania
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(English)In: Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-48722 (URN)
Available from: 2011-10-27 Created: 2011-10-27 Last updated: 2015-04-29
4. Social capital and HIV infection in Bukoba urban district, Kagera region, Tanzania
Open this publication in new window or tab >>Social capital and HIV infection in Bukoba urban district, Kagera region, Tanzania
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(English)In: Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-48723 (URN)
Available from: 2011-10-27 Created: 2011-10-27 Last updated: 2015-04-29

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