These detailed discussions with PLHA on ART who are currently receiving microcredit reveal considerable diversity in the benefits and challenges associated with microcredit in this population. First, we believe that SEEP's microcredit loan is correcting an important market failure by providing loans to those who need it yet feel shunned by both the formal and informal credit market systems. Similar to previous studies, we found that after being on ART most participants had regained physical strength and were able to resume work [24
]. Yet, the consequences of HIV on the socioeconomic well-being of affected individuals render many PLHA in need of economic support even after receiving HIV medical care. Microfinance is one type of such economic support, but only when it is offered through AIDS service organizations do PLHA generally find microcredit loans to be accessible. More than half of the participants in our study were interested in applying for microcredit loans because they wanted to expand their business and/or they desired to work. Yet, roughly two thirds of them had never accessed loans from other formal and informal institutions before enrolling in SEEP. Likewise, at the time of the interviews, the same proportion of participants still felt that they could not access other sources of funding, citing complex bureaucratic systems, requirement for collateral and fear of confiscation of property. Among these reasons, the most frequently cited was the perception that other institutions discriminated against their HIV status.
Second, our data reveal mixed evidence with regards to the economic benefits of microcredit loans for PLHA. More than half of the respondents indicated that their businesses were performing well or neutral, and the vast majority indicated the loan had played an overall positive role in their lives. Yet many respondents stated having had repayment problems either personally or with other group members. Despite being on ART and having access to microcredit loans, PLHA continue to face seasonal income shocks that make the weekly payment system problematic. In addition, many participants indicated that they had to divert money to pay for school fees and occasionally for treatment due to bouts of sickness. To fully discern the economic feasibility of the loans, more systematic, quantitative data are needed regarding loan repayment and default rates, as well as business income, profits, and debt.
Third, although the economic impact of the loans may be mixed, there is clear evidence that the loans have positive social and psychological effects. When we asked respondents about their ability to take care of their families, most respondents indicated that they were able to send their children to school and keep their families intact. More than two-thirds of the respondents felt good about themselves though some respondents mentioned that, while they were happier overall and confident, they were also stressed about not meeting their weekly payments. Equally important is the fact that more than half of the participants felt that their status had improved in their respective communities. These findings are in agreement with social cognitive theory, both of which posit that a positive change in an individual's economic stability can influence a person's self-efficacy and thereby have a critical influence on behavior and performance related not only to income generating activities but also social outcomes [25
]. The findings from this study suggest that, when physical health and functioning are largely restored, microcredit loans help to bolster confidence, perseverance and motivation for expanding one's business and improving overall economic well-being.
Fourth, we also found the microcredit loans to have positive spill-over effects on other dimensions. All participants indicated that they benefited from having had the opportunity to learn about book keeping and other business management skills, importance of savings, and procedures to follow when paying back loans. They also indicated that they appreciated learning about nonbusiness-related aspects of how to improve their health and quality of life, including how to live positively with HIV. The positive impact of the training program was also evident when we asked participants to list the main benefits of the SEEP program, as the fourth most cited reason was the training program. Furthermore, more than half of the participants expressed the desire to receive more training. For these reasons, we believe that microcredit programs should place more of an emphasis on developing innovative approaches to offering training and education programs to their client base, in the realm of business management and operations, as well as other dimensions of overall health and well-being.
Fifth, while the microcredit literature has mostly looked at the issue of networks in terms of accountability, our qualitative data show that such networks also function as strong support structures. In our analysis, more than half of the participants mentioned that they liked being part of a group. Many respondents reported that group members assisted each other to help make repayments and shared ideas related to business. They also mentioned that each group established a common fund and members pooled a certain percentage of their money in this fund to help other members. In the case of PLHA, we believe that such networks can play a crucial role in overcoming stigma and engaging in positive thinking and living. While we did not specifically probe for the impact of networks on stigma and self-perception, some participants mentioned that the program helped them build “networks of new friends” and overcome stigma, evident in the following testimony, “Our life situation is not easy. But the moment you meet the person who is also infected you gain some strength and become consoled. It has therefore helped us to fight against stigma.”
With this study's small convenience sample, these findings are not representative of all PLHA receiving ART and microcredit loans. Nonetheless, the study interviews provide important insights into the effects of microcredit on the well-being of clients in the lower economic stratum of Ugandan society. The interview data highlight substantial economic, social, and psychological benefits with microcredit. By providing respondents with the ability to expand their businesses, keep their children in school, and maintain the livelihood of their families, microcredit loans play a positive role in the lives of PLHA. These loans not only improved the self-perception of PLHA but also uplifted their status in their communities. It also provided them with opportunities to learn and network with other PLHA. We are currently conducting a prospective longitudinal cohort study to quantitatively evaluate the economic, social, and sexual impacts of microcredit loans among SEEP clients. We believe the results of our upcoming study will help us evaluate the overall viability of microcredit loans as a critical policy lever for improving the socioeconomic health and well-being of PLHA in resource-constrained settings.