Recent theoretical work has highlighted some of the potential economic and social pathways that link HIV and property rights violations (Dworkin et al., 2009
; ICRW, 2004
; Kes, Jacobs, & Nami, 2011
; USAID, 2009
) but further empirical research is clearly needed to elucidate these processes. There is ample reason to believe that inequitable access to land and property may shape the structural context through which imbalances in power are sustained, creating risk environments for women. Because customary norms and practices throughout most of the world recognize the male head of household as the main authority figure and principle owner of land assets, land ownership in “developing” countries reflects dominant roles and elevated status in society and households (Deere & Leon, 2001
; Palmer, 2008
; Pena, Maiques, & Castillo, 2008
). It is well established that when culturally sanctioned gender roles foster power imbalances, women often have little control over their physical safety or sexual decisions (Connell, 1987
; Gupta, 2001
; Kalichman et al., 2005
). Because access to and control over hard assets, such as land and property, can improve women’s status in the communities in which they live and increase their household bargaining power (Aliber & Walker, 2006
; Izumi, 2007
; Walsh, 2005
), it is possible that programs which bolster women’s land tenure may mitigate the harmful effects of HIV/AIDS and reduce HIV/AIDS risks (Dworkinetal., 2009
; ICRW, 2004
; Kes et al., 2011
There are very few works that empirically examine the processes through which property ownership may operate to reduce primary and secondary transmission or improve treatment and care outcomes. Through our in-depth qualitative research, we found that there appear to be economic and social processes through which secure property rights might decrease the HIV vulnerability of women. Some of these processes included: providing women with a secure place to live, serving as a site for economic activity and means of livelihood, reducing the exchange of sex for goods, food, money, or shelter, and reducing economic dependencies with male partners. With the help of property rights programs that work to respond to property rights violations, and prevent disinheritance and asset stripping (such as the CWDG model examined in this paper), land can also serve as women’s collateral for credit for income-generating activities that can act as risk reduction mechanisms (Pronyk et al., 2005
; Sherman et al., 2006
). Such programs are important not only because they increase women’s ability to secure their livelihood, but also because these shift the dynamics of land ownership. This is critical because women often do not have any collateral for loans because land is often registered only in the man’s name as the head of the household.
Our research highlighted an important aspect of gender inequality within the era of HIV/AIDS: blaming the woman for “bringing the disease” into the family. In the context of widespread antenatal HIV testing, a pregnant woman is often the first family member to test and may be blamed for bringing the virus into the family or may suffer from adverse consequences of status disclosure (Bond, Chase, & Aggleton, 2002
; Turan, Miller, Bukusi, Sande, & Cohen, 2008
). Women are less likely to test for HIV if they fear violence or discrimination by partners (Antelman et al., 2001
; Kilewo et al., 2001
; Medley, Garcia-Moreno, McGill, & Maman, 2004
). For HIV-positive women, the threat of violence is also an important barrier to HIV status disclosure (Moore, Kalanzi, & Amey, 2008
) and enrollment into care and treatment (Hatcher et al., 2012
)—both of which are considered essential steps to preventing further HIV transmission. Thus, the current study contributes to the literature by highlighting that a fear of violence and discrimination by extended family
in the process of disinheritance may create additional pressures for women to avoid HIV testing, care, or treatment. Such a finding has implications for the structural prevention of primary and secondary transmission of HIV.
Our finding that many women migrated once they were disinherited and asset stripped parallels research elsewhere in sub-Saharan Africa that calls attention to the contribution of migration to exacerbating women’s HIV/AIDS risks. These risks are posited to be due to the specific reasons for women’s migration (e.g., violence, HIV, disinheritance), risks in the migratory process itself, and/or women’s increased biological and social vulnerability to HIV risks at the point of destination (Camlin, Kwena, & Dworkin, 2012
; Camlin, Kwena, Dworkin, Cohen, & Bukusi, 2012
; Kes et al., 2011
; UNAIDS, 2010
). Hence, innovative programs such as CWDG that prevent a loss of property and assets may act as an important structural tool for HIV prevention. The CWDG model may prevent HIV by reducing disinheritance and therefore preventing migration to beaches, markets, or urban slum dwellings, where we learned that sex is frequently exchanged for food, money, goods, educational fees, or housing. Certainly, depending on the reasons as to why women migrate, some women may want to leave their home and not return. For those who do migrate, HIV prevention interventions and linkages to care at these destinations are needed for both widows and children. Yet, CWDG may provide an important model for reducing primary and secondary transmission by securing women’s economic well-being and livelihoods and preventing out-migration at the community source while helping women to return to land and to their homes at their point of origin.
Consistent with the current HIV/AIDS literature, our own research also revealed that there were cultural practices such as widow inheritance (where a woman whose male partner has died is expected to have sex and/or a marry or have a long-term relationship with a male relative) that may further contribute to HIV/AIDS risks (Agot et al., 2010
; ICRW, 2004
; Izumi, 2007
; Walsh, 2005
). Here, programs that engage and build the capacity for village elders and community leaders to learn and apply rights-based knowledge may be particularly promising, particularly given the influence that such leaders have on shifting cultural patterns that are deemed to be harmful while also influencing outcomes associated with land ownership.
Our research revealed that improving women’s ownership of property and assets may also expand their capacity to manage and lessen the risk of HIV acquisition and decrease behaviors that lead to secondary transmission. The economically and socially empowering aspects of property ownership may be particularly important in Kenya where our own and other research suggests that households affected by HIV/AIDS may be more likely to experience land disputes and threats to land tenure compared with other households (Aliber & Walker, 2006
; Seeley, Grellier, & Barnett, 2004
Much work remains to be done in the field of structural HIV prevention. There is a clear need for rigorous measurement that can characterize the empowerment-related processes (social and economic) that are associated with land access, use, and control—and to examine their individual and community-level impacts on HIV. Little research has evaluated men’s responses to programs, such as the CWDG model, that seek improvements in women’s property access to, use, and control over land. Given recent research that reveals that HIV programming that focuses on women’s empowerment can be synergistic with or create tensions with the goals of gender equality and health programming, the involvement of men in these efforts should not be overlooked and should be carefully considered (Dworkin, Dunbar, Krishnan, Hatcher, & Sawires, 2011
). Finally, little research has characterized the strategies that community programmers deploy to successfully protect women from losing property, assets, or being disinherited. This knowledge will be critical for the development of future research that seeks to examine the impact of property ownership as a structural HIV prevention or treatment intervention. Our own research in these areas is in process and forthcoming.
There were several limitations to this study. First, interviewees were part of a program that focused on land rights and HIV issues; hence, their own personal investment in the program likely contributed to bias. To reduce this bias, we hired interviewers external to the program and asked a very large number of probes to check answers for consistency. Second, while our sample was relatively large for a qualitative study, it was by no means fully representative of all staff in this particular program. Third, the sample was also not generalizable to all regions in Kenya that have a high seroprevalence rate or to all programs that focus on work at the intersection of property and HIV prevention/mitigation. Still, within this understudied area, we have offered preliminary qualitative results about some of the economic, social, and cultural mechanisms that may be operating to link property rights violations and HIV risks, as well as elucidating some of the ways that property rights abuses can contribute to the disruption of clinical care. Suggested areas for future research include a quantitative examination of whether widows experience higher rates of HIV and violence because of a loss of land ownership relative to their landowning counterparts. In addition, testing the impact of an integrated property rights and HIV prevention program to see whether it is more efficacious than our best HIV prevention alone is a fertile question to explore.
Indeed, the need for action at the program and policy level at the intersection of property and HIV and AIDS has become increasingly clear. Three of the Millennium Development Goals intersect at the juncture of this topic—Goal #1 is to reduce poverty, goal #3 is to promote gender equality and empower women, and Goal #6 is to combat HIV and AIDS. At the 53rd Commission on the Status of Women in New York in 2009, the UN special envoy for AIDS in Africa, Elizabeth Mataka, was quoted as saying that “lack of equal rights for women to inheritance and property rights excludes women from accessing resources that would help reduce their vulnerability to HIV and cope with the consequences of the epidemic” (UNAIDS, 2009
). Additionally, Kenyans have voted recently on a new Constitution and a National Land Policy (Kenya has not had a clearly defined National Land Policy since independence), both of which could create a vibrant new policy environment in which to improve upon women’s property rights and HIV/AIDS risks. Now is the time to translate these innovative programs and national policy shifts into targeted research agendas within the HIV/AIDS prevention science base, and to disseminate the findings of such research.