Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
AIDS Behav. 2023 Jan;27(1):245-256. doi: 10.1007/s10461-022-03760-z. Epub 2022 Aug 5.
Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.
很少有研究探讨土地获取这一健康结构驱动因素，以及女性参与生计干预措施以改善粮食安全和艾滋病毒结果的情况。这项定性研究嵌入在 Shamba Maisha（NCT02815579）中，这是一项在肯尼亚西部艾滋病毒感染者农民中开展的多部门干预措施影响的随机对照试验（RCT），旨在探讨感知到的土地获取和控制对农业生产力、投资和收益的影响。在接受干预措施投入 3 至 6 个月后，对 30 名经过有目的抽样的男性和女性进行了深入访谈（IDIs）；数据采用演绎和归纳编码进行分析。农业实践和参与 Shamba Maisha 取决于土地保有权和参与者对其土地的感知强度，那些认为自己土地不安全的参与者不太可能进行长期农业投资。土地保有权受到许多因素的影响，对妇女造成了独特的挑战，这对干预措施的参与和成功产生了负面影响。数据强调了安全土地保有权对类似干预措施成功的重要性，特别是对妇女而言；未来的干预措施应整合土地安全规划，以提高所有人的成果。
